Cancer Patient Experience

Liz Kendall Excerpts

Wednesday 30th October 2013 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Owen, and I really want to congratulate the hon. Member for Hertsmere (Mr Clappison) on securing this important debate.

I will start with why this issue is so important. At the risk of stating the obvious, first and foremost, it is crucial for patients and their families, and as the hon. Member for Strangford (Jim Shannon) said, many of us—not only people of his age—are affected. Today, the father of one of my dearest and oldest friends is going through yet another operation for cancer. I saw him on Saturday night. I shall spend today thinking about him and all his family, and I hope that it goes well.

We know that a good experience makes all patients feel as though they have been supported and respected as individuals, whereas a bad experience can make them feel, at best, as though their needs do not matter and, at worst, that their basic human dignity has been denied. Cancer patients whom I speak to, such as those at the local Macmillan Cancer Support group, which I recently joined in my constituency, constantly emphasise their experience of care and how they are treated by NHS staff as absolutely critical at such a frightening time in their lives. However, the importance of the 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. A systematic review of 55 studies, which was published in the British Medical Journal last year, found that good experience is linked to better outcomes for individual patients—both the outcomes that patients themselves report and objectively measured outcomes. It was also found that patients who have a good experience are also more likely to stick to their recommended treatments and medicines and to use preventive services, such as screening, immunisation and healthy living programmes.

The third reason why patient experience is important is that there is increasing evidence—from the US, if not from the UK—that it is linked to getting better value for money. A good patient experience, in the US at least, is associated with a reduced length of stay in hospitals and fewer problems with patient safety—so-called adverse patient events. Hospitals that achieve good scores on patient experience also have higher staff retention rates, which also contribute to lower costs through lower staff turnover. Understanding the link between staff experience and patient experience is absolutely essential in this debate. That is actually common sense: when staff feel valued and respected, they are more likely to treat patients in the same way.

What makes for a good experience for cancer patients? Macmillan Cancer Support says that three issues are consistently highlighted. The first is meaningful involvement in their care, not only for individual cancer patients, but for their families, too. The second is excellent communication, so the patient’s diagnosis, treatment options, risks and follow-up care are clearly and simply explained. The third is properly co-ordinated care. When people are going through a desperately difficult time, the last thing that they want to face is a battle between all the different services. They want their hospital, primary and community services, social care and wider help—such as financial information and welfare and benefits advice—brought together in a seamless package that is built around their needs and not the individual institutions. That kind of whole person care is vital to all patients, not only those with cancer, but if we can get it right for cancer patients, I think that we can get it right for all patients, too.

The previous Government made huge strides in improving cancer care through the work of the national cancer plan and the cancer networks. There is still further to go, particularly with earlier diagnosis, but major progress was made in starting to bring NHS care for cancer patients up to the standards in other countries. The national cancer patient experience survey, which was started under the previous Government, was absolutely integral to that. The latest results, from August this year, found that about 80% of cancer patients rate their care as good or excellent. However, there are warning signs that problems are building in the system, which could harm that progress.

Waits for vital cancer tests are getting longer. The number of people waiting more than six weeks for diagnostic tests, including ultrasounds, colonoscopies and gastroscopies, has increased by 65% between July 2010 and July 2013. The cancer networks that were so important in improving the quality and co-ordination of care have been abolished, with their work subsumed into generic clinical networks, and many staff say that that risks losing their vital specialist and local expertise. We have seen a reduction of 5,000 nursing posts since 2010, including in vital specialist services, which is putting huge pressure on remaining staff.

Many hon. Members have talked about the persistent long-term variations in the experience of cancer patients. The national cancer survey has consistently shown worse outcomes for patients with rarer cancers, for younger patients—an issue highlighted by the Teenage Cancer Trust—and for patients from ethnic minority communities, which is an issue particularly close to my heart as an MP for the very diverse city of Leicester. There are also continuing problems with ensuring that patients get the financial information and benefits advice they need and with the crucial issue of end-of-life care.

I am sure hon. Members saw the excellent report published earlier this week by Macmillan Cancer Support, which found that 73% of people with cancer would prefer to die at home but that less than a third are able to do so. Therefore, some 36,000 cancer patients died in hospital when they would have preferred to die at home. That is not only terrible for cancer patients and their families at an awful and difficult time; it does not deliver best value for taxpayers’ money either. Research by the national end-of-life care programme suggests that there are potential net savings of some £950 for every person who dies in the community, rather than in a hospital, because of the reduced use of hospital beds.

The Minister, whom I welcome to her post, may not be aware of this because she was not in her post at the time, but in the cross-party talks on Andrew Dilnot’s recommendations for funding social care, the shadow Health Secretary and I proposed removing the means test for end-of-life social care to help make choice a reality at that difficult time. I hope that the Minister will be able to update us on the Government’s actions.

I will now focus on what we need to do to put cancer patient experience much more fundamentally at the heart of the NHS. I understand that the national cancer patient experience survey is currently under review. Will the Minister commit to that survey continuing to happen during each year of the coalition? Those data are vital, but we must use them effectively. A key point highlighted by the hon. Member for Basildon and Billericay (Mr Baron), who chairs the all-party group on cancer, is that we must ensure that each clinical commissioning group is properly held to account for improving patient experience, including for cancer patients.

Currently, there are generic indicators on patient experience of hospital care and the friends and family test for acute inpatient care and A and E, but is NHS England developing more specific patient experience indicators for individual hospital services, including cancer, and, across the whole patient pathway, for primary and community services, too?

As hon. Members will know, last week, the Care Quality Commission published results of its new hospital inspection scheme, which is based on 150 indicators. I welcome and pay tribute to the excellent work of the chief inspector of hospitals, Professor Sir Mike Richards, who is the former national clinical director for cancer, but only two of the 150 indicators in the CQC’s new methodology currently address patient experience. Again, those indicators are generic. What plans does the CQC have to ensure that patient experience of individual services, including cancer services, is assessed? Will the chief inspector of hospitals work with the chief inspectors of social care and GPs to ensure that we join up our thinking in that area?

I will conclude on an important point relating to what the hon. Member for Basildon and Billericay said. We must ensure that we address patient experience locally and on the ground, not just nationally. Although holding CCGs to account and the CQC’s monitoring of hospitals are important, they essentially happen after the event—after care has been delivered. We must ensure that patient experience is at the heart of what all parts of the NHS and all staff do day in, day out. I have two suggestions for how we can make that happen.

First, we have to transform the use of what I call real-time patient feedback—not annual surveys or annual monitoring, but day in, day out use of patient feedback. There are brilliant services such as Patient Opinion, which allows patients to tell their story, positive or negative, online, by phone or in writing. Hospitals, GPs and social care providers that register with Patient Opinion can see what people are saying about them on that same day. I know because I used the service when I had to make an unfortunate visit to an urgent care centre this time last year. Patient Opinion is a powerful tool for individual patients to tell their story, for members of the public to see what others are saying about their service and for staff to hear first-hand, immediately what they can do to improve the quality of care. What plans do the Government have to encourage greater use of such services across the NHS and social care?

Secondly, the education and training of NHS staff is important. Last week, I visited the university of Worcester, which is doing pioneering work. Patients and users help to interview student nurses who apply for the course to ensure that they have the right values and attitude. Patients and users help to develop the curriculum used to train student nurses and other health professionals to ensure that it covers the issues that really matter to patients. Patients and users are also an integral part of the course, and they help with the training process.

In Leicester, we also have a groundbreaking project between De Montfort university and Macmillan Cancer Support in which students training to be nurses, NHS managers or pharmacists volunteer for Macmillan. Those students get vital skills and experience of communicating with cancer patients. How will the Government ensure that such work to improve the skills, knowledge, experience and training of staff starts when they begin working for health services? What vital work is being done to hold CCGs to account and to monitor the quality of care in hospitals?

[Albert Owen (in the Chair)]

I also congratulate the Minister and welcome her to her new role.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

My hon. Friend will be aware that this is a matter for local commissioners to decide and it is not for Whitehall to impose solutions on them. There are issues and efficiencies that Morecambe Bay trust can drive by better managing its estate and reducing temporary staffing costs. The hospital and trust will, of course, want to look into those issues in improving their financial outlook and the quality of care they can provide for patients.

