Kettering General Hospital

Lilian Greenwood Excerpts

Friday 9th November 2012 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

Will the Minister give way?

[Dr Poulter]

It is interesting to find a Member from Nottingham, who I hoped would be in her constituency on a Friday looking after her constituents, taking such an active interest in this debate. However, I am happy to give way once on this issue.

[Lilian Greenwood]

I am attending this debate because I was here earlier to deal with a private Member’s Bill on behalf of the shadow transport team. Whatever the Minister says, is it not a fact that in the official documents, the “best” option is downgrading Kettering general hospital’s accident and emergency, maternity, children’s and acute services, and cutting a significant number of beds? How can he say that those services are safe?

[Dr Poulter]

The hon. Lady is turning this into a political debate, which is exactly what the Labour candidate in the Corby by-election has done. That is completely wrong and what she says is not true—it is scaremongering. There are no official documents at the moment because there is no consultation of that nature at the moment. There is no NHS consultation. Perhaps she should focus more on Nottingham, which is where her constituency is. I am sure her constituents would rather she were on the train back to hold a constituency surgery, which is what I will be doing after this debate, rather than making silly, ill-founded and mistaken political points about matters that bear no resemblance to her constituents’ concerns. I hope she will draw a lesson from this. I know she has been put up to making that point, but this is not the time.

The hon. Lady’s point was ill-founded. There is no consultation active in Kettering at the moment. There were some leaked documents about a range of options, which incorrectly set a number of hares running. The Labour candidate in the Corby by-election has already retracted his position. My hon. Friend has held the debate today because of that scaremongering, and because he is such a strong advocate for the needs of his patients in Kettering and his hospital. He wants to reassure them that Kettering hospital has a viable future.

[Lilian Greenwood]

Will the Minister give way?

[Dr Poulter]

I will not give way again. This is an Adjournment debate, not a general debate on the Floor of the House. The hon. Lady did not contact me before the debate to say that she would make a point—no Labour Member did. This is not a time to raise those points. The debate is about reassuring my hon. Friend that Kettering hospital has a viable future, which it does. That is confirmed clearly by Healthier Together, which has also confirmed that no active consultation is taking place; that, at the moment, we have only potential options appraisals; that A and E and maternity are safe; and that Kettering hospital has a viable future. I hope that the hon. Lady will put as much dedication into standing up for her hospital services in Nottingham as she has to making cheap party political points in a debate about a different part of the country.

I should now like to address some of the points, questions and legitimate concerns that have been raised, mostly as a result of the outrageous scaremongering by the Labour party. The Healthier Together programme has been put together, but, as I have said, there is no formal consultation at the moment. I am sure the concerns my hon. Friend so eloquently raised will be fed into it, and that the debate, and the comments of the Prime Minister and Health Ministers, will be part of it.

We recognise, as my hon. Friend has outlined, the importance of proper public engagement throughout any consultation process—as and when it comes. He will be aware that there has already been significant public and stakeholder engagement on how services in the midlands might need to look in future. As he rightly said, there are new demographic challenges—more people are moving into that part of the country—and the process of engagement must continue. If a formal consultation is opened in future, it is important that it meets the clear clinical tests for service reconfiguration. However, I should repeat that no formal consultation has been opened and it would be incorrect to allow any further Labour party scaremongering on that point.

It is worth bearing in mind that part of the reason for the concerns about services in my hon. Friend’s part of the world is the massive private finance initiative debt signed off by the previous Government to Milton Keynes hospital, which has struggled ever since the PFI was signed. That has led to significant pressures on Milton Keynes and other hospitals in the region. As we know, some services are specialist centres. It might be worth reflecting, before any further cheap political points are made, that one reason why there was a discussion about a consultation on services was the big PFI legacy of debt, which is stopping the delivery of high-quality front-line care. That is a direct legacy of the previous Government signing off bad PFI deals in health care. It is worth reflecting on that before any more scaremongering takes place.

When reconfiguration of health care takes place, the previous Government—and this Government—have laid down some key tests of what makes a good reconfiguration. It has to be led locally by local commissioners and decision makers, and my hon. Friend made that point very clearly. Any significant proposed changes to services would be subject to four reconfiguration tests set out by the previous Secretary of State for Health. They are local support for the changes from GP commissioners and clinical leaderships; robust arrangements for public and patient engagement, including local authorities; greater clarity about the clinical evidence basis underpinning proposals; and the need to take into account the development and support of patient choice.

In my hon. Friend’s region there are considerable distances between the hospitals involved and, if at some point in the future a consultation opened up, those greater travelling distances between hospitals would be taken into account as it may impinge on patient choice. I hope that restating those configuration tests is helpful. If there is concern that those tests have not been met, an independent review can be carried out by the independent reconfiguration panel, at the discretion of the Secretary of State. I hope that my hon. Friend finds that reassuring. I reiterate that at the moment there is no consultation formally on the table in Kettering, and its accident and emergency and maternity services are safe.

