NHS: Long-term Strategy

Liz Kendall Excerpts

Wednesday 11th January 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Today’s debate has laid bare the dire state of our health and care system after 13 long years of this Conservative Government: more than 7 million people waiting for hospital treatment, 400,000 for more than a year; the worst ever waits for A&E, with 50,000 patients a week now waiting more than 12 hours in A&E; excess deaths this winter at their worst level since 1951, except for the pandemic years; ambulance response times plummeting; cancer targets missed; and waits for mental health care so bad that thousands of patients end up forced to go to A&E or even attempting to take their own lives. In social care, the situation is even worse: 165,000 staff vacancies, 30,000 more than in the NHS; more than half a million older and disabled people waiting to have their needs assessed in the first place, not even on a waiting list; and millions—millions—of families pushed to breaking point because they cannot get the help they need to look after their loved ones.

The question I want to focus on today is why we have ended up here. Labour Members have never claimed that everything was perfect in the NHS when Labour last left government, but Conservative Members squandered a golden inheritance of the lowest ever waiting lists and the highest ever patient satisfaction, with access to services we can only dream of now. Ministers want to blame all of the current crisis on covid and this year’s winter flu, but the truth is that waiting times were at record levels and staff shortages were soaring long before the pandemic struck.

The most glaring reason for the problems we face is the sheer incompetence of this Government. To take just one example, effective winter planning in the NHS is a non-negotiable and a key test for any Secretary of State. When Labour was in Government, winter plans were done and dusted well in advance. I know that from my time working in the Department of Health. So, it beggars belief that not a single penny of the original winter hospital discharge funding was out of the door by the end of November. Some £300 million of it still has not reached the frontline. Their latest flawed plan to buy up care home beds, when what most people need is care in the community or their own homes, was not even announced until 9 January. That is not effective planning; it is scrabbling to shut the stable door after the horse has bolted.

There are even more fundamental reasons for the current crisis than the Government’s sheer incompetence. The root cause is a decade of Conservative economic failure trapping Britain in a vicious cycle of low growth, low pay and high taxes, which in turn has failed to provide sufficient or sustainable funding for our public services, including decent pay for frontline staff. Einstein’s definition of madness was to keep doing the same thing over and over again but expecting a different result. Yet that is precisely what we saw in the Chancellor’s autumn statement, so Britain is once again set for, at best, anaemic growth by the end of the Parliament. Britain deserves so much better than this. Labour’s green prosperity plan, our industrial strategy and our plan to fix business rates set out a different path for the future. No wonder the chairman of Tesco says that in terms of a growth plan Labour is the

“only team on the field”.

Economic growth that delivers proper investment in the NHS and social care is vital, as Labour’s record in Government shows, but on its own it will not secure a care system fit for the modern world. It also requires reform. On that, Ministers have again utterly failed to deliver. Mr Deputy Speaker, you will forgive me if I take the House on a brief trip down memory lane. Remember the Lansley reforms? I am sure Conservative Members would rather forget. That legislation so large it could be seen from outer space, but no one understood what it was for. Years of time and effort were squandered on a disastrous internal NHS reorganisation that failed either to integrate care or to deliver the improvements in patient care that the Conservatives claimed. There was the Conservatives’ cap on care costs—[Interruption]—and their solemn promise that no one would have to sell their home to pay for their care. Remember that? [Interruption.] It was first promised in 2012, postponed in 2015 and 2017, and re-promised by the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) on the steps of Downing Street. [Interruption.]

[Mr Deputy Speaker (Sir Roger Gale)]

Order. It is perfectly plain that the hon. Lady does not want to give way.

[Liz Kendall]

Thank you, Mr Deputy Speaker.

The promise was buried once and for all by the Chancellor in his autumn statement last year—a Chancellor, I remind the House, who said that his biggest regret as Health Secretary was failing to put in place a long-term plan for social care.

In contrast—[Interruption.] I am sure the right hon. Member for Vale of Glamorgan (Alun Cairns) will be interested to hear this. In contrast, Labour has a 10-year plan for investment and reform in our NHS and social care. It includes the biggest ever expansion of the NHS workforce, funded by scrapping non-dom tax status; ensuring that patients can see the doctor they want in the manner they want, whether that is face to face, over the phone or online; a new deal for care workers—[Interruption.] Maybe the hon. Member for Ashfield (Lee Anderson) would like to listen to our plan and suggest it to his Ministers. We will have a new deal for care workers to tackle staff shortages and give older and disabled people the support they need. Above all, we will have a relentless focus on prevention and early intervention. There will be a new principle of home first, shifting the focus of care out of hospitals and into the community, with more people being cared for in their own home, which is where they want to be.

Using new technology, providing genuinely joined-up care and support, putting people first, giving staff the support they deserve, providing investment with fundamental reform: that is Labour’s plan, not the failed sticking-plaster approach that we have seen from the Conservatives over the past decade. Britain deserves a fresh start. We deserve a better future. That is what Labour will deliver. I commend the motion to the House.

