Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 26th February 2013 Commons Chamber

[Anna Soubry]

Yes, it is always a great pleasure to meet my hon. Friend, and he raises an important issue. I have met a number of other colleagues to talk about their concerns about screening—or rather the lack of screening—for young women under the age of 25 in relation to cervical cancer. That is a concern and we look forward to working on that. I am very happy to meet my hon. Friend.

[Liz Kendall (Leicester West) (Lab)]

The Government have been woefully complacent about producing their sexual health strategy. The Minister constantly says that responsibility for decisions lies locally, but will she admit that the Government’s reorganisation has created huge confusion, splitting the commissioning of sexual health services between GPs, councils and the national board, and that the Government’s lack of interest has delayed the sexual health strategy by 21 months? Will she explain the reasons for the delay, and when the strategy finally comes out, will she commit to it addressing seriously the rationing of access to contraceptive services for women aged over 25?

[Anna Soubry]

Is it not remarkable to have criticism of a reorganisation from someone who supported a Government who had nine reorganisations in nine years? The sexual health strategy document is very important, which is why we are working hard to ensure that it is absolutely right. I re-wrote a large section to ensure that it will deliver—[Interruption.] I do not know why the hon. Member for Hackney North and Stoke Newington (Ms Abbott), from a sedentary position, says “Ah.” It is an important document and we want to get it right, and I am sure she will welcome it when it is published. However, let me make it clear: any delay in the document is not preventing rightful commissioning at a local level. I saw that yesterday when I went to Bedford and met the Brook organisation and the Terrence Higgins Trust, which have long been engaged, certainly in that county, in a tendering process from the local authority to continue to deliver excellent services.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 15th January 2013 Commons Chamber

[Dr Poulter]

Bursaries are already available to medical students to encourage recruitment to the medical profession. As for the specific question of A and E recruitment, at the end of last year I published—alongside the report from the Doctors and Dentists Review Body on the consultant contracts and clinical excellence awards—a report on junior doctors in training. That has given us an excellent opportunity to consider what rewards and inducements may be available to encourage junior doctors to move into A and E and other specialties in which the work is particularly intensive and the meeting of staffing requirements has posed a long-standing challenge.

[Liz Kendall (Leicester West) (Lab)]

The Government say that the number of doctors in the NHS has increased by 5,000 since they came to power. When did those doctors start their training?

[Dr Poulter]

We know that it takes five or sometimes six years for doctors to complete their medical training. The key difference is that under the plans left by the last Government not all doctors were guaranteed places of work in the NHS after completing their training, whereas the present Government are ensuring that they find NHS jobs. That is why we have 5,000 more doctors in the NHS. The same applies to midwives: under the last Government they were not finding places after completing their training, but under this Government they are, and there are 800 more of them.

Dementia

Liz Kendall Excerpts

Thursday 10th January 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to have listened to so many excellent and moving speeches from both sides of the House. This is by far the best debate I have sat through since becoming a Member of Parliament and I feel very lucky to be part of it. I thank the Backbench Business Committee, and warmly congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), my right hon. Friend the Member for Salford and Eccles (Hazel Blears), and the hon. Member for Chatham and Aylesford (Tracey Crouch) on securing this extremely important debate.

As we have heard many times today, dementia is a cruel and distressing disease that affects an increasing number of people in this country. Like many hon. Members who have spoken, I have seen the impact that dementia has had on my constituents and in my own family. Women in their 60s and 70s are seeing their once proud, sharp and vivacious husbands not only struggle to get up in the morning or go to the toilet, but to finish sentences and remember key points of their married lives together, and their hopes of having a great retirement with the person they love are fading away. Sons and daughters are trying to help their mums and dads walk, talk and feed themselves—just as they used to do for them—and coping with the terrible shock when their own parent does not recognise them or seem to know who they are.

Dementia is distressing not only because of the physical impact it can have on the person with the condition and the practical struggle that many families face in caring for their relatives, but because it affects something so essential to our humanity—our relationships with our families and the people we love and care for most. Relationships are based on memory and shared experiences. If memory fades and those experiences and relationships are lost, it feels as if the disease is taking away the essence of the person we love and therefore something fundamental about who we are too.

People are frightened of dementia because they fear it will destroy their minds and relationships as well as their bodies, and because they think that nothing can be done. That, however, is not the case. Although there is currently no cure for dementia, as many hon. Members have said, with the right care and support, people with dementia can enjoy a good quality of life, even in advanced stages of the condition.

Hon. Members have spoken passionately about services in their own constituencies and places they have seen. Last year I visited a day care centre, Dove House in Barnet, provided by the fabulous Alzheimer’s Society. The people there told me how going to that day centre and having stimulating, non-medicating help and support such as gardening, cooking, singing or music, had brought their loved one back to life in a way they did not think was possible, and also that they had got a desperately needed break and therefore their relationship had improved.

There is superb residential care for people with advanced dementia at Fountain Court in Wolverhampton, which I visited last year. It is run by an inspirational manager, Michaela Wilson, who demonstrates the kind of creative thinking mentioned by my hon. Friends the Members for Liverpool, Walton (Steve Rotheram) and for Bridgend (Mrs Moon), and many others. I will give two brief examples of that.

First, there was one resident who never took a cup of tea. Michaela Wilson was worried about that because people need hydration, but she saw that he kept tapping his pocket and realised, “Ah. He is used to having change in his pocket and thinks he is supposed to pay for this.” She gave him change every morning; he put it in his pocket, it always fell out, but he took a cup of tea.

