Hospital Car Parking Charges

Lilian Greenwood Excerpts

Monday 1st September 2014 Commons Chamber

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on securing this debate. I start with the point on which she finished, which is that the NHS is supposed to be free at the point of use. When we set sometimes exorbitant charges at different hospitals, we are effectively taxing the ill and their families.

Members have talked about the families of patients in hospital for the long term, with all the costs involved for relatives who visit them. This is honestly not a party political point, but in 2009, when my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) was Prime Minister, the Labour party suggested that those who had family members in hospital for a long time should get special permits to enable them to visit without having to pay each time, but that was scrapped in 2010 when the current Government came in. I ask them to reconsider that proposal. One way in which they could act very positively would be to have a similar provision such that the family of those in hospital for the long term can get and use special permits. That would certainly deal with the problem of the long-term ill.

There is another group of people whom we have not mentioned. We now have an elderly population and most older people have not just one health issue, but several health complications, so they often end up having to go to hospital to see consultants and doctors for six, eight or nine different illnesses or health issues. Each time they go, they or the person accompanying them has to pay hospital parking charges.

I give the example of my mother, who is 82 years of age. She has several different health issues, and every time I take her to my local hospital—I am her carer—it costs £3, just for five or 10 minutes. I am in the privileged position of being able to afford that, but there are many people in my constituency, who have caring responsibilities for adult and often elderly family members, who may only be on the minimum wage.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that for the many elderly people who do not drive, public transport is a really important issue, just like parking charges? Is she aware that Queen’s medical centre in Nottingham is soon to have the first dedicated hospital tram stop, which will improve access for older and disabled people in particular?

[Yasmin Qureshi]

I did not know about the Nottingham tram, but I am pleased that people there will have a tram stop to deal with the problem. Something like that would be brilliant in my constituency. There is a bus that goes to my hospital, the Royal Bolton, but because of its location the service is not frequent, so getting there is quite difficult. Such public transport solutions can help people as well. My hon. Friend is absolutely right that many older people cannot drive, so they also have that challenge.

Perhaps we do not think enough about the number of appointments most older patients have, as do those who are generally ill and have to go in and out of hospital for appointments numerous times. The way forward may be to abolish car park charging full stop, so that a scheme can be applied nationally. The minute we have a discretionary system and leave each hospital trust to decide for itself, some—perhaps because where they are located means they have a large parking space—can charge a small amount, such as 50p, while other hospitals that lack space because of where they are must charge a bit more. Leaving things to discretion means having, as everyone says, a postcode lottery. A better solution might be to make special dispensation, across the whole country, for those going to hospital appointments or those who are in hospital for some days.

Although I have a legal background, I am not normally an advocate for a lot more law, because it is not always a good idea to have loads of legislation. In this case, however, it is worth thinking about having legislation or a directive with the even more novel approach of abolishing such charges altogether. At the end of the day, nobody goes to hospital for pleasure; they go out of necessity and because they are unwell. Therefore, a hospital that raises £500,000 or £1 million, with all the budget it has—

Care Homes

Lilian Greenwood Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for his question. Of course the work has to go way beyond just what the CQC can do. I mentioned in response to my right hon. Friend the Member for Banbury (Sir Tony Baldry) the fact that organisations focusing particularly on compassionate care now carry out inspections and make reports. I have also mentioned NHS Choices, which means that any member of the public can give their comments on the care experience of a loved one. The more people use their power to highlight unacceptable things that are happening in care homes, and indeed great things, the better.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituent Maureen Pycroft witnessed appalling standards in the home where her husband Barry was meant to be cared for, and she was horrified to learn that the same care provider went on to run other services and abuse other vulnerable people some years later. Will the Minister assure me that the CQC now has powers to ensure that when there is abuse in homes, the providers who run them will be barred from running homes in the future?

[Norman Lamb]

The hon. Lady is absolutely right, and that is why we are introducing the fit and proper person test for every director of every care or health care provider. If they have been complicit in unacceptable standards or prosecuted for unacceptable care, the CQC can require them to be removed from the board of a care provider. The new standards should help considerably.

Hearing Loss in Adulthood

Lilian Greenwood Excerpts

Tuesday 12th November 2013 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

I am glad that we are debating an issue that affects all our constituencies, and I know that it is a matter of real concern to many Members in this House and in the other place.

I would like to begin by paying tribute to the work of the Ear Foundation, a cochlear implant support charity in my constituency. I was glad to secure the debate, and I hope that it will draw attention to the vital work it does to support adults and children with hearing loss.

One in six people in the UK experience hearing loss, and seven in 10 can expect to be affected by the time they reach their 70th birthday. That means that 10 million people live with hearing loss, and an ageing population means that that number will rise in the years ahead. To communicate is to be part of society. Losing one’s hearing is not just about the absence of sound—if not addressed, hearing loss can result in the loss of our social life, cutting us off from family, friends and work.

Deafness in adulthood is linked to depression, unemployment, poor mental and physical health and an increased risk of other conditions, including dementia. Hearing loss is a constant condition, and in most cases there is no cure. It is no exaggeration to say that it can destroy lives. People with hearing loss can find it difficult to negotiate everyday challenges in the workplace, on the bus, at the supermarket, or in the local doctor’s surgery, leading to isolation, exclusion and frustration.

Research carried out by Action on Hearing Loss has found that adults who lose their hearing are likely to withdraw from social activities. When they do take part, communication difficulties can result in feelings of loneliness. Hearing loss can also damage personal relationships. Many deaf people find it difficult to join in with family conversations and jokes. Couples say that they feel more distant from their friends, and partners of people with a hearing problem describe feelings of loneliness and frustration. Travelling on public transport becomes a challenge, and a platform alteration or a delayed connection can be a major problem if someone misses the announcement. That can leave deaf people feeling anxious and vulnerable when travelling, and worried about being stranded or lost. The debate among policy makers focuses mainly on quality-of-life issues, but failure to address hearing problems has implications for society as a whole.