Cancer Services

Liz Kendall Excerpts

Thursday 8th December 2022 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank the Backbench Business Committee for granting this hugely important debate and the hon. Member for Winchester (Steve Brine) for securing it. Ever since he was elected in 2010—the same year as me—he has championed health issues. We have sat on several Bill Committees together and I know that he will continue to champion health issues in his new role as Chair of the Health and Social Care Committee. I was particularly pleased to hear him say he is determined to continue focusing on cancer care as that issue touches so many of our lives personally and professionally. I wish him well in his role.

The central point made in the Select Committee report is that early diagnosis and prompt treatment of cancer is critical to improving survival chances and to bringing the UK up to the standards of other countries. The grim reality is that patients are having to wait longer at every stage of the process and the fundamental reason for that is a shortage of staff. The report says:

“Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce and we found little evidence of a serious effort to do this.”

I am afraid this is a terrible indictment of the Government’s record on cancer care, and that is despite repeated warnings not only from Members on this side of the House but from cancer charities, NHS staff and a range of other organisations.

Members may know that the former Chair of the Select Committee and now Chancellor used to rightly say that the Government needed to do far more in terms of the workforce and that they did not have a proper workforce strategy; indeed, I think he may have joined Labour Members in the Lobby in voting to try to make that happen. Since becoming Chancellor he has been more silent on the issue. Labour, on the other hand, does have a clear workforce plan that would help make serious improvements in cancer care alongside many other parts of NHS treatment. I will say more about that later.

I want to start, however, by setting out some of the current situation on waiting times for cancer care, and there are problems every step of the way. More than 60% of cancers are diagnosed following a GP referral, yet the report rightly says pressures on general practice mean there is a big increased risk of cancer being missed in primary care. The report says:

“The NHS has lost 1,704 fully-qualified full-time GPs since 2015 despite repeated commitments to recruit more”.

The impact of these GP shortages is clear.

The standard is supposed to be that 93% of patients should wait two weeks between initial referral from a GP to cancer treatment. As of October this year only 77.8% of patients were seen within two weeks. That means 53,128 patients waited longer than they should. That is in contrast to when Labour last left Government, when over 95% of patients were seen within two weeks. The Government will no doubt say that that is entirely down to the covid pandemic. I am absolutely clear that covid has had a huge impact on cancer care, but let me remind the House that the Government were failing to hit the two-week referral target even before the pandemic. There are many problems in many other steps along the way. The Government have never hit their diagnosis target of at least 75% of patients being told whether they have cancer within 28 days of an urgent referral from either their GP or a cancer screening programme.

As hon. Members have said, patients are waiting longer and longer for treatment. If we look at the two-month target, we see that in the East Kent Hospitals University NHS Foundation Trust, which serves the Minister’s constituents, 27% of patients are waiting longer than two months to have their treatment. That is two months when people will be terrified and anxious about what will happen to them. Will their cancer be getting worse? Their family members will be worried, too. In Leicester, the city that I represent, more than half of patients are waiting longer than two months for their treatment. I am afraid that the human cost of that has yet to be fully recognised by the Government.

The key reason for that is a lack of staff. Alongside the shortages of GPs that I mentioned, the report says that

“the NHS is estimated, on a full-time equivalent basis, to be short of 189 clinical oncologists, 390 consultant pathologists and 1,939 radiologists, and will be short of 3,371 specialist cancer nurses by 2030.”

It adds that there is “no detailed plan” to address that. When the Minister rises, I hope that she will set out what she intends to do about that. The Labour Party has set out its long-term workforce plan, which will have independent workforce projections, new career paths in the NHS and new types of health and care professionals to help solve those problems. That includes doubling the number of medical school places to 15,000 a year, doubling the number of district nurses who qualify each year and creating 10,000 more nursing clinical placements, paid for by scrapping the non-dom tax status, because we believe that people who come and live in this great country should pay their fair share of tax.

I could say far more about transforming cancer care and the need to fundamentally shift the focus of support towards prevention and early intervention, with more action on tobacco, on obesity, on exercise, and on alcohol —all the things that we know make such a difference. I could say far more about end-of-life care, which the hon. Member for Erewash (Maggie Throup) spoke about, and the need to join NHS services with social care and support so that people have choice about how and where they die. Within these time constraints, I want to say that I am optimistic about the future facing cancer patients in this country. There have been huge advances in science, medicine and technology, and Britain has been leading the way in much of that. It gives us hope for the future, but cancer patients and their families need the Government to act to solve the huge problems in the NHS, starting with the workforce, to get those waits down, get early diagnosis up and transform survival rates for cancer treatment.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 6th December 2022 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Liz Kendall (Leicester West) (Lab)]

Let’s just tell it like it is on the Government’s record on social care reform. Their cap on care costs was first promised 10 years ago. In 2015, they delayed it and in 2017 they scrapped it. In 2019, the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) again promised to fix the crisis in social care, but last month the Chancellor buried the policy, once and for all. After 12 long years, what have Conservative Members got to show on social care: the highest ever staff vacancies; millions left without the care they need; hospitals full of people who do not need to be there; and families picking up the strain. Isn’t the truth on social care, just as with our economy, transport, housing and schools, that the Conservatives have run out of excuses and run out of road, and the country deserves a change?

