Lymphoedema Services

Marcus Jones Excerpts

Tuesday 27th March 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I congratulate the new hon. Member for Gower (Tonia Antoniazzi)—I knew the last one—on securing her first debate in Westminster Hall, as she said, which is on a very important issue.

Lymphoedema Awareness Week took place earlier this month, so today’s debate is timely. We heard much from the hon. Lady on the impact of the condition, which she set out very well, although Members should watch themselves looking at people’s legs and feet in supermarkets. I am sure therein lies a problem for me in Winchester, but I take her point. She set out very well the difference that high-quality care and support can make. We can all agree that we want that for people affected by lymphoedema. I hope the debate will encourage service providers across England to consider the improvements that they might make.

It is estimated that between 75,000 and 220,000 people in England are affected by lymphoedema. The condition is caused by abnormal accumulation of lymph fluid in body tissue, which can be the result of a congenital defect, of damage to the lymphatic system or of removal of lymph nodes by surgery, radiation, infection or injury. Obviously, cancer plays a role in that, which I will come to. Regardless of the cause, it is important that the NHS responds appropriately in diagnosing and managing the condition, and that it provides appropriate support and advice to those affected. A lot has changed since we had the last debate.

[Mr Marcus Jones (Nuneaton) (Con)]

Will the Minister say more about consistency of services for lymphoedema across the country, and acknowledge the role of our hospices? In my constituency, the Mary Ann Evans Hospice, of which I am a patron, has a lymphoedema care service, which is very valuable to local people.

[Steve Brine]

In my response I will touch on services across England. My hon. Friend is right to mention the hospice movement. Many people working in hospices become experts in this field by virtue of their day-to-day work. I am very happy to endorse what he said, and I thank everyone working in the hospice movement who is helping patients affected by lymphoedema.

In Scotland, Wales and Northern Ireland, certain national lymphoedema initiatives have been developed—we have heard about the initiatives in Wales. Health is a devolved matter, and devolution is important. The devolution settlement from the last Government stands, and allows the four nations of our United Kingdom to develop the services that they believe meet the needs of their resident populations and the respective size of them. In England, responsibility for determining the overall strategic national approach to improving clinical outcomes for healthcare services lies with NHS England, and the provision of lymphoedema care is the responsibility of local NHS commissioners.

Although lymphoedema has no cure, interventions such as decongestive lymphatic therapy, skincare, exercise advice and weight management can ease symptoms and improve quality of life for those affected. The hon. Lady was absolutely right to raise the issue of weight management—there is a lot of discussion in this place about the obesity challenge that we face. This condition is a not-often-talked-about consequence of the obesity challenge, and I am grateful she raised it. People with lymphoedema can usually be treated through routine access to primary or secondary care services with access to dedicated lymphoedema clinics. I have experience in my family of attending such clinics.

To support clinicians in the diagnosis, treatment and support of patients with lymphoedema, an international consensus document on the condition was produced in 2006, which is endorsed by the British Lymphology Society and the Lymphoedema Support Network. Additionally, the Royal College of General Practitioners offers an e-learning course on lymphoedema—the hon. Lady said that that was one of her concerns. That often supplements GPs’ existing understanding of the condition, which is covered in the GP curriculum, and I am pleased to say that it is identified as a key area of knowledge that we expect of them in their qualifying exams.

We heard from the hon. Lady about calls for a national lymphoedema service in England. Hon. Members may be aware that, in 2015, the British Lymphology Society submitted a proposal for a nationally commissioned specialised lymphoedema service to the Prescribed Specialised Services Advisory Group—we like our titles and acronyms in health—which is an expert committee appointed by the Department to consider these very matters.

Four factors should be considered when determining which prescribed specialised services should be directly commissioned by NHS England, the first of which is the number of individuals needing the service. The second factor is the cost of providing the service—after all, it is a publicly funded health service. The third consideration is the number of persons able to provide the service—the workforce—and the fourth is the cost to clinical commissioning groups in England for providing the service.

Taking account of those four factors, the advisory group concluded that lymphoedema services were not suitable for national commissioning. As the patient population was high in England, there were numerous providers and the burden to commissioners was low. However, we keep that under constant review, which links to my next point about Wales. We recognise that there can be opportunities to learn from our partners in the devolved Administrations while taking high-quality clinical advice from our advisers, such as I just mentioned.