There is a second example of such creative thinking. The home is brilliantly designed—lights go on when people get out of bed, and doors open. There was a yellow toilet seat because people with dementia recognise colour, but one guy kept getting out of the other side of the bed and going to the toilet in the bin. The staff were getting a bit annoyed, so Michaela Wilson said, “At least he recognises he’s supposed to go to the toilet somewhere,” so they put a second bin there. The man slept better and was more relaxed. It was a fantastic service.

The quality of dementia care is changing, but not quickly enough and not in enough parts of the country. Many hon. Members have said that we need to do for dementia over the next 10 years what we have done for cancer over the past 20 years. Above all, we need to give people hope that something can be done. That is essential in ensuring that everyone gets an early diagnosis, because people do not want to come forward if they believe that nothing can be done if they are diagnosed.

We must do even more to raise awareness of dementia and to tackle the stigma many people still feel, so that they are not embarrassed if their husband, wife, mum or dad butters the plate and not the toast in a café, or if they cannot order from the menu. We must transform information for families and say what dementia is, how it can affect them and what help and support is available. There are many different bits of information in different places, but for such a distressing condition, we need to bring it together.

NHS social care and voluntary services must work far better together—that point was made by many hon. Members, including the hon. Member for Hexham (Guy Opperman)—so that families do not have to battle different parts of the system when they are already distressed enough. Care and support must be personalised to each individual and their family. Dementia affects people’s memory and the way to reach out to them is by finding a hook into that memory, so care and support must be highly personalised.

That has radical implications for the education, skills and training not just of nurses and care assistants, but of general practitioners and managers, who must hold their staff to account for the care they provide. That is particularly relevant in communication skills, as my hon. Friend the Member for Bridgend has said, and, as many hon. Members have said, we need further progress in dementia research.

The Labour Government began the journey towards delivering better dementia care—I am grateful that the right hon. Member for Sutton and Cheam recognised that. In 2009, we launched the first ever national dementia strategy, “Living well with dementia”, which began the process of establishing memory clinics, providing better training for GPs, and improving the quality of dementia care for people in hospitals.

In early 2010, we appointed the first national clinical director for dementia and commissioned a quality standard for dementia from the National Institute for Health and Clinical Excellence. The current Government’s dementia challenge builds on many of the improvements Labour introduced. I welcome the increase in funding for dementia research and the aim of creating more dementia-friendly communities. If the Alzheimer’s Society in Leicester, Leicestershire and Rutland is anything to go by, I am sure the Alzheimer’s Society nationally will do a superb job in recruiting and training volunteers as dementia friends.

However, we need to assess those initiatives against the wider and—I would argue—far bigger impact of the Government’s policies on the NHS and local council social care. Let us look at district nursing, which is just one essential aspect of better dementia care. Those vital nurses work alongside GPs, care assistants and other staff to help people who usually have dementia and another condition—co-morbidity and multi-morbidity are the big challenges we face. District nurses help people to stay healthy and well, living in their own homes, but 1,400—one in five of the total—have been cut since the coalition came to power. That is not good for patients, but it is not good for taxpayers either, because people with dementia end up in more expensive hospital or residential care when they cannot get the support they need to stay at home, which is what they want to do.

Delays in patients being discharged from hospital specifically because of a lack of NHS services in the community—this is not about social care, but about NHS in the community—such as district nurses have increased by 38% since August 2010. The delays cost the NHS £6 million every month.

If the problems and difficulties in the NHS are bad, those in social care are far worse. More than £1.3 billion has been cut from local council budgets for older people’s social care since the Government came to power. As my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said, council budgets are being cut by a third. Adult social care makes up about 40% of that budget and is councils’ biggest discretionary spend. Any money that is going across from the NHS is not ring-fenced, so inevitably those services are suffering. Councils are doing their best to save money by changing the way care is provided and by working more closely with the NHS. Faced with the scale of cuts to council budgets, however, many have little choice but to restrict the number of people who qualify for help, reduce day care services and increase charges for vital support, such as home help and residential and respite care, if they are to balance the books.

That is having a real impact on people with dementia. We are seeing an increasing number of 15-minute home visits. They are simply not long enough to get a very frail and distressed elderly person with dementia up, washed, dressed and fed, and end up costing the taxpayer more. The Alzheimer’s Society says that one in five people with dementia are admitted to long-term care institutions earlier than would have been the case had they received the right support at home.

There is a dementia challenge, but we cannot tackle the crisis in dementia unless we tackle the crisis in care. That means addressing the current and growing crisis in social care and putting in place a better, fairer system for the future. This is not an easy thing to do, as Labour discovered when we were in government. We have welcomed Andrew Dilnot’s recommendations on long-term care funding as a step towards a better, fairer system. We initiated cross-party talks on this vital issue, which unfortunately broke down when the Government unilaterally issued their own progress report on funding care and support, but I want to state clearly for the record that if the Government were serious about those talks we would be back in like a shot. We now see media reports that the Government intend to implement the Dilnot principles, but not until after the next election, and put a cap on care costs at £70,000 or above, rather than the £35,000 Dilnot recommends. Dilnot says that

“moving outside the range of £25,000 to £50,000 could mean that the overall reforms would fail to satisfy our criteria on fairness and sustainability.”

Capping care costs above £50,000 would mean

“people with lower incomes and lower wealth would not receive adequate protection.”

