Oral Answers to Questions
Laura Smith Excerpts(4 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
I thank my right hon. Friend for her question. The National Institute for Health and Care Excellence guidelines state clearly that GPs should not use BMI as the sole indicator for treatment. I have just met the eating disorder charity Beat to discuss how we approach eating disorders. With the £2.3 billion that we have invested in mental health services, we have made a commitment that any young person presenting with an acute eating disorder will be seen within one week, and others within four weeks.
Laura Smith (Crewe and Nantwich) (Lab)
Matt Hancock
That is an incredibly important matter. It was addressed in the Care Act 2014, but I am happy to look at any proposals, because it is important that we get fair treatment right across the country.
Cystic Fibrosis Drugs: Orkambi
Laura Smith Excerpts(4 years, 10 months ago)
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Laura Smith (Crewe and Nantwich) (Lab)
It is a pleasure to serve under your chairmanship in this hugely important debate, Mr Hanson. I thank all the constituents who signed the petition, and those in the Public Gallery.
I am not surprised that my constituency featured so high up on the list of respondents, because my constituent, Elle Morris, became the face of a poster campaign this year pleading for life-changing drugs to be available to UK sufferers of cystic fibrosis. I was lucky and privileged to know Elle, who was from Nantwich, and to have her visit us here in Parliament. She sadly passed away in her parents’ arms at Great Ormond Street Hospital for Children on 3 January 2018.
Elle had undergone a successful double lung transplant in July 2017, but complications set in when microbacteria, which originally infected her lungs, got into her bones. Sadly, despite treatment, which included the removal of part of her sternum and rib cage, she passed away. Now her image is being used in a campaign pleading for others to get access to the potential life-prolonging treatment drug, Orkambi. Her face has been displayed on four of the country’s largest digital screens, in Birmingham, the south-east, south London and Manchester, promoting #OrkambiNow. It goes without saying that we in Crewe and Nantwich are exceptionally proud of everything that Elle achieved in her short life, and all that she continues to achieve. Her campaign group, Elle’s Wishes, documented her brave journey, including her support, alongside the successful campaign run by the Daily Mirror, for opt-out organ donation.
Ahead of today’s debate I asked Elle’s mother Becky, a friend of mine, whether there was anything specific that she wanted me to mention to the Minister. Becky is an amazing credit to her daughter and continues to campaign tirelessly for CF sufferers. She said:
“Orkambi becoming available is so important to Elle’s memory and it would prevent future heartbreak and suffering to other CF patients and their families. It’s that step closer to maintaining health, and preventing more damage to a sufferer until a cure can be found. Organ donation is the only option currently and the cost is huge, and as we found not always successful as it suppressed the immune system which is vital for CF sufferers to keep strong and built up. If it was your child, would you do anything possible to keep them alive and as healthy as can be? Is there really a cost between a child and their health and their life? Elle was a true CF warrior and fought so hard. She appreciated life so much, the simple things like the countryside, school, spending time with her friends. She loved her home and her cups of tea. She could have potentially still been enjoying those things and looking forward to her 14th birthday in January 2020 but instead she didn’t reach her 12th birthday. Please, please, as a bereaved mother missing her beautiful daughter every day consider doing everything you can to help those that still have hope. Why should they suffer? Yours Becky Whitfield.”
I have many other constituents, as we all have, who are fighting CF or supporting family members who are suffering. It is frankly not good enough that Orkambi, which we all know can help to save lives, is not currently available on the NHS unless compassionate grounds are given. We have debated the subject before, and we know that cystic fibrosis affects about 10,400 children and adults in the UK, that Orkambi will change cystic fibrosis care for the better, and that it works for eight in 20 people. About 50% of individuals with cystic fibrosis in the UK have the genetic mutation that Orkambi can tackle, so the approval of Orkambi for use on the NHS could benefit about 5,200 people living with cystic fibrosis. Orkambi has been shown to slow decline in lung function by 42% and cut the number of infections requiring hospitalisation by 61%. It gives patients not only more control over their lives but a greater quality of life.
Orkambi is available for patients in other countries including Austria, Denmark, France, Germany, Luxembourg, the Netherlands, Italy, Greece, and the United States. I agree with the Health and Social Care Committee that it is hugely disappointing that NHS England and Vertex are yet to come to an agreement. I ask the Minister to explain her understanding of the position that has been reached. The Scottish Medicines Consortium has managed to agree a figure, and we must do the same.