We are aware of the recent evaluation of the lymphoedema service in Wales, which was published in the British Journal of Nursing, and we agree that the results appear to be very positive in addressing the challenges faced in Wales. We also note the caution applied to some of the figures but, as I say, we keep it under constant review, and the hon. Lady’s debate is helpful in that regard.

In my experience as a Health Minister, NHS commissioners are always keen to hear about services that have demonstrated savings and improved care in other parts of the country and the United Kingdom. For example, the Healthy London Partnership, a collaboration including London’s NHS, councils and Public Health England, for which I have responsibility, has drawn on the work of the Welsh lymphoedema service for its own service. We watch that closely. NHS England is also aware of the evaluation of the Welsh service and—the hon. Lady asked about this—is in touch with the national clinical lead for lymphoedema in Wales, who is one of her constituents. That relationship is ongoing and bearing fruit.

The hon. Lady mentioned cancer, for which I am the Minister responsible. Lymphoedema resulting from cancer treatment, which, sadly, has touched my life, is common. About one in five people have lymphoedema of the arm after breast cancer treatment that affects the lymph nodes, which are so difficult. Much of the lymphoedema service improvement in England has developed as a result of national initiatives to improve cancer services and, sadly, the high number of breast cancer incidents. There is growing recognition of the need to support cancer survivors after they fall off the cliff edge when their treatment ends. Lymphoedema services are a key part of that, and I have seen them when out and about doing my job.

Over the years, the Government have driven forward the cancer survivorship agenda, which I am passionate about and committed to, first through the national cancer survivorship initiative, and then through the living with and beyond cancer programme, for which I am responsible. Central to that work has been embedding in mainstream NHS commissioning a recovery package, which is a combination of interventions that, when delivered together, can greatly improve outcomes and the co-ordination of care beyond the cancer pathway, which is what we are looking at, including through better and earlier identification of the consequences of treatment for conditions such as lymphoedema.

Members will be aware that our world-class cancer strategy for England, which has another two years left to run, was published in July 2015 by the independent cancer taskforce. It recommended that NHS England should accelerate the commissioning of services for cancer survivors, including the development of a minimum service specification to be commissioned locally for all patients, based on the recovery package I just mentioned. That specification was published in April 2016 and includes provision of lymphoedema care. It was followed by £200 million of funding to support the implementation of the recovery package and other areas of the strategy, which I am sure I will talk about again in debates in this place. Those services should be provided on the basis of need, not of whether someone has had cancer.

Finally, let me highlight the research that is being undertaken. We invest more than £1 billion a year in health research through the National Institute for Health Research. The NIHR is currently supporting three important lymphoedema studies: an analysis of genes and their functions in primary lymphoedema; an investigation of the pathophysiology of breast cancer-related lymphoedema of the arm, which I mentioned; and a feasibility trial of early decongestive lymphoedema treatment for women newly presenting with breast cancer-related upper limb lymphoedema, which is very important.

As well as thanking you, Mr Gray, for sitting through what I hope has been as interesting a debate for you as it has been for us, let me thank the hon. Lady again for using her first Westminster Hall debate to raise this important issue and highlight the many challenges that people with lymphoedema face. I am confident that, by continuing to build our expertise, increasing the research I listed and ensuring that our commissioners and clinicians have the training, tools and guidance to deliver high-quality lymphoedema care, we can ensure that patients receive the treatment and support they need and deserve. As ever, I am grateful to Members. We keep everything under constant review, because ultimately we have a publicly funded health service that is there for patients. As the Minister with responsibility for primary care, I have responsibility not only for cancer but for prevention, and I am interested in anything that can help us to reduce people’s suffering and the cost to that publicly funded health service.

Question put and agreed to.

NHS Winter Crisis

Marcus Jones Excerpts

Monday 5th February 2018 Commons Chamber

[Stephen Barclay]

I have already said that I recognise there is increasing demand, and set out many of the measures we are taking through the 111 service and other areas. The hon. Lady’s own trust has received an additional £3.2 million to address many of those pressures, and the key question is how that will be deployed by the trust to address many of the blockages in the pathways at the moment.