A £75,000 cap would not even help many families on middle incomes. The long-term care insurer, Partnership UK, says that a person paying the average cost for a single room in a nursing home in the south-east would not hit the cap for five years because that care is so expensive. The average length of stay in Bupa care homes is about two years. In other words, the person would die before they reached the cap. There is a concern that a £75,000 cap would not encourage people to take out insurance because the premiums would not be affordable. If these reports are true, will the Minister stop, think again and get around the table for cross-party talks, so that together we can put in place a decent, fair and sustainable plan for the future?

In conclusion, we need fundamental reforms to transform dementia care. We need one care system, not separate systems for people’s physical, mental and social care needs. We need care and support that is radically reshaped around the needs of individuals that involves their families and the wider community, and is provided by NHS and social care staff with the right skills, training and understanding. Like my right hon. Friend the Member for Salford and Eccles, my parents taught me the values of justice and fairness. In the century of the ageing society, we will deliver justice and fairness to people with dementia only if these reforms are made. I hope that that is something Members on both sides of the House will work together to achieve.

Liverpool Care Pathway

Liz Kendall Excerpts

Tuesday 8th January 2013 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this extremely important debate and on his heartfelt but calm and thoughtful opening speech, which set exactly the right tone. How we care for the dying is a measure of how we care for all sick and vulnerable people. It is a litmus test not only for the NHS and the wider care system but for society as whole.

This debate comes at an important time because, as the hon. Gentleman said, in recent months growing media attention has been paid to the Liverpool care pathway. Several Members have talked about the misconceptions and the inaccurate information that has been published about it. I have read the recent consensus statement from 22 patient and professional organisations and also the full care pathway documentation, and it is clear to me that the Liverpool care pathway is not in any way about ending someone’s life but about supporting the delivery of excellent end-of-life care.

The pathway does not seek to replace clinical judgment; it is not a treatment but a framework for good practice. It does not seek to hasten or indeed delay death, but to ensure that the right type of care is available for people in the last days or hours of life, when all the reversible possibilities for their condition have been considered. I do not believe that it is a deadly or lethal one-way street. Precisely because it is not always easy to tell whether someone is very close to death, the pathway emphasises the need for constant and regular review, and if a patient’s prognosis changes, their care needs should be reassessed and, if appropriate, the use of the pathway stopped.

The pathway does not preclude the use of clinically assisted nutrition or hydration; in fact, it explicitly states that patients will be supported to eat and drink for as long as possible. It absolutely emphasises that wherever possible patients must be involved in decisions about their care, and that carers and families should always be included in decision making. Such involvement of patients and families is enshrined at the very heart of the Liverpool care pathway.

[Robert Flello]

Does my hon. Friend agree that if there is no consultation, and there is denial of care and of treatment that eases pain, it is not the Liverpool care pathway?

[Liz Kendall]

I absolutely agree. The issue we face is less about the pathway itself and absolutely about how it is implemented in practice. The pathway document states on its very first page that the pathway is only as good as the teams who use it.

There has clearly been an issue about taking a pathway that was developed by experts in one part of the country over several years, with regular training and audit, and trying to implement it across the wider NHS. Individual patients and families—as we have heard—and also the national audit of the Liverpool care pathway, suggest that there are genuine problems with communication. Too many patients and families are not properly informed about what the pathway is and how it works, and they are not effectively involved and their consent not sought at every stage and on all the necessary decisions. One incident in which patients and families are not fully and sensitively involved is one too many. It is not acceptable, and it directly contradicts the very essence of the Liverpool care pathway and its key principles and values.

[Rosie Cooper]

Will my hon. Friend give way?

[Liz Kendall]

If my hon. Friend does not mind, I will not give way as I do not have much time.

I welcome the fact that the issues are now being looked into. I understand that three separate reviews are being undertaken. The national end-of-life care programme is doing a short, snapshot review of complaints about the use of the Liverpool care pathway, the Dying Matters coalition is working with families whose loved ones have been on the pathway, to see what worked well and what did not, and the Association for Palliative Medicine and a range of other national organisations are talking to clinicians, to get their opinions regarding integrated care pathways in the last days of life, of which the Liverpool care pathway is one.

In November, the Minister said he would appoint an independent chair to co-ordinate the work of the different reviews, so I ask him: has a chair now been appointed? Will the chair, the Department of Health or any other organisations consider any additional issues, alongside the work that is under way? For example, will the way in which the Liverpool care pathway is paid for be reviewed? It is important that hospitals receive proper payment for the care they give and for any associated training, but any evidence that patients are being put on a pathway for financial reasons is a serious matter and is totally unacceptable.

Will there also be a review of the education and training in end-of-life care for new and existing staff, in particular training in how to discuss difficult, complex and emotional issues with patients and their families? One of the real challenges is that the process of death and dying is so uncertain. A patient’s prognosis is not always clear; the situation changes. Doctors are used to treating and curing, giving clear evidence, treatment and advice—or they are trained to do so—but it is not always possible.

I want to finish on a broader point, which is important for us in this House. The difficulty that NHS and care staff, the media, families and the public have in discussing end-of-life care reflects wider society’s lack of familiarity with death and dying, which was not the case 100 years ago. Age, cause and place of death are generally very different now from what they were at the beginning of the last century, when a far greater proportion of deaths occurred in childhood or early adult life, often from acute infections, with most people dying at home. Now, more than two thirds of the 500,000 deaths a year are among people aged over 75, most of them following a long-term illness such as heart disease, cancer, stroke, chronic respiratory disease or dementia, and most are in hospitals and care homes.

Many people do not, therefore, experience the death of a loved one until they are well into mid-life. We do not see dying people and dead bodies—not for real. We see them on television and in computer games but not in real life, and we do not talk openly in society about death. I know that in all our families it is difficult to discuss death, but in the century of the ageing society, with chronic conditions as the major cause of death and disease, that must change.