[Jim Shannon (Strangford) (DUP)]

I have sought the hon. Lady’s permission to intervene in the debate. In Northern Ireland, 300,000 adults experience deafness or tinnitus—a sixth of the population, which is similar to the rest of the United Kingdom. Does she agree that a UK-wide strategy—and perhaps the Minister would respond to this—would benefit the core of the community across the United Kingdom, especially people with deafness?

[Lilian Greenwood]

I thank the hon. Gentleman for his intervention. He is quite right: these are issues that affect the whole of society, and I hope that the Minister will respond positively to his suggestion.

A 2006 study estimated that unemployment resulting from hearing loss cost the UK economy £13 billion a year. Too many people are forced to resign, retire or face redundancy as a result of their disability. People with hearing impairment report that their employers often have a passive attitude, providing adjustments and support only when prompted, and a significant number face outright discrimination.

Of the 300,000 people of working age with severe hearing impairment, 20% report that they are unemployed and are seeking work. Another 10% report that they cannot seek work as a result of their condition. As the state pension age rises and more jobs depend on communication skills than was the case 20 or 30 years ago, that vulnerability to unemployment is a growing problem. It represents a worrying underuse of the economic capacity of the nation.

Despite the scale and impact of hearing loss in the UK, adults with profound and severe hearing problems face major challenges when accessing health services. For many people, even seeing their GP can be a challenge, especially when surgeries rely on telephone booking systems and do not use visual display screens. One in seven respondents to an Action on Hearing Loss survey reported missing the call for their appointment while sitting in the waiting room. Poor deaf awareness among health professionals, such as not looking directly at a patient to allow for lip-reading, can lead to patients with hearing loss feeling unclear about the medical advice or information provided. According to the same survey, 28% of people with hearing loss have been unclear about a medical diagnosis and 19% have been unclear about their medication.

Diagnosis of hearing loss among adults is too often down to chance. Many are reluctant to seek help, and evidence suggests that people wait an average of 10 years before doing so. Stigma is a key factor in this delay in taking up hearing aids, which makes some people unwilling to tell others about their hearing loss. An Action on Hearing Loss report found that one element of stigma is the fear that deaf people are seen as less capable. A 2005 MORI poll of more than 20,000 people showed that one in five expressed concern about being treated differently.

Earlier diagnosis is essential to ensuring that people with hearing loss can access the support and services that can help them best manage their condition. A hearing screening programme for people aged 65 would help to overcome some of the barriers that prevent people from addressing their hearing loss. I pay tribute to the hon. Member for Eastbourne (Stephen Lloyd), who has led the Hearing Screening for Life campaign. Research by the consultancy London Economics suggests that such a programme would represent good value for money, so will the Minister consider establishing a pilot hearing screening programme?

There are approximately 4 million people with undiagnosed hearing loss in the UK who could benefit from hearing aids or, in a smaller number of cases, a cochlear implant. However, research suggests that GPs are often reluctant to refer patients for assessment or lack the knowledge to do so. Forty-five per cent. of patients presenting hearing loss symptoms are not referred, so something is clearly amiss. GPs’ lack of awareness of the impacts of deafness in general and a lack of knowledge of the benefits of cochlear implantation in particular give rise to concern. Greater education of GPs and audiologists on hearing technologies and the potential benefits of cochlear implantation for adult patients is therefore vital. I would be grateful if the Minister updated the House on the Government’s plans to ensure that training and updating on hearing technologies is provided consistently across the country.

Despite the obvious need, there is relatively little recognition of the impact of hearing loss or of the latest technologies that can improve hearing. We know that hearing aids improve adults’ health-related quality of life by reducing the psychological, social and emotional effects of hearing loss. For those who are severely or profoundly deaf, and for whom hearing aids offer little benefit, cochlear implants offer the chance of useful hearing.

[Jim Shannon]

I thank the hon. Lady for giving way; she is being very gracious. One of the issues that have come to my attention as an elected representative is that hearing aids are sometimes thought of as a big thing attached to the ear, but thanks to the advance of technology hearing aids are very small now. Perhaps that means that cosmetically they are less noticeable, and people can have the implant and lead a normal life. Is that one of the things that the hon. Lady feels should happen?

[Lilian Greenwood]

My hon. Friend is right. There is a need to increase awareness of what a cochlear implant is, how it operates and even what it looks like.

Despite the digital revolution in the NHS, in which high-quality hearing aids are now routinely fitted, there remains an under-utilisation of implants for adults, notwithstanding comparable advances in implant technology. One person who has benefited is Abigail from Nottingham, who found her implant an enormous benefit to her life. She was born deaf and grew up wearing two hearing aids until her hearing deteriorated, and doctors told her that hearing aids were no longer of benefit to her. Following detailed and intensive assessment she was approved for an implant, and when this was switched on it gave her new-found confidence. It rebuilt her self-esteem, enabling her to communicate more comfortably with her husband, family, friends and colleagues. Having a cochlear implant has given her a new lease of life, without having to rely on others to help her with communication, such as by telephone. It has also helped her immensely at work, where she can now communicate with colleagues on an easier level. It has helped her gain promotion and do a job that she enjoys. The cochlear implant has enabled her to get on with life at home, at work and socially, and with her hobbies, including music. She also does volunteering work in the community.

A cochlear implant stimulates the hearing nerve by means of rapid electrical impulses, which bypass the non-functional inner ear in people who are severely or profoundly deaf. Sounds heard with a cochlear implant are not the same as those heard with a human ear, but with the right support a person with a cochlear implant can adapt to the novel signal and use their implant to understand speech and other sounds, much like normal listening. One cochlear implant recipient said:

“I feel that so much of my previous life and true self has been restored, regaining my pride and ability to contribute actively in society on an equal basis.”