[Liz Kendall (Leicester West) (Lab)]

Whatever the Minister claims, the reality is that the Secretary of State has lost grip of NHS finances just as he has lost grip of the crisis in A and E. Earlier this month, we learned that half of all NHS hospital trusts are now predicting deficits—up from one in 12 last year. As a self-proclaimed champion of openness, will the Minister now commit to publishing those deficit figures monthly and guarantee that all NHS acute trusts will balance their books by the end of the year? It is a simple question—yes or no.

[Dr Poulter]

The hon. Lady is being economical with the figures. I indicated earlier that 70% of trusts and 89% of foundation trusts are predicted either to break even or end the year with a financial surplus. That is hardly a difficult position. Those trusts that have deficits are often a direct legacy of the PFI deals negotiated by the previous Government and the right hon. Member for Leigh (Andy Burnham) when he was Secretary of State. The sector as a whole is predicting £109 million of surplus. That is hardly a deficit. I know that the Labour party is not very good with figures and cannot add up, which is why this country is in such an economic mess, but the figures speak for themselves: £109 million of surplus is predicted for trusts and foundation trusts.

Managing Risk in the NHS

Liz Kendall Excerpts

Wednesday 17th July 2013 Commons Chamber

[Mr Hunt]

My right hon. Friend makes an important point. There are many locums who work extremely hard and are very committed. However, it is true that one feature of a number of the failing hospitals in yesterday’s report was that they had a high proportion of locum staff. It is harder to build up a sense of teamwork if there is a huge turnover in the people working in NHS organisations, and I know that many will reflect on that.

[Liz Kendall (Leicester West) (Lab)]

Will the right hon. Gentleman give way?

[John Pugh (Southport) (LD)]

Will the right hon. Gentleman give way?

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Walsall South (Valerie Vaz) in this important debate. As my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) and my hon. Friend the Member for Halton (Derek Twigg) said, over the past three years the biggest risk to NHS patients and taxpayers has been this Government’s decision to force through the largest back-room reorganisation in the NHS’s history at the same time it faces the biggest financial challenge of its life.

We left government with the lowest ever waiting lists and the highest ever patient satisfaction, but we knew that further changes were essential to improving the safety and quality of patient care and getting better value for taxpayers’ money. And we had a plan to make it happen in every region in England, through Lord Darzi’s report, “High Quality Care for all”, which set out precisely how we would achieve the kind of reconfigurations of hospitals that the hon. Member for Bracknell (Dr Lee) mentioned and precisely the kind of integrated services focused on prevention in the community mentioned by my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Walsall South. But Ministers scrapped those plans and instead forced through a top-down reorganisation that not only wasted billions of pounds, but meant that local services lost grip and focus precisely when they were needed most.

The Government were repeatedly warned about the risks of their Health and Social Care Bill. While they have refused to publish their own national risk register, up and down the country local NHS organisations did the job for them. Those local NHS risk registers warned that front-line staff would be cut. They were right: over 4,000 nursing posts have been lost under this Government. They warned that specialist cancer networks would be scrapped, and they have, along with Labour’s stroke networks, both of which were vital to improving the quality of patient care. The local risk registers also warned that structural upheaval and fewer front-line staff would destabilise winter planning and mean more patients waiting longer in A and E. That is precisely what has happened.

This Government have presided over the worst A and E crisis in a decade. At its height, 100 trusts failed to meet the four-hour A and E target. Even during spring, more than half of all hospital trusts missed the target. The risk to patients is not just that they have been left waiting for hours in distress and pain on trolleys or in the back of ambulances. As Sir Bruce Keogh’s excellent review states,

“over 90% of deaths in hospital happen when patients are admitted in an emergency rather than for a planned procedure”.

He goes on to say:

“The performance of the majority of the trusts was much worse than expected for their emergency patients.”

He is right. At the end of last year all 14 of those trusts were missing this Government’s lower A and E target, yet under the previous Government all 14 were meeting our higher A and E target.

Instead of getting to grips with the real causes of the A and E crisis so that they can deliver real solutions for patients, the Government have consistently sought to score political points by blaming the 2004 GP contract. [Interruption.] The Secretary of State says from a sedentary position that that is what the evidence says. Well, NHS England, the NHS Alliance and the NHS Confederation beg to disagree, to name just a few. They say that the real causes are primarily that more very elderly, sick patients are ending up in hospital and getting stuck there because of pressures on social care budgets, and that there are not enough services for specific groups of patients such as those with mental health problems and drug and alcohol addiction.

Ministers’ sheer incompetence in introducing the NHS 111 phone line has compounded the pressures in A and E. They were repeatedly warned, by the Royal College of Nursing, the British Medical Association, the Ambulance Service Network, NHS Direct and potential private providers, about problems with their rushed roll-out, but they ploughed on regardless. The result was patients left hanging on the phone or waiting hours for call-backs, more ambulances being sent, and more patients ending up in already struggling A and Es. A report on this fiasco by the NHS Alliance, which represents primary care providers and commissioners, says that

“providers were put under unprecedented pressure by the Department of Health to meet their go live dates even if...they weren’t prepared”.

They say that the Government’s contracts focused more on cost than quality, yet they have disgracefully ended up failing on both.

We now face the real risk that the Government will fail to put in place many of the key changes that patients and the public desperately need. It is right that the Government are looking at the training of nurses throughout the NHS. I have no doubt that Sir Mike Richards will be an excellent chief inspector of hospitals. However, regulation happens after the event, whereas we need to focus on preventing problems from happening in the first place. That means having clear lines of accountability and responsibility from the bedside to the boardroom. It means listening to patients and the public. It means having a strong voice for local Healthwatch bodies. Hon. Members will know that up and down the country those have been very slow to get up and running and have very few staff. The task put on to them—to make sure that they are a strong voice for patients and the public—will be extremely difficult to carry out.

The Government are missing out on three key issues that have repeatedly come up in this debate. The Keogh review found time and again that staff shortages in the 14 hospitals with higher mortality rates are a real risk to the safety and quality of patient care, as did the Francis inquiry into the appalling failings at Mid Staffs hospital. That is why Francis makes very clear recommendations about staff numbers. The Secretary of State would not take an intervention from me earlier, so I will tell him what I was going to say now. Recommendations 22 and 23 in the Francis report say:

“The National Institute for Health and Clinical Excellence should”

set out

“standard procedures and practice”

and those should include what each service

“is likely to require as a minimum in terms of staff numbers and skill mix. This should include nursing staff on wards, as well as clinical staff.”

The report also says that

“no unregistered person should…provide…direct physical care to patients”

and that this

“should apply to healthcare support workers”.

We tried for many years to improve their training, but without their being registered so that it could be guaranteed that they had the training required, it was not possible to do so. I called for this back in 2001, before I became an MP. The same arguments were being made then. We have not made progress and we need to do so now.

Finally, Francis says there should be a statutory duty of candour on individual registered staff as well as providers, yet the Government are dragging their feet on all those key recommendations. As Peter Walsh, the chief executive of Action against Medical Accidents, said yesterday,

“ministers are still refusing to accept key recommendations such as minimum staffing levels for wards and regulation of healthcare assistants.”

He also said that he hoped that Sir Bruce Keogh’s report will change the Government’s mind, and Opposition Members agree with him.

Government Members have made unfounded accusations that Labour Members covered up problems in the NHS, but our record proves that we did the precise opposite: independent inspection of the NHS for the first time; national data published on heart and stroke care and hip and knee operations for the first time; patient choice of hospital enshrined for the first time; and, far from ignoring mortality rates, it was the Labour Government who published them on the NHS Choices website for the first time.

Government attempts to smear former Ministers are shameful, but the real tragedy is not the cynical, political agenda being pursued by the Conservative party; it is that over the past three years the Government have put the NHS through risks that could have been avoided and they are failing to put in place the real changes and reforms that patients and the public need. I commend the motion to the House.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I am pleased the 111 service worked more satisfactorily in my hon. Friend’s case. NHS England is working on the funding formula and it hopes to make any necessary changes in time for the next funding round, which starts in April 2014.