There are other significant challenges facing Kettering hospital and the local NHS, as my hon. Friend outlined. They are the same as those faced by the NHS everywhere— ensuring that we have services that are fit for purpose for the future to better look after the many older people—people are living longer—and the need to provide more dignity in elderly care. Part of that is having local bread-and-butter services. My hon. Friend rightly made the point that some health care services have to be regionalised, such as specialist trauma centres. The clinical evidence is that such centres save lives and, in my part of the world, we have one in Addenbrooke’s. Dedicated centres for stroke care also improve care for patients and the quality of outcomes for people with stroke, so that they can resume their daily activities much more quickly. Those day-to-day, bread-and-butter health care services that are so important, such as maternity and accident and emergency—and the cardiac services that Kettering is rightly proud of—are needed at a local level, and I am sure that any test of reconfiguration would confirm that they should remain accessible locally. We are very aware that many parts of the country are not urban. Many people face the challenges of rural life and the distances to travel between centres. Whenever services are redesigned in the future, it is important that those bread-and-butter services are available for local patients.

I reiterate the fact that there is no formal consultation proposal, and there is no place for scaremongering in these debates. I am sure that the future of Kettering hospital is a vibrant and successful one. I know that my hon. Friend has strongly advocated the dedication of local staff and I hope that he will take my reassurance back to them—so that they do not listen to the scaremongering—that Kettering hospital will still have a viable A and E and viable maternity services, and a very strong future.

Question put and agreed to.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

My hon. Friend makes an excellent point. It was the previous Government who, through the “Agenda for Change”, gave flexibility to NHS trusts to allow some employers to pay a 30% premium in areas with workplace shortages.

[Lilian Greenwood (Nottingham South) (Lab)]

17. At a time when NHS budgets are under exceptional pressure, my constituents simply do not understand why the Government are so intent on pushing trusts to divert money away from patient care and into wasteful local pay bargaining. Is there not a risk that Nottingham’s excellent NHS hospitals and community services will be unable to recruit and retain the best staff if regional pay results in cuts to their salary scales? The Government are supportive of the idea, endorsed by the previous Government, that local pay flexibility allows additional rewards to be paid to staff in areas with workplace shortages, as my hon. Friend the Member for Banbury (Sir Tony Baldry) just made clear. The Government are supporting the unions, employers and employees, as the NHS Staff Council, in coming together to try to agree how we need to modify the “Agenda for Change” and other agreements to ensure that they remain fit for their purpose of protecting employees.

[Dr Julian Huppert (Cambridge) (LD)]

13. What assessment his Department has made of the extent to which the cancer radiotherapy innovation fund will increase access to intensity-modulated radiotherapy.

Health and Social Care Bill

Lilian Greenwood Excerpts

Tuesday 20th March 2012 Commons Chamber

[Frank Dobson]

No.

The Government have not made such a case for change. They have not convinced the 1 million-odd people in the national health service that these changes are needed, and if they cannot convince the people on whom the service is going to depend, they are taking a real chance with its future.

The Prime Minister attributes his commitment to competition, including outside competition, to some of the most worthless and shallow research that has ever been conducted at the London School of Economics—and that puts it in a pretty extreme category. The researchers said that they identified that hospitals they claimed competed with one another had achieved a 7% improvement in the period for which patients awaiting an operation had to wait once they got into hospital. A 7% improvement is a period of less than an hour. Then, without any justification whatever, they generalised from the particular and said that the hospitals they claimed competed with one other were 7% more efficient right across the board. It is on that basis that the Prime Minister says that he wants to introduce competition into our national health service.

[Lilian Greenwood (Nottingham South) (Lab)]

rose—

[Andrew George (St Ives) (LD)]

Will the right hon. Gentleman give way?

Health and Social Care Bill

Lilian Greenwood Excerpts

Tuesday 20th March 2012 Commons Chamber

[Stephen Pound]

As ever, my hon. Friend makes an important point. In responding to it, I would like to ask the House to cast its mind back to the contribution of my right hon. Friend the Member for Wentworth and Dearne (John Healey). He rightly said that this is not an issue of party politics. The fact that we see party politics in its worst form—its most loathsome shape—forming before our very eyes, clouded in some foul, mephitic, stygian Hades, is to be deplored. We should all listen to my right hon. Friend and actually try to admit to ourselves that we do not know everything—that the people’s voice does deserve to be heard and that the national health service is just that: a national health service, for all people. Everybody has that right to have their voice heard.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that one of the deepest problems with this Bill is that the people’s voice has not been heard? These proposals were never put before the people in party manifestos. That is exactly why they feel so very angry.