[Mr Marcus Jones (Nuneaton) (Con)]

Despite the challenges this winter, does my hon. Friend not agree that we can be extremely proud in this country that we have an NHS free at the point of delivery to all of our citizens? Will he confirm that that will continue to be the policy of this Government, and does he agree with me that we should not listen to the voices from across the Atlantic saying we should adopt a different system?

Social Care

Marcus Jones Excerpts

Wednesday 25th October 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Communities and Local Government (Mr Marcus Jones)]

This has been a wide-ranging and important debate on one of the most important social issues and challenges we face in our country.

Delivering good-quality care for our most vulnerable people is a clear priority for this Government. To ensure local government has the resources to fund adult social care through to 2019-20, the Government have given councils access to £9.25 billion of dedicated funding for adult social care over the next three years.

Beyond the immediate term, there is also the need to address the challenges of social care for our ageing population. Therefore, the Government will bring forward proposals for consultation, to build widespread support for reform. The consultation will set out options to improve the social care system, put it on a more secure financial footing, support people and their families to prepare for old age, and address issues related to the quality of care and the variation in practice.

Overall, local government spent £14.9 billion in 2016-17 on adult social care—up by £500 million from 2015-16, and over £500 million more than budgeted for. This year, councils are budgeted to spend £15.6 billion.

The Government continue to provide local government with the additional resource it needs to deliver care. At the spring Budget, an additional £2 billion of funding in England was announced, of which £1 billion has been provided in 2017-18. That was in addition to the resource made available in the local government finance settlement, where we provided £240 million for adult social care. It was also in addition to the £2.5 billion put through local authorities in the improved better care fund.

Alongside Government funding, more flexibility has been provided. Local government has been able to raise more income through the adult social care precept, with the flexibility to increase it by 3% this year. That adult social care flexibility was subsequently used by 147 out of 152 social care authorities, with 109 using the full allocation, or close to the full allocation, of 3%. I should point out that it is also down to the Government that, overall, council tax remains lower in real terms than it was in 2010.

In terms of the integration of health and social care, we should remember that the better care fund is the first national mandatory integration policy. We should not shy away from the fact that integration is not easy, but the Government are supportive of the best-performing systems, where local government and the NHS work together to tackle the difficult issue of delayed transfers of care. We understand that delayed transfers of care are only one part of what authorities deal with to deliver social care in communities up and down the country, but we also understand that improving working between local government and the NHS is absolutely key to delivering better joined-up care for local people.

It is also right that, in November, we will consider a review of the 2018-19 allocations of social care funding provided at the spring Budget 2017 for areas that are not performing well. We expect that that would encompass only a small number of local authorities, although we are clear that the funding will remain with local government to be used for adult social care. We also favour, if needed, the option that places conditions on how a proportion of the 2018-19 funding is used to support an authority’s delayed transfer of care performance.

[Barbara Keeley]

Will the Minister give way?

[Mr Jones]

I will in a moment, but I want to make a little more progress and mention some of the people who have spoken in the debate.

The hon. Member for Denton and Reddish (Andrew Gwynne) finally hit the nail on the head right at the end of his speech in saying that we needed to approach this important, difficult and delicate subject in a non-partisan way. I was very disappointed, though, that 98% of his speech was spent on the politics of fear and, in some ways, misinformation. That was very much out of kilter with much of the debate across the House.

My hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, made some very important points. She was absolutely right first to pay tribute to careworkers and carers—that is absolutely the right thing for us to do. She mentioned the remuneration of care work, as did other hon. Members across the House. It is important to point out that careworking is an extremely important job. The national living wage, which was £5.93 an hour in 2010, is now £7.50 an hour, and lower-paid workers pay £1,200 less in income tax than they did in 2010. We are well on the path to rewarding careworkers far more than they have been in the past, although we would acknowledge that there is more to do.

[Barbara Keeley]

If the Minister values care, would he comment on untrained members of the public being offered £1,000 a month to rent out rooms as an alternative to care for patients recovering from surgery? Do he and his Government support that, because it is frightening from a safeguarding point of view?

[Mr Jones]

It is important that we always have workers who are trained, and we are providing care in good-quality settings. We heard several times that 80% of our care homes are providing quality of care that is either good or outstanding.

My hon. Friend the Member for Totnes mentioned the integration of health and social care, and the importance of the health service in the context of the review that is going to be done. She spoke about future planning of the workforce, which is also very important.

