Care Bill [Lords]
Liz Kendall Excerpts(10 years, 5 months ago)
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Paul Burstow
I am grateful to the hon. Gentleman for that intervention. He makes an important point. If one looks at the trends, one sees that there is no doubt that there are questions to be asked about why some people are not receiving the service that one would expect. Some of that—although I do not pretend that this covers anywhere near all of it—can be explained by the changes to the way in which services are organised. Some of it can be explained by the need to do more to re-able people and to enable them to maintain their independence. I do not say that to evade the question. That is why I have put new clauses 7 and 9 before the House. I genuinely think that whoever is in government in future will have to have a much more systematic approach to making decisions about how we meet demand.
That brings me on to new clause 7, which simply says that the Government should take a longer-term view. It states that every five years, the Government should look 20 years forward and take an independent assessment of the future demand for care and health services. That could be done by the Office for Budget Responsibility. It could provide modelling for the whole health and social care system that looks at the impact on demand, technology, demography and health status, and at the balance between all those factors. It could also look at the interactions between health and care, primary and secondary care, physical and mental health, and treatment and prevention. That would finally implement a recommendation that was made by Derek Wanless in his review for the Government in 2000. That is supported by the King’s Fund, which has suggested much the same thing.
In Committee, neither the Government nor the Opposition were able to make any funding commitments about part 1 of the Bill. I entirely understand why that is the case. However, we know that as the eligibility criteria are drawn more tightly, more people are excluded from help. In the long run, that does not save money, but shunts the costs. It pushes people away from living an independent life and towards a life of dependency. I hope that all parties will, in the end, sign up to something like new clause 7 as a good part of the future sound governance of our health and social care system. I hope that the Minister will support that.
I apologise to the House for speaking at such length, but I have put forward a number of issues that I hope will provide a framework for debating this important set of reforms. I look forward to the Minister’s response.
Liz Kendall (Leicester West) (Lab)
We are discussing a huge number of new clauses and amendments, and I will try to keep my comments brief to allow Back Benchers on both sides time to speak. I want to start with our new clauses 17 and 18, which deal with the critical issue of linking the quality of care with standards in the care work force. New clause 17 would require the Secretary of State to review the economic and financial factors affecting the employment of care sector workers, including their recruitment, training, employment and retention, and the extent to which the policies of care providers were making it more or less likely that the aims of the Bill were being achieved.
Jonathan Edwards (Carmarthen East and Dinefwr) (PC)
The Social Services and Well-being (Wales) Bill is going through the Welsh Parliament. My party tabled an amendment to the Bill that would have prohibited the use of zero-hours contracts in the care sector in Wales, but the Labour Government there voted against it. How disappointed is the hon. Lady with her colleagues in Wales?
Liz Kendall
I am sure that my colleagues in the Welsh Assembly want to do everything they can to improve care and support. Today we are discussing the care sector in England, and I hope that the hon. Gentleman will give his support to what we are proposing.
Liz Kendall
I am really sorry, but I want to make a bit more progress. I have a lot of new clauses to get through, and Back Benchers have also tabled new clauses and amendments.
We also know that many care workers do not even get the minimum wage at the end of the week, because they are not paid for their travel time, among other things. Her Majesty’s Revenue and Customs recently undertook an evaluation of minimum wage enforcement in the social care sector. It found that a staggering half of all care providers had failed to pay the minimum wage to at least one of their employees, yet despite Ministers’ insistence that such people will be named and shamed, not a single provider in the care sector has so far been identified.
We need to look at all those employment issues, which I think have a fundamental impact on the quality of care. If the Bill is to promote well-being, shift services towards prevention and improve standards, we must get to grips with those issues; otherwise, it will not work. New clause 17 would require the Secretary of State to conduct an overall review of the economic and financial factors affecting employment, publish the results and consult on the findings.
Mr Redwood
I quite agree that we need a high quality work force who are well trained and supported, but if the review concludes that they are not, is the hon. Lady saying that controls should be imposed on local authorities from the national level?
Liz Kendall
If the right hon. Gentleman reads our new clause 18, he will see what our approach is. Local councils commissioning social care and having to fulfil their obligations under the Bill will need to look at employment terms and conditions. We have tabled the new clause because unfortunately the Government are removing the Care Quality Commission’s role in assessing how well councils are commissioning services, which I think is a mistake.
Alison McGovern (Wirral South) (Lab)
Given the point my hon. Friend has just made, does she agree that it is all the more important that councils up and down the country follow the lead that Labour Wirral has shown in sticking to the principles of Unison’s ethical care charter, which tries to rid us of 15-minute appointments and limit zero-hours contracts?
Liz Kendall
I know about the approach that has been taken in Wirral and think that it is an excellent example. If we kept the CQC’s role in assessing how well councils are commissioning services, that is just the sort of thing that it would be able to spread. It is a real problem that that role is being removed. We will come later to our amendments that seek to return it to the CQC.
I will now turn to a group of new clauses on how better to identify and support carers. They stand in the name of Opposition Front Benchers, but really they are the work of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has made sterling efforts in this regard. We have tabled them to give carers the focus and attention they deserve. They pick up on some of the points that the right hon. Member for Sutton and Cheam (Paul Burstow) made. New clause 19 would ensure that all health bodies have effective procedures in place to identify people who are or are about to become carers and ensure that they get the help and advice they need. New clause 20 would require local authorities to take all reasonable steps to ensure that schools in their area identify young carers and put support in place. New clause 21 would require universities and colleges to do the same.
As the right hon. Member for Sutton and Cheam said, family carers—unpaid family members looking after the people they love—are the absolute backbone of our care system. They need and deserve more support. They are looking after their relatives because they want to, but they really need help. One in five family carers provide more than 50 hours of care every single week, and their own health suffers as a result. One in three have to give up work or reduce their hours, which means their income suffers and the cost to the taxpayer goes up.
The Bill puts in place welcome new rights for carers, building on the approach taken by the previous Labour Government, but they will be meaningless if carers are not identified in the first place. Many carers do not actually come into contact with local authorities. Macmillan Cancer Support has made a powerful case, showing that 95% of the over 900,000 carers of people with cancer in England have not received a carer’s assessment—only one in three of them have even heard of it. That is because they are mostly in touch with the health system. Unfortunately, hospitals and GPs still do far too little to identify carers of people who have cancer and other conditions, such as stroke and heart disease. I understand that GPs identify only around 7% of carers, and other health professionals, particularly in hospitals, identify only one in 10. We need clear duties on those bodies and proper processes in place, because too often at the moment there is just a tick-box approach. I recently had to move GP practice, and the form I filled out contained two pages on how much alcohol I drank, which was welcome, and a little box that asked, “Are you a carer?” I knew what that meant—but did it mean a paid care worker, or a health care worker? That is not good enough and needs to be thought through.