It is disgusting that, while children such as my constituent die from their condition, it is reported that a pharmaceutical giant such as Vertex can charge the NHS an unaffordable price for a life-changing drug and get a huge increase in its revenue. Vertex reported that its net income more than doubled in the last quarter from $158 million to $337 million. It said that the jump in profits was
“largely driven by the strong growth in total CF product revenues”.
It is frankly disgraceful that we live in a world so driven by profit-making and the market that such companies can hold lives to ransom in that way. I challenge Vertex to waive confidentiality so as to give evidence for its claim to have made
“the best offer in the world”
to the NHS.
The NHS has made its proposals public. That big pharmaceutical firm must do the same if it is to have any chance of having the public’s confidence that it is behaving in an ethical way. Failing to do so only helps to build the case against the continuation of the marketised pharmaceuticals industry in its current form. Perhaps it is time for Government to reconsider their role in the sector and to intervene, with legislation or by other means, to prevent such situations, where profit margins become the primary concern, rather than the lives of children who suffer from CF, like Elle.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hanson, in this very important debate. I thank the hon. Member for Sutton and Cheam (Paul Scully) for opening this debate on behalf of the Petitions Committee and for his excellent opening speech, in which he took many interventions. I thank all hon. Members for their passionate contributions. I counted more than a dozen speeches by Back Benchers, but I lost count, because I was distracted by the mouse that joined us. Given that it has been such a busy day in the main Chamber, this debate has shown how important this issue is to the House, as well as to all our constituents who have signed this important e-petition.
Access to drugs for patients with cystic fibrosis is an issue that is incredibly important to us all. I congratulate, in particular, my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Jarrow (Mr Hepburn), and the hon. Member for Dudley North (Ian Austin) on their tireless campaigning on this issue, along with patients, campaigners and charities, such as the Cystic Fibrosis Trust. I commend the trust for its expert briefings and support to patients and their families over many years.
Finally, I thank the 108,144 people who signed this e-petition, 310 of whom live in my constituency. As has been said, we debated a similar e-petition in March 2018, and there have already been five parliamentary debates about access to such medicines. I hoped, as others did, that by now cystic fibrosis patients would have access to the drugs that they need and deserve. Unfortunately, that has not been the case.
Just over a year ago, on 16 May 2018, in response to a question from my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce), the Prime Minister called for a “speedy resolution” to the crisis. However, the only speedy thing has been the deterioration of the health of cystic fibrosis sufferers while they wait for a resolution of the crisis.
More than 10,000 people in the UK live with cystic fibrosis, and it is thought that around 50% of CF patients could benefit from Orkambi; that is more than 5,000 people. Although that is a lot of people, in NHS terms it is a small cohort. And yet Orkambi is still not available to patients, despite being licensed for use in the UK since 2015.
The UK is currently a world leader in cystic fibrosis outcomes, but that is changing. People with cystic fibrosis are physically sicker than they would be if these medicines were available to them. NHS England continues to make offers to Vertex, including the largest ever financial commitment in its 70-year existence, but that was rejected. Since then, an even better offer has been made, but again Vertex has been unwilling to accept it.
I know that that is frustrating for patients and their families, who have waited years for access to these life-saving drugs. We are all frustrated on their behalf. As my hon. Friend the Member for Colne Valley (Thelma Walker) Valley mentioned, in March it was reported in the news that nearly 8,000 packs of Orkambi had been destroyed because they were past their sell-by date. That would have particularly stung patients and their families. Those drugs were valued by Vertex at £104,000 per patient per year. With my limited maths skills, I reckon that means that more than £60 million of drugs were destroyed by Vertex—drugs that could have been given to patients.
It is an outrage that Vertex would destroy so many packs of a life-saving drug while in a cost dispute with NHS England. So many patients could have benefited from those drugs. It was spiteful of Vertex to watch those drugs go out of date so they would have to be destroyed. In the midst of all that, Vertex reported a 40% rise in its revenues, with net income doubling in the previous quarter. I am sure I am not alone in feeling shocked and angry at that.