[Liz Kendall (Leicester West) (Lab)]

Ministers were repeatedly warned about problems with their 111 roll-out by the Royal College of Nursing, the British Medical Association, the Ambulance Service Network and private providers, but they ploughed on regardless. The result was patients left waiting hours for call-backs, more ambulances sent out and more pressure on already struggling A and Es. I am sure the Secretary of State is aware of the pattern of the seasons, so if he wants to avoid another A and E crisis this winter, can he explain why Bruce Keogh’s review of urgent and emergency care will not even report until next spring?

[Mr Hunt]

Actually, the hon. Lady is wrong, because Bruce Keogh’s review of urgent and emergency care with respect to vulnerable older people, and particularly with respect to the way the 111 service operates, will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter, and it is very important that we should do so.

Social Care Reform (Disabled People)

Liz Kendall Excerpts

Thursday 11th July 2013 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Clark. I thank the Backbench Business Committee for giving us time to debate this very important issue, and I congratulate the hon. Members for Bradford East (Mr Ward) and for South Derbyshire (Heather Wheeler) for sponsoring the debate. It is a great pleasure—this is the first time that it has happened to me—to follow my right hon. Friend the Member for Stirling (Mrs McGuire), who made a very powerful speech.

This subject is hugely important. One in five adults in Britain has a disability of some kind, and that figure is rising due to medical advances and better survival rates. As my right hon. Friend says, it could happen to any of us, so this is not a side topic but an essential issue. Britain will not be a fair country if disabled people are denied the opportunities that many of us take for granted, and we will not be a successful country if we miss out on the talents and contribution of disabled people, not only in economic terms, but in our communities and wider cultural and social life.

Good social care is essential to enable disabled people to be full citizens and live full and fulfilling lives. As hon. Members have said, that is about not only the basics of life—help getting up and getting washed, dressed and fed. It is about what I call the very stuff of life—ensuring that disabled people can spend time with their family and friends; learn and get new skills; find a job; contribute to their local community; take part in sport, art, culture and music; and have fun. In other words, it enables disabled people to have the same aspirations as every other citizen. That is why today’s debate, the joint report from the all-party groups on local government and on disability and “The other care crisis” report are important.

This is not about a particular public service, but about what kind of society and country Britain should be in the 21st century. Despite all the economic challenges, we are one of the richest countries in the world. What kind of country and society do we want, to ensure that we have genuine fairness and opportunity for people of all kinds? The debate is therefore about not only social care, but wider life, which is why it is so important.

As hon. Members have said, there is a growing crisis in social care for working-age adults with disabilities, and services have now reached breaking point. That is eloquently spelled out in the joint report of the all-party groups and “The other care crisis”, the report by Scope, Mencap, Leonard Cheshire Disability, Sense and the National Autistic Society. It rightly says that social care does not only affect older people: one in three people who use social care are working-age people with disabilities. It also says that local authority budgets for adult social care have been under pressure for many years, but have now reached breaking point, as councils have lost a staggering 28% of their budgets so far under this Government, with even greater reductions announced in the latest spending review. As a result, councils are reducing the number of disabled people eligible for free care and support.

The report says that 40% of disabled people are failing to have their basic needs met. They are unable get the help that they need to eat, wash, dress or get out of the house, and their mental health suffers. There are some terrible, upsetting and distressing quotes from people with disabilities. Disabled people’s families also suffer huge stress and strains.

[Norman Lamb]

I agree with the points the shadow Minister makes, but she mentions cuts to local government budgets and I hope that we can all be realistic and honest about the situation that we face. Is she saying that a future Labour Government would substantially increase funding for local government? Alternatively, does she recognise that, collectively, we must all think about different ways to make the money go further?

[Liz Kendall]

I believe that we must fundamentally rethink how our care and support system works. The Minister knows that my right hon. Friend the Member for Leigh (Andy Burnham) and I have called for a far bigger and bolder response, by fully integrating the NHS and social care. I shall come to the Government’s proposals for the £3.8 billion of pooled resources. With the greatest respect, I think that the Government should be bigger and bolder in their response, with full and true integration that goes beyond the NHS and social care. If we really join up local services and support and bring together support from the Department for Work and Pensions, there is huge potential to do much more to give better care, better outcomes and better value for money. I will say more on that in a moment.

In “The other care crisis”, organisations raised concerns about the number of people—105,000 in total—who will lose out if the Care Bill goes ahead as it stands, given where the eligibility criteria will be set. The report warns that the huge strides made over recent years in promoting independence and personalising care and support will go backwards, as councils and other providers revert to more traditional service models—salami slicing services separately—thus restricting peoples’ independence. That specific crisis in social care for adults with disabilities will lead to a far bigger crisis: a crisis in opportunities for disabled people to live the life they want, which other citizens have; a crisis for taxpayers, because failing to invest in up-front preventive social care services will lead to more expensive NHS and social security bills; and a crisis for our country as whole, as Britain misses out on the talents and contribution of disabled people and we all end up paying more as the price of failure.

What should happen instead? The Care Bill could and should be a profound opportunity to establish a framework for social care that could be truly transformational for disabled people. The Bill is the result of the Law Commission review of adult social care legislation, initiated by the previous Government.

[Norman Lamb]

Give us some credit for it.

[Liz Kendall]

I give much credit to the Minister, but the Bill is the continuation of a process that Labour established when we were in government—I want that on the record. [Interruption.] I fully and readily acknowledge that local council budgets have been under pressure for many years. He knows better than anyone that towards the end of Labour’s time in Government we tried to reach an agreement on a social care funding system, which I will come back to in a moment. [Interruption.]

[Katy Clark (in the Chair)]

Order. I ask the Minister to intervene formally if he wishes to say anything, for no other reason than it would assist the Hansard writer.

[Katy Clark (in the Chair)]

No problem at all.

[Liz Kendall]

I never mind interventions in debates; I warmly welcome them.

I shall make five specific suggestions to the Minister about how the Care Bill could be developed. First, the definition of well-being in the Bill is important. I welcome how broad it is. It covers mental, physical, social and economic well-being; personal relationships; and a person’s ability to contribute to society. The definition also includes ensuring that individuals have control over their day-to-day living, but I question whether the definition is as strong as it could be. The joint report from the all-party groups asks why it could not specifically include promoting independence, to strengthen the definition further.

An issue raised by my right hon. Friend the Member for Stirling relates to my point about definitions. The duty to co-operate in the Bill says that local councils will need to work with a range of partners. I understand that Ministers usually do not want to specify lots of organisation types, but I am concerned that although local councils would, we hope, know that they had to co-operate with the NHS, there is a real issue about the DWP. There is not that link-up locally, and if people’s ability to get training and to participate in the work force is so important, will the Minister consider whether, either in the Bill or in guidance, there needs to be more detail about who local councils should co-operate with? I am concerned that that local relationship might not be there.

Secondly, the eligibility criteria are, as the hon. Member for Bradford East said, the most crucial aspect of the social care system because they determine who is and is not eligible for social care support. We absolutely welcome the commitment to clear national eligibility thresholds, but the Minister knows that disabled people, organisations that represent older people and many of the groups involved are hugely disappointed that the draft regulations have set the thresholds at substantial rather than moderate. I am fully aware of the cost pressures on the system, but has the Department done a true cost-benefit analysis, to consider the potential saving? The hon. Member for South Derbyshire made a point about how investing up front can save money further down the line. Has the Minister discussed with his Treasury colleagues whether, if a longer time frame were used for assessing the costs, we would end up saving money for taxpayers if the moderate level was set?

My third point relates to the so-called capped care costs model—aka Dilnot. The Minister knows that I am concerned that the so-called cap on care costs is not really a cap. I am concerned not only because it does not cover hotel accommodation, but because it covers only what someone’s local authority would pay rather than the amount they might actually pay in residential care and because no one will benefit from the cap until 2020.

[Norman Lamb]

Does the hon. Lady accept that if the cap were to cover all someone’s care costs, however much they chose to pay, wealthy people who chose to live in much more expensive care homes would be at a substantial advantage?

[Liz Kendall]

The Minister will know that my point is that I warn Ministers, including the Prime Minister and the Deputy Prime Minister, that going around the country strongly saying that it is a cap on care costs will create confusion—that is the best word I can use.