The late Lord Ashley, who is remembered and was rightly held in extremely high regard by many in this place, was known to call his cochlear implant a miracle. Surely it is time that everyone who needs a cochlear implant had access to their own miracle. There are an estimated 100,000 people with profound hearing loss, and 360,000 with severe loss. Although it is difficult to determine the exact number of adults who need an implant, on any of the current measures of profound deafness the current level of provision for cochlear implantation would appear to be significantly below any predictions of need.

The Ear Foundation suggests that as few as 5% of adults who might be able to benefit from an implant are currently getting one, and the UK is fitting only half the number of implants in adults as Germany and Austria. Speaking at last month’s Westminster launch of the Ear Foundation report “Adult Cochlear Implantation”, Dr Andrew Dunlop, a GP who suffered sudden hearing loss himself, described his own experience of deafness, undergoing assessment and receiving a cochlear implant. He said:

“I was fortunate, that as a healthcare professional, I knew my way around the system and was not overwhelmed when dealing with fellow doctors, audiologists and consultants. Sadly, the story for less informed individuals is not quite the same. My return to Practice emphasized to me just how much of an iceberg of unmet need is within the community at large, with many very able individuals assuming wrongly that they have no options after optimal provision of hearing aids and seem reduced to a second class life of social isolation, loss of self-esteem and frequently unemployment.”

Today’s debate is my attempt to chip away at that iceberg.

The criteria for implants are set by the National Institute for Health and Care Excellence, with guidance last reviewed in 2011. However, the criteria are based on evidence from patients who were predominantly wearing technology from the late 1990s, and since then there have been significant advances in cochlear implant technology. Many clinicians would argue that the criteria do not reflect real world listening, and that more realistic tests should be deployed instead.

Since the last review, there have been supportive studies on the effectiveness of bilateral implants—one implant for each ear—which NICE believes provide too little benefit for adults to justify NHS funding. One patient who was refused implantation described the process as follows:

“The conditions they did the testing in were ideal. It was perfect but they made no allowance for the difficulties you get if somebody is talking from the side, or if there is any background noise…and of course under those circumstances you do very well and it makes no allowances for the problems you run into in real life.”

In addition, the use of sentence tests, rather than monosyllabic words, enables deafened adults to use their previous linguistic knowledge to complete the test, thus appearing to have hearing that is too good for cochlear implantation. Brian Lam and Sue Archbold, authors of the Ear Foundation report, conclude that there is an urgent need to look at the deployment of a wider range of tests. They also argue that testing in noise and assessment of performance with monosyllabic words would be more appropriate. This would reflect current practice in Germany, where criteria are more flexible.

A growing body of evidence indicates that bilateral implants provide added improvements in speech perception in noisy environments over unilateral implantation, and better sound localisation, leading to improved quality of life. The Ear Foundation has recommended that NICE review its current guidance on cochlear implantation, and in particular on the criteria for unilateral and bilateral implants for adults. Will the Minister look into this matter and consider asking NICE to conduct such a review? Does he agree that where a clinician believes that it is in the best interests of an individual patient, there should be some discretion in applying these guidelines?

Charities in the field have welcomed the Department of Health’s development of a national hearing loss action plan, but they are disappointed that it has been delayed by a year. I join those charities in urging the Government to prioritise its publication. Last month the noble Baroness Jolly stated in the other place that the Government aim to publish the action plan as soon as possible. I would be grateful if the Minister updated the House on when it will be published and how its implementation will be monitored. Has he assessed the suggestion of establishing a lead commissioner for audiology so that there is greater focus on good commissioning across all clinical commissioning groups?

The right hon. Member for Gordon (Sir Malcolm Bruce), who chairs the all-party group on deafness, last month challenged the Government, and any Government who come after them, no longer to leave deaf people behind. Today I echo those words. I hope that the Government can help move this issue, which affects all our constituencies, beyond debate and ensure that action is taken to address it.

--- Later in debate ---

[Norman Lamb]

My responsibilities stretch only to England, but clear co-ordination and joint working with the devolved Administrations absolutely make sense on an issue that transcends borders, so I agree with the ambition that the hon. Gentleman sets.

This cannot just be about prevention because that is not always possible; it is also about dealing with the consequences of hearing loss. The Government are committed to delivering health outcomes that are among the best in the world for people with hearing loss. We are developing measures to identify those with hearing loss as early as possible, including the roll-out of a national hearing screening programme for newborn babies that enables the early identification of deafness, providing a clear care pathway for services and allowing parents to make informed choices on communication needs.

Today, however, we are focusing on adults with hearing loss. I realise that there is currently considerable interest on hearing loss screening for adults, which the hon. Lady mentioned. The UK National Screening Committee advises Ministers and the NHS in all four countries on all aspects of screening policy. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria. In 2009, the committee recommended that routine screening for adults’ hearing loss should not be offered because of a lack of evidence to warrant such a screening programme. However, as part of its three-year review policy cycle, the committee is reviewing the evidence for a national adult hearing screening programme. A public consultation will be held shortly and details will be available on the committee’s website. I encourage the Ear Foundation and many others to contribute to that consultation.

We welcome the recent report by the Ear Foundation, which clearly sets out the benefits of cochlear implants for children and adults. Abigail’s story, as told by the hon. Lady, demonstrates what a massive impact that can have on an individual’s life. It completely transformed her life, and no doubt that experience is repeated very many times around the country. The report will be of enormous use to NICE if it decides to update the technology appraisal that it published in 2009. I encourage the Ear Foundation to engage with NICE. I am sure that it is already in touch, but it is very important for it to provide any emerging evidence to NICE to help it to update, if necessary, the guidance provided on implants.