The hon. Member for Leicester West (Liz Kendall) made some very sensible points and comments about the politics of dealing with long-term funding of social care, and said that it does not serve people or their carers if we are partisan. Even so, she slipped into a bit of partisanship towards the end, showing how difficult this situation is. On the whole, however, she made some very sensible points.

My hon. Friend the Member for Erewash (Maggie Throup) was right to point out that this is a long-standing issue that many Governments over decades have ducked. She mentioned the situation in Derbyshire with her council, which seems to have been left a difficult legacy by its Labour predecessor. I am certainly willing to meet her to discuss that issue.

My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) mentioned the positive impact that the £2 billion of additional funding that was announced in the Budget for the adult social care precept has had in his area. He also made a sensible point about the potential for devolution to bring more integration between health and social care. My hon. Friend the Member for St Ives (Derek Thomas) said that health and social care is not just a responsibility for national Government because there is a responsibility on us all, particularly at a local level within the health service and in our local authorities.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised the importance of suitable accommodation to enable older people to live independently and help us to avoid many of the healthcare costs that we face. My hon. Friend the Member for Yeovil (Mr Fysh) mentioned the pressure that the national living wage puts on the system. It is quite right that we pay our careworkers more, and that is why we have given councils access to up to £9.25 billion of extra funding by 2020.

Many positive speeches were made during the debate, but unfortunately I have not got time to mention them all. The problems in social care have developed over many decades. The Government are absolutely right to recognise the challenges of adult social care and tackle them head-on. That is why we have provided further funding up to 2020. We need to address the issue, and that is why we will work across the sector to bring about change and a sustainable solution for the future so that the most vulnerable in our society can get the care that they deserve and need.

Question put and agreed to.

Resolved,

That this House notes the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home; further notes that this proposal would leave people with a maximum of only £100,000 of assets; calls on the Government to confirm its intention not to proceed with this commitment; and further calls on the Government to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care and to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.

[Barbara Keeley]

On a point of order, Madam Deputy Speaker. Again we see the Government refusing to vote on a motion—[Interruption.]

Francis Report: Update and Response

Marcus Jones Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I am glad to note that this is rapidly becoming one of the most open and transparent exchanges of questions and answers we have had in the Chamber. I am, of course, aware of trusts which say that they will find it difficult to meet stretching efficiency targets, but I would say to them that if they look at some of the safest hospitals in the world—such as Salford Royal in England and Virginia Mason in Seattle—they will find that they have the lowest costs. It is not a choice between cost and safety; better safety leads to lower cost.

[Mr Marcus Jones (Nuneaton) (Con)]

Will my right hon. Friend join me in welcoming the progress that has been made at George Eliot hospital since the Keogh review? The employment of 91 extra doctors and nurses has certainly helped, but does he agree that we cannot be complacent and must continue to root out bad practice wherever it exists, in a very open and transparent fashion?

[Mr Hunt]

Absolutely. I have visited George Eliot hospital, and observed a few beds in the A and E department. One of the most inspiring things about it is that it came out of special measures by developing a strong link with University Hospitals Birmingham NHS Foundation Trust—under the leadership of Dame Julie Moore—which enabled it to learn very quickly what changes were needed. The “buddying” of trusts in difficulty with high-performing trusts is one of the measures that have worked the best.

NHS Major Incidents

Marcus Jones Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

We are not in election purdah. The point is that during election purdah we will continue to publish the weekly A and E performances and other figures from the Office for National Statistics, and that has always been the system. But there is a difference between what is happening in the run-up to this election and what happened in the run-up to the previous election. This time, the CQC is free to speak up, without fear or favour, about the quality of care in every single hospital in this country, and it will continue to do so.

[Mr Marcus Jones (Nuneaton) (Con)]

The Leader of the Opposition and the shadow Secretary of State visited the George Eliot hospital on Monday. The Leader of the Opposition praised the hospital for its progress under this Government. If we consider that, and then look at the way the Opposition come to this House and make political point scoring their No. 1 aim, we can see not only that they are hypocritical but that they want to put politics before patients.

[Mr Hunt]

I commend my hon. Friend for the support he gives to his local hospital. I visited it and did part of a shift in the A and E department. This was a hospital that, under the previous Government, had one of the highest mortality rates in the country. We introduced a new special measures regime and independent inspections. Labour tried to vote them down, but the result is that that hospital has come out of special measures, forged a strong new partnership with UHB and gone from strength to strength. Things are getting better because we are being honest about poor care, and did not sweep it under the carpet.

