Health and Social Care

Maggie Throup Excerpts

Monday 27th February 2017 Commons Chamber

[Maggie Throup (Erewash) (Con)]

I would like to start by paying tribute to the many thousands of health and social care workers who every day support some of the most vulnerable people in our society.

We are talking today about how to balance the books. The NHS “Five Year Forward View” identified that, if the trajectory of healthcare spending continued at the same rate as just a couple of years ago, an extra £30 billion would be needed by 2020. It also stated that over £20 billion could be identified in savings and efficiency measures over that period, which is why the Government have allocated an additional £10 billion to 2020-21. We can quibble about whether it is £8 billion or £10 billion, but it must be recognised that NHS England asked for £8 billion and that the Government are delivering it.

To some extent, what has not happened yet is the other side of the bargain: finding the savings of £22 billion. Perhaps it was never possible. Perhaps the timescale for delivery was too short. Next year we celebrate 70 years of the NHS. So to change how it worked in less than five years was probably too big an ask. That said, in many areas of the NHS, change is happening and savings are being made. But it takes time. I want to give a couple of examples to illustrate where savings can be made. They might involve upfront costs but for long-term savings.

Prior to being elected to this place, I spent a lot of time and energy promoting diagnostic tests that could be carried out at a patient’s bedside, in a GP surgery or even in a patient’s home—possibly also in community pharmacies. Such testing is used extensively in Scandinavia and other European countries, but we are lagging behind. If we adopted such tests more widely, many savings could be made, but, more importantly, it would better for the patient, which surely should be the key determinant.

One example is the point-of-care test measuring a protein called C-reactive protein. The protein is raised when someone is suffering from a bacterial infection but not if the infection is caused by a virus. Without the test, patients might be prescribed unnecessary antibiotics, which is not good for the patient or the NHS budget, and in some instances, patients might be admitted to hospital unnecessarily. Yet all that is needed is a small device and a drop of blood. I know all this from personal experience: had such a test been readily available for GPs to carry out in surgeries or patients’ homes, it would have saved my mother a five-day hospital stay. Not only would that have saved the health service money, but my mother would have been far better off staying in her home at the time of her illness. We cannot continue doing as we have been and expect different outcomes.

[Jason McCartney (Colne Valley) (Con)]

My hon. Friend talks a lot of sense. Does she agree that the NHS should not make the mistakes of the past by going down the route of more disastrous private finance initiative deals? As she might know, my local CCG is developing a business case to bulldoze Huddersfield royal infirmary, replace it with a small planned care unit and move everything else to Halifax, including A&E, and is coming forward for £285 million. If it does not get that from the main funds, it will go down the PFI route, but the trust is already crippled by the disastrous PFI at Halifax, which cost £64 million to build but will eventually cost £774 million.

[Maggie Throup]

I thank my hon. Friend for his pertinent comments. I did my training as a biomedical scientist at Halifax general hospital and the royal infirmary in Halifax, so I know the area very well. Yes, we must not go down the route of more disastrous PFI agreements.

[Fiona Mactaggart (Slough) (Lab)]

On the hon. Lady’s point about tests that are not being deployed, but which could save money, I have long been concerned that many areas do not issue women at risk of ovarian cancer with the CA 125 test. It is not a definitive test, but it can help identify the cancer early, which can save money. Does she agree that we need leadership from the top of the NHS on such clinical issues to ensure that short-term savings decided by an individual CCG are not putting patients’ health at risk?

[Maggie Throup]

The right hon. Lady makes a very good point, and we could have an entire debate on the topic of prevention and screening.

The spending of the NHS budget affects social care, and the spending of the social care budget affects the NHS. As we have heard from other hon. Members, the two are linked, but are funded in different ways. All too often, these budgets are costed only in silos.

Taking the treatment of stroke patients as another example, there is a new technique available called mechanical thrombectomy. I recently met a young man who was fortunate enough when he had a massive stroke to be near one of the few centres in the UK that carries out that procedure—if a young man in such a situation can be viewed as fortunate at all. As a result of the procedure, the young man can lead a full life rather than being disabled for the rest of his life and possibly dependent on social care, too. However, the procedure cannot yet be rolled out across the country due to the limited funding available to train specialists to carry it out and to fund the procedure itself. What are the lifetime costs, mainly imposed on social care, for those patients who do not get that procedure or other such procedures, irrespective of the personal costs to the individuals?

There are great examples of integrated working between the NHS and social care, but it is far too slow to spread new and best practice. Locally in my constituency, Erewash CCG is a Vanguard site. One of its actions is to carry out what are classed as “ward rounds” in residential and nursing homes. There is already strong evidence to show that that is reducing hospital admissions for elderly people. However, it is not being rolled out quickly enough to other areas.

I do not believe that continually throwing more money at the NHS and social care is the answer. If we want different results, we need to do things differently. That is what the sustainability and transformation plans aim to do. I have read the Derbyshire STP in depth, and while I applaud the aims of the plan, there appears to be very little indication of how it will be implemented. My concerns are around workforce balance, transitional costs to implement the STP, capacity in the community and stakeholder buy-in.