[Stephen Pound]

I am grateful to my hon. Friend for her question. It is a great sadness and reflects ill on my personal life that I spend many a night browsing through Liberal Democrat and Conservative manifestos. I have searched; I have examined; I have deconstructed; I have applied the principles of Jacques Derrida to those manifestos. Have I found in there any smidgen, any suggestion, any hint or any implication that the NHS was to be fragmented, privatised and ultimately destroyed, and the connection between the people and the NHS to be ripped up, torn into shreds like the integrity of the Liberal Democrats, hurled from the window to flutter in the breeze of history, never, ever to be seen again? Had I found that, I would almost certainly have voted Labour—but as I did so anyway, that is neither here nor there. But the point that my hon. Friend makes is absolutely right. How can the people, who fund the NHS, who are born in the NHS, who live in the NHS and who will ultimately quit this mortal bourn in the NHS—when they depart this vale of tears, it will be with the comforting arm of the NHS about their shoulders—feel that they are best served by this organisation if their voice is not heard?

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Speaker]

We are immensely grateful to the Secretary of State. He is testing the knee muscles of colleagues very considerably, and we are grateful to him for that, I am sure.

[Lilian Greenwood (Nottingham South) (Lab)]

Today’s report by Macmillan Cancer Support showed that over the past 40 years there has been virtually no improvement in life expectancy for those diagnosed with a brain tumour. Brain Tumour UK and experts such as my city’s own Professor David Walker are calling for action to improve diagnosis and treatment. What action is the Department taking to address their concerns?

[Paul Burstow]

I am grateful to the hon. Lady for her question. Macmillan has done a very good job by highlighting the need to focus on survival rates with regard not only to brain cancers but to lung cancers. Through our outcomes strategy, we are focusing on earlier diagnosis and ensuring that the care pathway is faster and delivers the appropriate treatments at the right time.

NHS Care of Older People

Lilian Greenwood Excerpts

Thursday 27th October 2011 Westminster Hall

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Betts. Like the hon. Member for Mid Norfolk (George Freeman), I must apologise that I have to leave at 4.30 pm, so I may not hear all the contributions that are made.

I congratulate the hon. Member for Stourbridge (Margot James) on securing this vital debate and on asking many important questions about quality of care and patients’ experiences of hospital. In addition, I welcome the contributions that have been made by other Members, which have been very important in fleshing out those issues.

I will make quite a brief contribution to the debate. Hon. Members have rightly recognised that, although there are some serious concerns about the care of older people within the NHS, there is also good practice that we can build on. So I will limit my remarks to giving one example of good practice that I hope will be of interest to hon. Members.

Earlier this year, I visited Queen’s medical centre, which is one campus of Nottingham University Hospitals NHS Trust. For those who are not familiar with it, it is a major acute and teaching hospital in Nottingham. While I was there, I visited ward B47, which is an acute medical ward for patients with dementia and delirium. Ward B47 has received a national health and social care award for mental health and well-being, and it was highly commended for putting patients and the public first.

While visiting ward B47, I met Professor Rowan Harwood, who is a consultant in health care of the elderly, Caron Swinscoe, who is the clinical lead for dementia, the ward’s matron, Ali Cargill, and Louise Howe, who is an advanced practitioner in occupational therapy, specialising in mental health services, and who spent 10 years working in mental health before she came to work on the ward.

Queen’s medical centre set up the medical mental health unit as part of a collaborative research project between Nottingham University Hospitals NHS Trust and the university of Nottingham, which was funded by the National Institute of Health Research and the Department of Health. The unit at Queen’s built on earlier work in 2005 by the Royal College of Psychiatry, which had shown that patients with dementia and delirium formed a large proportion of in-patients in acute general hospitals and that they had much worse outcomes than those in-patients with less complex problems. The unit was specifically designed to start to address that situation.

Ward B47 is a 28-bed ward, with three registered mental health nurses, a specialist mental health occupational therapist and an activities co-ordinator. Those staff members are working together with an existing multidisciplinary team, which includes an occupational therapist with experience in discharge planning. That new team was set up in January 2010. In addition, the environment of the ward was changed and all staff were given additional training in person-centred care.

In this debate, hon. Members have quite rightly spoken about the Care Quality Commission’s findings in relation to quality of care and about what are, in some cases, the extremely distressing experiences of their own constituents and families. Even where care is good—I am pleased to say that, in most cases, it is good—hospital admission can be a distressing and frightening experience. For older people with dementia, hospitalisation can be even more difficult and confusing. Families often report concerns and anxiety about the effect that a stay in hospital has on their loved ones, even where care is good.

My first impression on entering ward B47 was that it was different from other wards that I have seen. It was a calm but stimulating environment, and I will say a little more about the physical aspects of the ward. The most obvious difference was that there was a central activities room where a number of patients were taking part in activities supported by the co-ordinator and other staff. Even in the short period that I was there, I could see that the activity that was under way—patients were playing a game that involved throwing beanbags on the floor—encouraged physical activity. Obviously, people’s abilities were different, but the staff encouraged those who could participate to do so. The activity prompted conversation, interaction and engagement, preventing people from becoming isolated and allowing other staff to spend time with the more unwell patients who required more attention—a subject that other Members have touched on.