I also stress the need to do far more to identify young carers, who we know can see their lives and life chances suffer because of what they do to help look after sick or disabled parents. Many schools might not understand if kids are not doing their homework or not turning up on time because of their responsibilities. If young carers are lucky enough to get to university or college, they may find their studies hard because they are travelling to and from home to try to help support their loved ones. We believe there should be clear duties on those bodies to identify young carers.
New clauses 22, 23 and 24 are about getting people the right financial advice—an issue we discussed a lot in Committee. The Bill introduces a new and complicated system of social care funding with the so-called cap on care costs and new deferred payment schemes. It is complicated and I have lost track of the number of times people have said to me, “Well, it’s okay because at least my care costs will be capped at £72,000 now”, and I have to go through the process of explaining to them that that is not actually the case. People are unaware of the new system, and if they are looking at financial products to help them cope with later costs, they need decent financial advice.
Currently, financial advisers must have studied a range of different financial and regulatory subjects, and they must sign up to a statement of professional standing and a code of ethics and conduct. Has the Minister talked to the Financial Conduct Authority about whether the training of financial advisers should change as a result of the Bill? Is he confident that all financial advisers can give people advice about the products they might want to take out to protect themselves against future costs, on the basis of the Bill?
I am concerned that unless people get high quality, proper financial advice, we could be in for another mis-selling scandal because the issue is complicated. People will have to figure out how much their average local authority rate will be for their area in five, six or seven years’ time, and how different that will be from what private providers charge. Will people’s care needs enable them to start counting towards the cap on care costs if they are not defined as “substantial”, as under current eligibility criteria? I would struggle to figure out all those finances, and we must ensure that financial advisers are properly trained.
New clause 22 states:
“The Financial Services Consumer Panel at the Financial Conduct Authority”
should publish an annual report on the
“availability, quality…and effectiveness of financial advice”
available to care users and their families. New clause 23 states that the FCA should consider raising the level of qualifications that financial advisers must have. We must ensure that people get high quality financial advice so that they are not mis-sold any products.
We also want much greater efforts to raise public awareness of the new capped cost model introduced by the Bill. Under the Bill, local authorities have a duty to raise awareness, but new clause 24 would make that much stronger and require them
“to prepare, publish, consult on and implement”
a proper plan for raising awareness among their local residents. That is important so that people know about the new system and what it means for them.
I support new clause 11, which would ensure that all users of publicly funded or arranged care have direct protection under the Human Rights Act 1998. Under the law as it stands, the fundamental protection and access to individual redress offered by the Act are not applied equally in all care settings. In the other place, Lord Low tabled the former clause 48, which sought to close that loophole. There was a long discussion on it in Committee—the clause was passed in the House of Lords but the Government voted to remove it in Committee. The Minister’s argument was that it went too far, because it would mean that the Human Rights Act applied to entirely privately funded and arranged care. He also claimed that the clause was not needed because the CQC could deal with the problems.
Liz Kendall
Perhaps the hon. Gentleman will let me finish this point.
For working-age disabled people, the level at which the eligibility criteria are set is crucial and could mean the difference between being able not just to get access to training and a job but to spend time with their family or go out into their community—things that we take for granted. As hon. Members know, Scope and other organisations have warned that the Bill could risk shutting more than 100,000 disabled people out of the system, with all the human and economic costs that that entails.
The Minister will know that in Committee many hon. Members cited the economic modelling that has been done by organisations such as Deloitte, which shows that shifting the focus of investment and resources up front can save more money further down the line. The Deloitte modelling predicts that for every £1 invested in care for disabled people with moderate needs, savings of £1.30 per person are created. It predicts £700 million of savings for central Government from helping disabled people and their family carers to get work, and £570 million of savings to local NHS and local council services by avoiding the use of more expensive residential and crisis care and by reducing the need for more expensive medical care.
Such a long-term approach, whereby we assess the true costs and benefits over a longer term, is a good framework for making decisions about where priorities lie—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. Before the shadow Minister considers taking further interventions, she may not have realised that although the House appreciates that she is making some important points on a complex matter, she has spoken for some 24 minutes. She will not be aware, but I am, that a very large number of colleagues wish to speak in this debate and there is a limited time, so she might consider bringing her remarks to a close.
Liz Kendall
Thank you, Madam Deputy Speaker. I have two more paragraphs. I agreed that I would speak for 25 minutes, so at 24 minutes I am almost in.
New clause 9 would help secure that shift in approach. I ask hon. Members to consider the new clause seriously because we need to introduce the up-front prevention, help and support, which requires a change in the way we look at the costs and benefits in the system.
Francis Report
Liz Kendall Excerpts(10 years, 5 months ago)
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Liz Kendall (Leicester West) (Lab)
It is a pleasure to speak in this important debate. Members on both sides of the House have shown that we are determined to learn the true lessons from the appalling failings at Mid Staffordshire and to understand what needs to change to prevent them from happening again.
We have heard many serious and thoughtful contributions, but I want to start by paying tribute to the hon. Member for Stafford (Jeremy Lefroy), whose calm, considered, thoughtful and dignified approach to the issue and the work he has done on behalf of his constituents is a lesson to us all. My right hon. Friend the Member for Cynon Valley (Ann Clwyd) hit the nail on the head when she said that there is nothing to be gained by politicising these issues, but everything to be gained by understanding the lessons and being open about the problems so that they can be tackled properly.
My hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) and my right hon. Friend the Member for Rother Valley (Kevin Barron), along with many other hon. Members, emphasises the importance of openness. As a constituency MP, I have seen how the NHS too often tries to sweep patient complaints and mistakes under the carpet, ignoring them and pushing patients away. Being open early on, admitting mistakes and learning the lessons is a much better way forward.
A number of hon. Members spoke specifically about the process that Mid Staffordshire hospital is currently going through. My hon. Friend the Member for Stoke-on-Trent North (Joan Walley) and the hon. Member for Stafford rightly said that there is a lack of clarity about the process and the timetable. I hope that the Minister, when he responds, will give those hon. Members and their constituents much greater clarity on what will happen.
My hon. Friends the Members for Rotherham (Sarah Champion) and for Wythenshawe and Sale East (Mike Kane) raised important points about making the system more accountable and how that is much harder since the NHS reorganisation, with all the different bodies—a point I will return to in a minute. My hon. Friends the Members for Worsley and Eccles South (Barbara Keeley), for Easington (Grahame M. Morris) and for Stockton North (Alex Cunningham) rightly talked about staff shortages and the serious impact they can have on patient care. If we are to get to the root of the problem, simply publishing data every month is not good enough. I was really pleased that the right hon. Member for Sutton and Cheam (Paul Burstow) talked about mental health. We have been talking mostly about physical health, but he was right to raise those concerns.
In the time available I cannot do justice to all the points raised today, or to the Francis report’s 290 recommendations, so I will focus my comments on the two most fundamental challenges we now face: first, ensuring that the views of patients, their families and the public are heard and acted on, at every level and at all times; and, secondly, ensuring that there is clear leadership to make the service changes we need to improve safety and quality at a time of unprecedented pressures on the NHS. Unless we do that, there is a risk of the failings in Mid Staffordshire happening again.