By refusing to play fair with NHS England, Vertex is holding lives at ransom, and patients and their families are the ones left suffering. Therefore, I was not surprised by the feature on “Newsnight” last week about parents and families establishing a cystic fibrosis buyers’ club to buy the generic drug Lucaftor from Argentina. The stress and frustration that families face because of Vertex mean that they now feel they have no other option but to take matters into their own hands.
Laura Smith
It is great to hear my hon. Friend’s response. It seems perverse to me that the interests of big pharmaceutical companies can hold such enormous sway in this country, to the extent that cystic fibrosis sufferers can be left without their treatment—treatment that has the potential to prolong their lives significantly.
Mrs Hodgson
I agree with my hon. Friend. I hope that the Minister will have some ideas about how this drug company can be held to account and not be allowed to continue in this way. I hope the Minister agrees that the situation should never have been allowed to get to this stage.
Lucaftor has the same active ingredients as Orkambi, and the Argentinian pharmaceutical company Gador is offering a price of £23,000 per patient per year, which drops to £18,000 if patients and their families can get together a group of more than 500 patients to purchase Lucaftor as a collective. That is significantly lower than the £104,000 Vertex wants for Orkambi. I say “want” deliberately—it is not the cost, but what Vertex wants. Of course, for many patients in the UK, Lucaftor will still be way too expensive to access, so it is not a feasible alternative at all. That is why NHS England and Vertex need to come to a conclusion that puts cystic fibrosis patients first, and ensures that they have access to the life-saving drugs they need and deserve.
Oral Answers to Questions
Laura Smith Excerpts(5 years, 2 months ago)
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Matt Hancock
My hon. Friend, who is an advocate for Stafford beyond compare and an advocate for its A&E—he has personally put much effort into saving it and ensuring that it is in good shape—rightly makes the point that paying per person who comes through the door does not accurately reflect the costs of providing A&E, so we are moving to a much greater proportion of block funding for A&Es, with a smaller element that varies according to the costs of serving everybody, to ensure that the finances follow the need.
Laura Smith (Crewe and Nantwich) (Lab)
The latest figures show that more than one in five patients visiting Leighton Hospital A&E in Crewe has had to wait for more than four hours, yet instead of receiving support, the trust has been financially penalised, unable to access capital support to fund improvements to its A&E, while at the same time losing out on the performance element of the provider sustainability fund. Can the Minister explain how the Government are supporting Leighton Hospital?
Matt Hancock
We are supporting Leighton Hospital through the delivery of the long-term plan and the extra £20 billion—£33 billion in cash terms—the first £6 billion of which comes on stream in April, in two months’ time. It is true that a record number of people are going to A&E. We have to make sure that the record numbers being treated within the four-hour target are supported, but that we also support hospitals to do yet more.
NHS Long-term Plan
Laura Smith Excerpts(5 years, 3 months ago)
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Matt Hancock
My hon. Friend is absolutely right. We need not only more funding for mental health, which is in the plan, but more joined-up delivery of mental health services. Since the birth of the NHS, mental health services have been separate from physical health services, but treatment needs to be for the whole person—their physical, mental and social health. We need not only the money but the join-up, and my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Mental Health, Inequalities and Suicide Prevention Minister, is working closely on that.
Laura Smith (Crewe and Nantwich) (Lab)
I agree with the shadow Secretary of State completely. I do not feel satisfied that the Secretary of State recognises the urgent need to reverse cuts to social care budgets alongside this plan. Does he see that savings made by reducing avoidable admissions and delayed transfers of care could go towards delivering a more ambitious 10-year plan for our NHS?
Matt Hancock
As I have said, after I became Secretary of State, we put £240 million extra into social care, and there will be £650 million next year.
Oral Answers to Questions
Laura Smith Excerpts(5 years, 6 months ago)
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Stephen Barclay
I commend my hon. Friend for his excellent report for the Centre for Policy Studies, which highlights the opportunities provided by technology. I was at a Scan4Safety event last night, looking at how barcodes are being used at six trusts, and at how that could be expanded to deliver 4:1 efficiency savings and improve patient care through the safety it offers.
Laura Smith (Crewe and Nantwich) (Lab)
Does the Minister believe that the practice of cutting funding to hospitals that miss A&E targets helps to improve the patient experience at those hospitals? Will he agree to meet me to discuss how this issue has affected Leighton hospital, which serves my constituents?