I do not want to focus on older people; I want to come to the point that the APPGs raised. The joint report states that the majority of working-age people with disabilities will not benefit from the so-called capped social care costs model, because they will not have had the chance to acquire assets. How many disabled people will benefit from the model? Why does the Minister believe that it is more important to put in excess of £1 billion into implementing the Dilnot model rather than into the current system, which is being increasingly squeezed?

My fourth point is about personalisation. I am a huge champion of personal budgets. I have seen them transform many of my constituents’ lives, not just because they promote genuine independence by giving people a say in how they live their lives rather than the system telling them how they should, but because they are essential to integration. The people themselves know best about how to join up their needs and support, because they do not see the two things as separate. However, I have heard the concern expressed in many different places across the country that personal budgets are getting a bad name. People feel that they are increasingly not based on their needs and that less money is being given than is needed, because of how the resource allocation system works.

Another important recommendation in the joint APPG report is about considering whether the resource allocation system should go on to a statutory footing, supported by new duties on councils to be transparent about decisions. I do not want personal budgets to get a bad name, with people feeling that they are a cover for cuts, rather than being based on what people need.

My final point is on the absolutely essential issue of prevention and integration. The Government announced in the spending review that there will be pooled budgets across health and social care totalling £3.8 billion, including £2 billion transferred from the NHS. The joint APPG report states that much of the previous transfer of money from the NHS to social care never reached the front line, and there is a concern that just continually transferring money in that way is not sustainable. How will the Minister ensure that the money gets to the front line? Will it be available, as I think the hon. Member for South Derbyshire said, for working-age adults with disabilities, rather than just for older people? Finally, will the Minister acknowledge that if this keeps happening year after year, it would be far better to have much fuller integration, such as the whole-person care approach proposed by Opposition Members?

--- Later in debate ---

[Norman Lamb]

I will come on to the work that we intend to do on a more sophisticated way of assessing eligibility and responding to assessments. I absolutely accept the current danger that the system in effect says, “Go away, become more ill or more disabled, and when there is a real crisis, we might help you.” I want us to be more sophisticated and to intervene in ways that will help to build capacity and resilience and to stop the deterioration of health. I genuinely believe that the Care Bill will give us the foundations for a much more rational approach.

[Liz Kendall]

May I take the Minister back to the £3.8 billion pooled budget? He said that it was absolutely available for care and support for working-age people with disabilities. Will he explain, when the money goes down to clinical commissioning groups and local councils, first, where it will go to, and secondly, how he will ensure that it actually goes to working-age people with disabilities? I know how the NHS works, and all the focus is on the frail elderly because they are in hospital. The NHS wants to get them out of hospital—that is its prime focus—so unless there is something specific in what the Minister sets up, the money will not go to working-age people with disabilities.

[Norman Lamb]

We will publish further details about how the system will work. To deal with the hon. Lady’s challenge to our approach, we could go for another massive re-organisation, which in a sense is what she is advocating—

[Liz Kendall]

indicated dissent.

[Norman Lamb]

Well, it is. To bring health care and social care together structurally would be a massive re-organisation, and there is no way of avoiding that. The smart way is to focus on the care that an individual receives. The issue is not just about bringing health and social care together and integrating those two systems but about the health service itself and the fact that, institutionally, we have separated mental health from physical health and primary care from secondary care, which is crazy. The whole thing is fragmented, but we should shape services around the needs of patients. The Government’s approach, based on the duties to integrate in the Health and Social Care Act, is the smart, fast way of achieving much more joined-up care for the patient, whether individuals are elderly or of working age. I want to make some progress with my speech.

The Government are committed to improving the lives of disabled people and to supporting them in their independent lives. In very difficult financial circumstances, we have done much to achieve that through the disability strategy, welfare reform—it is incredibly controversial, but any Government would have to pay attention to the extraordinary growth in welfare spending—and a whole raft of condition-specific initiatives.

One outstanding issue still needs to be addressed—social care reform. The importance of care and support for disabled adults cannot be understated: it is the enabler of independent living. We hear much about the ageing population as the driver for care reform, but a third of all health and care users are working-age disabled people, so it is vital that the social care reforms address their needs. The fact that my hon. Friend the Member for Bradford East and his colleagues have secured this debate is valuable because it ensures that we focus on the needs of working-age disabled people. I repeat that there is a risk of their being forgotten, which must not happen.

Earlier this year, I read with interest the “Promoting Independence, Preventing Crisis” report into making social care reform work for disabled adults. It was a joint inquiry by the all-party groups on local government and on disability. I congratulate them on an important piece of work, and I will attempt to address some of the points raised in a moment. I first want to talk about some of the things we have done.

We know that disabled people face a number of challenges. They are far less likely to be in employment than non-disabled people. In fact, shockingly, only 46% of disabled people are in employment compared with 76% of their non-disabled counterparts. Some 19% of individuals living in a family with a disabled member are in income poverty, although I am pleased to say that that has been falling over time. Progress is being made, but much more needs to be done.

The first thing to say about all the Government’s reforms is that we are committed to the UN convention on the rights of disabled people, which includes the right of disabled people to independent living. The Department of Health has been working closely with the Office for Disability Issues on the new cross-Government disability strategy, “Fulfilling Potential”, which was published last September. It is about making the UN convention a living reality for disabled people in Britain. It describes the rights that disabled people—just like anyone else—have in all areas of life, and the duty on Government to ensure that those rights are met.

The shadow Minister made a point about co-ordination with the DWP. There is scope for much more joined-up working at a local level to bring disparate public services together and to achieve far more bang for our buck than we presently manage.

Carers

Liz Kendall Excerpts

Thursday 20th June 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to follow the excellent speeches made by Members on both sides of the House today. I thank the Backbench Business Committee for giving us the opportunity to debate this crucial subject, and I particularly congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Banbury (Sir Tony Baldry).

One in 10 of all adults are now caring for an older or disabled person—6.5 million in total, up 600,000 from 10 years ago. The biggest increases are among those aged over 65 and those caring for more than 50 hours a week. This is a huge change in society that we all need to do more to understand and get to grips with. Our care system simply would not function without the vital support family members provide for their loved ones; as many Members have said, their financial contribution is estimated at more than £100 billion every single year. Despite that, all too often, carers go without the support they deserve and desperately need to look after the people they love. That is why today’s debate is so important.

The last Government made important progress in improving support for carers. We introduced new rights for carers, including the right, for the first time, to request flexible working. We improved information and advice, and had training programmes for carers such as the expert carers programme, the benefits of which I have seen in my own constituency through the brilliant work of CLASP, the carers centre in Leicester. We funded breaks for carers. Many Members have spoken powerfully about how important breaks are. If carers who are caring for many hours a week have a bit of a break in sight, it really helps them to carry on. We also introduced financial incentives for GP surgeries to identify carers and refer them to local councils for support. That was part of the quality and outcomes framework, which was introduced as part of the 2004 GP contract, and was the very first step in providing a specific financial incentive for GPs to identify carers.

However, as all Members have said, far, far more needs to be done. Like many Members, I have seen in my constituency and within my own family the often desperate daily struggle that is still faced by too many people who look after a loved one who is disabled, physically frail or has dementia—sometimes all three. I pay tribute to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who powerfully explained her own experience of the physical and emotional demands of caring for a loved one. As she said, there are the physical demands of helping someone to get up in the mornings. Carers can be exhausted from getting up two, three or four times in the night to help someone go to the toilet, and from helping them move around the home. There are also the emotional demands. When a carer sees the person they fell in love with become frail and perhaps lose some of their pride and strength, it is terribly upsetting. If a son or daughter sees the parent who brought them up and taught them about the world—for good or for ill—begin to fade as a result of dementia, and they begin to feel as if they themselves are becoming the parent, it changes something essential in the nature of that relationship. I have always believed that relationships are essentially what make us human. If someone has dementia and begins to forget the relationships they have, it takes something away from the carer, as well. Caring for a loved one is physically and emotionally demanding. Many Members have talked about the role of public services. Health professionals are taught to understand physical and mental illness, but not necessarily the wider emotional and social issues.