NHS (Government Spending)

Marcus Jones Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

I am very grateful, Mr Speaker.

In urgent questions, there is obviously a time limit on our ability to read out quotes from NHS England documents, but there is no such time limit in an Opposition day debate, so let us take the opportunity to spell something out clearly for the record. The Secretary of State is here now. I apologise for not noticing him as he came into the Chamber, but he is here now, and that is good, because I can hold this document up and show it to him—it says “NHS England” on the front. He is nodding; he has accepted that point. I turn to page 21, where in paragraph 7.2.3, under the heading—[Interruption.] Government Members want to shout me down. If the Under-Secretary of State, the hon. Member for Battersea (Jane Ellison), is patient I will read out the full quote from the NHS England document. It refers to principles for considering escalation and the responses to be had. Paragraph 7.2.3, under the heading “Politics”, says:

“(a) Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?

(b) Is there a requirement to bolster or assure public confidence?

(c) Is there a risk of reputational damage?”

I do not understand why an NHS document contains those exact words. The Secretary of State can probably read them from there, across the Table—he is nodding again. Yet only a few minutes ago he denied that NHS England had such a document. What am I holding up—a mythical piece of paper? We can now at least establish that NHS England has been issuing documents suggesting that reputational damage and politics need to be taken into account when preventing major incidents. We have now at least had the opportunity to read into the record, as Hansard will reflect, the full text of that NHS England document.

This is the set of situations and circumstances that the NHS faces: pressures on A and E departments, pressures on cancer treatment, and pressures on the major incidents as we have seen. Why are things in such a fragile and critical state? The Government took £3 billion out of elderly social care and wasted it on a £3 billion reorganisation of the NHS that nobody voted for and nobody wanted. They are cutting corners and rushing the care that is needed to help the frail elderly to stay out of hospital. What greater example of a false economy could there be?

[Mr Marcus Jones (Nuneaton) (Con)]

Given the hon. Gentleman’s comments about the adult social care budget and the Opposition’s complaints about the money that has been taken from local authorities, will he commit to giving the money that he says has been taken from local authorities back to them in the next Parliament, should we have the misfortune to have a Labour Government?

[Chris Leslie]

That was a very helpful intervention. I thank the hon. Gentleman, who has only a number of months to go in his current job. We have explained how we can hire a further 5,000 home care workers, a further 3,000 midwives, a further 20,000 nurses and a further 8,000 GPs through the time to care fund—the £2.5 billion a year that is fully costed and fully funded. I will methodically go through the detail of how we pay for that—he need not worry about that.

National Health Service

Marcus Jones Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.

I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?

Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.

That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how

“hundreds of thousands of older people who need social care are being left high and dry.”

[Mr Marcus Jones (Nuneaton) (Con)]

If we were unfortunate enough for Labour to win the forthcoming general election, by how much would it increase councils’ adult social care budgets?

[Andy Burnham]

I am talking about creating a single budget. There is a big difference between that and what the hon. Gentleman says. I am saying that the time has come to merge the adult social care budget and the NHS budget. More than that, we are going to put an extra £2.5 billion into that integrated system. He should not come here today telling me what I need to do: where is his plan to put more money into the national health service?

--- Later in debate ---

[Andy Burnham]

I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.

The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.

For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E

“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”

My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?

The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.

As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?

Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?

On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?

[Mr Marcus Jones]

Will the right hon. Gentleman give way?

[Andy Burnham]

I have said that I will not give way again.

All those measures could help in the short term, but the truth is that all parties must recognise that there will not be a long-term solution to the A and E crisis until we face up to the crisis in social care, and rethink how we care for the most vulnerable older people. It is not just about money; we need radical changes in the way we use existing budgets for health and care. We need to merge them so that we can change the way in which we care for older people. We need a model of care that starts in the home and supports people there, so that we can drastically reduce the numbers unnecessarily ending up in hospital and becoming trapped there.

Although that model is not just about money, it is partly about money: if such a transformation is to happen, extra investment will be needed to stimulate it. The Secretary of State likes to hold up the better care fund, but I am afraid that councils and the NHS simply do not share his optimism. It robs Peter to pay Paul: the money transferred to councils is nowhere near enough to backfill the cuts to social care, and it leaves a deepening hole in NHS finances. [Interruption.]

