Health and Social Care

Lord Walney Excerpts

Monday 13th May 2013 Commons Chamber

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who made a thoughtful and considered speech on an issue of great importance nationally, as well as to his constituents.

It was a pleasure to be in the Chamber to hear such a powerful speech on plain packaging for cigarettes from my hon. Friend the Member for Barnsley Central (Dan Jarvis). Frankly, if Ministers are not convinced after hearing his arguments, they should probably not be in their place. I think that they are convinced and I hope to see them make progress.

I want to start on a note of consensus. I welcome the inclusion in the Gracious Speech of the Bill on mesothelioma compensation. This dreadful disease is a time bomb that, once detonated, often goes on to kill within months. With its shipbuilding heritage, more individuals in Barrow and Furness suffer from mesothelioma than in any other constituency in England. We owe a duty of care to all those who are suffering: they made an honest living and what is happening to them is not right. We should applaud all those who have pushed for further progress, including former Labour Ministers and the hon. Member for Chatham and Aylesford (Tracey Crouch), who I understand wanted to be here but is on her sick bed.

There are early concerns about the Government’s paucity of ambition. It is vital that the Government mandate a scheme that will build fittingly on the work of my predecessor, Lord Hutton, who expanded and speeded up compensation in the previous Parliament. However, many will see the thin programme last week as a missed opportunity to address increasing alarm about the Government’s poor stewardship of the NHS. It would be too optimistic to hope that Ministers have had an early change of heart on the costly and ill-conceived reforms they have just bulldozed through Parliament. In addition to the lamentable absence of plain packaging legislation, they could have introduced measures that sought to bridge the yawning gap between their rhetoric on listening to local people and the reality that is seeing the clear wishes of residents on NHS services ignored up and down the country.

In Barrow and Furness, we hope that health professionals in charge of provision across Morecambe bay will heed the passion and powerful arguments from local people on oncology, maternity, and accident and emergency provision. While residents understand that it can make sense to travel to get the best that 21st century health care can offer, like so many across the country they love their local hospital, they think it should have its fair share of the very best, and they think local provision, that is accessible to them and visiting loved ones, is a basic part of a quality service, not something to be dismissed as an unnecessary luxury.

I have some hope that the new management team at Morecambe Bay NHS Foundation Trust will listen to local concerns. An early test will be the publication of revised plans for Furness General hospital’s oncology unit this month. However, we see what is happening in other areas where the Government’s local engagement test is proving to mean little more than holding a meeting and nodding in an understanding manner, and ignoring everything people say and downgrading services anyway. When my constituents see the scale of the upheaval and cuts to front-line nursing staff involved in reducing the budget of Morecambe Bay Trust by £25 million within two years, they are, understandably, very wary of trusting Government promises that no efficiency savings will be allowed to affect the quality of patient care. I hope the Minister will tell me whether the Government will heed calls, including from the trust itself, for a rethink on the speed and scale of the cuts they are imposing.

Will the Government not take heed of the dismay felt about recent NHS reorganisations and enact measures to strengthen the power of local opinion in determining the future of our hospitals? We live in times of strained resources, but faith in the future of the NHS may continue to be eroded until we learn genuinely to trust local communities. When we come to look back at the history of the NHS over the current decade, I think we will see this as the time when we were bound overly tightly to the idea that the clinician always knows best. We will come to see the Government’s blind faith in the clinical stamp for taking services away as an early 21st century equivalent of the “Whitehall knows best” mentality that gripped reforming Governments after the second world war. Just like the “Whitehall knows best” ethos of the 1940s and 1950s, the clinician knows best mantra has the best of intentions but is insufficiently responsive to challenge from the patients who rely on the services that are being shaped by those at the centre.

Let me be clear. It is essential that health professionals make their case when decisions are made. Their expertise is immense and people should not deviate lightly from their plans. However, it is by no means certain that any one group, even one bursting with medical experience, will always call it right first time. Their views must be subject to scrutiny. Often the clinical push to concentrate a specialism at a single site takes less account of local geography and community links to health facilities than is demanded by local people, who ultimately pay the clinicians’ wages.

This is not an argument for sentimentality. The views of local people will sometimes be irreconcilably different in a single area, but if, for example, Barrow families suddenly face the prospect of a 100-mile round trip to visit a relative—because a unit at Furness General hospital has moved to Lancaster—their views on the move will be important. Many communities across England are fighting for their local health services. Some are threatened by cuts, but others are at risk from this clinically led decision-making model.