Stephen Barclay
The hon. Lady may have missed our recent announcement of significant additional funding, ahead of winter pressure, to assist hospitals. As the Secretary of State announced, the extra £20.5 billion real-terms increase is part of a wider commitment to support our hospitals.
Breast Cancer
Laura Smith Excerpts(5 years, 6 months ago)
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Steve McCabe (in the Chair)
This debate can last for up to three hours, but hon. Members are not obliged to fill the entire time.
Laura Smith (Crewe and Nantwich) (Lab)
I beg to move,
That this House has considered the future of breast cancer.
It is a pleasure to serve under your chairmanship, Mr McCabe, and to have been selected to introduce this important debate. I welcome my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and, of course, the Minister. Their presence underlines the importance of this issue. I also welcome everybody in the Public Gallery, many of whom have had personal experience of breast cancer, and all other hon. Members here today. It is important that we demonstrate our commitment to raising the profile of this issue across the party political divide. I am sure we have all been touched by this terrible disease in some way in our own lives.
I pay tribute to the remarkable people up and down the country who raise awareness of breast cancer and fight against it in their everyday lives. I want to take this opportunity to mention Rachael Bland, the BBC Radio 5 Live newsreader and presenter, who sadly passed away on 5 September. She did a remarkable thing by blogging about her experience in “Big C. Little Me.” and bringing down the barriers when it comes to living with breast cancer. Her strength and courage touched many of us, and her family and friends should be incredibly proud of her.
Between 2014 and 2016, an average of 457 women a year developed breast cancer in the South Cheshire clinical commissioning group area, which covers my constituency of Crewe and Nantwich. Sadly, in the same period, an average of 101 women lost their lives to the disease.
Today is World Menopause Day. It may seem odd that I have chosen to start my speech by talking about what might, at first glance, appear to be an unrelated issue, but the reverse is true. Breast cancer is most commonly diagnosed in women between the age of 50 and 65—the age at which women undergo the menopause. Some breast cancer treatments can bring about menopause symptoms, because they reduce oestrogen levels in the body. To make matters worse, women diagnosed with breast cancer usually cannot use hormone replacement therapy, the primary treatment for menopause symptoms, because there is strong evidence that it can increase the risk of breast cancer coming back. Some might ask whether it is really a big enough issue to warrant special attention, but we cannot afford not to pay special attention to it.
It is absolutely vital that we continue the fight to ensure that those diagnosed with breast cancer live, but we must also fight to improve their quality of life. About 70% of women with breast cancer experience severe night sweats and hot flushes, which cause major physical discomfort and anxiety, and affect their confidence. In some cases, they can even lead to serious sleep deprivation. Such problems can persist for many years. The severe and persistent symptoms of menopause are one of the main factors contributing to women discontinuing their treatment. Given that doing so can increase the chance that their breast cancer will come back, we have simply got to take this issue seriously.
What can be done? Professor Fenlon of Swansea University believes that cognitive behavioural therapy can help to ease physical symptoms, and is leading a clinical trial to assess how feasible it would be to train breast cancer nurses to deliver it. If clinical trials deem it to be effective, it has the potential to improve the quality of life of half a million women living with or beyond breast cancer in the UK, so I urge the Government to provide the NHS with resources to make the programme available in all our hospitals.
That brings me to the next issue I want to focus on: the geographical inequality in treatments and related services. It is important that the advances that I hope we are about to make in this area benefit everyone. The main CCG covering my constituents is NHS South Cheshire. I am proud to say that it was recently rated outstanding based on four pan-cancer measures, including waiting times, one-year survival rates and patient experience.
However, the report by the all-party parliamentary group on breast cancer states that there is a postcode lottery for breast cancer outcomes. All hon. Members will agree that it is simply unacceptable that women in some areas are more than twice as likely to die prematurely as women who are treated elsewhere. My CCG is set to merge with three others in the near future, and I want to ensure that my constituents continue to see waiting times fall, survival rates rise and the patient experience improve. I was shocked to read that women in some areas are one third less likely to have attended breast cancer screenings in the past three years than women living in other parts of the country.