As the hon. Member for Banbury (Sir Tony Baldry) said, death comes to us all, and we should strive for as good a death as possible. That will, of course, mean different things to different people—I would like to go quickly, and I hope that the people I love go quickly, too, and do not have a long, slow death.

[Rosie Cooper]

We will not be bumped off.

[Liz Kendall]

Indeed, or have a premature death. For many of us, a good death means being treated as an individual with dignity and respect, without pain and suffering wherever possible, and in a familiar environment surrounded by the people we love. We need a full and frank debate about these difficult issues, handled calmly and sensitively and based on evidence and fact rather than on myths and misconceptions. Dying matters, not just to the NHS and the wider care system but to us all, and for that reason I am grateful to the hon. Member for Montgomeryshire for securing the debate.

Thalidomide Trust (Grant)

Liz Kendall Excerpts

Thursday 20th December 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank the Minister for the advance copy of his statement.

Thalidomide survivors waited far too long for Governments over many years to address the appalling physical and emotional difficulties that they faced as a result of thalidomide prescribed by the NHS from 1958 to 1961. The last Government took the first steps towards addressing this unacceptable situation. In January 2010, the then Minister of State rightly offered our sincere regret and deep sympathy for the injury and suffering endured by all those whose expectant mothers took the thalidomide drug. I want to repeat that sincere regret and sympathy today.

The previous Government also acknowledged the urgent need for extra help for thalidomide survivors to meet their care and support needs, by putting in place a three-year pilot scheme. The pilot, as this Minister said, has helped survivors to improve the quality of their lives and to cope with their increasing loss of mobility and independence as they get older by helping them to buy and put in place the things that they say make the most difference to their lives.

I welcome the Minister’s announcement that the Government will continue the scheme for 10 more years with a grant in the region of £80 million. That will mean a huge amount to the 431 thalidomide survivors living in the UK today. As the Thalidomide Trust says, the money will allow one survivor with no arms to buy the special adaptations she has been unable to afford, and a man with no legs to make a down payment on a van adapted so that he can drive it from his wheelchair. It will allow a deaf thalidomide survivor to continue to employ someone to be her signer when she goes out so that she can retain her confidence and ability to remain active and mobile.

I have a number of questions about the scheme that I hope the Minister will answer. He will be aware that Scotland, Wales and Northern Ireland made proportionate contributions to the fund set up by the previous Government. Will the devolved Administrations make similar contributions to the fund he has announced today? He says that the grant will be reviewed annually, but there might be concern that that is not as stable as some survivors would like. Will the Minister guarantee that the views, needs and concerns of survivors will be at the heart of those reviews, and will he explain why we need an annual review, and not a three-year review as under the previous Government?

Will the reviews look specifically at the increasing needs of thalidomide survivors as they get older? Evidence collected over the past two years confirms that their health and mobility is deteriorating rapidly now that they have reached their 50s. Because of those increasing needs, will the Minister commit today to ensuring that there will be no less funding in the years ahead?

I will conclude, as the Minister did, by thanking and paying tribute to the work of the Thalidomide Trust, its national advisory council, and all campaigners who have fought to make successive Governments face up to their responsibilities. Members across the House sincerely regret how badly thalidomide survivors were let down, and we will strive to ensure that that never happens again.

[Norman Lamb]

I appreciate the shadow Minister’s support for today’s announcement and she is right to say that people have waited far too long for an acknowledgment of the tragedy and for practical action. I acknowledge—as I did in my statement—the actions of the previous Government in initiating the pilot scheme, and the expression of regret made by the former Health Minister. One powerful thing about the scheme, as designed in the original pilot, is that it gives maximum power to the individual to determine and respond to their priorities and needs. That means that the money can be used in a host of different ways, as the hon. Lady described.

The hon. Lady raised a fair point about the devolved Administrations, and we must be equally concerned about thalidomiders in Scotland, Wales and Northern Ireland. The devolved Administrations did not feel able to commit to the 10-year period here and now, but they are fully committed to continuing that help and we will work closely with them to ensure that individuals in those Administrations are not left behind in any way.

The hon. Lady rightly mentioned the annual review, which is a question of proper accountability. The trust has done a brilliant job and I acknowledge its work. It is a completely responsible organisation that knows better than anyone how best to deploy the available resources, but as it acknowledges, it is right for it to be held to account for how public money is spent. There is no intention at all to question the purpose of the grant, and we want to give the certainty provided by the 10-year period. The fund will be index linked so that the value of money from the pilot scheme is maintained throughout that period. The review is simply to ensure that the scheme still makes sense and that we are using the available resource in the best possible way. I have every confidence that that will be the case and, as the hon. Lady requested, the needs of the thalidomiders who benefit from the money will be put at the heart of the reviews. We will not let those people down in the commitment that we are making today, and the funding will be maintained.

The hon. Lady rightly talked about deteriorating health because the body has been under such extraordinary strain. I spoke to thalidomiders earlier today. It is remarkable what their bodies have been able to do, often in the absence of limbs, but that puts an enormous strain them, and the wear and tear is now having its effect. We do not know what the prognosis is going forward. It is therefore right to take stock and see what their needs are after a 10-year period, but the commitment to those people must remain.