The ward’s staff explained how and why they were doing things differently. In making my remarks, I draw specifically on an article by Louise Howe, the occupational therapist, published in OTnews in May 2011. In it she states that the staff had observed that many patients lost their ability to function independently during a stay in hospital, and she gives a typical example. An elderly woman who had been living independently was admitted to hospital and, although forgetful, was able to carry out daily tasks such as preparing a meal. After a month, the occupational therapy team carried out an assessment and found that she was having difficulties recognising and using everyday items. The team was concerned that when she was discharged she would struggle to live safely in her own home—to cook and be around hot objects—and that prompted Louise and the OT service to come up with an approach to maintain patients’ abilities while in hospital. Essentially, they would assess patients’ level of function on admission—how able they were to wash, dress and self-care—and develop an individual care plan that all staff would work to, to help patients to maintain activities and skills. Patients would then be reviewed on discharge to see whether the actions had been successful.

The team also started to change the environment to make it more enabling for patients with dementia, with clearer signage on the ward, large clear clocks—people like to be able to assess how long things take—redecoration to make the individual bays look unique so that patients could distinguish their own beds, and memory boxes above beds to display personal items and make the environment more welcoming. The ward also commissioned photographs, showing staff and patients talking, completing self-care tasks and participating in group activities, and they were displayed around the ward to provide comfort and reassurance. Although that might sound like a small thing, staff and patients and their families reported that it was a welcome and positive move.

The occupational therapy team has strengthened links with community mental health services to ensure continuity of care after discharge, and has built links with bodies such as the Alzheimer’s Society, which provides a weekly advice and support service on the ward. The unit’s work is being researched by the university, which is looking at a number of measures—with a properly assessed control group—to compare mental state, delirium, pre and post-admission function, quality of life and carer feedback. The response from staff and visitors has so far been positive, the findings look good, and the team is looking to develop the ward further, for example by providing a more comprehensive programme of activities, including in the evenings when patients can become particularly distressed. It is also considering breakfast and afternoon tea groups to encourage patients to maintain their domestic skills, and the provision of sensory stimulation for patients who find interaction difficult and relaxation for those who find the environment over-stimulating.

I appreciate that my contribution has focused on one ward in one hospital and that there are many issues to address, but I hope that where there is good practice in the care of older people in an NHS hospital it can be used effectively to improve quality of care and patient outcomes across the wider health service and that we have the resources to enable that to happen.

Health and Social Care (Re-committed) Bill

Lilian Greenwood Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries]

There are lots of comments being made from a sedentary position, Mr Speaker, but The Times has actually fed that divide directly and repeated much of the information it has been given. I want to answer some of the accusations made about me in response to the amendment. I do not have the press barons’ money to mount and fund a campaign. I have not received a penny. In fact, I am broke. My office has not received a penny in funding.

[Lilian Greenwood (Nottingham South) (Lab)]

Will the hon. Lady give way?

[Nadine Dorries]

No.

I have also been accused of being a religious fundamentalist. Like 73% of the country, I am a member of the Church of England and have Christian beliefs, but I am not sure when that became a crime and prevented me from having an opinion. On Saturday, The Guardian printed a flow chart showing the conservative Christians who are supposed to be mounting a sphere of influence with the amendment. I did not know who 95% of the people mentioned were or the organisation they represent. If I followed Islam or Judaism, I wonder what the response would have been to such a flow chart in The Guardian. I found the chart absolutely reprehensible and disgusting.

Southern Cross Healthcare

Lilian Greenwood Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

I made it clear in my statement that the Department has taken steps, working with landlords, Southern Cross and others, to ensure that each party is clear about its responsibilities, and clear on what actions they would take in the event of business closure. However, I also want to be clear that as we move forward, we need to ensure that we learn lessons from this in the context of regulation, and to ask how this was allowed to occur in the first place. Now is not the time for those questions. My focus, as the Minister, is ensuring a successful restructuring of the business, and ensuring that the business remains focused on the welfare of residents.

[Lilian Greenwood (Nottingham South) (Lab)]

I am sorry to press the Minister again on this, but I think he recognises that changes to care, even when well planned, have a serious impact on the health of care home residents. Can he guarantee that if those commercial discussions fail, residents will continue to be cared for in their existing homes?

[Paul Burstow]

The Government have made it clear that in no circumstances will we allow the residents of any of those care homes to find themselves made homeless without good continuity of care. That is the pledge that we make.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

The key point that I take from the hon. Gentleman’s question is the importance of ensuring that there are clear benefits for those who rely on mental health services. Obviously, I cannot prejudge any decisions that are being made locally, because they may well come to a Minister for a decision in the future. I will, however, undertake to consider further the point that the hon. Gentleman has raised, and if necessary to write to him with more detail.

[Lilian Greenwood (Nottingham South) (Lab)]

18. What assessment he has made of the potential role of (a) competition and (b) co-operation and collaboration in the NHS.