Patients have had issues accessing off-patent drugs such as bisphosphonates, which were originally licensed for the treatment of osteoporosis but were discovered to be effective in preventing breast cancer recurrence in some post-menopausal women. When CCGs were asked last year whether they routinely fund bisphosphonates for that purpose, only 42—20%—said that they did. At the time, South Cheshire CCG said it was not doing so. I hope that the situation has improved, given that the National Institute for Health and Care Excellence has recently published updated clinical guidelines that recommend bisphosphonates. I am currently waiting to hear back from South Cheshire CCG. Is there an opportunity for the Government to make some specific interventions in the NHS long-term plan to prevent more cases of secondary breast cancer?
There is currently little incentive for manufacturers to license off-patent drugs for new uses in breast cancer. Breast Cancer Now is calling on the Government to introduce a catalyst fund in the NHS long-term plan to provide that incentive. That would make it quicker and easier for patients routinely to access cheap off-patent drugs. Breast Cancer Now commissioned York Health Economics Consortium to model how many lives we could save if the best outcomes were reached everywhere. It found that more than 1,100 lives could have been saved in 2016 if all CCGs in England had been able to reduce their mortality rates to match the lowest. Geographical inequality is not just an issue of principle; we have the potential to save lives, and if we save only one life, does that not make it worth addressing?
I would be grateful to hear from the Minister about the steps he is taking to facilitate the sharing of best practice between cancer alliances to reduce those variations. What conversations has he had with the Chancellor and his Treasury colleagues to ensure the long-term funding of cancer alliances?
If cancer alliances are properly to invest in the future of services and plan strategically, we must provide them with multi-year budgets. The APPG’s report on geographical inequality highlights that there are still worrying gaps in data collection, including in relation to the number of people living with secondary breast cancer. It is absolutely essential that we improve the cancer dashboard with more detailed performance data. After all, identifying and understanding these inequalities is the first step towards addressing them.
Laura Smith
I thank everyone who has attended the debate—especially because I am not sure whether the heating bill has been paid in here. It is absolutely freezing, so well done to all those in the Public Gallery.
Breast cancer is the most common cancer in the UK. Every 45 minutes, another life is lost to the disease; it claims almost 1,000 lives every month in the UK. I pay special tribute to the charities that help to raise awareness, support those affected in all our communities and, of course, fund research into this devastating disease. Thanks to that research, more people are surviving breast cancer than ever before. I hope that I live to see the day when everyone who develops breast cancer lives.
I want to thank the Minister, the shadow Minister and the hon. Member for Central Ayrshire (Dr Whitford), who represents the Scottish National party. Her expertise in this area is very welcome, and I have learned a lot. I thank the hon. Members for Strangford (Jim Shannon) and for Bexhill and Battle (Huw Merriman) for their contributions. Special thanks go to my hon. Friend the Member for Lincoln (Karen Lee), who spoke so passionately about her own experience. Her daughter would be very proud of her work and all that she does, and her friends and family are proud of her too.
As a 33-year-old mother of two young children, I would welcome earlier screening with open arms, but as the hon. Member for Central Ayrshire pointed out, it is also about education in how to check for lumps—what they look like and feel like. I check my breasts, but I am not convinced that I am doing it right, so it would be good to be shown how to do that. I will call on her from now on—she will not be able to get rid of me.
Praise must go to the all-party parliamentary group on breast cancer for its report on the geographical inequalities. I encourage all hon. Members who are yet to read the report to do so. I hope to see everyone join in for Wear it Pink tomorrow. My trophy for winning the title of best-dressed MP for Wear it Pink is in pride of place between my son’s football trophies, but my two-year-old daughter has claimed it as her own prize—it is her “booby trophy”. Thank you for chairing the debate, Mr McCabe and thanks again to everyone who has attended.
Question put and agreed to.
Resolved,
That this House has considered the future of breast cancer.
Social Care Funding
Laura Smith Excerpts(5 years, 6 months ago)
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Laura Smith (Crewe and Nantwich) (Lab)
I thank the shadow Secretary of State for mentioning my constituent Joyce, who has literally become the face of hundreds of thousands, maybe more, who are in a similar situation, by featuring on the front cover of Age UK’s aptly named report, “Why Call it Care, When Nobody Cares?”.
Why are people like Joyce being so badly let down? In my opinion, the answer ultimately lies in the marketisation of adult social care. It has been characterised by stealth over four decades, initially as a limited initiative to improve choice and create a competitive mixed economy, and then to the virtual elimination of public sector provision. There has been growing tension between the need for private companies to sustain a profitable business and the needs of vulnerable people for care and support. Local authorities have had an almost impossible task with ever-stretched budgets and they have been reduced to the role of commissioning authorities. What does this result in? Money matters; people’s care does not.