[James Duddridge]

The hon. Gentleman is making some valid points, several of which I am deeply sympathetic to, but on clinicians, is he referring to GPs or specialists? Does he think that the clinical commissioning groups of GPs who are more fixed in the community could have an impact on, for example, oncology and other specialisms in local hospitals?

[John Woodcock]

That is a good point, and it remains to be seen. We hope so, but the system has yet to be put to the test.

I am disappointed that no move towards genuine localism was outlined in the Gracious Speech. It is time for a people’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto that ought to be heeded. That would require a step change in our NHS away from a model that, yes, might have helped deliver improvements in health outcomes of which the country should be proud, but which has done so—

[Norman Lamb]

Will the hon. Gentleman give way?

[John Woodcock]

I will give way, if the Minister is quick, because I do not have much time left.

[Norman Lamb]

I am interested in what the hon. Gentleman is saying, and I accept the point about the importance of accountability. [Interruption.] He has just realised that he has got an extra minute of time, so I have done him a favour. Does he accept, however, that the old NHS, which we reformed, had no local accountability at all and that we have introduced some accountability through the health and wellbeing boards, bringing together local authorities and the NHS?

[John Woodcock]

It is an interesting point. I am not claiming that the system operating now is fundamentally different from that of three years ago, but around the country people who were promised a say in local decisions have been devastated to find out that they have none. Unquestionably, what has been put in place is not adequate. It is a sop to localism that does not do what it says. It would be a step change to move away from the current model.

Following the current model has meant alienating many local people who understood the trade-offs, but nevertheless fervently desired to keep services local. Whatever happens, surely the current tension between national planning and local unrest is unsustainable in the long term. In opposition, the Conservative party told the public that it understood that and pledged to end local hospital service closures, but of course its promises turned out to be a cheap election con trick. Instead, Ministers have forced through an expensive, chaotic and divisive health reform package that ultimately has pushed NHS decision making still further from the people it serves. We need a change of direction. Local communities pay for the health service they receive, and they deserve to be treated with greater respect.

--- Later in debate ---

[James Duddridge (Rochford and Southend East) (Con)]

It is a privilege to be called to speak in the debate, and it is good to follow the hon. Member for Bridgend (Mrs Moon). Some of her comments about rare kidney diseases resonated with me, as I have recently visited the very good renal centre in Southend. I have also looked into the issue of rare diseases. Individually, they might be rare, but collectively they are quite common as a group, and the funding for the relevant drugs and for more general treatment can be tricky.

I have a quite carefully drafted speech here, but I was blown away by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who spoke without notes and whose speech was a fantastic tour de force. I am tempted, perhaps unwisely, to pick up on a number of issues that have been mentioned in the debate, some of which have been quite controversial. I did not listen to every single speech today; I missed half an hour. While I nipped out for a cup of tea, I heard colleagues on this side of the House speaking out against equal marriage—perhaps some Opposition Members did so as well—but I for one am glad that that legislation will be dealt with in this Session. The carry-over motion will ensure that we have ample time to debate it and to work through some of the issues. In 20 or 30 years, we will look back in confusion as to what the problem was. We are perhaps introducing the legislation faster than the public has an appetite for, but politicians sometimes need to lead rather than follow.

At lunchtime today, I had the privilege of having lunch with my mum and dad, who were in very good form. They said that they had been looking for me during the Queen’s Speech but had been unable to see me, and I told them that the debate was carrying on today. I asked them what they had thought of the speech, and they told me they thought it was very funny. I am not sure that either Her Majesty or the Prime Minister wanted to create that impression. I asked my mum why she found it funny, and she described how Black Rod had got stuck halfway down and been held up by the Speaker.

There has been a debate today about whether the Queen’s Speech was too narrow. The right hon. Member for Rother Valley (Mr Barron) criticised Conservative Members for talking more about what was not in the speech, but the general public do not think in terms of Bills and Acts; they think in themes, as my hon. Friend the Member for Blackpool North and Cleveleys said. One theme of today’s debate has been immigration seen through the prism of the NHS, although the general public probably also look at it through other prisms, including housing and Europe. Looking at the Queen’s Speech in a thematic way is perhaps slightly more useful.

I am tempted to make some comments on Europe. It is constructive that we should vote on the matter. If the coalition is to survive, it will need to be more comfortable about having open debates rather than simply private ones. We will need to have more open debates, rather than fewer, if the coalition is to be healthy all the way through to 2015. It is a strength of democracy to have open debate rather than narrowly commit ourselves to certain lines.