NHS Funding

Liz Kendall Excerpts

Wednesday 12th December 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

During this debate, Ministers and the few Government Members who have spoken have either denied that the Government have broken their promise to increase NHS spending or have claimed that it does not matter, as if the Prime Minister’s clear, direct and personal pledge to voters can easily be swept to one side. They—perhaps with the exception of the hon. Member for Southport (John Pugh)—have also skated over or ignored the waste, confusion and utter distraction of their back-room NHS upheaval.

In contrast, Opposition Members have talked about the harsh reality of the double whammy of cuts and reorganisation on their constituencies. My hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friends the Members for Lewisham, Deptford (Dame Joan Ruddock) and for Rother Valley (Mr Barron), my hon. Friends the Members for Corby (Andy Sawford), for Bolton West (Julie Hilling) and for Easington (Grahame M. Morris), and the hon. Member for Strangford (Jim Shannon) spoke powerfully about their concern that changes to local services are being driven by money alone, not by improving patient care. I also pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who spoke with bravery and compassion about the unacceptable standards of care in parts of the country, which must be tackled.

Perhaps the most worrying example of the combination of cuts and reorganisation that the Government are forcing through involves what is happening to cancer networks. Those groups of local specialists were set up more than a decade ago under Labour’s 2000 cancer plan to help tackle one of Britain’s biggest killers. It is widely acknowledged that cancer networks have played a central role in improving mortality rates, cancer survival rates and equality of cancer care, and they have done that on small budgets with few staff, offering good value for taxpayers’ money. Crucially, the specialist local skills of cancer networks are vital to making even greater improvements that cancer patients need and deserve in the future.

Ministers have repeatedly promised to protect budgets for cancer networks. On 31 January last year, the then Health Secretary told the House that

“cancer networks funding is guaranteed during the course of 2011-12.”—[Official Report, 31 January 2011; Vol. 522, c. 612.]

On 27 November this year in a debate on the NHS mandate, the new Health Secretary told the House:

“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]

Those promises have been broken.

In response to a freedom of information survey from Labour, cancer networks report budget cuts of 13% in 2011-12 alone—[Interruption.] The Secretary of State shakes his head but he can look through all the figures, including individual examples, if he wants to see those cuts. In total, budgets have been slashed by 26%—by a quarter—since the Government came to power.

The Government’s national cancer director, Professor Mike Richards, at least has the honesty to say that

“cancer networks will have a smaller proportion of the budget in future.”

I understand that the Health Minister in the House of Lords, Earl Howe, has also been forced by an urgent question to admit that less money will be available to cancer networks.

[Mr Jeremy Hunt]

Will the hon. Lady give way?

[Liz Kendall]

I will, of course, give way to the Secretary of State.

[Mr Hunt]

First, these networks are brilliant. They are a good thing and they have done a huge amount. The Government support them and we are expanding them. That is why instead of just having cancer, cardiac and stroke networks, we will also have networks for dementia and maternity. The budget for those networks is going up by 27%.

[Liz Kendall]

The budget for cancer networks has been cut by a quarter. The Secretary of State is not expanding those networks but merging them and diluting their specialist expertise, as I will show. The cuts and the Government’s NHS upheaval mean that cancer networks have lost one fifth of their staff, withdrawn or scaled back current work, and put future projects on hold—[Interruption.] The Secretary of State is still denying that so let me tell him what the networks actually say.

The Arden cancer network in Coventry and Warwickshire says that it has lost its vital chemotherapy nurse. The Peninsula cancer network in Devon and Cornwall says it has had to turn down £150,000 from Macmillan Cancer Support to fund a programme for cancer survivors because its future is so uncertain. Essex cancer network says that posts have been removed, its staff are in a redeployment pool, and that it will have

“no presence in Essex from April 1st next year.”

Instead of supporting those vital local experts, as well as specialists in heart and stroke networks, the Government are merging them into 12 generic clinical networks that cover bigger geographical regions and far more health conditions. No one is against sharing the skills and experience of cancer and cardiac networks. However, as Maggie Wilcox, a former palliative care nurse, breast cancer patient, president of Independent Cancer Patients’ Voice and the layperson on the recent review by the Department of Health into breast screening said,

“subsuming cancer networks into generic clinical networks could be disastrous for cancer patients…you cannot be both a specialist and a generalist.”

That is especially important in an area as complex and fast-developing as cancer. Staff will not be able to make the same depth or scale of improvements if they are forced to cover a large area and more conditions with fewer members of staff.

The Secretary of State ploughs on regardless, denying that there is a problem and telling BBC Radio 5 Live that it is too early to know what will happen. How utterly complacent and out of touch. Networks are already disappearing. Their staff have left or are looking for jobs because their future is in such disarray. With their reckless NHS reorganisation, the Government have wasted not just taxpayers’ money but the knowledge and expertise of specialist staff, and patients are paying the price.

[Mr Hunt]

With respect to the hon. Lady, we have increased the budget for strategic networks by 27%. What would have happened to that budget if we had a lower NHS budget, as her party’s Front Benchers have been arguing for?

[Liz Kendall]

I do not think the Secretary of State understands that in a really complex and fast-developing area such as cancer, we need to know about individual, specific issues and concerns. If there are fewer staff covering bigger areas and more health conditions, we will not get specialist expertise.

If the Secretary of State does not believe me, perhaps he would like to comment on what Dr Mick Peake, the clinical lead for NHS cancer improvement and the national cancer intelligence network, has said. He has stated:

“With the shift towards GPs commissioning, the need for this expert…clinical advice will become ever more crucial…I am worried that in the process of reorganisation of the networks…we will lose many expert and very committed individuals, and that this could impact on the quality of commissioning and cancer services in the future.”