Due to a lack of access to the care system for members of the public, people who pay for their own care, often at very high prices through their homes, their life savings and their pensions, subsidise both state-funded residents and the state. Despite that, the care market in England is highly unstable because of the significant cuts to local government budgets and the growing role of private companies operating business chains based on high risk financial models. We have already seen failures of care homes in my constituency. No serious thought has been given to how to deal with this prospect and the policies that have been introduced are too insubstantial to make any real difference.
I also wish to touch on the sleep-in crisis, on which I, like many others, campaigned for justice. In July 2018, the Court of Appeal delivered a ruling that was a hammer blow for thousands of careworkers who work sleep-in shifts. The Court denied these workers the hourly minimum pay that is the very least that they deserve. In the aftermath of that ruling, Unison—and I—made a commitment to those careworkers and everyone affected that we would keep fighting for what is right. Everyone who understands the work of careworkers knows that sleep-in shifts are working time, so they must be paid that way. If someone is not allowed to leave their place of work, are obliged to be away from their home and family, and are up and down all night caring for those in real need, they are at work and should be paid for it.
The problems in social care are clear, and Labour Members believe that now is the time for action rather than further reviews and more consultations. We will build the national care service that this country deserves: a needs-based compassionate service that provides dignity in later life and promotes independent living for working-age adults with disabilities; that is based on people and not profit; and that, like the NHS, is seen as a wealth creator and not a burden.
Department of Health and Social Care and Ministry of Housing, Communities and Local Government
Laura Smith Excerpts(5 years, 9 months ago)
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Laura Smith (Crewe and Nantwich) (Lab)
It is a pleasure to follow the hon. Member for Northampton South (Andrew Lewer).
One thing I think we can all agree on is that we take our health for granted. We all get bogged down with everyday worries and problems, and all too frequently we hear the phrase, often from those who are more experienced, “Your health is the most important thing. Don’t take it for granted.” Of course, everyday life—education, work, family, bills and so on—are very real challenges that we all face, and it is sometimes easier just to hope for the best and go for the line, “Fingers crossed, it won’t happen to me.” The reality, however, is that at some point every one of us will experience either poor health or the likelihood of having to care for a loved one who is suffering.
My real concern is that our health and social care system is built on shifting sands, and there seems to be no long-term strategy from the Government for dealing with the challenges we face as a nation. We have an ageing population, a growing population and a population with more complicated health needs, yet we lack forward thinking and planning.
At the time of my election last June, the Care Quality Commission had found that one in four social care services was failing on safety grounds, with at least one care home closing every week, while only 2% of providers were regarded as outstanding. Our Prime Minister acknowledged that our social care system was not working, and promised to fix it—it was even in the Conservatives’ manifesto—but that promise has been broken. Since then, the Chancellor failed even to mention social care in the autumn Budget, and he missed another opportunity in the spring statement. The single departmental plan of the Health Secretary’s Department of Health and Social Care has failed to acknowledge the social care workforce. The result is that care providers up and down the country, including in my constituency, have been placed in special measures and face closure.
It is devastating to see people at breaking point because of this undignified and broken system. It is not just those in need of care who suffer, but their families. I recently visited a very good care home in my constituency, and I spoke to a gentleman who told me how wonderful his care was at that home. He also stated that he had now spent his life savings on his care, and would more than likely have to sell his home, which his children live in, to be able to continue to fund his necessary care. He expressed his regret at an unfair system, in which dignity in old age is determined by the amount of money people can pay.
I wish to draw on one particular issue that has not had the publicity it deserves, even though it threatens the viability of the care sector and could jeopardise the care of the most vulnerable people in our society. It is the Government’s mismanagement of the sleep-in crisis. I first learned about this issue when a senior council worker at Cheshire East Council was sacked after raising concerns about dozens of careworkers who had been paid less than the national minimum wage by the Conservative-run council, which had pledged to pay all its workers a living wage. Since then, one of the Conservatives’ own councillors has said that the council knew it was underpaying careworkers as early as 2014, adding that he would resign if he was proven wrong.