Alun Cairns
I am grateful to the hon. Lady for giving way, unlike her colleague earlier. In the spirit with which she has opened her contribution, and in relation to the comments made by the right hon. Member for Cynon Valley (Ann Clwyd), the comments of the Royal College of Surgeons and the example I highlighted of worrying cases in the NHS in Wales, will she make every effort to influence her colleagues in the Welsh Government, and indeed the Welsh Health Minister, to conduct a Keogh-type inquiry into the NHS in Wales?
Liz Kendall
Wherever there is evidence of poor care, it must be looked into. The hon. Gentleman did not mention that the Welsh Assembly has ordered a specific independent inquiry by experts outside Wales into aspects of care at the Princess of Wales and Neath Port Talbot hospitals, which I welcome.
Of all the lessons to be learned from Mid Staffordshire, the most important one is that the primary cause of the failures was the hospital and the trust board not listening to patients and their families, and not putting their needs and concerns first. Sir Robert Francis rightly says that there must be fundamental changes to ensure the real involvement of patients and the public in all that is done and to secure a common patient-centred culture throughout the NHS.
National Voices, a coalition of more than 130 patient, user and carer organisations, says that a concerted drive to listen to patients and carers must be a top priority for all trust boards and care organisations. It emphasises that over and above regulation, which it says has
“an important but limited role in ensuring quality and safety.”
Ministers have rightly spoken about the need for effective regulation and have taken some welcome steps, but the Care Quality Commission and the new chief inspectors will not be the main way of preventing the sort of failings we saw at Mid Staffordshire. Regulation identifies problems when they have begun, rather than preventing them from happening in the first place. Regulators cannot be everywhere all the time, but patients and their families are, which is why their views must be heard from the bedside to the boardroom, and at the heart of Whitehall.
The Labour Government made important progress. They published, for the first time, data on stroke and cardiac care. That helped to improve standards for patients and was a powerful incentive for staff to make changes. The next step is to provide systematic and comprehensive patient feedback. That must move from being the exception to being the norm.
The Government’s friend and families test is welcome as far as it goes but, as National Voices says,
“it is a crude measure on which the NHS would be unwise to place too much reliance.”
It asks only whether patients would recommend an NHS service to others, but not why, and it does not provide the detailed, real-time feedback that patients want and staff need to improve the quality of care. Developments such as the patient opinion and care opinion websites offer a powerful way forward. They enable people to tell the story of their NHS or care experience online, in writing or on the phone. That gives patients a voice, allows other people to see what is being said about a service, and in a simple and cost-effective way provides staff with a direct incentive to improve.
The Secretary of State said we must all be champions for change, and hon. Members may remember that I wrote to everyone saying that as a Member of Parliament they should sign up because it is a great way for us to understand what is really going on. I have asked my hospital trust and other services to do the same. That will be a powerful way of making change happen.
We must also look at how staff are trained to ensure that they always put patients first. Places such as Worcester university are leading the way: patients and families help to interview people who are applying to be nurses and health care assistants; they help to develop the content of courses so that they include what really matters to patients; and they take part in teaching students. Ministers should have spent the last three years championing such initiatives instead of reorganising the training structures as a result of the Health and Social Care Act 2012.
Individual patient voices are not the only ones that must be heard. We need a strong collective voice for users. The Francis report recommended investing in patient leaders to speak out on behalf of the public, to help to design services locally, and to hold them properly to account. Ministers claimed that that is what Healthwatch would do, but their rhetoric is simply not matched by the reality: national Healthwatch has nowhere near the same power, authority or levers to change services as NHS England, the Care Quality Commission or Monitor.
Local Healthwatch bodies are also weak. They were late out of the starting blocks and are woefully understaffed. Last week, we heard that £10 million of the £40 million budget that was promised for local Healthwatch has gone missing, despite the explicit recommendation in the Francis report that
“Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch”.
If Ministers are serious about giving patients a strong voice locally, they must look again at the support that Healthwatch is getting on the ground.
A strong patient voice is more essential than ever before because of the huge pressures on local services. Across the country, the NHS is struggling to cope with the increasing number of frail elderly people ending up in hospitals that were designed for a different age. Twenty per cent. of hospital beds have older people in them who need not be there if they had the right support in the community or at home. Half a million fewer people are receiving basic help to get up, washed, dressed and fed as council care budgets are cut to the bone. Mental health services, especially for children, are under intolerable strain as money for vital community services is being diverted to cope with pressures elsewhere in the system. This is not good for patients and families, it puts staff under pressure, and it ends up costing the taxpayer far more as people end up in more expensive hospital care or, in the case of mental health patients, being transported hundreds of miles around the country.
The NHS needs radical change, not to its back-room structures but to its front-line services and support. Improving safety and quality means that some services must be concentrated in specialist centres and others must be shifted out of hospitals into the community and towards prevention, fully integrated with social care. Under the previous Government, plans had been drawn up to reorganise services in every English region through Lord Darzi’s next stage review, but rather than pushing forward with those plans and making the changes that patients want and need, Ministers scrapped them simply because they were developed under the previous Labour Government. Instead, they embarked on a huge back-room NHS reorganisation, wasting precious time, effort and resources.
As several hon. Members have said, the new NHS structures are utterly confusing, with no clear lines of accountability or responsibility. There are now 211 clinical commissioning groups, 152 health and wellbeing boards, 27 NHS England local area teams, four NHS England regional teams—I am not sure what they are doing—23 commissioning support units, and 10 specialist commissioning units, alongside Monitor, the Care Quality Commission and NHS England. Can you make sense of that, Mr Deputy Speaker? Who is providing the leadership? Who is to be held to account? Across the country, people are doing their contract negotiations for next year, trying to make changes to services, and they say to me that there is no clear leadership in the system. That must change.
We have heard a lot about changing the culture in the NHS. That culture is about behaviour and the millions of personal interactions that happen every single day in the NHS. Getting those right will not happen through regulation alone but by giving patients and the public a powerful voice in every part of the system. This issue has had too little attention since the Francis report was published. Crucially, the culture is about leadership, and leadership comes from the top.
I warn Ministers not to be complacent about saying that the bullying culture has gone. On Friday, I met the chief executive of a trust who showed me an e-mail from the NHS Trust Development Authority, which is quite close to Ministers’ doors. I will not be able to say exactly what it said because it contained swear words, but it said, in effect: “Open the beep beds; just beep do it.” That was in an e-mail to a chief executive. The bullying culture is still going on. Ministers need to get a grip, particularly on what is happening at the NHS Trust Development Authority, which is causing real problems in the system.
Grahame M. Morris
This is more pervasive than something that happens at the highest level. When members of my trade union, Unite, from the Yorkshire ambulance service raised legitimate concerns about the impact on the service of privatisation and de-skilling, the reaction of management was to de-recognise the trade union. That is outrageous.
Liz Kendall
This is not leadership; this is not what we want in our health service.