[Helen Whately]

We have delayed our social care charging reforms because we listened to those in the system and we heard local authorities asking for more time to prepare. Importantly, we have allowed local authorities to keep the money allocated to that in their bank accounts to fund some of the current pressures on social care. I ask the hon. Lady to recognise the record funding settlement for social care in the autumn statement—£7.5 billion for social care over the next two years—which she has not even acknowledged. That is coupled with the fact that we are pressing full steam ahead with our system-wide reforms to social care, with funding of more than £1 billion to support the workforce and innovations in social care and to transform the quality and access to social care across the country.

Social Care

Liz Kendall Excerpts

Thursday 24th November 2022 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Ali. I congratulate the right hon. Member for Ashford (Damian Green) on securing this debate.

It is about time that we celebrated the huge value and potential of social care, and about time that we see the fact that we are an ageing society, and all living for longer, as something that we should be excited about, proud of and look forward to, not something that is simply a problem and a drain. However, we must also be realistic about how we get from where we are to fulfilling the full potential of social care.

I shall make three broad points today about the value of social care, first, to those who draw on it, secondly, to the communities they live in, and thirdly, to the wider economy—a point the right hon. Member for Ashford rightly touched on.

At its best, social care is about ensuring that every older and disabled person can live the life they choose, in the place they call home, with the people they love, doing the things that matter to them most, as Social Care Future has so powerfully argued. Put simply, social care is—or should be—about ensuring that every older and disabled and person can live an equal life to everybody else. That is its intrinsic value.

I would go further. We all benefit when we have a decent social care system, not just because we may all end up using it or relying on it because of having to care for and support our own parents, but because we ourselves may live to require social care. This is not going to happen to somebody else: it is going to happen to us all, so we had better get it right.

I also argue that our communities massively benefit when we have a decent system of social care. We lose out when older and disabled people cannot make their full contribution in the workplace, in our voluntary and community organisations, and in being part of our lives, like everybody else. It is a tragedy that so many older and disabled people feel shut away and shut off from the rest of their communities. They lose, and we lose too.

I am optimistic about social care. I believe that in the 21st century—the century of ageing—social care is an essential part of a modernised welfare state and our economic infrastructure. But I am also realistic about the challenges we face. The truth is that social care is in a worse situation than it has ever been, after a decade of cuts, the pressures of covid and now the cost of living crisis.

I recently heard directly from members of the Care & Support Alliance about the quite frankly awful choices facing users and their families: disabled people trapped in their own homes because they cannot afford fuel to go out, and their care packages are being cut; older people skipping meals or only eating cold food because they do not want to use their gas and electricity; tens of thousands of people waiting for care assessments, seeing their health worsen day by day; thousands more trapped in hospital, where neither they nor their families want them to be; and families having to spend even more money on care, or cutting back support and giving up their own jobs because they cannot afford the help they need for their loved ones.

As the right hon. Member for Ashford said, at the heart of it all is the absolute crisis in the care workforce. Vacancy rates are up by more than 50% in the past year. There are a record 165,000 vacant posts. Employers are simply unable to recruit or retain the staff they need, especially when people can earn more in hospitality and retail. The Government have still failed to produce a proper, long-term workforce plan. I was very interested in the right hon. Gentleman’s comments—I agree with them—about how we could look at how the care workforce might link up with “Agenda for Change” so that we can get a decent workforce system and plan across health and social care.

Recently, we finally heard details of how the £500 million social care discharge fund will work. I understand that £300 million is going to the integrated care boards and £200 million to local authorities. How much of that will go directly on paying more for the workforce? We cannot do the discharges without the staff. We may need beds, but it is really about the staff. Will the Minister say more about that, because it is an absolutely essential point?

Alongside what I call the intrinsically moral case for care is the increasingly strong economic case. I believe that our care system is, like the NHS, the bedrock of our national prosperity. If the care sector is struggling, other parts of the economy will begin to break down, as those who need care see their own health suffer and the demands on families and friends mount. Having more and better paid care workers in every village, town and city will probably make the biggest contribution to levelling up the economy and getting growth into every part of the country, because we know that care workers do not save their money but spend it locally. Not every rural village can have a solar factory, but every village, town and city needs decently paid care workers. That would make a huge contribution to women’s equality too. We know that the workforce is predominantly female, often from black and minority ethnic communities, and always low paid.

First, then, having more and better paid staff could help to boost jobs and growth. Secondly, it is about helping the rest of us stay in work. Almost 5 million people are already juggling work and care. That is one in seven of all workers. Half have to give up work because they cannot get the support they need to look after their loved ones. Families lose their incomes. Businesses lose their talents. The Government lose their taxes. We would not accept half of all new parents completely exiting the workforce, so why do we accept it for family carers?

The truth is that in modern Britain social care and, I would argue, childcare are as much a part of our economic infrastructure as the roads and the railways. They should be at the heart of our economic policy and strategy for growth. That is why Labour has made improving care one of the four missions of our industrial strategy. We understand its centrality to the workforce and economic growth. We are calling for a 10-year plan of investment and reform, and a new deal for care workers to ensure they get the pay, terms and conditions, training and career progression they need. We need to improve access to care early on, because the quicker people get help, the more likely it is they will stay living independently for longer.