Unison brought a successful claim to an employment tribunal, where it was ruled that careworkers who sleep overnight in care homes are entitled to the national minimum wage for each hour that they are at work in what are referred to as sleep-in shifts. In February 2015, the Department for Business, Energy and Industrial Strategy updated its guidance to reflect the court ruling, and this should have been the end of it. The Government, now knowing that their previous guidance was wrong, should have taken swift action to ensure that all careworkers received the back pay they were owed and were paid the national minimum wage.
Yet freedom of information requests have revealed that HMRC was instructed in February 2016 that staff were not entitled to the national minimum wage during sleep-in hours. In my opinion, this mistake is unforgivable. Over a year later, HMRC has finally started enforcing complaints made by workers, who are in addition seeking six years of back pay to make up for missing wages. However, the Conservatives stopped this by delaying in July 2017, and again in September 2017. Incredibly, local authorities were not instructed to pay the national minimum wage for these sleep-in shifts until October 2017. From 2015 to 2017, careworkers were ignored.
A careworker in the constituency got in touch with me because he did not know where else to turn. He described how staff morale was at rock bottom, with many careworkers suffering from poor mental health, worrying about their job security, relying on food banks and payday loans, and being too scared to take time off sick and unable to afford going on annual leave.
Fiona Onasanya
Does my hon. Friend agree that we must not allow the sleep-in crisis to be kicked into the long grass? We must draw attention to it, and the Government must do something about it.
Laura Smith
I absolutely agree.
The careworker who contacted me described how careworkers feel that they have no voice and no respect. Is it any wonder that more than 900 careworkers leave their job every day? The way that this crisis is being handled is utterly disgraceful, and the Government have missed opportunity after opportunity to put things right. How can we expect the care sector to function, given all this uncertainty?
After years of continued mismanagement, the careworkers’ back pay bill is due in November. The reality is that the Government have never paid local authorities enough money to allow them to provide sleep-in shifts at the national minimum wage. We know from sector surveys that care providers cannot afford to pick up the Government’s tab. If they are made to do so, some will close and some will hand back contracts, leaving the vulnerable people they support to find new carers and local authorities to struggle further. Some will be forced to cut the additional services they provide, such as those that help disabled people live more independent lives. Blackpool has already seen one care provider close. We do not have long until we start seeing the effects across the UK. It is vulnerable people and low-paid carers who will suffer.
The Government have had three years to get to this point, so where are their proposals for safeguarding the viability of the care sector? I ask the Government please not to wait any longer. The careworkers deserve better, the providers deserve better, and the citizens of this country deserve better.
Oral Answers to Questions
Laura Smith Excerpts(5 years, 10 months ago)
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Caroline Dinenage
My hon. Friend is absolutely right to draw attention to the fundamental importance of being reassured that all services that are provided are safe and reliable. Since the CQC has been looking at services up and down the country, it has brought to them a level of transparency and, indeed, quality. We keep under review the services that it regulates, and this is certainly something that we can discuss with it.
Laura Smith (Crewe and Nantwich) (Lab)
Will the Government end uncertainty for people with learning difficulties who need social care by funding the historical liabilities associated with the sleep-ins crisis?
Caroline Dinenage
We are aware of concerns in the sector with regard to sleep-ins and we are looking very carefully at the options. We have been developing the evidence base very carefully. We have been engaging with the European Commission, the sector and other Government Departments.
Oral Answers to Questions
Laura Smith Excerpts(5 years, 11 months ago)
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Mr Hunt
I thank my hon. Friend for raising this serious issue, and I can reassure her that a lot of work has been going on inside the Government to work out how to resolve the issue. A court case is due that may have a material impact on those numbers, but we are continuing to work very hard and fully understand the fragility of the current market situation.
Laura Smith (Crewe and Nantwich) (Lab)
In December, the health survey for England revealed that older people in more deprived areas are twice as likely as average to have unmet social care needs. Is this not yet another example of Tory cuts reducing councils’ abilities to meet the requirements of people with care needs?
Mr Hunt
I welcome the question, but let me also gently tell the hon. Lady what the actual story is with respect to cuts. Yes, the social care budget was cut after the 2008 financial recession, but she may remember that a different party was in power when that happened. Under this Prime Minister, those cuts have been reversed and the social care budget is going up by £9.4 billion in this spending review period.