Real leadership is about setting a vision and working with staff and patients to make it happen. Yesterday Sir John Oldham published the report of his independent commission on whole-person care, which was drawn up with people who have worked in the system and sets out the reforms that we need to ensure that our NHS and care services are fit for the future. Across the NHS, patients and staff are crying out for clear leadership. Until we get this right, we will not really have learned the lessons from the failings of Mid-Staffs.
Oral Answers to Questions
Liz Kendall Excerpts(10 years, 6 months ago)
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Norman Lamb
I mentioned earlier that the rapid review that is being undertaken by NHS England will report in March. It is essential that we have sufficient beds available, as close to home as possible, for children and young people. As I also said earlier, as far as possible children should be cared for at home, and only as a last resort should they go into in-patient care.
Liz Kendall (Leicester West) (Lab)
The pressure on children’s mental health beds is now intolerable. Earlier this month, the 14-year-old daughter of one of my constituents desperately needed a bed but the local trust’s chief executive told me that not a single bed was available anywhere in the country in the NHS or the independent sector. The Minister has said that this is unacceptable as though it is nothing to do with him, but he voted for an NHS reorganisation that is wasting time and money as vulnerable children are forced on to adult wards or transported hundreds of miles across the country. When the review reports, what action will he take and by when will it be implemented?
Norman Lamb
For a start, we now have 15,000 more clinicians working on the front line than when this Government came into office in 2010. Also, in the reforms that the hon. Lady mentions, we legislated for parity of esteem so that mental health is treated equally with physical health. However, I have accepted her case and agree that the situation is intolerable. We have to make sure that beds for children and young people are available when they are needed.
Cancer Priorities
Liz Kendall Excerpts(10 years, 6 months ago)
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Liz Kendall (Leicester West) (Lab)
Like other hon. Members, I thank the Backbench Business Committee for providing time on the Floor of the House for us to debate this excellent report by the all-party parliamentary group on cancer.
I commend the hon. Member for Basildon and Billericay (Mr Baron) for his tireless work on this issue. Like the hon. Member for Salisbury (John Glen), I have been in this place for four years and have been amazed at the work that the hon. Member for Basildon and Billericay has done and at his forensic attention to detail. He never gives up and I am sure that he never will. I am grateful to him for that. I also pay tribute to the work of my hon. Friend the Member for Easington (Grahame M. Morris) and the noble Baroness Morgan of Drefelin, who are officers of the group.
The hon. Member for Harrow East (Bob Blackman) was right to say that hearing the words “You have cancer” is one of the most frightening things that can happen to somebody. It is frightening not only for the person who is given the diagnosis, but for their family. He was also right that more and more of us will hear those words in the future. As we live for longer, the prevalence of cancer increases. Just last week, the World Health Organisation warned that the world faces a “tidal wave” of cancer, with the number of cases globally set to reach 24 million a year by 2035. We often think of cancer and heart disease as issues of the western, developed world. In fact, long-term conditions are becoming the primary health conditions in developing countries as well. We have made big strides in tackling conditions such as malaria and HIV, but long-term conditions such as cancer are big issues in developing countries.
In the UK, 330,000 people are diagnosed with cancer each year. That figure has gone up by 50,000 in a decade. The primary reason for that is the ageing population. Cancer Research UK has highlighted a number of other risk factors: alcohol and the increase in obesity are two of the biggest drivers of that change.
Cancer Research UK produced a report in December, which showed that cancer deaths have dropped by 20% over the past 20 years. I am proud of the Labour Government’s contribution to that record. We launched the first ever national cancer plan in 2000 and made cancer a top priority. That work was led by Professor Sir Mike Richards who, as Members will know, is now the chief inspector of hospitals. The plan was backed by increased funding and, crucially, by reforms to drive improvements in cancer care, including better diagnosis, reduced waiting times for treatment and better standards of care. As a result, survival rates have improved steadily and cancer deaths have fallen by 50,000 a year.
Many hon. Members have rightly highlighted the need to ensure that patients with cancer have the best outcomes and survival rates, and that we narrow the gap with other countries. Many figures have been cited, but in some areas we have seen the gap narrow. An article by John Appleby from the King’s Fund in the British Medical Journal in January 2011 reminded us that death rates for lung cancer in men peaked in the late 1970s, but they have steadily come down and are now lower than those for French men. There has been a similar trend in breast cancer mortality for which we have virtually closed the gap with France. As the all-party group on cancer report rightly said, however, we need to do much more to prevent, treat and cure cancer, which means raising awareness of the symptoms of cancer among members of the public and GPs.
Mr Clappison
I am grateful to the hon. Lady for expanding my point because, as I made clear in my speech, I am not out to make any political point about this. According to Eurocare statistics, which I have been supplied with by the House of Commons Library and which refer to December last year—more recent than the article the hon. Lady mentioned—the survival rate for lung cancer in Frenchmen is 4% better than for people in this country. For lung cancer we lag behind nearly every other country in Europe, certainly western Europe.
Liz Kendall
I am not a statistician; I am reporting something from the British Medical Journal. There are different ways of cutting the statistics and different reports, but I absolutely agree that we need to do more to catch up with other European countries. There are a variety of statistics on that, and in some areas—but not enough—we have made big improvements in recent years.
We must raise awareness of the symptoms of cancer among members of the public and GPs, to ensure that everyone gets the earliest possible diagnosis. We must tackle variations in treatment so that everyone gets the best possible care, and we must provide better support to cancer patients and their families as they go through treatment, not just in terms of physical care, but emotional and social support such as help with finances, benefits and work. The hon. Member for Harrow East made an important point about how when they go through such a terrible time, many patients have a problem with their finances and benefits. I visited a brilliant multidisciplinary cancer team at Leicester Royal Infirmary, where Macmillan Cancer Support had a brilliant network of people providing financial information and support, as well as emotional support. That joined-up care is exactly what we need.
We must also ensure that people who have recovered from cancer can cope with life after cancer. People’s experience of the condition, as many hon. Members will know, does not end—hopefully—with the all-clear, because there are all sorts of emotional problems after that. As the hon. Member for Salisbury said, we must ensure that patients who cannot be cured, and their families, have real choice and control over the last days of their life, including where they die. The hon. Gentleman has probably not been reading the Hansard reports of the Care Bill Committee, but there is cross-party support for moving more quickly on that issue. In that Committee, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), said that he was personally committed to getting that up and running and sorted out quickly.
As the hon. Member for Salisbury said, we should help people to stay at home with the right social care and support, including support for family members. It can be quite frightening to think that one’s loved one may be dying at home, and people can feel panicked about that. If we can provide the right social care support, and Macmillan specialist nurses to sit with people through the night, it can be better for those families and also provide better value for money. I hope that when the Care Bill reaches Report, we will get some clearer commitments.