The Secretary of State asks where I would get the money from, and I will tell him. The Opposition have committed to provide extra money for an integrated NHS—£2.5 billion a year over and above what he has committed—with social care as part of a single service for the whole person. By contrast, under the public spending plans the Government have set out for the next Parliament, it is clear not only that the A and E crisis will deepen every year, but that it will soon become a full-blown NHS crisis.

The NHS used to be the Prime Minister’s priority; now it does not feature in his top six election themes. We know that there will be no money for it beyond what the Government have promised, because the priority is tax cuts for higher rate taxpayers, although they have not yet identified where the money for that will come from. If the outlook for the NHS is grim, it is utterly dire for local government and social care. Taking public spending back to 1930s levels will absolutely decimate what is left of our social care system, and if the system goes into freefall today’s problems in the NHS will become entrenched. Will the Secretary of State go back to the Chancellor, argue for a better deal for the NHS and social care, and match Labour’s pledge to prevent a permanent care crisis in the next Parliament?

The NHS is now at the crossroads, and the coming election presents an enormous choice between Labour’s plan to lift the NHS out of its current crisis by investing £2.5 billion in the NHS of the future, and the coalition approach under which—with the Government unable to face up to the mess of their own making in A and E or to produce a plan to turn it around, and unwilling to find the extra money it needs—the NHS is dragged down by a toxic mix of cuts and privatisation. The stakes could not be higher. This crisis cannot go on: patients have suffered enough. They need an election, a change of direction and a Labour Government to secure the NHS.

--- Later in debate ---

[Mr Hunt]

That is the reality: there are new and improved services for the NHS up and down the country, but what we get from the Labour party in my hon. Friend’s constituency is scaremongering leaflets saying that hospitals are being closed when they are not. Labour should apologise for scaring very vulnerable people. It claims to stand up for them, but by scaring them it is doing the exact opposite.

[Mr Marcus Jones]

Unfortunately, the right hon. Member for Leigh (Andy Burnham) did not do me the courtesy of giving me a right of reply when he mentioned the walk-in centre in my constituency. Does the Secretary of State not think that it was completely irresponsible for the right hon. Gentleman to make such comments, given that the issue was raised by a whistleblower and that the information does not come from the clinical commissioning group that is considering walk-in centres in my constituency?

[Mr Hunt]

Exactly. My hon. Friend makes the point very well, and I will tell him something else about the hospital in his constituency. The George Eliot hospital was a failing hospital with very high mortality rates, and its deeply entrenched problems were swept under the carpet by the previous Labour Government, but this Government have turned it around and it is now a successful hospital. It is doing incredibly well because we faced up to the problems that Labour ignored.

NHS (Five Year Forward View)

Marcus Jones Excerpts

Monday 1st December 2014 Commons Chamber

[Andrew Stephenson (Pendle) (Con)]

rose—

[Mr Marcus Jones (Nuneaton) (Con)]

rose—

[Mr Speaker]

Wow—what a choice! I call Mr Andrew Stephenson.

[Mr Hunt]

I am happy to do so. It is an absolutely brilliant hospital. I was really impressed when I saw that it has integrated its IT systems with those of local GPs better than anywhere else I have seen in the UK, and it is now looking at integrating those systems with local residential care homes. It has a fantastic Skype system for patients who are vulnerable and have mobility problems. It is an amazing place, and my hon. Friend is absolutely right to draw attention to it.

[Mr Marcus Jones]

The previous Labour Government left my constituents with one of the worst health funding allocations in England. Despite the extra investment that this Government have put in, the issue still has not been properly resolved. Having heard my right hon. Friend’s advice earlier, I will be making representations to NHS England. Will he join me in supporting my constituents in getting a fairer funding deal?

[Mr Hunt]

I want everyone to have a fairer funding deal, and today’s announcement is significant in that respect. One of the reasons it has been difficult to help people to move closer to their target funding allocations is that the increases in the NHS budget have been only 0.1% every year, so we have not had the margins necessary to make changes. Precisely by how much, and where, we make those changes is a matter for NHS England, but I will happily refer my hon. Friend’s concerns to it.