A large number of services are already commissioned for people with hearing loss, and a number of specialist centres in England provide implants for children and adults. It is important that GPs understand the criteria for referral, as well as the obvious benefits of this technology for people with hearing loss. That touches on the hon. Lady’s point about the importance of health professionals, whether GPs or anyone else in the health system, gaining a better understanding of the potential for this technology. There have been considerable improvements to services for people with hearing loss in recent years, including reduced waits for assessment and treatment to within 18 weeks—a significant advance.

[Lilian Greenwood]

I thank the Minister for his positive response to the questions that I posed. What will he personally do to ensure that such training and updating on hearing technologies by health professionals and GPs takes place?

[Norman Lamb]

I do not want to give a bland answer, but I take this issue very seriously. I have noted what the hon. Lady has said. Health Education England is responsible for the training of health professionals. I will pursue the hon. Lady’s point and would be very happy to report back to her.

There is now a greater choice of hearing aid services through independent high street providers—which are easily accessible for members of the public—and the new any-qualified-provider commissioning model offers even greater choice and convenience.

We have also asked NICE to produce clinical guidelines and related quality standards for the assessment and management of adult-onset hearing loss and guidelines for the assessment and management of tinnitus, which the hon. Member for Strangford (Jim Shannon) has referred to in the context of Northern Ireland. Those guidelines will be scheduled into NICE’s development programme over the coming months.

Enabling those with hearing loss to have the same opportunities and to live as independently as everyone else is essential. It is therefore vital that public services are geared up to help and support them. Public authorities, including health and social care bodies, are required by the Equality Act 2010 to make reasonable adjustments for disabled people, to ensure that they can use a service as close as is reasonably possible to the standard usually offered to everyone else. The Department of Health has agreed to explore with its partners what more can be done to accommodate the communication needs of disabled service users.

Work is going on across the Government to support the needs of people with hearing loss. The Department for Transport’s Access for All programme has delivered access improvements at 1,100 stations since 2006, including induction loops at ticket offices and help points on platforms. The hon. Member for Nottingham South mentioned the specific problems that people face when travelling and the anxiety caused by worrying about not hearing an announcement. There will be facilities on platforms for deaf users and systems that show train information on LED display screens. Last year, a further £100 million was announced to extend the programme until 2019.

Courthouses have been provided with hearing loops since December 2012. In policing, police link officers for deaf or hard-of-hearing people use and are qualified in British sign language and work with the community to raise awareness of how to access the police. Staff in Derbyshire have passed level 1 of their training with Action on Hearing Loss, and they accepted an Action on Hearing Loss charter mark, “Louder than Words”, recognising the efforts they have made to communicate more effectively with deaf people. I pay tribute to those parts of the public sector that have made the effort to improve the way in which they communicate. Far more needs to be done, but they are the exemplars that others should follow. For those who do not use BSL, text relay, which enables deaf and hard-of-hearing people to text the police, is in place in most emergency call centres.

I hope that those examples give a flavour of some of the work that is being done across the public sector and confirm the Government’s continued commitment not only to preventing, but to treating hearing loss and promoting and protecting those affected.

[Lilian Greenwood]

Will the Minister give way?

[Norman Lamb]

The hon. Lady is just in time.

[Lilian Greenwood]

Before the Minister concludes his speech, will he address my specific suggestion to establish a lead commissioner for audiology, to ensure that there is a focus on good commissioning across the health service?

[Norman Lamb]

I will discuss that suggestion with NHS England, because that is its responsibility under the new design of the health system.

Let me end by congratulating the hon. Lady again on raising this really important issue, and I repeat that I am happy to engage with her to try to make progress.

Question put and agreed to.

A and E Departments

Lilian Greenwood Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

As I said, we need to address all the problems with 111. The lack of confidence in GP out-of-hours care is one of the contributing factors to a lack of public confidence. The meeting that the hon. Gentleman mentions will be going ahead.

[Lilian Greenwood (Nottingham South) (Lab)]

Eighteen months ago, Nottingham University Hospitals NHS Trust experienced a sustained increase in visits to A and E and hospital admissions, resulting in thousands of cancelled operations. The trust conducted an independent investigation to help it to understand and respond to the crisis, which had multiple causes. Will the Secretary of State confirm that the study did not conclude that poor provision by GPs or the out-of-hours service was to blame?

[Mr Hunt]

If I recall correctly, the study said that there were multiple causes, but it was Nottingham university that said that poor out-of-hours GP provision was responsible for an increase in paediatric A and E admissions, so Nottingham university understands this issue.

Home Care Workers

Lilian Greenwood Excerpts

Wednesday 6th March 2013 Westminster Hall

[Mr Smith]

Absolutely, and I am coming to that point. I could not get myself completely ready in the limited time that some care workers have; some are allocated 15-minute slots for visits.

When things go wrong, it is vital that staff speak out, yet too often care workers feel vulnerable and not in a position to do so. I note that last month, the Secretary of State for Health said that he was “very sympathetic” to extending to home care workers the duty to whistleblow that the Government are thinking of applying to nurses. I urge the Minister to do so.

It is crucial that inspection is extensive, robust and effective. It is all the more so given the importance of care and the fact that it takes place in people’s homes, away from immediate supervision. There are concerns about that in Oxfordshire right now. Our local paper, the Oxford Mail—I am sure you will remember it well, Mr Turner, from your time in Oxford—has highlighted concerns raised by our local patient voice and county councillors about the adequacy of local CQC inspection arrangements. In November, there were just two inspectors for Oxfordshire, and even now there are only five, who between them are responsible for inspecting 447 health and social care institutions and thousands of home care visits.

There is all-party concern. Conservative councillor Jim Couchman, who chairs the county’s adult services scrutiny committee as well as being a member of the health overview and scrutiny committee, said after meeting the CQC:

“We did get pretty worried by what we saw as an extremely ill-equipped organisation to deal with the responsibility accrued to it…The CQC is not a proper inspection team in any way, shape or form.”