The overarching question that the all-party group focuses on is how we can make such things happen on the ground. It takes the new structure within the NHS and asks, “How are we going to make this work?” The Health and Social Care Act 2012 reform was not perfect, and it was clear that cancer networks took the lead in driving changes and improvements in cancer services. As my hon. Friend the Member for Ashton-under-Lyne (David Heyes) has said, we had 27 cancer networks that brought together the commissioners of services and the providers of cancer care to plan high-quality services in their areas. They were staffed by people with specific expertise in cancer care and local knowledge of the different hospitals and services. They worked across primary and secondary care and on a wide range of issues such as increasing the uptake of screening, improving training for staff on the best possible treatments, spotting early symptoms and signs, and championing a focus on the patient experience and the patient’s pathway through the system.
As the all-party group’s report states, there is concern, including among organisations such as Macmillan, that the good work and vital expertise of those networks are being lost. I was first alerted to the problem by Dr Mike Peake, a lung cancer specialist at Glenfield hospital. He is also the national clinical lead for cancer and responsible for the national cancer intelligence network. The worry is that the Government’s reorganisation means that the dedicated cancer networks have been abolished and subsumed into 12 generic strategic clinical networks, which cover a larger geographical region and have fewer dedicated staff. The fundamental concern is that moving from a specialist to a generic focus will reduce the ability, which we desperately need, to drive improvements in cancer care.
Members on both sides of the House, and clinicians and staff, are saying that in every other part of the health system we need to concentrate specialist services like cancer services to improve outcomes, rather than having them delivered through every district general hospital. It does not make sense to people: we say that we want clinical advice to drive clinical improvements and change, but then we go the opposite way—from specialist to generic. That is a cause for concern.
There is also confusion about how the strategic clinical networks will work with all the other parts of the new system—the 10 specialist commissioning hubs, the 19 commissioning support groups, the 211 clinical commissioning groups, the 27 local area teams, the 152 health and wellbeing boards, NHS England, Public Health England and Health Education England. The new system is very confusing. People have to work together, so clear lines of responsibility and accountability are important.
We urgently need clarity on two points. First, will the Minister update Members on what is happening in the strategic clinical networks, and, specifically, how is the cancer expertise being protected? Secondly, will she outline precisely how the strategic clinical networks will work with other parts of the system?
The all-party parliamentary group report makes many excellent recommendations and raises many issues. I cannot go into all of them in detail, but will focus on the two that I believe are the most important for patients. The first, as most hon. Members have said, is early diagnosis. The second is improving the patient experience, which we have not discussed in detail.
Getting early diagnosis right is the key to improving survival rates. Several things would make a difference, but I shall describe the most important ones, the first of which is raising public awareness of symptoms. If the Government want to meet their target of saving an additional 5,000 lives by 2014-15, we must arm people with knowledge of the warning signs and symptoms. Once again, the Government’s reorganisation means that the responsibilities for public health are split between lots of different bodies and we are not clear how they will work together. The APPG report says that the responsibilities for increasing public awareness must be more clearly spelt out for NHS England, the Department of Health and Public Health England, and for local authorities and health and wellbeing boards. I hope the Minister will set out exactly who will be responsible for running public awareness and other campaigns.
Secondly, we have to improve the ability of GPs to spot signs and refer people to specialists for early diagnosis. As the report states, more than a quarter of people diagnosed with cancer see their GP three times or more before they are referred to a specialist. Under the old system, before the Health and Social Care Act 2012 and the reorganisation, cancer networks absolutely led improvements in training for GPs and other health professionals, but it is not really clear who is going to do that now. How will NHS England work with Health Education England, the royal colleges and other education providers to ensure that training programmes for health professionals are really there on the ground?
Thirdly—this is probably the most important point in the report, one which the hon. Member for Basildon and Billericay emphasised—how are we going to hold clinical commissioning groups to account for the one and five-year survival rates? The report states:
“NHS England has not provided any guidance on how the one- and five-year survival rates will be used to drive improvements in CCGs.”
The data may be available, but what will happen to them? Will NHS England identify poor performers? Will it make practical support and guidance available to CCGs? How will we know whether actions and steps have been taken? How can we hold them to account? As a local MP, I would certainly want to know how my CCG rates, what the problems are, what it has not been doing, what its action plan is and when it is going to report back. We do not know any of that. The survival rate targets are excellent, but we have to make sure we can deliver. At the moment, we simply do not have the mechanisms to do that.
The other point I want to focus on is improving the patient experience. This is not only absolutely central for patients, but a key driver of improvements in the quality of care and better value for money. As such, it should be a much higher priority in the NHS. We all know, whether from personal experience, the experience of those we love or those in our constituencies, that a good experience makes patients feel as though they have been supported and respected as an individual. A bad experience makes them feel at best that their needs do not matter, and at worst that their basic human dignity has been denied. Cancer patients I have spoken to, for example those at the Macmillan Cancer Support group in my constituency, constantly emphasise their experience of care and how they are treated by NHS staff. That would be important at any point, but for someone going through such a frightening time, it is even more important.
The importance of patient experience goes far beyond the personal value to individuals. There is now strong evidence that good patient experience is consistently and positively associated with better health outcomes, and safer and more clinically effective care. The British Medical Journal published a systematic review of 55 studies last year, which provided very clear evidence. Patients who have a good experience are more likely to stick to their recommended treatments and medicines, and more likely to use preventive services such as screening and healthy living programmes.
There is also increasing evidence, although I would say that it is from the US and not the UK at this stage, that a good patient experience is linked to getting better value for money. It is associated with reduced length of stay in hospitals and fewer problems with patient safety—the so-called “adverse incidents”. A good patient experience is also associated with higher staff retention rates and, in turn, lower staff turnover. That is common sense: when staff feel valued and respected they are more likely to treat patients in that way.
For all the reasons I have outlined, the patient experience in cancer care should be given an even higher priority. The cancer patient experience survey introduced by the previous Government has made a big difference in trying to drive improvements. I welcome the assurances given to the all-party group on cancer that the survey will continue, but for how many more years? We must ensure that we use that information to drive changes on the ground, and I will make some concrete proposals on how to do that. First, commissioners should be held to account through the inclusion of a cancer patient experience indicator in the CCG OIS. If that is how we hold them to account, we have to include patient experience. Secondly, patient experience should be much more central to the hospital inspection process led by the chief inspector of hospitals. Currently, out of 150 CQC indicators, only two concern patient experience. We need more patient experience indicators in the work of the CQC, including one specifically for cancer teams or services.
Thirdly, we need to look at how we improve professionals’ training in patient experience. I want to highlight a brilliant example from my own constituency that I hope the Minister will look into. Under a joint Macmillan and De Montfort university partnership project, people training to be nurses, pharmacists and NHS managers get training from Macmillan in patient experience and how to talk to and support patients. In return, those students volunteer for Macmillan in the community in order to increase awareness about cancer, particularly among black and minority ethnic groups—Leicester is a very diverse city. That is something to think about. Has the Minister spoken to Health Education England and the royal colleges about how to improve training in patient experience for professionals, and will she speak to Ministers in the Department for Business, Innovation and Skills to see what other universities could do to learn from the fantastic work at De Montfort?