I want to talk about three critical areas where we need to make progress, the first of which is identifying carers. If we do not know who they are, we will not get them the help and support they need. The second is ensuring they get the right information, advice and support from the NHS as well as social care. The third is helping carers to stay in employment, which many Members have talked about. That is particularly important as we all live longer and need to work for longer. If the public finances are to remain stable, we must do everything we can to help people in that regard. My hon. Friends the Members for Worsley and Eccles South and for Birmingham, Selly Oak (Steve McCabe) talked about the importance of identifying carers. The hon. Member for Ceredigion (Mr Williams) said that there is a great deal of awareness of carers and of the use of that term, but lots of people still do not realise they are a carer or think of themselves as such; they are simply trying to be a good daughter, son, husband or wife. Others do not ask for support because they worry that people will think they cannot cope; there is a lot of associated guilt. We need to identify these hidden carers.

There are many examples of good practice, but perhaps the best I have seen is in Torbay, where the issue of identifying carers in GPs’ surgeries and hospitals has been closely examined. If someone who has had a stroke comes in with a family member, it is recognised that that family member is likely to be a carer. A great range of support is provided. The approach taken in Torbay starts with the person who may need health care; as a result, they immediately talk about their family member.

I want to offer some practical suggestions to the Minister on how to make further progress. Will he consider amending the quality and outcomes framework? At the moment, it provides a points incentive and a financial incentive for GPs to refer carers to social care services; but why not to other health services, if carers’ health needs are so important? Secondly, will he give guidance on the best questions used to indentify carers? When I recently registered with a new GP, the leaflet provided asked, “Are you a carer?” I knew what that meant because I am familiar with the policy debate, but most people would wonder what that meant—paid carer, unpaid carer?

I spoke at the event that launched the research into attendance allowance claimants by the Strategic Society Centre and Independent Age. There are 1.3 million older and disabled people in England with very high levels of need. The research shows that 35% of attendance allowance claimants are cared for by a son or daughter, 30% by a partner, and 15% by another family member. The DWP has that information. I hope the Minister will talk to his DWP colleagues about drawing up a proper action plan.

Thirdly, I want to join my hon. Friends in pressing the Minister on what action will be taken through the draft Care and Support Bill to identify young carers. Will he update us on his meeting with the Education Minister? What is the obstacle to amending the Children and Families Bill, the draft Care and Support Bill, or both? I tell the Minister that the Opposition will table relevant amendments if the Government do not.

I turn now to improving information and advice for carers. Carers UK says that a third of those caring full time for an older disabled or seriously ill friend or relative receive no practical support, and those who do often find that services do not fit around their particular needs, especially if they are struggling to hold down a job. As many Members have said, these services still too often end up offering last-minute help and support, when families have already reached crisis point. I pay tribute to my hon. Friend the Member for Corby (Andy Sawford), who talked about his nan. Before she got any support, a crisis point had already been reached. That was no good for her, and it is no good for taxpayers. More than one in five carers who have been admitted to hospital as an emergency case in the last three years say that it could have been prevented, had they been helped to look after their own health, or been given a break from caring or other forms of support. Given that money is so tight across the NHS and council care services, we have to get those up-front preventive services and support in place.

I have another practical suggestion for the Minister. As he knows, there is a brilliant national GP patient survey, run by Ipsos MORI, which provides detailed information about the needs of patients registered at a surgery. The last time I looked through it, I do not think there were any questions about whether the respondent was a family carer. It was about the needs of the individual patients, not carers. Such a question would provide us with some brilliant data that could be given back to individual surgeries as the basis from which to start developing support.

[Norman Lamb]

The GP survey is absolutely something that we can consider. If we can demonstrate how individual surgeries are performing against their responsibilities towards the whole family, and not just towards the person who is receiving medical treatment, we might well drive changes of behaviour in the surgery.

[Liz Kendall]

I am very pleased to hear that from the Minister and I will continue to follow it up with him. Including such questions in the survey would not cost any more and the data are collected by individual practice, so we would all be able to look at the GP surgery data in our own constituencies and ask what action plans were being followed. Clinical commissioning groups could be required to follow that up.

The third issue that many hon. Members have talked about is helping carers to stay in paid work. Families need the income carers get from paid work and our economy needs the skills and talents of carers. That challenge will only increase as our population ages and as more people live for longer and have to care for longer.

The biggest group of carers are people aged 50 to 65, many of whom still want and need to work. Many are women who, as hon. Members have said, are stretched at all ends. Some are looking after their children or grandchildren, or sometimes both, as well as caring for a frail partner or elderly relative and trying to hold down a job. To have one in three carers being forced to give up work or reduce their hours because the right services and support are not available does not make sense for our economy as a whole. The right hon. Member for Sutton and Cheam talked about the LSE and Age UK research that shows that that is costing more than £5 billion a year in lost tax revenues and increased benefit bills.

I strongly urge the Minister to talk to his colleagues in the Department for Business, Innovation and Skills about how the Government can do more to promote flexible working among family carers. We have made great progress in arguing that child care is part of our economic infrastructure, and, as the population ages, social care must be too. I believe that from cradle to grave, child care and social care must be the twin pillars of a reformed welfare state.

In conclusion, the draft Care and Support Bill is an important step forward and is very welcome. It builds on the recommendations of the Law Commission’s review into adult social care legislation, established and initiated under the previous Labour Government. Indeed, many of its recommendations were set out in our White Paper on social care, produced just before the general election. On its own, however, the Bill will not be enough.

Rights in law simply will not be delivered on the ground if the services are not available locally to make them a reality. Local council budgets for adult social care have been under pressure for many years, but they are now at crisis point as council budgets have been cut by a third under this Government. The Local Government Association says that councils have had to reduce their adult social care budgets by £2.7 billion over the past three years—that is a staggering 20%. The LGA says that

“eligibility thresholds cannot be raised much higher, 87% of councils are now at the substantial/critical threshold”.

That affects not just the statutory services, but the voluntary organisations that several hon. Members have rightly championed. Cuts from Leicestershire county council mean that CLASP carers centre in Leicester wonders whether it will even be able to survive. Many Members have talked about the important role of the voluntary sector, but without state funding many such organisations will not exist in future.

Will the Minister back calls from Opposition Ministers for £1.2 billion of this year’s NHS underspend, handed back to the Treasury in March, to be given to social care to ease the short-term funding crisis over the next two years? What representations has he made to the Chancellor on council care budgets for the spending review? Has his Department made the clear economic and social justice cases for preventing them from being slashed further? If any NHS funds are to be transferred to local councils in next week’s spending review, will they be specifically ring-fenced so that money gets through to the front line?

Ultimately, we need a bigger and bolder response to meet the needs of our ageing population and to help Britain’s carers. We need a fully integrated NHS and social care system with one budget. We should take the £15 billion spent on social care and the more than £100 billion spent on the NHS and join them together so that we get better care and better value for money for taxpayers. I believe that that is what Britain’s carers deserve.

--- Later in debate ---

[Norman Lamb]

The hon. Lady asks whether I have taken that message on board—I could not have missed it. I totally agree with what has been said and I am going to discuss the role of health professionals.

I know that there is a lot of concern about young carers, and it comes particularly from the hon. Lady. I said in the Queen’s Speech debate that I would meet the Under-Secretary of State for Education, my hon. Friend the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children and families, and I have done so. I appreciate that until something concrete happens the hon. Lady will, rightly, keep pressing. I give her my assurance, again, that I understand and accept the case she is making. My hon. Friend the Minister and I are entirely clear that our joint aim is to ensure that young people are protected from having to undertake excessive and inappropriate caring responsibilities. During debates on the Children and Families Bill, he confirmed that he and I are of one mind on the need to protect young carers by using a whole-family approach to the assessment of adult care needs.

The Care Bill itself is not the place to go into the detail of how assessments should be conducted; that will be set out in regulations and statutory guidance. A whole-family approach will undoubtedly benefit children, but I am keen that it also encompasses other significant family relationships. We need to look genuinely at the whole family, whatever the relationships are between those receiving care and those giving it.

In last week’s debate, my hon. Friend the Minister confirmed that his Department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need, and how we can ensure that children’s legislation works with adult legislation to support the whole family. I am clear that we have to address the concerns, and while we significantly advance the position of adult carers, we cannot leave young carers behind. The approaches do need to be different, because we need to recognise philosophically that children should not be caring inappropriately. Of course sometimes they have to do that, but we want to relieve the caring burden as far as is possible, while recognising that sometimes there will be a caring role for some.