Thirdly, although we will always need care homes, we need a fundamental shift toward prevention and early intervention, with a new principle of “home first”—putting the home first every time. That includes greater housing options, home adaptations, technology to help people to stay living independently and, critically, work with local voluntary and community groups to do things such as tackle loneliness and isolation. People do not always need to turn to the state for the help and support they need.

Fourthly, for disabled people, who are all too often completely cut out of this debate, social care is not all about helping them to get up, washed and dressed—vital though that is. It is about them living independently, having fulfilling lives and having the same sort of access to friends and work that everybody else takes for granted. We need to ensure that working-age adults with disabilities have greater choice and control over their support and personal budgets. We need to make direct payments really work and give people the power to change services, as they know what is best.

Finally, I want to talk about unpaid carers—an issue that has been going on for years and years. Carers say they have to battle their way around the system, telling their story time and again. They need joined-up services; one point of contact, information and advice; proper breaks; and flexibility at work. I think the family friendly and flexible working agenda for the future is absolutely about people in their ’50s and beyond, and I am not just saying that from a selfish perspective.

In conclusion, in the 21st century and in one of the richest countries in the world, the goal of ensuring that all old and disabled people live the life they choose should not be regarded as extraordinary. It is the missing part of the jigsaw of the welfare state. It was never part of it when it was created, because back then life expectancy was 65 and women stayed at home. We need to change our thinking so that social care is at the heart of the modernised welfare state and an essential part of our economic infrastructure. We cannot do it all at once, but with a 10-year plan of investment and reform we can achieve it.

I have to say that it beggared belief that the Chancellor, when Chair of the Health and Social Care Committee, said that his greatest regret as Health Secretary was not putting in place a long-term plan for reform, but then put the final nail in the coffin of reform in his autumn statement. I urge the Minister to make the case again. Yes, we need to tackle the immediate challenges, but we need a long-term vision to be implemented. I look forward to her comments.

Huntington’s Disease

Liz Kendall Excerpts

Wednesday 9th November 2022 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve with you as Chair, Mr Robertson. I really congratulate my right hon. Friend the Member for Leeds Central (Hilary Benn) on securing this debate. He spoke with great authority and passion, including about the person he knows. It means a lot that this place can reflect how people really feel when they have to live with this terrible disorder and the impact it has on their families.

As we have heard, it is a totally life-changing disorder, impacting on not just the person’s health but, I would argue, everything that makes them human, which is their relationships with the people they love most. We are the sum total of our experiences and memories, and our relationships with people. When someone we love loses those memories and becomes a different person, it has a deep effect on us, too. As Members have already said, it is about not just the 8,000 people who are living with this diagnosis in the UK—including about 100 in Leicester and Leicestershire, which is the part of the country that I represent—but their 32,000 children. Growing up knowing that the disease may end up affecting them too is a terrible burden.

The support that should be available needs to be very broad, and I know from my experience of working in health and care over the last 30 years that that is one of the key areas where we fall down. When so many different types of services and support are needed, bringing those all together for a very specialist and rare condition is one of the biggest challenges we face in the health and care system. As we begin to know more about diseases, particularly through genetic developments, we are going to see more and more of this in future. If we can get it right for Huntington’s, we know that we may be able to get it right for other conditions.

There are three areas that I want to talk about today. The first is obviously the critical issue of access to mental health services. Provision of comprehensive, specialist psychological care is an essential component of treating and dealing with Huntington’s disease, yet we know that access to that specialist care is limited and varies significantly across the country. Despite clear commitments from statutory bodies over many years—over the past decade, at least—the situation has improved little for families.

Research from the Huntington’s Disease Association shows that a quarter of people living with the disease are unable to access psychologists, psychiatrists and other counselling when required. I was really struck when the hon. Member for Strangford (Jim Shannon) said that there are only two specialist nurses for 2 million people in Northern Ireland. That simply is not good enough. Specialist nurses provide unbelievable support to families, and have the ability, knowledge and time to talk things through, so that has to change. That is part of a wider picture of significant staff shortages in mental health. Currently, one in seven mental health doctor posts and one in five mental health nursing posts are vacant. We simply cannot provide the access or standards of care that we need, including for people with Huntington’s disease, unless we tackle that problem.

As part of Labour’s plan for mental health, we would recruit 8,500 more mental health professionals, funded by closing tax loopholes for private equity fund managers and removing the VAT exemption from private schools. That would give us the extra staff we need across the board, including for people suffering from Huntington’s disease and their families. People often suffer from anxiety and depression after a diagnosis. My right hon. Friend the Member for Leeds Central talked about the impact on children and young people, who experience anxiety, depression and self-harm as a result of what they fear may lie ahead of them. We must focus on that issue.

Labour’s plan for mental health will also help to improve the quality of services, including by broadening the range of services available to those with severe mental illness. They will also require talking therapies and other interventions to help them live as well as they can as the disorder progresses. I hope the Minister will set out in detail what the Government will do to increase the mental health workforce, both in community services and in the specialist services that people with severe conditions require.

Staff shortages in mental health are a critical issue, but there are wider barriers. Many people with Huntington’s disease say that they struggle to get a specialist referral in the first place because there is a lack of awareness of the issue. My mental health trust has talked about the issues we have faced across county borders. We are developing specialist services for Huntington’s disease, but neighbouring counties are not, so it is challenging to get cross-county referrals.