To conclude, Members on both sides of the House want to see big improvements in cancer care. The new system in the NHS is confusing. Both as MPs and as people with families and friends, we want the right people held to account so that they take the right action, but it is not yet clear how that accountability will work. For me, that was at the heart of the all-party group’s report. The Minister might not be able to respond to all the many questions she has been asked in this debate, but if she cannot, I hope she will write to me about the specific issues I have raised. This is about improving patient experience and early diagnosis and ensuring that CCGs are held to account. We as MPs must hold them to account on behalf of our constituents.
Oral Answers to Questions
Liz Kendall Excerpts(10 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dr Poulter
My hon. Friend is absolutely right to highlight the fact that integrated care working, better intermediate care and ensuring that GPs work closely with accident and emergency departments are exactly the kind of factors, along with joining up health and social care, that take pressure off A and E departments. I am delighted that things are going so well in his local area.
Liz Kendall (Leicester West) (Lab)
Happy new year, Mr Speaker.
People want a care system that gets the best results for patients and one that makes the best use of taxpayers’ resources, but under this Government they are getting neither. Half a million fewer people are now getting social care services to help them to continue to live at home, and half a million more older people are being admitted as more expensive hospital emergency cases that could have been avoided. Will the Minister tell us how that record represents good care and good value for taxpayers’ money?
Dr Poulter
The point I made earlier is that the number of cases of bed blocking due to social care delays has decreased under this Government. Also, it was the previous Government who began to change the eligibility criteria. Labour Members talk about a crisis in social care, but per-head funding for social care fell in the last term of the previous Government. That is the legacy that we are dealing with, and we are sorting it out—
Care Bill [Lords]
Liz Kendall Excerpts(10 years, 8 months ago)
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Liz Kendall (Leicester West) (Lab)
Today’s debate has been about one of the most important issues facing Britain today: how we care for the increasing number of older and disabled people. The Care Bill is the result of the Law Commission’s review of adult social care legislation, which was initiated by the previous Government. The Opposition welcome the Bill’s emphasis on prevention, promoting well-being and new rights for users and carers.
I want to pay tribute to the work that has already been done to improve the Bill by members of the Joint Committee on the draft Care and Support Bill and by Members of the other place. It now promotes the integration of care and support with health and housing, which is really important, and requires local councils and the NHS to work together in relation to the needs of young carers and, in that regard, I want to thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), in particular, for her tireless efforts.
The right hon. Member for Banbury (Sir Tony Baldry), my hon. Friend the Member for Blaenau Gwent (Nick Smith), my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), my hon. Friends the Members for Edinburgh East (Sheila Gilmore) and for Hayes and Harlington (John McDonnell), the hon. Members for Pudsey (Stuart Andrew), for Strangford (Jim Shannon) and for Totnes (Dr Wollaston), and my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Worsley and Eccles South all spoke about further changes that should be made to the Bill, for example to ensure that NHS staff identify carers, to support parent carers, to improve the safeguarding of people in social care, to improve the assessment process and advocacy, to ensure an effective transition of support from childhood to adulthood, to transform end-of-life care and to deal with portability, particularly of community care packages, in the devolved Administrations. I am sure that we will return to those issues in Committee.
The main concern, raised repeatedly by hon. Members today, is that the Bill does not address the fundamental issue facing elderly and disabled people and their families or put in place the really bold reforms we need to tackle the growing care crisis in England. It is true that council care budgets have been under pressure for many years, but this Government’s decision to impose the biggest reduction in any Department on local councils has the pushed care services that hundreds of thousands of people rely on to “the brink of collapse”—not my words, but those of Age UK.
Adult social care budgets have been cut by £2.7 billion under this Government. The result is that fewer people are getting the care they desperately need, particularly at home, which is the key issue for the future, as my hon. Friends the Members for Sheffield, Heeley (Meg Munn) and for South Shields (Mrs Lewell-Buck) pointed out. Frail, elderly people are receiving home visits that last barely 15 minutes, or in some cases only five or 10 minutes, as we have heard. Disabled people are being trapped in their homes, denied the basic opportunities to work, train, volunteer or have a social life that other people take for granted, a point powerfully made by my right hon. Friend the Member for Stirling (Mrs McGuire). Paid care staff on zero-hours contracts are not even earning the minimum wage, let alone a living wage, and unpaid family carers have been left struggling without the help they need to look after their loved ones, which means that their own health suffers, too. At the same time, more people are being charged more for vital services such as home visits and meals on wheels, which are up by £740 a year since the election.
Reducing care budgets by that scale hurts some of the most vulnerable people in society. It is also a false economy, because as more elderly people do not get the help they need to stay at home, they are ending up in hospital in increasing numbers, which costs the taxpayer far more. Delayed discharges from hospital have soared by 42% since the election, as my hon. Friend the Member for Easington (Grahame M. Morris) rightly said. Delayed discharges have costs taxpayers £225 million this year. That could have paid for almost 17 million hours of home care. It is spending money in the wrong place in a way that is not good for the people using the services and does not provide value for money.
Families are also paying the price. As my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said, one in three carers now has to give up work or reduce their hours because they cannot get the help they need to look after their loved ones, and this costs the Treasury £1 billion in lost tax revenues alone. The Bill will not solve these problems. The new rights it contains and the new focus that it places on prevention and well-being risk being meaningless as care budgets are reduced to the bone.
Nor are the Government being straight with people about their plans to reform long-term care funding in future. Any measures that protect people from catastrophic care costs are welcome, but Ministers have not spelled out the reality of their plans. They have repeatedly claimed that no one will have to pay more than £72,000 for their care, but this is not the case. People’s care costs will start to count towards the so-called cap only if they are assessed as having eligible care needs. Nine out of 10 councils provide care only for those with “substantial” or “critical” needs. If someone needs help to stay living at home but their council assesses their needs as “low” or “moderate”, what they pay for home visits will not count towards the cap.
With regard to residential care, the cap will not be based on what someone actually pays for their home care but on the standard rate paid by their local council. I see that the Secretary of State is being informed by the Minister about the reality of these plans, so I hope that he listens to more of my speech. The standard rate paid by local councils is currently, on average, about £470 a week. Government Members, as well as Labour Members, will know that many of their constituents pay far more than £470 a week for their care home, but these extra costs will not count towards the so-called cap. People will also, rightly, have to contribute towards their hotel and accommodation costs. The Government are setting this contribution at £230 a week—much higher than Andrew Dilnot recommended—and these costs will not count towards the cap either. Taking both those factors into account, it will take elderly people almost five years, on average, to hit the so-called cap, during which time they will have clocked up, on average, £150,000 for their care home bill, and much more in many cases. Because elderly people stay in a care home for about two and a half years, on average, six out of seven people will be dead before they hit the cap.