[Liz Kendall]

Does that mean that there will be a requirement on schools, and on further and higher education bodies, specifically to identify young carers?

[Norman Lamb]

It is not my job to speak on behalf of the Department for Education, and the hon. Lady will have to be a bit more patient in waiting for further news on that subject.

Key principles to inform that work and discussion over the summer are, first, that the starting point should be assessing the needs of the adult or child who needs care and then seeing what remaining needs for support a young carer in the family has. The presence of a young carer should trigger either an assessment or the offer of an assessment to the person needing care. Secondly, a whole-family assessment is key when assessing an adult needing care where children in the family are providing care to the adult or undertaking wider family responsibilities. The adult’s assessment and eligibility for support should take into account their parenting responsibilities and the functioning of the family. Thirdly, assessments should establish why a child is caring and how to prevent—this is the crucial point—excessive or inappropriate caring responsibilities which could have an adverse impact on their education, social activities, emotional development or health. As much as possible we ought to be enabling a youngster to grow up like any other youngster can, without having inappropriate burdens on them that impact on their education and social life.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 11th June 2013 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. Talk to any A and E department in the country, and they will say that poor alternatives in the primary care sector are one of the things that are driving the pressures on them. It is important that we look at the structures put in place by the 2004 GP contract to see whether they are the right way to provide the care we need to give to older people.

[Liz Kendall (Leicester West) (Lab)]

Last week, the Select Committee on Health took expert evidence on the increased pressures in emergency departments and the causes of the worst A and E crisis in a decade. On Wednesday, the Chair of the Committee told this House that the 2004 GP contract

“is not why those pressures exist.”—[Official Report, 5 June 2013; Vol. 563, c. 1605.]

Will the Secretary of State tell us whether the right hon. Member for Charnwood (Mr Dorrell) is wrong?

[Mr Hunt]

I advise the hon. Lady to listen more carefully to what the Chair of the Select Committee said. He actually said that he agreed with much of what I said on the GP contract. While the Opposition are defending the status quo of the 2004 contract, independent support for reforming primary care is coming from the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association and even the head of the Royal College of General Practitioners.

Health and Social Care

Liz Kendall Excerpts

Monday 13th May 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a great pleasure to speak at the close of the debate after so many passionate and thoughtful speeches from hon. Members on both sides of the House.

My right hon. Friend the Member for Stirling (Mrs McGuire) and the hon. Member for Truro and Falmouth (Sarah Newton), who is not in her seat, rightly stressed that, although many debates on the future of health and care services focus on the needs of older people, social care is critical to adults of working age. My hon. Friends the Members for Bridgend (Mrs Moon), for Worsley and Eccles South (Barbara Keeley), and for Rotherham (Sarah Champion), spoke of the vital role of unpaid family carers, who are the bedrock on which the care system rests. They spoke particularly of the needs of young carers, who often feel that their childhood is being taken away from them by their caring responsibilities.

My hon. Friends the Members for Birmingham, Selly Oak (Steve McCabe), for Easington (Grahame M. Morris) and for City of Durham (Roberta Blackman-Woods) spoke of the growing crisis in social care funding, the increase in care charges that family members must pay, and the pressures on services and support. The hon. Member for Stafford (Jeremy Lefroy) gave, as ever, a thoughtful speech on how we might pay for NHS and social care in future. There will be different views on his proposals, but he made, as ever, a thoughtful contribution.

My hon. Friends the Members for Stretford and Urmston (Kate Green) and for Barrow and Furness (John Woodcock) rightly said that we have a duty to provide decent compensation and care for mesothelioma sufferers. My right hon. Friend the Member for Rother Valley (Mr Barron), my hon. Friends the Members for Vale of Clwyd (Chris Ruane), for Sheffield Central (Paul Blomfield), for Gateshead (Ian Mearns) and for Barnsley Central (Dan Jarvis), and the hon. Members for Salisbury (John Glen), for Mid Derbyshire (Pauline Latham) and for Strangford (Jim Shannon), spoke with passion about the Government’s failure to introduce standardised packaging for cigarettes to reduce premature deaths from smoking in this country. I hope the Government think again on that. Finally, my right hon. Friend the Member for Cynon Valley (Ann Clwyd) once again gave a direct voice to people who have suffered from unacceptably poor standards of care in the NHS. My right hon. Friend and all of us here are absolutely determined to stamp those out.

I want to focus on the measures in the Queen’s Speech on social care. The current legislation on adult social care is complex and confusing, and it needs reform. That is why the previous Labour Government set up the Law Commission review, which has led to many of the measures in the Care Bill. We support the new rights that the Bill contains; they build on the rights that Labour introduced in government, such as the right for family carers to request flexible working.

During the Bill’s passage, we will work to ensure that older and disabled people and their family carers get the best possible deal. We will seek to make amendments where there are serious omissions, such as the needs of young carers, or where improvements should be made, such as introducing free social care at the end of life. Organisations such as Sue Ryder and Macmillan Cancer Support have shown that such care can give people more choice about the place of their deaths and save taxpayers money by reducing the need for more expensive hospital care.

Those new rights, however welcome, risk being meaningless if people cannot get the services and support they need on the ground. That is the reality that hundreds of thousands of people now face. The 70 organisations that make up the Care and Support Alliance are clear that the Bill will not solve the crisis now engulfing social care. They warn that there is now a real danger that most people—not some, but most—will not get the help they need just to get up, dressed and out of the house as councils struggle to cope with swingeing budget cuts and growing demand.

Ever tighter eligibility criteria for council support mean that fewer older and disabled people get the help that they desperately need. Let us be clear. People talk about providing care and support only for people with substantial needs but not for those with moderate needs, but those latter needs are serious. I have seen in my constituency that “substantial needs” involve only people with terminal illnesses or who are incontinent or blind. There are many other very high levels of need. We are missing out support for those who desperately need it.

Even when people do qualify, they routinely face 15-minute home visits—barely enough time to get an elderly, frail, vulnerable person with dementia up, washed, dressed and fed. People wait a long time to get basic help such as grab rails and stairlifts so they are without the support for basic preventive care that helps people to live independently at home, which is what they and their families desperately want. Family carers are left struggling without the breaks that they need just to keep going or even a bit of emotional support and advice on the phone, as local voluntary organisations cut back and close.

The tragedy is not just that older and disabled people and their family carers suffer; it is that taxpayers end up paying more for the price of failure. Elderly people have to go into more expensive hospitals or residential care when they do not need to, because they cannot get the support they need in the community or at home. One in three family carers have to give up work or reduce their hours because they cannot get the help they need to care for their loved ones. Their own health suffers, which puts more pressure on the NHS, and their income suffers. The Treasury loses more than £5 billion a year in lost tax revenues and benefit bills because those family carers have to give up work.

The Government remain in complete denial about the scale of the care crisis we now face. They have been repeatedly warned by local councils about what the cuts in budgets and pressures on services mean. Councils are warning that in 15 years’ time they will not be able to provide the services that members of the community want and like—the libraries, leisure services and swimming —because of the pressures on local council adult social care budgets. The Government refuse to listen.

The Government are not being straight with people about their future plans either. The Prime Minister, Deputy Prime Minister and Health Secretary have repeatedly said that no one will have to sell their home to pay for their care. That simply is not the case. In future, all local authorities will have a duty to offer deferred payment schemes, lending people money to pay for their residential care. However, the loans will have to be paid back, after the elderly person has died, by selling the family home. The Government’s new scheme will charge interest on the loans, unlike under the current system, so people will lose even more of their family home than they do now. However, they have not told the public that they will be paying more, with that interest, under their new scheme. Will the Minister now come clean and tell families how much interest they will be charged? Will the Minister tell us how much interest families will be charged? Will he give a straight answer? He is not going to now. I hope he will when he responds to the debate.