What will be the impact on patients, who are what the network is supposed to be about? Let us take prevention. Who has championed prevention by increasing the uptake of screening programmes? Cancer networks. Who trains GPs to spot the signs of cancer so that patients get earlier diagnosis? Cancer networks. Who has helped patients get their tests and scans done in days, not months, and slashed waits for cancer specialists to two weeks? Who has helped hospitals compare their performance, use the best drugs and treatments and transform patient information and support, and who has been central to setting up the new national cancer outcomes database, which the Government rightly say will help reduce cancer variations and drive improvements in future? Cancer networks. So why is the Secretary of State diluting—[Interruption.] Oh, now he switches to talk about the cancer drugs fund, because he knows that by stripping away vital local expertise, he is putting care at risk.

When the Secretary of State tells Radio 5 Live that he does not know why Labour is flogging this issue, calls cancer networks a mere pilot and says that his upheaval will be in patients’ best interests, cancer specialists, patients and Opposition Members know that he is wrong. We know that he cannot sustain the progress on cancer and make even more improvements in future when he is ripping away the foundations of better cancer care. As Earl Howe has just told Members of the Lords, it is “perfectly correct” that the share of the pot that cancer networks will be able to get will be smaller next year than it is this year. I rest my case.

The Prime Minister said that he would increase spending on the NHS, but NHS spending is lower in real terms today than it was when Labour left office—broken promise No. 1. Health Ministers repeatedly claim that they have protected cancer network budgets—broken promise No. 2. No top-down NHS reorganisation, mental health a priority and social care budgets protected—broken promises three, four and five. The list goes on. The Prime Minister claims that his priority can be summed up in three letters—NHS. That very same organisation is responding with its own three letters—SOS. I commend the motion to the House.

Winterbourne View

Liz Kendall Excerpts

Monday 10th December 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I would like genuinely to thank the Minister for advance sight of his statement and the briefing I received earlier today. Members on both sides of the House were appalled and angered by the terrible incidents at Winterbourne View, and we share a determination to ensure that all necessary steps are taken to prevent a similar tragedy from happening again. Our goal must be to ensure that everyone with a learning disability or autism, including those with challenging behaviours, receives high-quality, decent and humane care and support, and that we finally end the practice of sending people to long-stay institutions, far away from their family and friends.

The Minister has announced a number of welcome measures that are a step in the right direction, but I remain concerned that some of the proposals are not clear or strong enough to guarantee the fundamental changes that people with learning disabilities urgently need. The NHS mandate published two weeks ago states there should be

“a substantial reduction in reliance on inpatient care.”

Can the Minister give a figure for that reduction? Without one, that laudable aim will be open to such wide interpretation that it risks appearing meaningless. Similarly, the Government say they want every local area to provide “appropriate” care and support. Will the Minister tell the House who will define what care is “appropriate” and how that will be measured?

How will the Minister ensure that all local commissioners have the necessary skills to make these changes? That was a problem with 150 primary care trusts, yet in future there will be 212 clinical commissioning groups. Those can, of course, draw on expertise in local councils, but the authorisation process for CCGs does not even mention learning disabilities as an area in which competence is required. If this is such an urgent national imperative for the Government, will the Minister explain why that is the case?

Some parts of the country continue to use long-stay institutions because they have not developed alternative care in the community and at home. In a time of constrained resources, when we need to make the best use of taxpayers’ money, there should be one budget for people with learning disabilities, not separate budgets for NHS and council care. Will the Minister explain how he will make that happen on the ground? For example, will he require the NHS Commissioning Board to instruct CCGs to provide funding to local councils if they are slow to do so or if they refuse?

The serious case review of Winterbourne View said that light-touch regulation by the Care Quality Commission was not appropriate for closed establishments, and that they should be treated as high-risk institutions, requiring frequent, unannounced probing investigations. The review says that the investigations should involve speaking to residents’ families and patients, and in particular to people who have left the institution, who may feel more able to speak out. The CQC recently completed a focused programme of inspections of long-stay institutions. Will that specific programme continue along the lines the serious case review recommends? Will the Government, in their review of the use of restraint, consider banning t-supine restraint, as the serious case review recommends?

One of the most disgraceful aspects of Winterbourne View is that vulnerable people were neglected and criminally abused while the hospital’s owners, Castlebeck, charged huge fees and made huge profits. The serious case review says that Castlebeck made decisions about profitability, including shareholder returns, over and above decisions on the effective and humane delivery of treatment. The average weekly fee for residents at Winterbourne View was £3,500—the fee rose to £10,000 for one patient. The review could not determine how much of that money went back into the hospital and how much was creamed off for profit because of the company’s complex financial structure—Castlebeck is owned by private investors based in Jersey and Geneva. That has made it virtually impossible to hold the company to account. Will the Minister confirm that the company has so far failed to meet two of the serious case review’s key recommendations —that it should fund therapeutic services for all ex-Winterbourne View patients, and that it should pay for the costs of the serious case review, which have so far been borne entirely by the taxpayer?

I welcome the Government’s commitment to examining how corporate bodies and their boards of directors can be better held to account. As a first step, will the Minister consider requiring private companies to publish the names of their owners, the members of their boards, and the details of their financial structures, before they can be licensed and registered to provide publicly funded care? The excuse that such information is too commercially sensitive should not be acceptable when the care of vulnerable people is at stake, and when it is paid for using substantial amounts of taxpayers’ money.