Ministers have repeatedly claimed that people will not have to sell their homes to pay for their care; again, this is not the case. The Bill puts a duty on councils to offer deferred payment schemes—care loans that will have to be paid back by selling the family home after the person has died. The loans will not be universally available, as Andrew Dilnot recommended, but means-tested. Interest will be charged on the loans, but that interest will not count towards the cap. Although the Government are raising the upper level of the means test, that will not help many pensioners on average incomes because of how the test works, whereby councils take a notional income from the remaining assets in a person’s house and add it to what they get from their pension and any savings or second pension. For many pensioners on average incomes, this combined total will take them over what their local council will pay for care, and they will therefore not qualify for any extra support.
Elderly people and their families deserve to be told the facts about the Government’s plans so that they can properly plan for the future rather than have Ministers attempt to pull the wool over their eyes. One of the main claims made by the Prime Minister about the Government’s reforms is that they are so clear and straightforward that lots of insurance products will emerge so that people can insure themselves to pay for their care in future. I would be very interested to hear from the Minister how many of these new insurance products have emerged so far.
Barbara Keeley
I chair the all-party group on social care and when the Dilnot recommendations were made we implored the Government to have a national debate so that all the issues my hon. Friend is raising so well could be explored. Judging by the look on the Secretary of State’s face, he needs to be given some of that information, too, so perhaps we need a national roadshow on what his Bill will actually do.
Liz Kendall
My hon. Friend makes her points diplomatically. It is only owing to the efforts of Members in the other place that the Bill includes a requirement for councils to provide people with clear information. These are huge issues for elderly people and their families. We are asking the Government to be straight and I hope that when the Minister responds he will confirm what I have been saying.
On top of everything—I hope the Minister will also address this—we learned in June that the Government will top-slice £335 million from existing council budgets to pay for the start-up costs of the new scheme in 2015-16. They propose to take money from existing users who are already desperately struggling to pay for reforms that will benefit a small number of future care users in five, six or seven years’ time. I think that many people will be astonished, particularly after the Government had claimed that all the additional costs for their proposals would come from elsewhere. I hope the Minister will explain whether I am correct in saying that that £335 million will be top-sliced from council budgets.
Labour Members will continue to focus on the reality of this Government’s actions, not on their rhetoric, and we will continue to expose their true record on the NHS and social care. Instead of making the real reforms needed to improve front-line services, they have wasted three years and £3 billion on a back-room NHS reorganisation that nobody wanted and that nobody voted for. Instead of working with clinicians and patients to make difficult decisions on the future of hospital services, they now want to give the Health Secretary unprecedented powers to impose changes without the consent of local people. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, the Government are taking away control from the very people to whom they pretend they want to give power. Indeed, National Voices—the voice of patients—says that the proposal is
“wrong in principle and counterproductive in practice”.
Instead of championing the full integration of health and social care to enable a powerful shift towards prevention and fully personalised care, as Labour proposes, the Government’s unambitious proposals bring together only 3% of the total NHS and social care spending. Instead of holding serious cross-party talks on long-term care funding reform, the Government chose to go it alone, water down Dilnot’s proposals and spin the results beyond recognition. That is why we have tabled our reasoned amendment and why I urge hon. Members to join us in the voting Lobby tonight.
Norman Lamb
Of course we have made it clear that people can choose to spend more, but I can say absolutely that by 2024-25, far more people—100,000 people—will be getting more financial support than under the system we inherited from the Labour Government. Everyone will be protected from catastrophic costs through the reassurance provided by the cap on care costs.
Norman Lamb
I need to press on.
Many people will pay significantly less for care than they do now. People will not be forced to sell their home within their lifetime to pay for care because we are introducing a universal, nationwide system of deferred payments to prevent that.
On deferred payments, there is total confusion about what Labour stands for. Lord Lipsey in the other place, apparently supported by the shadow Secretary of State and the shadow Minister, has attacked the threshold for our deferred payment scheme, which is currently under consultation. He argued that the threshold should be lowered so that those with bank accounts or shares worth considerably more than £23,000 will have access to the scheme. In the previous Government’s 2010 White Paper, however, the same £23,000 threshold was considered acceptable under the universal deferred payment scheme. Which is it—do the Opposition support a low threshold of that sort, or do they want to give more help to people with money?
Liz Kendall
I thank the Minister for giving way because I want to press him again about the care cap. On 11 February, the Health Secretary told The Guardian in relation to the cap, that
“that is the maximum anyone will have to pay.”
Does the Minister agree with his Health Secretary?
Norman Lamb
It is the maximum people have to pay once they have reached the threshold for care, but they can choose to pay more if they wish. The hon. Lady has refused to answer the question about what Labour Members believe is the right threshold. They have been utterly inconsistent. The shadow Secretary of State has also attacked our plans to charge interest to cover the costs of the deferred payment scheme, yet his 2010 plans proposed exactly the same thing. The only difference was that Labour’s plan was hidden in the impact assessment, not set out in the consultation for everyone to see.
Throughout these reforms we have worked alongside people involved in the care system, and tried to address the needs of people receiving services, their carers, local authorities, the NHS and voluntary groups. We wanted to build a consensus around the future of care and support in England and we have been willing to amend the Bill in the other place to address the concerns raised. The result is a powerful reform package that includes the well-being principle, legislation for personal budgets, incredibly important new rights for carers that have been widely welcomed, and legislation for adult safeguarding for the first time.
Many hon. Members have recognised the powerful case for integrating and joining-up care, and the hon. Member for Sheffield, Heeley (Meg Munn) highlighted the fact that many councils do not place integrated care high on their agenda. That is why the Better Care Fund is so important—it gets every local area talking now about the importance of joining up care and preventing ill health. Around the country we have 40 pioneers in integrated care, demonstrating how things can be done differently and how we can provide better care with less money.
I visited Barnsley, Torbay, Greenwich, Worcestershire and Islington—all have inspiring local leaders who are redesigning a dysfunctional system to provide better care for their citizens. This is a quiet revolution in care, but the changes will resonate across the country. I am immensely proud and grateful to my right hon. Friend the Member for Sutton and Cheam for producing the original draft Bill and for his support since then. Colleagues in the Lords have made important improvements to the Bill, and when—I hope—it becomes law next year, the Care Bill will be the most valuable legacy in health and care reform for a generation.
Question put, That the amendment be made.
NHS England
Liz Kendall Excerpts(10 years, 8 months ago)
Ministerial CorrectionsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Liz Kendall
To ask the Secretary of State for Health what the (a) total budget, (b) total number of staff and (c) budget for staff salaries is for those employed by NHS England but not for NHS England local area teams.
[Official Report, 28 November 2013, Vol. 571, c. 415W.]
Letter of correction from Dan Poulter:
An error has been identified in the written answer given to the hon. Member for Leicester West (Liz Kendall) on 28 November 2013.
The full answer given was as follows:
Dr Poulter
NHS England's total revenue budget for 2013-14 is £95.873 million, of which £2.016 million is to be spent on administration. How all spending is allocated is a matter for NHS England. NHS England has informed us that the administration budget for NHS England, excluding area teams and commissioning support units (its National Support Centre), is £332.2 million.
As at the end of October 2013, NHS England had 886.15 whole time equivalent staff in post within its National Support Centre.