I hope I am wrong with my analysis, because better integration and bold action are what are really needed. It is important for us not to shy away from the hard and difficult decisions that lie ahead.

--- Later in debate ---

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Bristol South (Karin Smyth). We are here to debate the financial sustainability of the health and adult social care sectors. Although health and adult social care are almost inseparable, I will focus on adult social care for brevity’s sake.

Although the acute care and adult social care sectors face similar unprecedented pressures, adult social care is different in one important way. Unlike the NHS, which has the ear of the Chancellor and the Treasury, adult social care certainly does not. All the evidence in recent months has served only to confirm that. The Chancellor’s decision not to make one extra penny of new money available in his autumn statement was met with almost universal criticism from across the health and local government sectors, and his recent decision to introduce the adult social care precept is damning evidence that a desperately outdated view of funding remains strong in the Treasury.

Adult social care is delivered locally by local authorities, so the Chancellor views its funding as a locally devolved issue. The Government’s decision to pass the blame to local councils and to underfund adult social care is nothing short of moral cowardice. They are deliberately underfunding adult social care in my home city of Bradford.

What is most desperate is the Government’s abandonment of the hundreds of thousands of older and vulnerable people who are reliant on vital adult social care services, day in, day out. We are talking not about hypotheticals but about the care happening today, right now. Real people are struggling to get by in my constituency of Bradford South. Bradford is a relatively young city; nevertheless, the number of people in Bradford over the age of 65 has grown substantially. Between 2012 and 2015, an extra 4,500 people were living in the district, and the number of people in Bradford with complex physical disabilities has grown by 400.

My local council, Bradford Council, agreed its budget last Thursday. Like many others, it had the task of agreeing swingeing cuts to scores of community services. In recent years, it has reduced its budget by more than £218 million, and a further £82 million in cuts will have to be made by 2020. Adult social care, as the biggest service overseen by Bradford Council, faces the lion’s share of the looming budget cuts. A further £19 million of cuts will fall on the city’s adult social care sector. The Government are washing their hands of any responsibility. By 2020, the revenue support grant, which is the primary source of central Government funding to Bradford Council, will drop to zero—zilch; absolutely nothing.

The Government’s half-baked answer is the adult social care precept. In the next two years, the precept is expected to raise an extra £6.6 million in Bradford, but that extra money is dwarfed by the huge cuts to Bradford Council’s revenue support grant. More to the point, the extra £6.6 million is not even enough to meet the increased cost of adult social care that will flow from the Government’s so-called national living wage. Because of the unprecedented increase in demand, such bruising budget cuts are only the tip of the funding shortfall. It is expected that the cost of supporting increasing numbers of older people, coupled with larger numbers of working-age people living with disabilities, will mean Bradford Council will have to shoulder an extra £1.5 million, each and every year.

[Maggie Throup]

Will the hon. Lady give way?

[Judith Cummins]

I am nearly at the end of my remarks, and the hon. Lady has had her turn to speak.

What is beyond doubt is that the Chancellor must act in the upcoming Budget. He faces his greatest test in this Parliament. I hope that he and his Government do not disappoint. Time will tell.

--- Later in debate ---

[Helen Goodman]

The proposal to close Darlington A&E has come up only under this Government. It was not proposed under the coalition Government or the previous Labour Government. This Government must take responsibility for what is happening now.

On Saturday, I went to Alston in Cumbria. The people there are also running a campaign to stop their local hospital closing, because they will then have to go to Carlisle, which is 34 miles away. That is a long way, especially in Cumbria, where the weather is absolutely terrible and the road is often blocked. Ministers need to take more account of this big rural issue. People in Alston are also worried that there will be a cynical saving—the hospital in Copeland—and that they will face even bigger cuts. Perhaps the Minister will give us an assurance about that. The interaction between health and social care is well understood. We all know that cuts to social care mean a worse quality of care and less time for individuals.

[Maggie Throup]

Will the hon. Lady give way?

[Helen Goodman]

I would rather not because of the speaking limit.

Cuts also mean pressure on the NHS. Durham has faced really big cuts to social care. Between 2011 and 2017, it has had to make £186 million of savings. Child and adult care services comprise 63% of the total budget in the area, and adult social care cuts have been £55 million. The much vaunted precept raises only £4 million, and we have another £40 million of cuts to come. Even taking into account the better care funding, cuts by 2019-20 will come to £170 million. That means that there will be no social care in whole villages in my constituency. We are told that the Chancellor is minded to do something about it. Will he make up the full £4.6 billion that was cut in the last Parliament?

We have discussed the long term, which we do need to think about. The discussion about social insurance is important and significant, but we should also think about which institutions we would be asking people to put their money and their savings into. A lot of private sector organisations are, frankly, ripping people off with fees of £600 and £900 per week, even in my constituency in the north, where costs are not the highest. With fees like that, we do not even see highly trained people with expertise in dementia, but the same workers on minimum wages with low levels of training. We need to look at a stronger mutual approach and cut exploitative private sector contractors out of adult social care.