Ministers also repeatedly claim that the Bill will cap the amount people are charged for their care at £72,000. The Health Secretary was at it again when he was at the Dispatch Box today, claiming that the Bill sets “a finite maximum cost” that individuals will have to pay. Again, that simply is not the case. The so-called cap on care costs is based on the standard rate local councils would pay for their residential care in their area—approximately £480 a week nationally—and not what people actually pay for their care. The 125,000 people who fund their own care fully, and many more who pay top-ups, will face far higher bills, particularly in the south and east of England. Government Members should take heed of that point, because if they tell their constituents that there will be a finite cap on their care costs, they will be sorely disappointed. The extra costs, above and beyond the standard rate that councils pay, will not count towards the cap. That means that older people will think they have reached it when they have not. In reality, it will take four years to hit the cap, yet the average length of stay in a care home is just over two years, and a quarter of people in care homes die after just a year. In other words, most people will be dead years before they reach the cap. Even if they are still alive, the state will pay only the standard council rate, leaving self-funders no choice other than to either leave the care home and move somewhere cheaper, or to pick up the extra costs.

The Government have failed to explain that people will not get their care for free if they have income or assets worth up to £123,000, the new increased upper means-tested limit. They will get care for free only under the lower means-tested limit, which is not being increased, and will be £17,500 in 2017. In between, there is a sliding scale of support. However, the way the means test works will mean that pensioners on average incomes—those who have worked hard and saved for a modest second pension of, say, £80 a week—will not get any council support, even with the increased upper means-tested limit, because councils calculate it by determining a notional income based on the capital in people’s homes. That, combined with the average pensioner income, takes them above the level at which they would receive council-funded support.

Government Members look surprised. That is unsurprising, as their Ministers have not spelled out the reality of the Government’s plans. Ministers should be straight about what their plans really mean, so that older and disabled people and their families can plan for the future properly. Instead, they tour the TV studios and make statements to this House giving false reassurances that are simply not borne out by the facts. We all know that people are fed up with politicians who say one thing and do another: claiming that people’s care costs will be capped when they will not, and claiming that raising the means test will help pensioners on average incomes with modest second pensions when it will not. I warn Government Members that that will not help to restore faith in politics or politicians, or help us to plan properly for the future.

Things could and should have been so different. Rather than forcing through their damaging and distracting backroom NHS reorganisation, the Government should have spent the last three years laser-focused on the service reforms people desperately need, shifting care out of hospitals and into the community and more towards prevention. Instead of diluting Dilnot’s proposals and then misrepresenting them to the public, they should have engaged in meaningful cross-party talks to agree a system that helps those on low and modest incomes, not just those predominantly at the top. And instead of driving greater fragmentation of NHS care services, jeopardising some of the best examples of integrated care, such as in Torbay, they should have adopted Labour’s plans for whole-person care, a single service with a single budget, funded through a year of care, that would shift the emphasis out of hospitals and into the community and result in better care for people and better value for money for taxpayers too.

Meeting the challenges of our ageing population is one of the biggest issues facing our country and society. We need a far bigger, bolder, straighter, clearer response, which this worn-out, divisive and divided coalition will never provide.

[The Minister of State, Department of Health (Norman Lamb)]

I thank hon. Members for their contributions to the debate.

Despite all the knocks that Opposition Members like to give it, the NHS is performing remarkably well, with 3.3 million more out-patient appointments, more than 500,000 operations, 1.5 million more diagnostic tests, the number MRSA infections halved and record low numbers of people waiting more than a year for their operations—just 665 people, down from 18,000 in 2010. These are real achievements for the NHS, and we should applaud and pay tribute to a really remarkable work force who have achieved these things despite tough economic times. The last Government rightly set in train £20 billion of efficiency savings, and those savings are being achieved despite the tough challenges.

Despite the doom and gloom heard during the debate, some brilliant things are happening in social care, including in some Labour authorities. In Leeds and Barnsley, for example, great things are happening, with people looking at new ways of doing things and redesigning services, recognising that times are tough and that, even under a Labour Government, they would face the same challenges. I recognise, however, that the system is facing real pressures, so it is disappointing that the Opposition, including the shadow Secretary of State and shadow Minister, the hon. Member for Leicester West (Liz Kendall), sought to polarise the debate by making exaggerated claims about the state of the NHS, when we all know the truth, which is that pressures are growing and have been for a long time. We have people living with long-term conditions, often for many years, and with a mix of mental and physical health problems. Those are the difficult cases sometimes clogging up our A and E departments, so let us have a mature debate about how we deal with the challenges.

We have a completely fragmented system and we are not spending money effectively to achieve the best possible care. Mental health is institutionally entirely separate from physical health, health care is separate from social care, and primary care is separated from hospital care. The whole urgent care system is under significant pressure. [Interruption.] I tell the shadow Secretary of State that on some of these issues we in fact agree more than he would sometimes like us to believe. The system is dysfunctional and we have to change it. We have had 4 million more people visiting A and E since the disastrous renegotiation of the GP contract by the last Labour Government. The hon. Member for South West Devon (Mr Streeter) talked about the significant pressures on A and E. Let me reassure him that Monitor and NHS England have issued a call for evidence on how the tariff system is working, with a view potentially to reforming it.

[Liz Kendall]

Does the Minister agree that in 2009, five years after the GP contract was agreed, 98% of patients were seen in A and E within four hours?

[Norman Lamb]

What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

--- Later in debate ---

[Norman Lamb]

I want to make some progress; I am conscious of the time.

The Bill will introduce a single failure regime, so that, for the first time, a trust can be put into administration because of quality failure as well as financial failure. Until now, it has been only the finances that can put a trust into administration. This Government recognise that quality failure is just as important, if not more so, and that such failure must carry consequences.

The stories recounted by the right hon. Member for Cynon Valley (Ann Clwyd) and the hon. Member for Bridgend (Mrs Moon) reinforce our determination to make improvements and to ensure that people get the best possible care. I again pay tribute to the impressive work carried out by the right hon. Lady, and I thank her for her work on complaints procedures. The hon. Member for Mid Bedfordshire (Nadine Dorries) also talked about the importance of compassion in good nursing care.

The Bill will make it a criminal offence for providers to provide false and misleading information. My hon. Friend the Member for Stafford (Jeremy Lefroy), who has done great work representing his constituents in the most honourable and responsible way, drew our attention to the importance of mortality statistics being accurate so that we can rely on them. Alongside this Bill, we will introduce the statutory duty of candour—something of which I am personally proud. It does not require primary legislation, but the Government will introduce it.

The funding of care is to be reformed so that there will be a cap on the care costs that people will pay in their lifetime. This is long overdue. Reform has been in the long grass for too long. Several hon. Members, including the hon. Members for Worcester (Mr Walker), for City of Chester (Stephen Mosley) and for Lancaster and Fleetwood (Eric Ollerenshaw), made the point that people will no longer have to sell their homes during their lifetime to pay for care. So often people have had to sell their homes in distress at the moment they go into a care home. When they cannot organise their affairs properly, they have to sell up to pay for care. No longer will that be the case. They can delay all those issues because of the right to deferred payments.

It is this coalition Government who have bitten the bullet on a very important reform. I am very proud of the fact that we are doing this, introducing a long overdue reform. Andrew Dilnot himself has strongly supported the Government’s action. That is happening together with a very significant extension of support—I take on board what the hon. Member for Leicester West said—to help people of modest means with their care costs. Each one of those measures would be significant by themselves. Together, they provide real optimism that we can shake off the shackles of the past and look towards the future, not with fear, but with optimism. The Opposition are wrong to dismiss the importance of this Bill. They should recognise just how much it could improve the lives of some of the most vulnerable people in society.

[Liz Kendall]

rose—

[Norman Lamb]

I am going to conclude.

We are two thirds of the way through this Parliament and we have already addressed big challenges that were ignored during Labour’s three terms in office. We have been and will always be 100% committed to an NHS that is not satisfied with mediocrity, but is always searching to be better, more focused, more helpful than ever before. Society is changing, drug costs are increasing and expectations are higher. The NHS and the social care system must change to meet those challenges and we are helping to make that happen, safeguarding the NHS now and in the future.

Ordered, That the debate be now adjourned.— (Mr Swayne.)

Debate to be resumed tomorrow.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 16th April 2013 Commons Chamber

[Dr Poulter]

Surely the validity of evidence is a matter for the court. I am sure my hon. Friend would recognise that there has to be a distinction between what we do here in Parliament and what is done in the courts. If NHS England would like to appeal the decision and if it thinks there are good grounds to do that, it must do that. The decision will then ultimately be made in the courts, on the basis of how valid that appeal is.