The total pay budget for the total agreed staff numbers within the National Support Centre (1,106.48 whole time equivalent) is £75.2 million. There are currently vacancies within this staff structure.
The correct answer should have been:
Care Quality Commission
Liz Kendall Excerpts(10 years, 8 months ago)
Ministerial CorrectionsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Liz Kendall
To ask the Secretary of State for Health how much the Care Quality Commission has spent on consultancy services in (a) 2010-11, (b) 2011-12, (c) 2012-13 and (d) 2013-14 to date.
[Official Report, 18 November 2013, Vol. 570, c. 825-26W.]
Letter of correction from Norman Lamb:
An error has been identified in the written answer given to the hon. Member for Leicester West (Liz Kendall) on 18 November 2013.
The full answer given was as follows:
Norman Lamb
The Care Quality Commission (CQC) has provided the following information:
Amount (£ million) | |
|---|---|
2010-11 | 1,832 |
2011-12 | 0.071 |
2012-13 | 1,752 |
2013-141 | 1,959 |
1 Up to and including 30 September 2013. Source. The CQC annual accounts, reports and monthly Department of consultancy returns. Definitions of ‘consultancy’ were taken from the Cabinet Office's Guidance on Actions and Processes. |
The correct answer should have been:
G8 Summit on Dementia
Liz Kendall Excerpts(10 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Liz Kendall (Leicester West) (Lab)
I welcome you to the Chair, Madam Deputy Speaker, as this is the first time I have spoken since you were elected. I also warmly congratulate the hon. Member for Chatham and Aylesford (Tracey Crouch), my right hon. Friend the Member for Salford and Eccles (Hazel Blears) and the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this really important debate. I am sorry that some Members have not had more of a chance to speak, because I know that they feel passionately about the subject.
Like other hon. Members, I welcome the G8 summit on dementia. It is important to be hosting the first summit dedicated to dementia when countries are facing so many other issues. It is also right because the ageing population, which includes an increasing number of people with dementia, is one of the biggest immediate and long-term challenges facing both this country and the world. Dementia already affects more than 800,000 people in the UK and that figure is set to rise to 2 million by 2050. It is estimated that more than 115 million people worldwide will be living with dementia in 40 years’ time.
Anyone whose family has experience of dementia will know how devastating the condition can be. It is therefore right that the G8 summit and the Prime Minister’s dementia challenge seek to boost national and international efforts on clinical research. Developing effective drugs and treatments is essential if we are to offer hope to people that something can be done about this terrible disease.
If we are going to address the challenge of dementia, we must face up to the equally important challenge of improving the quality of dementia care. We need to ensure that we do not neglect research into the support and services that aim to prevent the onset of dementia in the first place, which was something that many hon. Members spoke about. Although there is no certain way to prevent dementia, we know that a healthy lifestyle can lower people’s risk of getting not only dementia, but lots of other diseases, when they get older. Eating well, exercising regularly and stopping smoking may not grab the headlines in the same way as discovering a new job, nor attract research funding from institutions and companies, but ultimately they will be key to meeting the dementia challenge in the future. I hope that we will one day have a G8 summit on precisely those issues.
I want to focus my brief comments on the crucial matter of the quality of dementia care because, for my constituents and for people in my family and my friends’ families, the quality of care they receive, and the problems they have with it, represent the biggest challenge. People with dementia and their family carers are clear about what makes good dementia care. They want joined-up services and support so that they do not have to battle different parts of the system. They want care that is personalised to their individual needs. The vast majority of people with dementia want to stay living independently in their own homes for as long as possible, and families want to help to look after their loved ones as long as they get the right help and support.
Like many hon. Members, I have seen lots of inspiring examples of people working to improve care for people with dementia: day centres that provide stimulating activities such as gardening, cooking, singing and music; care homes that understand that they have to ask the families of people with severe dementia what kind of care and support they need, because those people’s memory has been taken from them; hospitals that involve families by asking them what food and activities their relative wants and needs; and, crucially, higher education institutions such as the university of Worcester, which I recently visited and is transforming staff training by getting patients to interview people who want to be student nurses, and then to develop and actually give the course, because how can NHS and social care staff know what dementia patients really need if they have not been trained in the first place?
Our loved ones will not get the quality of care we all want for them within a malnourished and depleted social care system. In fact, I think that the growing crisis in social care is the biggest threat to people suffering from dementia and the largest challenge we face. Council budgets have been under pressure for many years, but almost £2 billion has been cut from local authority budgets for older people’s social care since the Government came to power. Fewer people are getting the up-front care that they need to stay living at home. Home care visits have been shortened to barely 15 minutes, which is not enough time to get a vulnerable person with dementia up, washed, dressed and fed.
Care workers do an incredibly important job, but they are struggling. They are not paid even the minimum wage, let alone the living wage, and they are employed on zero-hours contracts. That is bad not just for people with dementia, but for taxpayers, because if those with dementia do not get the help and care they need so that they can live at home, they end up in residential or hospital care, which costs taxpayers more.
I want to ask about the Government’s plans because it is important that we are clear about them. I am sure that the Minister will talk about their plan to integrate services, but I want to echo a point made by my right hon. Friend the Member for Salford and Eccles. The integration transformation fund is not new money, but existing resources of £1.9 billion from clinical commission groups, with the rest coming from existing local council budgets. I think that £3.8 billion is a really unambitious amount of funding in the context of a total NHS and social care budget of £120 billion. We need the far bigger and bolder response of the full integration of NHS and social care budgets if we are to meet the challenge of our ageing population and dementia.
The G8 summit and the Prime Minister’s dementia challenge are welcome—they build on the previous Government’s approach—but the challenge needs to focus on improving the quality of care and research into prevention. I echo the important point made by hon. Members about the need for a commitment to renew the previous Government’s national dementia challenge, which expires at the end of next year, and the Prime Minister’s dementia challenge, which ends in 2015. I hope that the Minister will give such a commitment so that we can have the long-term strategy across all areas that we desperately need.
Oral Answers to Questions
Liz Kendall Excerpts(10 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
My hon. Friend knows that the funding arrangements are decided independently of the Government, by NHS England, which will make its decision at a board meeting before Christmas. He is absolutely right to suggest that the funding formula should reflect not only social deprivation but the age profile of constituents, because the oldest people are of course the heaviest users of the NHS.
Liz Kendall (Leicester West) (Lab)
The Health Secretary claims that he wants the NHS to be the best in the world at looking after the elderly. Nice rhetoric, but the reality is that we now have the highest-ever number of elderly people trapped in hospitals because they cannot get the health and social care they need at home. We now have the equivalent of five hospitals full of elderly people who do not want to be there, and that is costing the taxpayer £20 million a month. Is not the truth that care of the elderly is getting worse, not better, on his watch?
Mr Hunt
The truth is that the previous Government had 13 years to integrate the health and social care systems, but they failed. We are doing that, and we are also providing named GPs to the most vulnerable people, so that, hopefully, they do not have to go to hospital in the first place. That is doing a lot more for older people than the hon. Lady’s Government ever did.