On immigration, the right hon. Member for Rother Valley talked about the use of extremist language. Actually, far from its use being negative in this context, the use of immoderate language can sometimes be essential if we are to have an open discussion. Otherwise, the debate gets overtaken by the Daily Mail and the Daily Express. We should have a full and frank debate on immigration, and on other issues.

When we consider health—the main focus of today’s debate—I think politicians are sometimes too scared to ask questions about a merger or a closure, for example, and to query whether those are the right things to do. We should be more open minded. The hon. Member for Barrow and Furness (John Woodcock) said that more local people should be involved in the process. I am sure he is right, but I am not sure that that is a totally new thing, as the Minister intervened to say in the latter part of his speech. I was certainly very close to the position the hon. Gentleman stated. I am not sure which of us should worry more about that, but it is a statement of fact about how I felt.

The commitment to spending 0.7% of gross national income on international aid was not in the Queen’s Speech. That is a totally arbitrary figure, but it is a promise that all the main political parties made and one that I fully support. To be frank, I cannot get het up about whether or not the commitment is built into a piece of legislation. If my family was starving in Ethiopia, or in the northern badlands as Bob Geldof would describe them, I would not care whether the money was coming because it had been mandated or because it had been promised. It makes little difference. I certainly congratulate the Government on actually spending that money, which is far and away the most important thing.

Let me deal with the deregulation Bill—legislation announced in the Queen’s Speech to reduce the body of existing legislation. I feel that an awful lot more can be done. The Bill has not been published, but I think that the Government have been too modest in their ambitions when it comes to deregulation. The Better Regulation Task Force is producing some really strong ideas.

[John Woodcock]

I am fascinated by what the hon. Gentleman is saying. Perhaps he was about to mention this, but what does he want to deregulate?

[James Duddridge]

At the moment, we have piecemeal deregulation, whereby we look at specific issues and then deregulate. I was elected as chair of the Regulatory Reform Committee, which as a body deals with pieces of legislative reform that the Government think can be fast-tracked for regulation or deregulation in order to avoid burdensome regulation. That is very much a piecemeal process—we looked, for example, at veterinary legislation—but it would be much better to have a big thematic review of issues surrounding care homes, for example. Rather than look at health and safety, the medical issues or equipment separately, it would be better to have a thematic review, cutting across Departments in the same way this debate cuts across the division between the health service and social services, local councils and different funding streams. I think it is our responsibility to do that here in the House of Commons.

The deregulation Bill will be good and tidy up bits of the statute book, but I would like to see a lot more detail about how that is going to happen. A Joint Committee will be set up between the Lords and the Commons, and I would very much like to serve on it, but as much as possible we should open out the number of Bills that we are looking at. Setting aside the issue of whether we should be in or out of Europe, the increase in European legislation demands that we face up to a two-for-one deregulatory challenge, just to stay standing. We need to go further.

The economy is another key theme in the Queen’s Speech. Given our current economic position, if we had had a Conservative Government from the outset, I believe such a Government would have tested every single Bill by asking, “Will this Bill help the economy? If not, it is marginal, and we should push it to one side—certainly when it comes to parliamentary time and impact.” I think that the Budget is much more important. When we highlight the themes in the Queen’s Speech, we should not judge ourselves by the amount of paperwork we sign off. The Budget is, in many ways, more important. Corporation tax, the national insurance deal and so forth will get Britain booming. I have seen it in my local area, where, for example, Southend airport has boomed, generating over 500 jobs in the few years that it has been motoring in a serious way, as opposed to when it was a rather hobbyist airport. There is much still to be done, but we should not judge ourselves by the volume of legislation. In fact, through the deregulation Bill, we should be able to reduce that volume.

--- Later in debate ---

[Sarah Champion (Rotherham) (Lab)]

I would like focus on two groups of people who are not adequately covered in the Care Bill: young carers and the disabled.

I recently had the pleasure of spending time with a remarkable group of Rotherham young carers who are supported by Barnardo’s. Because of funding limitations, Barnardo’s is able only to work with young people between the ages of eight and 18, and only 100 in a year. Sadly and shockingly, Barnardo’s estimates that 3,000 young people are carers in Rotherham alone. It has on its waiting list children as young as six who are counting down the days until their eighth birthday when they can get some support.

The young carers asked me to make colleagues aware of their plight. Hannah told me that the main thing she wanted was recognition for the work she did. She understands her mum, who suffers from severe depression, better than anyone. Hannah wants her experience to be fed into her mum’s assessments. As she said,

“they trust me to look after her but they don’t trust my opinions.”