[The Minister of State, Department of Health (Mr Simon Burns)]

Co-operation and competition both have important roles to play in improving services for patients. We want to see better integration of services to improve quality and increase choice for patients. Following the listening exercise, we are awaiting the report on the best way forward.

[Lilian Greenwood]

The Deputy Prime Minister says that he wants Monitor to promote co-operation and collaboration, while the Secretary of State says that competition can lead to a far greater degree of integration. It is good that the Deputy Prime Minister has finally caught up with the views of the public and health professionals—but which of those fundamentally contradictory views will end up in the Bill?

[Mr Burns]

First, we all want co-operation and competition based on quality. We have had a listening event, and we are awaiting the recommendations of the forum set up under Professor Steve Field. Until we see that report, we cannot comment. I can tell the hon. Lady, however, that we do not want the kind of system of competition in the health service that leads to an independent sector treatment centre in Nottingham being paid 18% more than the NHS for the services provided, and getting £5.6 million for not doing a single operation.

Social Care Services

Lilian Greenwood Excerpts

Tuesday 17th May 2011 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I look forward to serving under your chairmanship, Mr Brady. I am pleased that we have the opportunity to debate this important subject, which is being discussed more widely around the country by families and individuals who fear for their future.

The Government will try to boast that they are providing extra cash for social care, but that is not how people out there see things. “Hardest hit”—that is how the thousands of disabled people who marched in the streets outside this place last week described themselves. One woman from Billingham in my constituency, who has been blind since the age of 18, was among those who made the long trek to Westminster, and she told me about her anxieties and the effect that the cuts will have on her life. She and the other demonstrators had every right to be angry; they will be the hardest hit by the Government’s proposed cuts to disability benefits and the hardest hit by the swingeing cuts to council services that began this year, with more to come over the next three years. That means four years of anxiety and dread for families and individuals whose way of life depends on services with an uncertain future.

Last year, adult social care services helped 1.7 million adults to do things that most of us take for granted. Those 1.7 million adults remember the Chancellor speaking of his £6 billion cuts to local government grants and saying:

“Not a single penny will come from the frontline services that people depend on.”

How hollow those words ring today. I am sure the Minister intends to refer to the £1 billion that the Government are giving councils over four years to spend on social care services and to the £1 billion that doomed primary care trusts are supposed to spend on them over the same period—cash they are expected to take directly from the health budget, which the Prime Minister claims to be so protective of.

The trouble is that even the Conservative-led Local Government Association calculates that £4.6 billion is needed just to stand still and to maintain services as they are today. The reality is that the £530 million of additional funding that the Government have provided for social care in their first year is dwarfed by the £3 billion that councils have had to cut. According to the Financial Times and the Association of Directors of Adult Social Services, £1 billion of that has been cut from adult social care.

[Lilian Greenwood (Nottingham South) (Lab)]

Adult social care accounts for £1 in every £4 that my local authority in Nottingham city spends. Does my hon. Friend agree that it is inevitable that social care services will be affected when a local authority’s budget is cut by more than 16% in just one year, as Nottingham’s has been?

[Alex Cunningham]

It most certainly is. My hon. Friend says that social care accounts for £1 in every £4, and a 16% cut represents a considerable reduction in the amount available to spend on social care.

ADASS also concludes:

“savings on this scale simply cannot be achieved through doing the same things more efficiently or by trimming management costs”.

As for the money that has gone to PCTs, can the Minister tell us, hand on heart, that he has any idea how much of it will be spent on social care this year? Given the revolution unleashed by the Health and Social Care Bill, PCTs have had other issues on their mind as they have sought to protect services during a transition period that will see them abolished. More importantly, this transition period threatens to reverse the progress made on health and social care over the past few decades. I just wonder what guarantees there can be that we will have properly commissioned and funded care once PCTs have gone and have been replaced by consortia that do not have the expertise and understanding of our community’s wider health and social care needs.

Media reports just this weekend outlined the profits that some think can be made from the health and social care system, effectively taking hard cash from the front line. The Prime Minister’s senior adviser, Mark Britnell, told a New York conference attended by the giant private health care providers that dominate in north America that the changes over the next two years will provide a “big opportunity” for the profit-making sector. As I am sure hon. Members will know, no one can make profits without taking cash out of the system. I look forward to hearing what reassurance the Minister can give those who will be hardest hit. What is his guarantee that profiteers will not have their way with the NHS and related social care services?

I know that Ministers get fed up with MPs from the north highlighting the divisions in our country, but the BBC is highlighting them now. In a survey released last week, it identified a new north-south divide, with social care spending this year falling in the north while actually rising in the south, although I will question the value of that so-called rise later. The BBC’s findings reflect the differential impact of the cuts, with councils in the midlands and the north more reliant on central grants and thus hardest hit. The findings may also reflect demographic differences and the effect of falling property values on people’s ability to self-fund.