Councillor Couchman has also told me since that apart from the enormity of the task required of such a small staff, the most surprising fact was that recruits did not need any experience or knowledge of the NHS, health care or social services. The CQC seemed more concerned about whether new staff had a background in regulation.

I was also concerned that when asked to talk to the Oxford Mail, the Care Quality Commission declined. When such worries are being voiced, it is all the more important for a body such as the CQC to come forward and answer questions as a basic responsibility of public accountability, as well as to take the chance to build public confidence rather than undermining it, as the CQC ended up doing. Will the Minister look into the position on care quality inspection in Oxfordshire? More generally, will he ensure that the commission has sufficient inspectors across the country with the right experience to do the job?

Feedback from users and their families is another important yardstick by which to lever up care standards. Our county council uses individual visits and client satisfaction surveys to inform contract monitoring. However, a wider public satisfaction rating is needed for the plethora of care agencies. One of the paradoxes of modern life is that, if advice is wanted on the standards of service providers such as restaurants, hotels and garages, or of products such as cars and electrical goods, there is no end of reviews out there to guide people, but for something as important as helping someone to find a good care provider, there seems to be nowhere to look for advice. In theory there is competition for provision, but in reality all the customers are groping around in the dark. That is a good reason not to emulate in mainstream NHS provision the privatisation that has already happened in care services.

Underpinning all that, action is desperately needed on the terms and conditions of care workers. They are doing a demanding job, often on the lowest wages and with minimal security. According to the Unison “Time to care” survey, more than half of home care workers overall and more than 80% in the private sector are not paid for travel time or costs; it has been estimated that between 150,000 and 200,000 home care workers are in effect paid less than the national minimum wage as a result. To make matters worse, more than half of private sector home care workers have a zero-hours contract with no guaranteed pay, and more than half of all home care workers reported that in the past year things have got worse for them on pay, working time and the duties expected of them.

[Lilian Greenwood (Nottingham South) (Lab)]

I thank my right hon. Friend for setting out clearly some of the home care issues. Does he agree that zero-hours contracts in particular make it difficult to ensure continuity of care for clients and difficult for a provider to invest in its staff, because they are constantly having to look for alternative work to make up the hours to obtain a decent income to support themselves and their families?

[Mr Smith]

My hon. Friend makes an excellent point, and must be reading my mind, because my next sentence was that zero-hours contracts present real problems for continuity of care, which was the point she made. It is important that vulnerable clients in particular have carers whom they know, trust and have built up a relationship with.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing the debate. It is a pleasure to follow all the speakers, who fully and excellently set out the case for care workers.

When I read the “Time to Care” report, I had an enormous feeling of déjà vu. Before becoming a Member of Parliament, I worked for Unison as a full-time officer. Back in the 1990s, one of my first jobs as a young officer was supporting the Derbyshire county council home helps joint consultative committee. “Home helps” was the name given to home care workers in Derbyshire, of whom there were thousands. The joint consultative committee used to bring together representatives of home care workers from across the county with senior management of social services, including the director of social services, who so understood the important role of home care that he was always prepared to attend meetings to listen to the views of home care representatives. It was an opportunity for them to raise their concerns and the issues that their members faced.

The 1990s was a period of huge change for such workers. The role of home helps was changing immensely: they moved from providing a service that was basically helping older people with cleaning, shopping, meals and even, back then, laying fires, to providing much more intimate personal care and dealing with people with increasingly complex needs. It was also a period of budget cuts, which accounts for the feeling of déjà vu. There was pressure to change services, to make them efficient, obviously, but also to open them to the private market.

I vividly remember Derbyshire home helps raising concerns about a proposed move to a time-recording system. When they arrived at a service user’s house, the first thing they had to do was telephone to tell social services where they were, so that there was much more detailed information on the amount of time they spent with each service user. A concern they raised at the time was that doing so would change their focus, so that rather than their prime focus being on the needs of the service user, their top priority when they arrived was to record their time so that social services could properly cost the service.

I also remember home helps raising concerns about short calls that did not allow them time to care, to listen to what services users wanted or to respond to their priorities.

[Andrew George]

The hon. Lady makes an excellent point about recording arrival and departure times. Often the system simply fails, not only in rural areas, where mobile coverage is poor, but when using the cared for person’s telephone. Carers often cannot get through and calling becomes a greater obsession than providing the care itself.

[Lilian Greenwood]

The hon. Gentleman is absolutely right. I remember well the representative from the High Peak area constantly making that exact point, which was that there was poor mobile phone coverage. They talked about how much of their time would be spent dealing with the telephone instead of focusing on the person who required their assistance. There were also worries about travel time.

I particularly remember the concerns of people who worked alongside private sector care providers where, they reported, staff training was often inadequate and there was often a high turnover of staff. They also reported that the care providers frequently did not provide personal protective equipment; they talked about the lack of rubber gloves and the like. We often had discussions about which tasks home helps were given time to carry out. They often pointed out that their service users wanted and needed things that might not be what the carers were commissioned to provide.

Unison’s “Time to Care” report and the Care Quality Commission’s “Not Just a Number” inspection programme made me wonder whether we should have listened more closely to the concerns and issues raised by those Derbyshire home helps 20 years ago, particularly when, in describing the current context, the CQC talked about the

“increasing pressure on social care budgets and the rise in the number of people with complex care needs and dementia.”

In describing its key findings—as my right hon. Friend the Member for Oxford East said, a quarter of services fell below the standards expected—the CQC said:

“What is concerning is that our findings come as no surprise to people, their families and carers, care workers and providers themselves.”

The findings really do not come as a surprise, because they are exactly the issues that have been raised over many years.

The CQC highlighted several problems, including service users

“not being kept informed about late arrivals, different care workers from one visit to another, not having their preferences clearly documented, a lack of support for care staff to carry out their work, and failure to address the ongoing issues around travel time.”