[Liz Kendall (Leicester West) (Lab)]

The best way to improve outcomes for heart disease patients and get the best value for public money is to help people to manage their condition at home. Will the Minister therefore explain the thinking behind the Government’s strategy of cutting one in five district nurses, so that delayed discharges from hospital due specifically to a lack of NHS community services rise by 40%, costing taxpayers £6 million a month as a result?

[Dr Poulter]

The hon. Lady and Opposition Members are fond of saying that we are cutting the NHS. It is their party that has said it will cut; they think it is irresponsible to increase funding for the NHS. We on the Government Benches have invested £12.5 billion more in the NHS. There are 6,000 more clinical staff working on the ground, focusing specifically on early intervention, early strategies and lifestyle. We now have almost 1,000 more health visitors working in the NHS and we have expanded the family nurse partnership programme. All these things will make a difference. Indeed, there is now a lot more joint commissioning between hospitals and primary care, to ensure that commissioning arrangements are in place better to support the role of community nurses and district nurses in preventive care and better look after people with long-term conditions.

Home Care Workers

Liz Kendall Excerpts

Wednesday 6th March 2013 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner, and to follow my hon. Friend the Member for Nottingham South (Lilian Greenwood) and all other hon. Members who have spoken.

I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing today’s debate. Home care workers often work in isolated environments, and the people who receive care are isolated. Too often, they do not have a voice, and one of our jobs as Members of Parliament is to provide a voice for the voiceless. My right hon. Friend has helped us to do that today.

The issue is extremely important. More than 800,000 people provide home care in the UK. Some 80% of them are women, and their median age is about 40. They provide vital, intimate and personal services to more than 1 million of the most vulnerable people in society. If any other policy area had that scale of figures, this debate would be on the Floor of the House, with many other hon. Members present. It is good to have hon. Members here in this debate, but the issue that requires addressing is a huge one.

The help that home care workers provide is crucial for older and disabled people, because it helps them do what they want, which is to stay living independently in their own homes. It is crucial for families, who often have to go out to work and cannot provide support and care for their elderly relatives. Also, they might not live nearby, as I know well myself. Home care help is crucial also for the public finances and taxpayers, because if we can keep more people living healthily and independently at home and not going into hospital, taxpayers will receive better value for money.

Like other hon. Members who have spoken today, I have been concerned about the issue for a long time. Last May, I held a domiciliary care summit in Parliament with the United Kingdom Homecare Association, with 50 providers coming along. I have work-shadowed home care workers in my constituency, including Amanda White. Going out on an early-morning shift with her was an eye-opening experience. I also speak to many older and disabled people and care workers in my constituency and across the country. Many of the points that I have heard have been repeated by right hon. and hon. Members today.

There are many examples of excellent, decent and respectful care. The home care workers to whom I have spoken, including Amanda, love their job. They feel that they are doing something important for vulnerable people, helping them to live the kinds of lives that they want. However, the overwhelming picture is of a vicious downward spiral, with ever-increasing demand and ever-decreasing budgets, poorly paid, motivated and trained staff, and poor-quality care. Just to summarise, I will go through five issues that many hon. Members have raised today.

The first issue is low pay. Many people do not get even the minimum wage at the end of the week, because they are not paid travel times. Unison’s survey, “Time to care”, which hon. Members have mentioned, found that half of those who responded said that they did not get paid travel time, rising to more than 80% in the private sector. King’s college London has found that between 150,000 and 220,000 people working in the social care sector get paid less than the minimum wage. I will ask the Minister some questions about that towards the end.

The second issue concerns shorter and shorter visits for people with higher and higher levels of need. It is important to remember that as budgets are squeezed, councils raise their eligibility criteria, so people who need care and support at home have greater needs but get shorter and shorter visits. According to the UK Homecare Association, three quarters of visits are for 30 minutes or less, and one in 10 visits are for only 15 minutes. As several hon. Members have said, that is completely inadequate to get someone up, washed, dressed and fed, particularly if they have dementia. Anyone who knows someone or has a family member with dementia will know that they often struggle in the morning, which is a really disorientating time.

[Jim Shannon]

One thing that carers provide to those on whom they call is a wee bit of a chat in the morning—someone to speak to—because many people have no one at all to speak to. When they come in, they light the fire and do all the things that the hon. Lady has mentioned, but communication between carers and those they visit is important. Does she think that that should be given more time?

[Liz Kendall]

Care and communication is vital for people with all sorts of frailties and conditions, but particularly for those with dementia, as carers try to keep their memories and brains going. Those people often feel lost in a fog, and having some kind of contact is vital to keeping them going, so it is important.

We have heard about the problems of call cramming, with carers being rushed, getting late to one client and leaving early for the next. Older people are worried when they are left waiting on their own, and staff are frustrated that they have to rush in and out.

The third issue that has been raised is zero-hours contracts. As hon. Members have said, such contracts are very bad for workers, because they find it difficult to budget and plan their lives. Zero-hours contracts make it hard to attract people to the sector. They are also terrible for the users—older and disabled people who do not get continuity of care. I cannot imagine someone coming round to get me out of my bed and take me to the shower. I would be naked and they would be washing me, but I would not know who they were, because they would often be different people each time. We would not put up with that for ourselves, and we should not expect it for older people either.

The fourth issue is the lack of training, which is a real problem in dementia care. It is only since having known people with dementia that I have fully understood why they are seen to get aggressive: they do not, but they are frustrated because they cannot remember things. Carers need detailed training for that.

The fifth issue is the vicious downward spiral or vicious circle that leads to poor care for users of services and real problems for staff. The last UK Homecare Association report states that vacancy rates are at 21%, so we are simply repeating the problems.

In my remaining time, I want to make three comments about why that is all happening and what we need to do. Clearly, demand has increased in recent years. However, as my hon. Friend the Member for Wirral South (Alison McGovern) said, when local councils’ budgets are being cut by a third, when adult social care is 40% of their budget on average and their biggest discretionary spend, and when the money that the Government say they have transferred from the NHS has not been ring-fenced, it is inevitable that care budgets are being cut. Figures from the Department for Communities and Local Government—the Government’s own figures—show that more than £1.3 billion has been cut from older people’s social care budgets since the coalition came to power.

There are a few deeper things going on. First, the caring profession is mostly delivered by women and is low-skilled. Such professions have always been neglected in the past, so that is a concern. Secondly, the problem is invisible: it concerns isolated staff and isolated, frail older people who do not have a voice. In talking about the care crisis, I always tell people that I have received five letters about the care crisis in my constituency and 99 about saving forests. I am passionate about forests, but getting only five letters on the care crisis shows that this is an issue of isolation and we should stand up about it.

[Andrew George]

Like the hon. Lady, I have shadowed care workers in my constituency. One point that often comes across is that when I ask those who pontificate from on high—criticising poor care standards and implying that it relates to the character of the people providing the service—whether they would be prepared to do this job, no one wants to do it, even at twice the salary.

[Liz Kendall]

I completely agree. That is why Unison’s report, “Time to Care”, which has given people a voice, is important.

The third fundamental issue is that our NHS and care system have not kept pace with changing demographics—people living longer—and changing needs and expectations. Families cannot always cope with caring for elderly relatives, and older people want to stay in their homes for longer. In the past, it was not the business of the NHS and social care to think about the home; its business was always about sending people to institutions.

What should be done? I want to raise four matters with the Minister. First, I know that the Low Pay Commission has looked at the minimum wage. Will he confirm, however, that as my right hon. Friend the Member for Oxford East said, Her Majesty’s Revenue and Customs has ruled that it is not legal to pay for travel time? If that is the case, what is being done about that? What action has been taken? In any other area, there would be legal action to enforce the minimum wage, so what is being done?

Secondly, I know that the Minister wants a shift to commissioning for outcomes, rather than by the minute. That is the Government’s policy, but how will he make that work in action? What are his levers over local councils? Thirdly, it is time to have a national strategy for improving training for home care workers. What are the Government’s plans?

Finally, although the announcement on the Dilnot cap is a step forward, Dilnot has always said, as the Minister will know, that proper funding is needed in the current system, which this Government have not produced. I know that he will be in intense conversations with the Treasury over the future budget. If, following the Budget, the Government decide to pull over more money from the NHS to social care, will he ring-fence that money this time?