In the north, spending will fall by 4.7% in the current financial year alone. Then there are deprivation factors to be taken into consideration. Local authorities in the most deprived areas—many are in the north, but they are elsewhere as well—have the worst mortality figures and the highest incidence of long-term ill health, but they are suffering the deepest cuts in spending power. Front-loading the cuts means that huge changes must be brought in quickly, giving little time for consultation with staff and service users over the best way to minimise the impact on front-line services. That said, I would not like anyone to get the impression that things are rosy in the south. The 2.7% increase in spending in the south is about half the rate of inflation and does not keep pace with need. Nor will it be enough to prevent real people from losing real support—support that, in the Chancellor’s words, they depend on.

My main purpose in securing the debate, however, is to consider the human impact of social care cuts, not just to debate dry spending figures.

[Alex Cunningham]

Yes, I agree that there is a considerable risk. I should say that I have been much impressed by the role played by local authorities in health scrutiny. I hope that the Minister will answer the hon. Lady’s question directly later.

The successful judicial review against Birmingham city council’s adult social care cuts looks set to be hugely significant. The Minister might be tempted to hide behind a carefully drawn veil of localism, but does he really consider it acceptable that Birmingham should seek to withdraw support from 5,000 people? Many of those people could be in a situation where abuse or neglect have occurred, or will occur, or they could be unable to carry out the majority of their personal care or domestic routines. They will be the real losers in all this.

Does the Minister consider it acceptable that 2,145 elderly and vulnerable people in Lancashire will have all care and support removed, as part of cuts that are the subject of another judicial review? Does he consider it acceptable that desperate families are being forced to go to the High Court to try to prevent devastating damage to their quality of life or that of family members?

In West Sussex, the “Don’t Cut Us Out” campaign has brought people together to campaign against eligibility cuts. If Members visit its website, they can read testimony from Tony, who has limited mobility. He must carry an oxygen cylinder wherever he goes and he is susceptible to blackouts and periods of deep depression. He will lose all the benefits and support currently provided by West Sussex county council. He says:

“My current care package...provides for 13 hours of care support each week and has kept me out of hospital for much of the last two years, saving the Country hundreds of thousands of pounds. Before, I was in hospital for six months at a time, and once discharged was being re-admitted every two weeks or so. I can’t imagine what my life will be like without this support.”

Back in the north, local people, service users and staff have been campaigning to halt the closure of Leeds crisis centre and the threat to mental health day services in Armley and Hunslet. At a packed campaign meeting organised by Unison, a campaigning trade union of which I am proud to be a member, a service user said, “I am saving the council money by using these services; when living in London, where there weren’t these services, I had many hospital admissions; I have had none since living in Leeds.”

Mencap provided me with a graphic example of what the cuts mean for George and his daughter, who are from Rotherham. George’s daughter has profound and multiple learning disabilities. Due to her disability, she is doubly incontinent and requires the use of many disposable items of medical equipment. She lives with her dad, and as part of her care package, the council picks up all body and medical waste from the household. The waste includes faeces, urine, blood and vomit. Mencap says that Rotherham council has gone from collecting the hazardous waste once a week to once every 14 days and has reduced the amount that it picks up by 50%. The council has also stopped providing specialist waste bags for the disposal of the waste, leaving the family to cover the additional cost themselves. That bodily waste now goes into black bin bags mixed with household waste, which are sent to landfill. These stories illustrate the fundamental truth: these cuts are a false economy with devastating human, social and economic costs.

In a recent national survey by a group of charities, including Carers UK and the Alzheimer’s Society, half the respondents said that increased charges for care meant that they could no longer afford essentials such as food and heating, and more than half said that their health had suffered as a result. We must consider the services run by voluntary organisations—dare I say it?, the big society—that offer early help for people who do not necessarily qualify for assessed council support. Day care centres, meals on wheels, support groups and drop-in centres are being cut because they are losing grant funding.

Jackie Dray used to run four support groups called “Elders with Attitude”—I love that name—in Birmingham, but she was told in March that her £30,000 council grant was to be cut altogether. She now runs only one group and is desperately looking for alternative funding. She said:

“They are cutting luncheon clubs or groups like mine that could make a difference between somebody remaining in the community or sinking into clinical depression and residential care. For a small amount of money, you could delay the point at which people have to go into hospital. I see a lot of clinical depression in carers and cared-for alike. People are teetering on the brink. There’s a lot of frustration, worry, lack of sleep.”

Before we can consider the future of social care services, we have to consider the consequences fully.

While we await the Dilnot commission report on long-term funding and the Government’s response to the Law Commission review, the Government are, in effect, already re-engineering the infrastructure of care and support. As services are razed, my fear is that capacity is being lost, services are being withdrawn and staff are being lost—capacity and skills that cannot easily be recreated. The Government are seeking to soften people up and lower their expectations, to get them to accept a return to reliance on family and buying from the open market with their own funds, or a patchwork of precarious charitable provision from a third sector suffering its own cuts and challenges.