How we care for the most vulnerable people is the hallmark of a decent society. I do not doubt the Government’s commitment to addressing this issue. I hope they listen to our concerns and strengthen their proposals, so that people with learning disabilities get the decent and humane care and support we would all wish for our families and friends.

[Norman Lamb]

I thank the shadow Minister for her contribution and appreciate the welcome she gives for the main thrust of the Government’s response. This is a moment when everybody must come together to be clear that a change of culture is necessary from top to bottom. This is not a party political issue. The culture must change, and everyone within the system—from top to bottom—must recognise their personal responsibility to achieve that.

The shadow Minister raised a point about the mandate. One very good thing about the mandate is that it gives us accountability and transparency in the system for the future, and enables us to hold the NHS Commissioning Board and other parts of the system to account on delivering what is in it.

The hon. Lady asked how we will measure success in relation to the reduction in numbers in long-stay institutions. There must be a focus on assessing an individual’s personal care needs—that is what counts. The arbitrary setting of a target on numbers would be completely inappropriate when we should be focusing on the needs of individuals. The guidance we have received is that while there are 3,400 people in in-patient facilities of one sort or another, we are talking about probably reducing that down to 300 or 400 people. That is the best assessment that has been made, but I stress again that it must be based on assessment of individual needs.

The hon. Lady rightly makes the point about the skills of commissioners. One of the big failures has been that of commissioners properly to look after the interests of highly vulnerable people. The programme, which will be led by the Local Government Association and the NHS Commissioning Board and funded by the Department with between £2 million and £5 million of support, will be there to provide support and guidance to ensure that local commissioners get this right. We should applaud the parts of the country where this is being done brilliantly at the moment. They can demonstrate best practice to areas that need to change.

The hon. Lady asked whether the Commissioning Board will hold CCGs to account. The answer is, absolutely. This is part of the transparency of the new system and they must deliver on what they will be required to do.

I agree with what the hon. Lady said about the budget. The report makes it clear that the starting point should be that pooled budgets are the appropriate way forward. This is patchy at the moment. If there are not pooled budgets, they should explain why. In my view, there is no good justification for not pooling the resources of the NHS and social care to ensure the best and most appropriate care for individuals. There is also a duty for the two sides—social care and NHS—to work together. The health and wellbeing boards help to bring them together, and that is valuable.

The hon. Lady asked about Care Quality Commission inspections. Unannounced visits will continue, and they will include people with learning disabilities and their families, so that their perspective is gained. This is not a time-limited programme—it will continue. I think that the CQC recognises that this is an area that requires focus because of the vulnerability of the individuals concerned.

On physical restraint, we will look at all elements, including those mentioned by the hon. Lady, so that the best possible guidance is given to ensure that the excessive use of restraint, which currently happens in too many places, comes to an end.

On Castlebeck, I absolutely agree that it should consider financial support for the costs incurred following the scandals uncovered in its care settings. The hon. Lady rightly points out the responsibility that goes with charging an average of £3,500 per week per patient. One of the great failures of the current system is that there is not sufficient corporate accountability to ensure that people are held to account when things go wrong. When we consider proposals to address that lack of corporate accountability, we will look at the hon. Lady’s transparency proposal on publishing a lot more information about financial structures. Indeed, in the consultation we announced a fortnight ago on the follow-up to Southern Cross, we are proposing that there should be transparency regarding financial structures and that that information is shared to ensure that we avoid being caught by surprise, which is what happened under the system in operation when Southern Cross crashed, leaving many people in an unacceptable state of anxiety.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mr Hunt]

Proud as we are of the cancer drugs fund, to hear such stories is extremely distressing, and our first thoughts are with the family of my hon. Friend’s constituent. We will of course look into the issue she raises, which is a cause of great concern. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), is a neighbouring MP and would be happy to meet her to discuss the matter.

[Liz Kendall (Leicester West) (Lab)]

The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and greater midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?

[Mr Hunt]

Cancer networks are here to stay and their budget has been protected. They are extremely important. The hon. Lady uses hyperbolic phrases such as “ripping away the foundations of better cancer care”, so perhaps she would like to talk to the 23,000 people who have benefited from the cancer drugs fund that her Government failed to introduce.

Winterbourne View

Liz Kendall Excerpts

Tuesday 30th October 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

(Urgent Question): To ask the Secretary of State for Health to make a statement on the steps the Government have taken to ensure the safeguarding of former Winterbourne View residents.

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

The review into the abuse at Winterbourne View hospital, established by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), set out 14 actions to transform care and support. Central to the review is ensuring the safety and well-being of these very vulnerable people. I shall publish the final report before the end of November.

When Winterbourne View closed, NHS commissioners put in place independent clinical and managerial supervision and commissioned an independent assessment of every patient. The Care Quality Commission worked with commissioners to relocate Winterbourne View patients to suitable alternative placements.

In March, the Department of Health review team commissioned NHS South of England to follow up the 48 patients who had been in Winterbourne View, and there was a further review in September. The first review in March revealed that 19 former patients were the subject of safeguarding alerts. In response to this, officials asked commissioners to take appropriate action and confirmed that a follow-up would take place in six months’ time. I was extremely concerned to be informed that this follow-up had revealed that there are current safeguarding alerts for six former patients. I am assured that these are all being followed up to ensure the safety and well-being of the individuals concerned. That is extremely important. Furthermore, the September follow-up exercise revealed that 32 Winterbourne patients were now living in the community in their own family homes, in supported living or in a residential care home, with 16 still living in hospital settings.