The real issue is the problem of co-ordinating the care pathway for people with Huntington’s disease. People and families feel that they are in a constant battle with support services, and have to tell their story time and time again. The last thing that people faced with this terrible situation want is to battle the services.

The charities working in this area and my right hon. Friend have called for the development of NICE guidelines to ensure greater consistency in treatment and support for people with this condition. There is a very strong case for that, not simply because NICE guidelines exist for people with other conditions, but because unless something is set out for rare conditions, it is a real challenge to improve the quality of care and support. I ask the Minister to engage further on this issue with my right hon. Friend, the Huntington’s Disease Association and NICE, to see what progress can be made.

Families do not just need help from the NHS; they need help from social care too. The average survival time after a diagnosis of Huntington’s disease is between 15 and 20 years. During that time, the condition targets nerve cells in the brain, causing motor, cognitive and psychiatric symptoms that get progressively worse. The person living with the disease needs various sorts of care, including from the social care sector, but too often the burden is being shouldered by families in an unsustainable way. Many families say that, until the onset of the symptoms, they do not get the support they need. Again, there is a huge number of vacancies in social care—160,000, which is the highest it has ever been. Families have no choice other than to take on more of that burden themselves, which has a huge impact on their jobs, relationships and careers.

At the heart of Labour’s plan for social care is a new deal for care workers. It would allow us to recruit and retain the staff we need by ensuring fair pay and terms and conditions, and by improving training and career progression. We simply cannot give the families of people living with Huntington’s the support they need unless we have a properly staffed care workforce. We would also have a new partnership with families, so that they get proper information, advice and breaks, and so that we join up services and people do not have to battle their way around the system.

We cannot improve the quality of care and support for people with rare conditions such as Huntington’s unless families are equal partners. That needs to be at the heart of any future development, and particularly the NICE guidelines. The people who know how best to join up care and support are the families, because they do not see their loved one’s needs in separate departmental service silos. They do not think, “They have a social care need over here, and a health need over there”—they see their loved one as one person. We need families to help develop the NICE guidelines.

Last but by no means least, we need to touch on the financial strain facing those with Huntington’s disease. People with Huntington’s and their families tend to have lower incomes. That is often because the person has to give up work, as do their family members in order to care for them, but lower than average incomes are compounded by higher than average costs. Because of the involuntary movements associated with the condition, people with Huntington’s need higher-calorie diets, which means increased food bills. They also have to stay at home, which means higher energy costs, and extra washing is required, too.

The Huntington’s Disease Association recently did a survey looking at cost of living issues. It found that many people were cutting back on the absolute basics and were really worried about the increasing risk of debt and homelessness. Indeed, it wrote to the Chancellor about this issue on 26 October. Could the Minister encourage the Chancellor to reply to that letter? This is a pressing and immediate issue that people are facing. Members will know that Labour has called for a windfall tax on gas and oil profits in order to support struggling families during the cost of living crisis, and I wonder whether the Government will now agree to that.

There is hope for the future. As my right hon. Friend the Member for Leeds Central said, there have been developments on diseases that we thought nothing could ever be done about. There is hope for scientific developments, especially in genetic technologies, but there are also things we can do in the here and now to better support families, such as improving the mental health and social care workforce, and dealing with the cost of living pressures that families face. I hope that the Minister will address those points.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 1st November 2022 Commons Chamber

[Mr Speaker]

I call the shadow Minister, Liz Kendall.

[Liz Kendall (Leicester West) (Lab)]

The previous Health Secretary promised £500 million social care discharge funding for this winter, but it is 1 November and not a single penny of that money has been seen. I am afraid that the political chaos and incompetence over the last few weeks means that local services cannot properly plan and thousands more elderly people are trapped in hospitals when they do not need to be, with all the knock-on consequences for the rest of the NHS. Will the Minister now tell us: is this money still available? When will it be released? Can she guarantee that it will be genuinely new funding, not found from cuts made elsewhere?

[Helen Whately]

I am sure the hon. Member heard the answer I gave a moment ago to a similar question. I absolutely acknowledge the challenge of discharges. The challenge is nothing new, but it has indeed worsened, in part due to the availability of social care. That is one reason why the Government have announced the £500 million discharge fund. I am just a few days into this job—[Interruption.] I am looking at the proposals on how this will—[Interruption.] If she will listen, I am looking to make sure that we allocate that money effectively, because we know that money is tight and we must absolutely make sure that every penny of the funding is well spent on improving the discharge from hospital to people’s homes.

Contact in Care Settings

Liz Kendall Excerpts

Thursday 27th October 2022 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank my hon. Friend the Member for Liverpool, Walton (Dan Carden) and the hon. Members for Chatham and Aylesford (Tracey Crouch) and for St Albans (Daisy Cooper) for securing this hugely important debate. I hope my hon. Friend the Member for Liverpool, Walton will forgive me for saying that I thought he spoke incredibly bravely and powerfully about his father, who I am sure would be very proud of him today.