Those are responsibilities of not just this Government but the previous Government, but the pressure on social services that are commissioning care services is even greater now, and we need to look again at what is required.

There is great similarity between the findings of the CQC and Unison’s “Time to Care” report. Although the care and welfare of service users is the most important focus, the CQC found that staff felt

“unsupported by their management teams and not…able to deliver care in the right way because they are too rushed, with no travel time and unscheduled visits added to their day.”

It also reported a lack of planning and supervision for staff. Training needs were not identified, staff were not confident in using their equipment, and inductions were not always completed following recognised standards.

As the hon. Member for St Ives (Andrew George) said, the voices of care workers are often not heard in debates such as this one. We ought to address that today. I was pleased to see that Unison’s report included many quotes from individual home care workers. It provided an opportunity for them to have a say and to talk about their experiences. My hon. Friend the Member for Wirral South (Alison McGovern) has already quoted one of the home care workers who contributed to the report, saying they did not have time to spend with their service users and they had to rush between calls.

One of the most important issues is about older people. I imagine that many hon. Members have this experience when they are out canvassing in their communities: they knock on the door of an older person, and perhaps the Member is the only person they have spoken to that day. Their priority is to talk to someone who is willing to listen. That was well recognised by one of the care workers who contributed to the report, who said that

“care is not just about duties but communication and many providers do not allow for this…How can half an hour be enough to get someone up, dressed, meds given and have a chat? People are being failed by a system which does not recognise importance of person-centred care.”

There are many quotes in the “Time to Care” report, which I am sure the Minister has read. I hope that he listens to the voices of home care workers and the issues that they raise.

It is vital that, like the director of social services in Derbyshire back in the 1990s, we listen to the voice of home care workers, because they meet service users every day. Most of them are incredibly committed to providing a good-quality service and ensuring that people receive the support that they need. It is also vital that we do not simply listen to them, but act. Will the Minister meet home care workers and their representatives to discuss the findings of Unison’s “Time to Care” and the CQC report? Will he set out today how he intends to respond to the findings of those reports?

--- Later in debate ---

[Norman Lamb]

I totally agree with her. If a worker can aspire to something better—perhaps a progression in their career—they will commit themselves very fully to the role. The idea of a vocational progression towards nursing, even if, at the end of the day, a degree is involved, should be opened up much more than it is at present. I completely agree with her on the points that she makes.

I share the concerns that hon. Members have raised about pay. There have been reports that some home care workers may be working for less than the minimum wage, which is an absolutely disgraceful situation for a vast number of reasons, not least because an illegally low wage will never produce excellent results and it is an exploitation of the worker that we must not tolerate. It is the responsibility of all employers, including home care providers, to pay staff at least the national minimum wage. The Government are working closely with the Low Pay Commission and local authorities to address that issue. I can assure all hon. Members that we will not accept anything less than 100% compliance with the regulations.

When I was a Minister in the Department for Business, Innovation and Skills, I wanted to change the rules to make it easier to name and shame employers who fail to pay the minimum wage. We must regard that as completely unacceptable practice, and any employer who indulges in it should be exposed; it is utterly intolerable.

[Lilian Greenwood]

rose—

[Norman Lamb]

I am conscious that time is tight and I want to address the remaining points.

The hon. Member for Erith and Thamesmead (Teresa Pearce), who is no longer in her seat, raised concerns about potentially bogus arrangements in her constituency in Bexley. I think that she is writing to me on that matter, and I will be happy to look into it.

Care providers are also responsible for ensuring that their services meet the requirements in regulations and essential standards. The regulator, the Care Quality Commission, has powers that it can use to make sure that that happens. The CQC has our full support to use those powers as it sees fit to drive improvements in services. It is worth taking a moment to talk about the CQC report, which we have been discussing this morning. Between April and July 2012, the CQC inspected 250 registered home care providers as part of a themed programme to highlight respecting and involving people who use services and safeguarding them from abuse and neglect. To ensure that everything was examined thoroughly, it involved the people who use the services as well as the people who provide them. It looked at how staff are supported and how standards are maintained. Overall, the CQC found that 74% of the services that it inspected met the standards, and about a quarter did not. That is unacceptable and we must all focus our attention on those services.

The right hon. Gentleman referred to concerns about CQC’s capabilities in Oxfordshire, and I am aware of local media attention on that. My officials have raised those concerns with CQC and they were assured that it is on track to achieve its goal of inspecting 100% of adult social care locations across Oxfordshire by 31 March, that its Oxfordshire compliance team now consists of 10 full-time inspectors and that, after a period of recruitment, CQC has had no vacancies in the area since last December. If concerns continue, I urge the right hon. Gentleman to contact me and I will be happy to look into them further.

The importance of commissioning must be stressed. Commissioning over short periods of time—that race to the bottom—is unacceptable. We must commission on the basis of quality, as the hon. Member for Leicester West said. Finally, let me thank the right hon. Gentleman for securing such an important subject for debate.

NHS Commissioning Board

Lilian Greenwood Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

I absolutely agree with my right hon. Friend. There has been a lot of cant and hypocrisy in this debate. The guidance given by the previous Government to primary care trusts in 2010 makes absolutely clear their commitment to competition. That shows how crazy this debate has become. We will ensure that the debate is balanced and that the interest of the patient trumps everything else, as it should.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituents’ view is absolutely clear: they do not want back-door privatisation of our national health service. I am pleased that the Minister is making a U-turn on these regulations, but given the chaos of recent days, how could anyone trust this Government with our NHS?

Backbench business

Lilian Greenwood Excerpts

Thursday 14th February 2013 Westminster Hall

[Caroline Nokes]

I commend my hon. Friend on the work that she is doing in that area. I sincerely hope that we see some progress on that, so that these websites, which are proliferating—there is evidence of a 470% increase in just one year, between 2006 and 2007—can be prevented from being accessed from family homes. US studies have shown a clear correlation between increased body dissatisfaction and viewing such sites.