When Hannah calls the medics to say that her mum is deteriorating, she should be taken seriously. Instead, young carers have to contact their Barnardo’s worker to lobby on their behalf, because they are not recognised by the authorities.

I welcomed many of the measures in the draft Care and Support Bill, but they are limited to adults caring for adults. The Care Bill represents a missed opportunity to improve the rights of all carers, including adults caring for children and young carers. The young carers I met know that, because of them, their parents do not have to stay in hospital, a mental institution or a care home. They know how much their help saves the Government. On their behalf, I urge the Minister to make sure that the Care Bill gives young carers a little support in exchange.

Consolidating provisions relating to adult carers in previous Bills will create neat, codified legislation, with

“clear legal entitlements to care and support”

for adults, while young people will be left with piecemeal, leftover legislation that practitioners will struggle to navigate. This is highly problematic. As I have said, workers often need to act as advocates for young carers and protect their rights. This area has long faced the challenge of a confusing legal framework, and the Bill has the potential to make matters worse. It appears to provide a clear picture of carers’ rights, while in effect excluding some of the most vulnerable carers.

I recognise that the bulk of the changes needed to protect young carers need to be made in the Children and Families Bill, but changes could also be made in the Care Bill. In order to prevent inappropriate caring, it is important that measures are put in place to ensure that adults’ needs are met and that young people with potential caring roles are identified as part of an adult’s assessment. Not only would that recognise the important role that young carers play, but it would allow their needs to be acknowledged formally, forcing existing services to be more accommodating. For example, all of the young carers I met faced challenges at school, with inflexibility on late homework, missing school and the need to call home during the day. If young carers are formally recognised as part of the assessment process, that could be fed through to the school and teachers could be notified of the young person’s needs, allowing them to be better supported.

On the Bill’s implications for those with disabilities, my office has seen a marked increase in the number of cases of disabled people struggling to make ends meet. The introduction of the employment and support allowance has been confused and poorly administered. I have dealt with numerous cases of vulnerable people being placed in unnecessarily stressful situations and left financially worse off by this Government’s reforms. Such cases already make up 10% of my overall case load. The abolition of incapacity benefit will soon be followed by the abolition of the disability living allowance and the introduction of personal independence payments, meaning that disabled people are being squeezed at an unsustainable level.

[John Woodcock]

My hon. Friend is making an important speech. Does she share the concern of my local disability association that the problems with the ESA benefit and how it has been reassessed have led to grave worries about the introduction of personal independence payments?

[Sarah Champion]

I thank my hon. Friend for yet another example of the extreme stress that people are being put under and the mismanagement of this entire process. The pressure of the burden being placed on them is intolerable.

I am extremely concerned that the Government’s Care Bill will put further pressure on that vulnerable group. The key issue for social care reform is eligibility. A third of social care users are working-age disabled people. The Bill will not improve the social care system for them, and 105,000 disabled will be shut out from receiving the social care that enables them to live their lives.

My hon. Friend the Member for Easington (Grahame M. Morris) mentioned statistics from Scope that make depressing reading. Four in 10 disabled people who receive social care support say that it does not meet their basic needs, including eating, washing, dressing and just getting out of the house. A third of working-age disabled people say that cuts to their social care have prevented them from working or volunteering.

The Bill appears to focus on the elderly and does not address the care crisis facing disabled people. For those working-age disabled people who do not meet the eligibility threshold, the £72,000 cap on care costs will not apply. They will continue to need to meet the cost of their social care. If an individual’s care needs increase later in their working life to the point that they become eligible for social care, the cap will not take into account the contributions they have already made to meet their care needs.

I agree that the introduction of a national eligibility threshold is a step in the right direction. Alongside a new assessment system, I hope that it will end the postcode lottery in care provision. However, it is vital that the threshold is set at a level that ensures that working-age disabled people receive support to meet their basic needs.

The Government spend £14.5 billion a year, or 2% of public expenditure, on adult social care, which includes older people’s services. However, it was estimated by the Dilnot commission that social care services are under-resourced by £2 billion. Those services are being further squeezed by the pressure of an ageing population and a 33% reduction in local council budgets. Local authorities are therefore dramatically under-resourced for the demands that are placed on them. As a consequence, they have been raising the threshold at which disabled people become eligible for support. Recent surveys suggest that almost half of local authorities plan to reduce spending on care services for adults, which will hit those with learning difficulties and those with disabilities.

Unless there is sustainable funding for adult social care, the situation is likely to get worse. The upcoming spending review must be used to secure more long-term funding for social care services to underpin the Care Bill. The Government must not lose sight of disabled people and young people as the Bill progresses.