The terrible consequences of banning families from seeing their loved ones in care homes is an issue very close to my heart. It is something that Labour has been campaigning on since the very first covid lockdown in June 2020. Indeed, we first called on the Government to bring forward a legal right for care home residents to see a family member or friend in February 2021. We continue to do so today because, as we have heard in the debate, this issue has not gone away, and because with winter almost here and, God forbid, in the event of any future pandemics, we need to ensure that the rights of residents and relatives are clearly guaranteed by law. We make this case because it is good for residents, good for family members and good for care staff.

I will say more about that later, but I want to start by thanking the organisations that have campaigned so hard on this issue, including Healthwatch, Mind, Mencap, the Alzheimer’s Society, Parkinson’s UK, Dementia UK and Disability Rights UK. I especially want to thank the Relatives and Residents Association, John’s Campaign and Rights for Residents, which have been at the forefront of the campaign. In particular, I pay tribute to Jenny Morrison and Diane Mayhew from Rights for Residents—two phenomenal women who have blazed a trail on this issue. After their terrible personal experiences, they set up Rights for Residents, to give a voice to all the other care home residents and families who had been banned from seeing their loved ones. The reaction to their campaign has been astonishing, which I saw for myself on joining them in Downing Street—or, rather, locked outside it—in September 2021, when they presented a petition calling for a change in the law, signed by more than 250,000 people.

Almost all the campaigners I met had never been involved in protests or petitions before. They were not there because of any political agenda, but because of their personal experience and the fact that they wanted to see a change. The reason why so many people joined Jenny and Diane is that this issue really matters. It matters to the thousands of families who have faced unbelievable anguish, guilt and distress because they were banned from seeing the people they love most—their mothers, fathers, husbands, wives, brothers, sisters, sons and daughters—at a terribly frightening time. It matters because of the physical and mental impact that isolation has on older people and, as the hon. Member for Chatham and Aylesford said, crucially, on people with physical and learning disabilities. We have heard much evidence about increased depression and anxiety, and people losing weight because they are not eating. The truth is that, as the hon. Member for St Albans said, families are not just visitors; they are an essential part of the care given to residents, and should be treated as such.

Banning families from seeing their loved ones also matters to care home staff. There is lots of international evidence that staff in many countries have faced increased workloads because some of the emotional and other support that was normally provided by families, such as helping people with eating and taking them on walks, completely disappeared when they were banned.

There is much I could say about all the powerful things that hon. Members said about their constituents; I was contacted by many deeply distressed constituents too. Because time is short, however, I will emphasise something that has not really been mentioned today, which is that families have always understood the need to protect their loved ones from covid and never wanted to expose them to unnecessary risks. All they wanted was to be treated the same as care home staff. They could not understand, once the PPE, testing and vaccines were finally available, why they were banned and treated differently from everybody else.

Throughout the pandemic, the Government have resisted calls for residents to have a legal right to see their family member. They have consistently said that the guidance they issued was enough, but the guidance, which changed more than 30 times during the pandemic, is not enough, as we have seen time and again. I will make two points. First, anything that is issued 30 times will be totally unclear. People will lose track and it will not be properly followed. Secondly, the clue to the problem with guidance is in the name—it is guidance, which can be ignored.

Neither is oversight from the CQC enough. The Joint Committee on Human Rights said in May 2021 that there was an

“astonishing lack of awareness by the CQC as to whether care homes are…allowing visits”.

The Chair of the Committee, my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), said at the time that the CQC’s assurance

“that visits are being allowed…is wholly unconvincing”.

We have heard evidence today that that remains the case and we know that the guidance and regulations are not working or being enforced.

The Relatives & Residents Association and Rights for Residents recently surveyed more than 650 families. They found that visiting restrictions during the majority of covid outbreaks between April and September this year were more restrictive than advised by current Government guidance. One in five outbreaks saw residents confined to their rooms. One in nine outbreaks saw residents not allowed any visitors at all. Shockingly, 45% of families who responded said that there were visiting restrictions in place despite there being no covid outbreaks. That is why those organisations have repeated their call for a new legal right to guarantee people’s access to in-person support from at least one care supporter—a person important to them, such as a relative or friend.

Opposition Members agree, as does the cross-party Joint Committee on Human Rights, which says that the default position must be that those in care homes can receive visits from a “significant person” and that blanket bans are in breach of the legal right to family life. We can learn quite a bit from other countries on this issue. I understand that the Dutch Parliament recently accepted a corona Act that guarantees that each resident has the right to welcome at least one visitor in the case of covid-19 outbreaks.

I ask the Minister to look at this subject again. She should heed what families want, what organisations representing residents and families demand, and what is done in other countries, and put this legal right in place.

[Mr Deputy Speaker (Mr Nigel Evans)]

I remind the Minister to leave a couple of minutes at the end for the hon. Member for Liverpool, Walton (Dan Carden) to wind up.

Sickle Cell Treatment

Liz Kendall Excerpts

Wednesday 8th December 2021 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Miller. Like everyone, I congratulate the right hon. Member for Wolverhampton South East (Mr McFadden) on securing this debate on an extremely important issue. I pay tribute to the members, officers and staff of the APPG on sickle cell and thalassaemia. The report “No One’s Listening” is one of the most powerful, serious and substantial reports I have read in a long time in this place and while working in the health and care field. The detail, analysis and recommendations it provides are really important and cannot be ignored.