We live in a complex, changing world where higher numbers of people than ever suffer from mental illness, and so it is with eating disorders. It is not just the number of sufferers, but the severity, that is increasing. What would have been considered an eating disorder 20 years ago might now be regarded merely as a bit of disordered eating. I do not say that in any way to dismiss the seriousness of disordered eating, but to demonstrate that the conditions now have to be a great deal worse to be recognised as such, and to make a sufferer a priority for treatment. That is one of the serious issues that I would like to mention.

In my home city of Southampton—not in my constituency, but in that of the right hon. Member for Southampton, Itchen (Mr Denham)—is April House, a unit specialising in eating disorders, which I have had the privilege of visiting, and where I met service users and health care professionals. I attest to the outstanding work done there. Some of the service users and staff are here today. I admire their courage and determination.

I agree with the firm message that I received from staff at April House. With all eating disorders, there is a critical window of opportunity when a sufferer has been diagnosed, wants help, has acknowledged that they have a problem, and are reaching out for the assistance they desperately need. That opportunity can easily be lost if help is not available at that time.

[Lilian Greenwood (Nottingham South) (Lab)]

The hon. Lady is making a powerful speech. I was concerned when I received an e-mail from one of my constituents, a student nurse, who wrote:

“I am currently on a mental health placement and two of my clients have eating disorders of varying degrees, however cannot seek support for their eating disorder due to cuts in services.”

Does the hon. Lady share my belief that, having raised awareness of eating disorders and encouraged sufferers to seek help, we must not then fail to provide the support and assistance that they need?

[Caroline Nokes]

The hon. Lady makes exactly the point that I am coming on to: it is critical that when sufferers feel that they can reach out for help and acknowledge that they have a problem, the help is there for them. A delay of six to nine months can be dangerous—or, indeed, fatal.

Cancer Care (England and Wales)

Lilian Greenwood Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns (Vale of Glamorgan) (Con)]

Thank you, Mrs Riordan, for calling me to speak and for chairing this debate. It is a privilege to serve under your chairmanship.

The subject under discussion is cancer care in England and Wales. Naturally, I understand that the Minister who is here is only responsible for treatment and care in England, and that health is a devolved matter, with responsibility for it in Wales falling to the Welsh Government. However, the different approaches will allow each nation to share best practice and compare outcomes, with the objective of raising the standard of cancer care wherever we live.

I do not want this debate to be party political; this issue is far too important for that. I want to compare the facts and to recognise success, wherever that may be found. The starting point for the debate must be mortality rates or, to put it another way, the success of any medical intervention. Overall, life expectancy among men in Wales is 77.6 years, and in England it is 78.6 years. Among women, life expectancy is 81.8 years in Wales and 82.6 years in England. I am sorry to say that the figures for Scotland and Northern Ireland are worse than the figures for either England or Wales.

However, focusing purely on life expectancy is too broad an approach, and we need to consider the influences on life expectancy. There may be historical and social reasons for the differences in life expectancy, but it is fair to say that cancer survival rates are a significant factor, which brings me to my key points. The most commonly diagnosed cancers are breast cancer among women and prostate cancer among men.

[Lilian Greenwood (Nottingham South) (Lab)]

Is the hon. Gentleman aware of the “Hear me now” report by Rose Thompson, the chief executive of BME Cancer Communities, which was launched here in Parliament yesterday? It revealed that the death rate from prostate cancer is 30% higher among black men than among their white counterparts. Does he agree that such inequalities in cancer outcomes must be addressed?

[Alun Cairns]

I am grateful to the hon. Lady for making an extremely valid point. The collection of data is exceptionally important, to identify which groups are potentially more vulnerable or which groups are not seeking the right sorts of treatment. Comparison between the home nations is important, but so is comparison between groups within the home nations, in order to bring the data together. It is exceptionally important if we are to reach the right conclusions.

I will focus on breast cancer to begin with. As I have already said, the mortality rate from breast cancer in England is 24.3 per 100,000 people, and in Wales it is 25.8 per 100,000 people. Clearly, those are worrying data, and it is worth considering the different approaches to treatment in the two nations.

In England, a patient concerned about the possibility of breast cancer can expect to see a consultant within 10 working days of the GP referral. In Wales, there is a different approach, which means that a GP differentiates between urgent and non-urgent cases. In cases that are deemed urgent, 95% of patients should expect treatment to start within 62 days, and in cases deemed non-urgent, the patient should expect treatment to start within 26 weeks. I want to underline this situation: a woman in England who is concerned about the risk of breast cancer will be reassured, or have her case elevated to the next level, within 10 days. In Wales, however, a patient has no such guarantee of consultant expertise until much, much later in the process.

We need to recognise that these are different measures and approaches. Breakthrough Breast Cancer has a helpful quote. It says that waiting for a referral is like being “left in the dark”.

Liverpool Care Pathway

Lilian Greenwood Excerpts

Tuesday 8th January 2013 Westminster Hall

[Glyn Davies]

My hon. Friend makes a very good point. Patients on the pathway should be monitored regularly, and if the patient shows signs of rallying, as does happen in a minority of cases, the treatment should be modified to support recovery. If that is not happening, the pathway is not being implemented properly. The Liverpool care pathway is not a pathway to death —a phrase I have seen used often, but which I think is unbelievably awful. It is a travesty of the truth to describe it as a form of euthanasia.

Why have we reached the point of huge public controversy, which has caused so much angst and fear? It has arisen from allegations—serious allegations, some of them from doctors and nurses—that the pattern of end-of-life care I have described has not been followed in some cases. There have been stories of dying patients being deprived of the food and water they needed and others being kept continuously sedated until they died; and of patients being placed on the pathway without consultation with them or their families, or to meet targets. The fear of that is especially shocking, and I hope the Minister will comment specifically on the issue of targets.