I want to turn to the ideal, which I thought all the parties shared, of personalisation in adult social care. I fear that that ideal is being lost. The cuts mean that the policy, which promised much, is fatally undermined. Social workers and care managers tell their union that they are being expected to reassess personal budgets with a view to cutting them. I know that they need to consider value for money for all care packages, but they believe that they are expected to make cuts to get the budgets down.

A forthcoming report on a survey that Unison conducted with Community Care will highlight the fact that the paperwork and bureaucracy associated with personal budgets is excessive and inaccessible for service users. I question the Minister’s decision to prescribe from Whitehall that personal budgets be provided in the form of direct payments. That appears to be at odds with his claim to be a champion of local determination and removes choice from people who wish to have a managed budget. It appears to be linked to the aim of completely withdrawing state provision. Individuals will be expected to navigate the market or take on what many will see as the onerous and stressful responsibility of becoming an employer. I urge him to reconsider the prescription of direct payments, as there is evidence that it will restrict choice, but more importantly, distress some of our most vulnerable people, who already have enough challenges in life.

As we contemplate the future of adult social care services, there can be no under-estimating the scale of the challenges that we face as a society: by 2041, the number of adults with learning disabilities, we are told, will have risen by 21%; the numbers of young people with physical or sensory impairments by 17%; and disabled older people by a massive 108%. We all know that the number of dependent older people is set to increase hugely. The Association of British Insurers says that currently 20% of men and 30% of women will require long-term care at some point. If we add to that the challenges of the increasing number of young adults with complex needs who will need very expensive care packages for decades; the 170,000 people with a learning disability who Mencap tell us live with parents and carers who are already over 70 years old; the growth in the number of people with dementia, which the Alzheimer’s Society says is set to soar by a third to 1 million people by 2025; the costs facing authorities due to alcohol misuse; and the number of people with obesity-related problems, then we can see that the Government’s proposals are destined to fall well short of what is needed.

The director of children, education and social care for Stockton-on-Tees borough council, which serves people in my constituency, says that we have to be mindful of the knock-on effect of the reduction in other funding streams that impact on adults—the independent living fund, the Supporting People programme and affordable housing funding. She tells me that some of the funding streams that have historically been linked with it are being reduced or ceasing, while her department works to maximise people’s independence.

[Lilian Greenwood]

Does my hon. Friend share my concern that these cuts come alongside the cuts to disability benefits outlined in the Welfare Reform Bill, in which Ministers talk about targeting those in greatest need? Is not there a danger that disabled people with moderate needs could lose all support and face isolation and a loss of independence?

[Alex Cunningham]

That is very much the case. A stream of people have come to our surgeries or to see us in Parliament, and there seem to be so many attacks—left, right and centre—on some of the most vulnerable people in our society. As my hon. Friend says, something needs to be done if we are to arrest this situation.

The director of children, education and social care for Stockton-on-Tees borough council says that the result of the cuts, if we have limited extra care and supported living options, will be a further over-reliance on residential provision. An integrated health and social care facility and extra care scheme in Billingham in my constituency was an important part of my council’s strategy for supporting people, but the Government refused the private finance initiative credits to make it happen. Would the Minister prefer his granny, mother or other elderly relative to be forced into residential care when they could have been supported in their own home or an extra care facility and had the independence that I know most older people want?

Another area of concern is the shortfall in funding to support carers. Yes, I know that the Government allocated a welcome £400 million for carers’ breaks, but other funding managed by PCTs to support adults and their carers is not ring-fenced in any way, and although some flexibility is needed, carers, who are often seen as the poor relation, could end up all the poorer.

The sector skills body estimates that the social care work force needs to double by 2025, yet it is a sector characterised by labour shortages, low pay, poor prospects and a poor image. Some 60% of care workers hold no care qualifications, and only 20% have a national vocational qualification level 2; only 10 % have an NVQ level 3. Before anyone intervenes on that point, I should say that I believe that previous Governments, including our own Labour Government, could have done more to address that issue. However, it is not just Governments’ responsibility; other organisations, including service providers, should play their part in driving up qualification standards and meeting the costs.

Is the provision made by such organisations being properly managed or being left to the market? In Stockton, we have over-provision of residential care places, some of which are under financial pressure, including those owned by Southern Cross, which is seeking £100 million from investors to secure its future. Surely we need some kind of controlled management or strategic planning to get this right and ensure that standards are maintained.

We must look to the future of adult social care. We need immediate action to lay the groundwork for genuine reforms to flourish. The Chancellor said that his cuts would not touch front-line services; he should be prepared to say that he got it wrong. There is an urgent need for a new plan that looks again at the local government settlement and works with local authorities to ensure that front-line services are funded to meet need. Everybody agrees that we must do more to give early help because it prevents dependence and saves money on acute care, and yet those services are first in line for the chop. Will the Minister genuinely and strenuously consider the recommendation of a duty to provide early help for adult services such as that which Professor Munro made for children’s services?