As we heard from right hon. and hon. Members, the report was carried out in response to the absolutely tragic case of Evan Nathan Smith, who died in the most utterly appalling circumstances with his whole life ahead of him. It is crystal clear from the coroner’s inquest that he would not have died had it not been for the failures in his care: the failure to get the pain relief he desperately needed, the failure to give him a timely blood transfusion and the utter lack of understanding about sickle cell Opposition the part of the staff looking after him, in an area where they should have known because of the local population.

Most importantly, the report highlights far more fundamental issues, which my right hon. Friend the Member for Wolverhampton South East picked out in his comments. First, this is not an isolated incident, as my hon. Friends the Members for Vauxhall (Florence Eshalomi) and for Streatham (Bell Ribeiro-Addy) so powerfully and personally described. There is a pattern of years of substandard care in this crucial area. Patients understandably lose trust in the system. Secondly, there is the issue of race—the racial inequalities in the standard of care being provided and the stereotyping and discriminatory attitudes towards black people that have contributed to that. Of course, those two things are inextricably linked—

[Mrs Maria Miller (in the Chair)]

Order. Could I encourage the hon. Lady to project her voice this way?

[Liz Kendall]

I apologise. I should be speaking to people rather than into a void.

Unless we understand those two fundamental issues, we will never get the change we need. I want to use my time not to repeat what others have said but to talk about how we get real and lasting change, thinking about some of my own experience of working in health and care for 20 to 25 years. There is a lot in the report that is excellent. Much of it is coming from the top down, and there are important recommendations that should be followed, but the real change that we need to see is to give patients and their families far more say, control and involvement in the system, because that is how we will get lasting change.

Five key areas need to be addressed. The first is tackling the appalling variations in care that the report highlights. The really important issue, which my hon. Friend the Member for Vauxhall picked up, is that as our country becomes more diverse—something we should celebrate—this issue will not just affect London. That point was made in evidence to the APPG by Global Blood Therapeutics, which clearly said that the geography of sickle cell is starting to change, with patients increasingly moving outside London. In understanding that, we have to ensure that variations in care are ended in all parts of the country.

One of the most important recommendations in the report is that all NHS trusts should share findings of their internal reviews into incidents involving serious sickle cell care failings with the National Haemoglobinopathy Panel so that learnings can be communicated across the country. It is within the remit of the Minister and the Department to ensure that that happens, so I hope she will set out what she intends to do and what discussions she has had with NHS England about making it happen.

The second key recommendation around variations is that the CQC should make compliance with NICE clinical guidelines on the delivery of pain relief within 30 minutes for sickle cell patients an essential criterion that it uses when assessing NHS trusts. As far as I can see, the CQC has not responded to the report. I wonder what discussions the Minister has had with the CQC about that, because it is crucial.

The third issue around variation, which the right hon. Member for Tunbridge Wells (Greg Clark) touched on, is that we now have integrated care systems across the country. Every time there is an NHS reorganisation, and there have been many over the last two decades—I have been involved in some myself—we lose institutional memory about these issues and findings. What discussions has the Minister had with colleagues in the NHS about how we ensure that, when people have made changes or are trying to make a difference, that is reflected in the new ICSs as they get up and running across the country?

The second key issue is around communication and the lack of joined-up care. There are so many parts of the NHS where those conversations do not happen, and it is patients who are left telling people what they need. Will the Minister set out what she will do to try to ensure that NHS trusts improve communication within their own hospitals and follow the particular recommendation that all haematology teams are informed whenever a sickle cell patient comes into A&E or on to a general ward? I will pursue that with University Hospitals of Leicester in my constituency as a result of the report to ensure that it happens.

Thirdly, improved awareness of the condition and training are critical. That has the power to make one of the biggest differences. Staff are not purposely not understanding it; they need to be trained in it. The report sets out recommendations about universities having proper training, and says that the Nursing and Midwifery Council and the General Medical Council should urgently review their approach to training on sickle cell conditions. Again, I do not think that the NMC or the GMC have responded, although I may be mistaken, but unless people are properly trained how will they make a difference in the future?

The fourth issue is that of race, racism and discrimination within the NHS. I know from my own diverse constituency and the work that I have done with Leicester Against Racism that there is much that can be done to improve understanding of the different issues facing black, Asian and minority ethnic communities in the NHS, to improve access to and outcomes of care, to understand the implicit and explicit discriminatory attitudes that may be present in the NHS and, crucially, to have better representation of BAME communities in senior NHS leadership positions.

During today’s debate people have talked about their own experiences, understanding the issues and showing that Parliament can act on the issues that matter to our communities because of our diverse representation. That is what we need in the NHS. I hope the Minister will be able to say what NHS England is doing about those issues.

Last but by no means least, the NHS always changes its structures and organisations, and people move around, so it is often difficult to embed change in the system. In my experience, the only way to do that is to give patients and their families far more voice, and I include training in that.

Imagine if my hon. Friend the Member for Vauxhall—if she was not extremely busy representing her constituents—was involved in the training of health professionals and told her story so that people could hear what had happened to her. It would be a powerful driver of change if the people who use services could be part of the training and the way the system is regulated. That is how we will get real change in the system and I hope the Minister will set that out.

In conclusion, the report provides an opportunity to make substantial and lasting change. I hope the Minister will set out the Government’s response when she stands to speak.