The priority is to improve commissioning to develop the good local services that will prevent people from being sent to hospital inappropriately. We are working closely with the NHS Commissioning Board, the Local Government Association and directors of social services on what support local services need. Although a small number of people will need hospital treatment, we expect to see—and, indeed, must see—a substantial reduction in the number of in-patients.

We intend to strengthen safeguarding arrangements to prevent and reduce the risk of abuse and neglect of adults in vulnerable situations. Where there are safeguarding concerns, the local safeguarding adults boards need to be closely involved. The boards will be placed on a statutory footing for the first time, ensuring a co-ordinated approach to local adult safeguarding work.

The Government will put in place the necessary legislation for safeguarding adults boards, and local councils should bring clarity to their roles and responsibilities, but it is the responsibility of the care provider—we must remember this—to ensure a culture of safety, dignity and respect for those in their care, including stopping abuse before it happens. Those providers must be held to account for the care that they provide.

--- Later in debate ---

[Liz Kendall]

I thank the Minister for his statement, but there remain serious concerns about whether the Government have taken all necessary steps to ensure that the former patients of Winterbourne View are now receiving safe and effective care. Last night’s “Panorama” programme revealed that 19 patients have been subject to safeguarding alerts since leaving Winterbourne View. Not all those alerts mean that someone has been harmed, but “Panorama” said that one was due to an incident of assault and another had resulted in a criminal investigation. Is that an accurate reflection of the picture?

Have the families of all patients with a safeguarding alert been given the full details? What specific action has been taken as a result of the alerts, and can the Minister guarantee that the patients in question are all no longer at risk? Can he also guarantee that all local commissioners responsible for all the former Winterbourne View residents now have a proper plan in place to ensure that they receive good-quality care?

Has the Care Quality Commission recently inspected all the providers that former Winterbourne View patients were moved to, and are the Government confident of the CQC’s findings? Last night’s programme raised particular concerns about Postern House, which the CQC inspected in January this year following the Winterbourne View scandal. The CQC said that it met all the essential standards of quality and safety, and that suitable arrangements were in place to ensure that people were safeguarded against the risk of abuse, yet “Panorama” revealed a number of problems at Postern House over several years and the fact that a former Winterbourne View patient had a safeguarding incident there in June this year. Is the Minister confident that all patients currently in Postern House are safe from the risk of abuse?

The Minister rightly said that responsibility for the care of people with learning disabilities lies with providers, commissioners and the CQC, but it is Ministers who set policy and have responsibility for ensuring that it is implemented. The Government have a particular responsibility to ensure that former Winterbourne View patients never have to suffer from such appalling abuse again. Organisations such as Mencap are also very concerned that the Government are not moving quickly or strongly enough to end the practice of sending patients with learning disabilities to long-stay institutions far away from their family and friends.

The Minister must answer our questions about whether former Winterbourne View residents are all now guaranteed safe care, and he must urgently bring forward proposals to reform learning disability services properly for the future.

[Norman Lamb]

I thank the shadow Minister for asking the urgent question. The view is shared on both sides of the House that what “Panorama” exposed is utterly intolerable and has to come to an end. I am absolutely determined that when I make the Government’s final response by the end of November, it will be robust and clear so that everybody understands what has to happen.

When I came into my job, I heard briefings about the whole saga and how long it has gone on. For years and years, public money has been spent on putting people into inappropriate settings, often putting them at risk of abuse. That is a national scandal, and it has to end. I will be very clear about ensuring that we take robust and effective action.

The hon. Lady is absolutely right that Ministers are here to set policy, and that is what I intend to do. Since my appointment, I have been working to ensure that we set the right policy to protect vulnerable individuals. She is right that they must never suffer from abuse. Of course, there is always the risk of rogue individuals who behave very badly, and they must be dealt with through the criminal law, as has been seen with Winterbourne View staff. I have also made the point that the corporate owners of such organisations must be held to account for things that go on in their homes if those homes have been neglected. I want to meet the parents of those who were at Winterbourne View to hear from them directly, and I will seek to make arrangements for that.

The hon. Lady mentioned the 19 safeguarding alerts. In fact, that intolerable figure was in March but by September, the number was down to six. She is right, of course, that not every safeguarding alert means that something awful is happening. It means that concerns have been raised, and it is important that people raise their concerns. I assure her that I will do everything I can to end this scandal and ensure that we have proper safeguarding arrangements in place.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Anna Soubry]

I thank the hon. Gentleman for his work. I am aware of the campaign that he has been running effectively in his constituency, based on the experiences of one of his constituents. As I say, however, and as he will know, pancreatic cancer is, by its nature, a particularly difficult cancer to diagnose early. We will all, of course, remember the untimely death of Sir Stuart Bell. Unfortunately, he was diagnosed only very shortly before his death. I wish that were not as common as it is, but we are doing everything we can to improve screening. I thank the hon. Gentleman again for his campaign, and I would be happy to meet him to discuss it further.

[Liz Kendall (Leicester West) (Lab)]

Cancer networks have played a crucial role in improving patient care, including by earlier diagnosis. The former Health Secretary promised this House that their funding would be guaranteed in 2011, but the South East London Cancer Network now says its budget was cut by 40% between 2009 and 2011. This year, it has been slashed by a further 55% and its staff have been cut from 15 to eight. Will the Minister now admit that her Government have cut funding for vital front-line cancer experts and have broken their explicit promises on cancer care?

[Anna Soubry]

My information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts—[Interruption.] It is about moving money around so that it goes to front-line services. This Government are determined to reduce bureaucracy in the NHS and to make sure that patients get the benefit of our spending—unlike under the last Administration, who had it round the other way.