Let me look at some of the allegations in more detail. According to the Daily Mail in June last year,

“NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds”.

The report is based on a presentation to the Royal Society of Medicine by Professor Patrick Pullicino, a consultant neurologist. He stated:

“The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.”

That is the debate being led by the Daily Mail. Professor Pullicino continued:

“Very likely many elderly patients who could live substantially longer are being killed by the LCP.”

Imagine how a frail elderly person entering hospital a few weeks after reading that would feel. Professor Pullicino added:

“Patients are frequently put on the pathway without a proper analysis of their condition.”

According to the Daily Telegraph, in September, a group of experts stated in a letter that

“dying patients…can…have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.”

The letter—again according to the Daily Telegraph—spoke of a “national crisis” in patient care, and

“a national wave of discontent…building up, as family and friends witness the denial of fluids and food to patients.”

According to the newspaper, some patients were wrongly being put on the pathway, which created a “self-fulfilling prophecy” that they would die. The report continued:

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway”,

and,

“many doctors were not checking the progress of patients enough to notice improvement in their condition.”

Those are shockingly serious allegations. If they are true, urgent corrective action is needed.

There is another side to the equation, however. More than 20 respected organisations, including the Department of Health, Age UK, the Alzheimer’s Society, Macmillan Cancer Support, and the Royal Colleges of Physicians, General Practitioners and Nursing, have signed a declaration that

“Since the late 1990s, the Liverpool Care Pathway has been helping to spread elements of the hospice model of care into other healthcare settings”.

It mentions:

“Published misconceptions and often inaccurate information”—

referring, I think, to the stories in national newspapers I have quoted. Our task and the Minister’s is to reconcile the support of all those organisations for the Liverpool care pathway with the allegations made—in good faith, I am sure—by people who believe that the pathway is what they call a pathway to death.

Any tool is only as good as the workman who uses it. The declaration states clearly that the Liverpool care pathway

“Relies on staff being trained to have a thorough understanding of how to care for people who are in their last days or hours of life.”

We have to face the fact that, in most professions, there are instances of excellence and malpractice, and health care is no exception. It would be surprising if, when 130,000 people a year are dying on the Liverpool care pathway, there were no cases in which the pathway had been misapplied. That applies to every branch of medicine and, indeed, every occupation. There are good and less good doctors and nurses; there are well run and less well run hospitals; but to lay the blame at the door of the Liverpool care pathway is like tearing up “The Highway Code” because there are some bad drivers. Where there is bad practice and poor care, it should be rooted out and replaced with good care.

It seems to me that the review the Government recently launched provides an excellent opportunity to consider thoroughly all those issues. It is urgently needed. The review should call for any evidence of poor end-of-life care. We need the Minister to assure us this afternoon that the stories I have quoted will not simply be taken at face value, but will be investigated in detail, so that we can establish the scale of poor end-of-life care, and understand the causes and correct them.

[Lilian Greenwood (Nottingham South) (Lab)]

I am listening carefully to the important points the hon. Gentleman is making. My constituents John and Mary Roche lost their mother five years ago. They came to see me because, having seen the media reports, they were concerned about her care toward the end of her life—she had been admitted to hospital and subsequently had her food and nutrition withdrawn. Does he think my constituents and others like them should be encouraged to share their stories, so that they can be taken into account in the Government’s review of the Liverpool care pathway and its appropriate use?

[Glyn Davies]

I thank the hon. Lady for making that point, because I most certainly do agree. I hope that, as a result of today’s debate, more people will come forward to put their experiences, especially of bad practice, in front of the Minister and the review.

We must not forget that it is necessary not to allow the shortcomings of some end-of-life care providers to undermine the outstanding work that the majority of doctors and nurses perform. It is easy to forget that, for those caring for people in the last days and hours of their life, alarmist stories cause real problems, misleading vulnerable people and their relatives into thinking that the unhappy experiences reported so prominently are typical of end-of-life care as a whole, making them reluctant to accept care that is genuinely beneficial, and generating fear of going into any sort of care setting. My sense is that the high profile given to these serious allegations, unaccompanied by supporting evidence, is analogous to shouting “Fire!” in a crowded theatre. We need to know that the Minister will consider all the allegations that are made, including those that have been reported, look at the evidence, and institute whatever changes are needed to ensure safety and thereby confidence in the integrity of the Liverpool care pathway.

I end with a general observation. I was appalled, as I am sure everyone in the Chamber was, by the recent revelations of poor care in a Worcestershire hospital, in Winterbourne View and in Stafford hospital. I was moved, as many of us will have been, by the observations made in the main Chamber before the Christmas recess by the right hon. Member for Cynon Valley (Ann Clwyd) regarding the inadequate and cruel care given to her late husband. We are reading about too many such cases. Considerable advances have been made in medical science, but we must ensure that, at the same time, we do not lose commitment in the NHS to basic care. I cannot help wondering whether the examples of poor end-of-life care that some relatives believe was given to their loved ones stem from the wider malaise of forgetting how to care for the sick, rather than from any specific clinical protocols such as the Liverpool care pathway.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 27th November 2012 Commons Chamber

[Dr Poulter]

I thank my hon. Friend for that question. This point has been raised before and although it sounds like a good idea in principle, the problem is that different aspects of care in different wards—for example, an older people’s ward compared with a ward that looks after younger people—will have differences in the intensity of nursing. Therefore, a mandated ratio would be difficult to implement. A ratio may be counter-productive to making sure that we can give more intensive nursing cover where it is needed, and could even encourage a race to the bottom.

[Lilian Greenwood (Nottingham South) (Lab)]

T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?

[Norman Lamb]

Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.