Adult Social Care

Liz Kendall Excerpts

Wednesday 1st December 2021 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank the Minister for advance sight of her statement—but really, is that it? There are some things she said for which Labour has been calling for some while, and which we support, such as improving housing options for older and disabled people, and the potential for technology to improve standards of care. However, there are two central flaws to the Government’s approach. Ministers have utterly failed to deal with the immediate pressures facing social care, as we head into one of the most difficult winters on record. They have also failed to set out the long-term vision and more fundamental reforms we need to deliver a care system that is fit for the future.

Last week we learned that a staggering 400,000 older and disabled people are now on council waiting lists for care, with 40,000 waiting more than a year. There are more than 100,000 staff vacancies, and turnover rates are soaring. Because of those shortages, 1.5 million hours of home care could not be delivered between August and October alone, and half of all councils report care homes going bust, or home care providers handing back contracts. Hundreds of thousands of older and disabled people are being left without vital support, piling even more pressure on their families and the NHS at the worst possible time, yet the Minister has announced absolutely nothing new to deal with any of that.

Where was the plan to end waiting lists for care? Unless people get support when and where they need it, they will end up needing more expensive residential or hospital care, which is worse for them and for the taxpayer. The Minister was silent on that issue. Improving access is the first step we need to deliver a much more fundamental shift in the focus of support towards prevention and early intervention so that people can stay living in their own homes for as long as possible. But without enough staff with the right training, working in the right teams, that will never be achieved.

Where was the long-term strategy to transform the pay, training, terms and conditions of care workers, to deliver at least half a million additional care workers by 2030 just to meet growing demand, and to ensure that care workers are valued equally with those in the NHS? Can the Minister tell me why the Government persist in having separate workforce strategies for the NHS and social care when the two are inextricably linked? And can she tell me how some kind of website is going to pay a care worker’s bills or put food on the family table? No wonder staff are leaving the sector in droves.

The proposals for England’s 11 million family carers, who provide the vast majority of care in this country, are frankly pitiful. Unpaid carers have been pushed to the limit looking after the people they love. Almost half had not had a single break for five years even before the pandemic struck, but I understand that the additional funding in the White Paper amounts to just £1.60 a year more for each unpaid carer. Families deserve so much better than this.

What we needed today was a long-term vision to finally put social care where it belongs—on an equal footing with the NHS, at the heart of a modernised welfare state. At its best, social care is about far more then helping people get up and be washed, dressed and fed, vital though that is; it is about ensuring that all older and disabled people can live the life they choose, in the place they call home, with the people they love, doing the things that matter to them most—in other words, an life equal to everybody else’s. That should have been the guiding mission of the White Paper, with clear proposals to make people genuine partners in their care by transforming the use of direct payments and personal budgets and ensuring that the views of users and families drive change in every part of the system, from how services are commissioned to how they are regulated and delivered.

This White Paper falls woefully short of the mark, and the reality of the Government’s so-called reforms is now clear—a tax hike on working people that will not deal with the problems in social care now and will not even stop people having to sell their homes to pay for their care, as the Prime Minister has repeatedly promised. Under the Conservatives’ plans, if someone owns a home worth £1 million, over 90% of their assets will be protected, but if their home is worth £100,000, they could end up losing it all. Millions of working people are paying more tax not to improve their family’s care or stop their own life savings being wiped out, but to protect the homes of the wealthiest. This is not fixing the crisis in social care, let alone real social care reform. It is unfair, it is wrong, and the Government must think again.

[Gillian Keegan]

I thank the hon. Lady for her warm welcome for the White Paper. [Interruption.]

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Gillian Keegan]

My right hon. Friend is absolutely right: charities are also a vital part of the network of support for our unpaid carers, and some of them did have to close during the pandemic, so we have been encouraging them to open up now that we can all open up. Additional financial support was provided for the charitable sector to make sure that it could continue its vital services during the pandemic when fundraising activities were very difficult.

[Liz Kendall (Leicester West) (Lab)]

Many families are pushed to breaking point because they cannot get the help they need to look after the person they love. Will the Minister now confirm that somebody who is trying to hold down a job and care for their elderly mum whose house is worth £100,000 will face a tax rise that will not improve their mum’s care or give them a break from caring, and will not even stop them from having to sell their mum’s home, because under the plans Tory MPs voted through last night, she will never hit the cap on care costs? Will the Minister further confirm that this tax rise on working people will be used to protect 90% of a home worth £1 million? If she disputes these figures, why does she not publish the impact assessment before MPs are asked to vote on the Health and Social Care Bill tonight?

[Gillian Keegan]

From October 2023, the Government will introduce, for the first time in our history, a new £86,000 cap on the amount any adult in England will need to spend on their social care. That will protect them from unpredictable and unlimited costs. But as well as that there is a more—[Interruption.] The hon. Lady may like to listen to the answer. As well as that, there is a more generous—[Interruption.] Please listen. On top of that, a more generous means test for adult social care will come into effect, allowing more people to benefit from the means-tested support. Under the current system, about half of all older adults in care receive some state support. This rises to roughly two thirds under the recently announced charging reforms, which will help many adults, including unpaid carers. Everybody will benefit from this system.