The Minister must reconsider the equation of personalisation with the transaction of receiving direct payment. Personalisation is not about ticking boxes and having the right number of people receive direct payment. Trying to make it work in the context of the cuts requires him to spend time talking to practitioners and service users about what is happening on the ground and what they think the priorities should be. We need to get it right for individuals.

We need an improved and comprehensive work-force strategy covering training, development and qualification standards as a condition of provider registration and a commitment to working towards a living wage for all care workers. We must work with work-force representatives to boost the autonomy and confidence of practitioners. I am sure that the Minister will welcome, as work-force regulators have, Unison’s duty of care handbook for health and social care staff. The handbook aims to promote awareness among workers of their duty of care and other professional duties, and of how to raise concerns about poor practice.

Costs, too, need to be addressed urgently. The Association of British Insurers says that the average cost of care in residential homes in the UK is approaching £25,000 a year, with people in England spending an estimated £420 million a year on private home care. This question was not sensibly debated during the general election. We need cross-party co-operation to reach a long-term sustainable solution to the problem.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Brady.

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate on an issue of huge importance to many of our constituents, who are among the most vulnerable in society, including older people, disabled people and carers—people for whom adult social care services are an essential source of support in their daily lives.

My hon. Friends have eloquently and passionately articulated the real and serious concerns about adult social care services, but I want to focus on the importance of the social work profession in building adult social care services fit for the future.

Labour Members are pleased that the Government have proceeded with the work that Labour started on reforming the social work profession, and I welcome the Government’s decision to continue to support the work of the Social Work Reform Board. As a consequence of cuts to budgets for adult social care services, it now feels as though the very future of social work with adults is under threat. Councils across the country are proposing deep cuts to the number of registered social workers they employ, to be replaced with a range of staff employed in roles such as care co-ordinators and support workers. I know that the staff are committed and caring, but, like my hon. Friends, my concern is that this restructuring is prompted not by seeking to improve the quality of care but by the need to reduce spending on salaries. Like my hon. Friends, I am fearful of the consequences of this loss of capacity. It represents a serious loss of skill and expertise in the work force, at a time when people’s physical, mental and emotional needs and family dynamics are becoming ever-more complex.

It is hard to escape the impression that social workers in adult services are, as my hon. Friend the Member for Blaydon (Mr Anderson) said, the Cinderella service—the poor relations. The media attention given to tragic deaths of children as a result of abuse has served to sharpen public focus on children’s social work, but the consequences of social workers in adult services being poorly managed, supported, valued, trained and developed are just as critical, as my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) pointed out. Excessive case loads, defective IT systems and too much paperwork are also facets of adult social workers’ daily lives, and they get in the way of those workers’ ability to practise effectively.

The Government have said that they have given the Children’s Workforce Development Council £79.9 million for social work initiatives in 2011 and 2012. There is work to develop an advanced professional status in children’s social work to enhance the development of those who want to progress in front-line practice rather than in management, and the Munro review of barriers to direct social work with children and families has come up with some excellent recommendations—all to be welcomed. Does the Minister understand, however, that the lack of similar investment and activity in adult social work is leaving practitioners feeling overlooked, and has knock-on consequences for morale and future recruitment and retention? What plans does he have to address those concerns?

My trade union, Unison, represents 40,000 social workers and has developed a 10-point plan for social work within adult services. I support its call for a “clear political commitment” through “policy and regulation channels”:

“to strengthen the role of social work in adult services”

covering the

“central importance of social work in care and support of adults, and…halting the development of ‘social work on the cheap’.”

Is the Minister willing to give such a commitment?

A survey last year of social workers in adult services found that two thirds of respondents felt that the time they had available to spend with each service user was not sufficient to meet their needs, and that nearly a quarter felt that the time available was very insufficient. An overwhelming 96% of respondents believed that too much of their time was spent on paperwork, and only a third believed that joint working with the NHS was effective in their area. They reported structural difficulties, such as remote management, the marginalisation of social work and the duplication of paperwork required because of incompatible IT systems. Although only 3.5% of social workers in England are directly employed by the NHS, many more are seconded to the service from councils, but the status, standing and representation of social work in the NHS is virtually invisible.

Social work plays a vital role in mental health services, addressing the social needs and safeguarding the rights of patients, and hospital social work is essential in enabling rehabilitation and preventing readmissions. A recent survey by Counsel and Care stated:

“Hospital social workers are being bypassed by health professionals, who in some cases are dealing directly with the family rather than using the social worker service to plan discharge...The hospital teams can sometimes function as ‘brokers’, trying to discharge older people in to care homes themselves without proper assessments being undertaken by social workers.”

Does the Minister agree that NHS trusts should ensure that social work is represented in their management and governance structures to prevent such practices? Health employers need to engage much more closely with the social work reform agenda, accepting responsibility for playing their part in its implementation.

Adult social care services are vital and will be increasingly needed in the future, as my hon. Friends have pointed out. Social work faces a number of serious and pressing issues, and I look forward to hearing how the Minister plans to address them.