Hospital Car Parking Charges

Marcus Jones Excerpts

Monday 1st September 2014 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

It is an honour to follow my hon. Friend the Member for Harlow (Robert Halfon), who has been at the forefront of this campaign. I trust that, now that he has the ear of the Chancellor, he will use that power to persuade our right hon. Friend of what needs to be done. Earlier this year, I went to see the Chancellor with a delegation led by my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski), and we put it to him that hospital parking charges should be scrapped altogether. I note that it is now estimated that the cost of doing so would be £200 million. At the time, it was £90 million.

We should look at this matter strategically and say that anyone who is going to hospital for treatment or to visit people who are suffering in hospital and who need to be there for an extended period of time should be exempt from all charges. It is difficult to introduce such a policy across the country for the simple reason that hospitals are in different locations. Some are co-located with stations, for example, and have decent public transport links. Others do not, however. We need a policy whose presumption is that anyone using the hospital car park because they are using the hospital services as I have described should be able to do so free of charge.

Such a policy could be implemented by requiring people to pay on exit. They could obtain a ticket on entry and have it stamped by a ward sister or a similarly appropriate medical person in order to exempt them from paying the charge. That would prevent commuters and others from abusing free hospital parking places.

I trust that we can look at this matter as a sensible investment. We clearly cannot expect the Department of Health to find the money itself. We expect it to provide the funding for treating people who are sick. We should look to the Treasury to provide the health service with the necessary funds to enable this initiative to take place.

[Mr Marcus Jones (Nuneaton) (Con)]

I completely agree with my hon. Friend that hospital parking charges should be scrapped. In the meantime, however, does he agree that when a hospital is at fault for delaying or cancelling an appointment, the patient should not have to pay more for their parking as a result?

[Bob Blackman]

I thank my hon. Friend for that intervention.

I was just coming on to the specifics of my area. My constituency and others now have centres of medical excellence, which means that people have to travel long distances for the treatment that they need. Many of them have to use their cars, because public transport is not an option. Over the past 18 months, I have witnessed people suffering when their appointment was delayed and they had to rush out to the car park to pay more at the pay and display machine. Such an encumbrance is unfair on people who need to receive important medical treatment, and it should without doubt be scrapped.

The guidelines should also stress strict adherence to a policy of paying on exit for the appropriate length of time spent in the car park, as opposed to using pay and display arrangements that involve people guessing how long they are going to spend in the hospital. I have witnessed at first hand people having to guess in that way and then finding that they do not need all the time they have paid for.

In my own area there is Northwick Park hospital, which is the centre at which many people from north-west London are treated, and Central Middlesex hospital, which is in the middle of an industrial estate and almost inaccessible by public transport, so anyone going there has to drive. There is no pay-on-exit facility available. In fact, the trust took away that facility and insisted that the parking area that was built for it be replaced with pay-and-display parking. It was a nonsensical decision, and I trust that the trust will review it and revise it accordingly. We also have Ealing hospital, which has a similar problem of not being anywhere near any public transport facilities. The tube lines run into the centre of London rather than radiating around the outside, so people travelling locally have to drive and use the car parking facilities.

I wish to touch on a specific case that I came across recently: Mr Francis Bacon, a registered disabled driver suffered a serious puncture while driving to a hospital appointment. He was unable to move his car, which some good samaritans pushed on to the pavement while he went to get help to change his tyre. He got his tyre changed by some good people who came and helped him and put him on his way. Sadly, a parking operative from Ealing council had come along and put a penalty notice sticker on the car, because Mr Bacon had had the temerity to park on the pavement. He could not move his car—his car was disabled, and he was disabled—yet he still got a parking ticket. Despite protestations from everyone concerned, Ealing council refused to cancel the ticket, which is typical of the wrong attitude of both local government and hospital trusts themselves. We need them to work in harmony to promote parking arrangements that suit and protect everyone. I trust that we can use this opportunity to encourage the Chancellor to provide extra funds so that we can do away with car parking charges once and for all.

Special Measures Regime

Marcus Jones Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for her support for the new special measures inspection regime for care homes. With respect to the merger of UHNS and Mid Staffs, we will make sure that the funding is available that is necessary for that merger to happen. Money is not the issue. The issue is doing what the TSA asked to be done quickly and in full, and making sure that we have the right leadership across both hospitals on a long-term sustainable basis. I do not think it is about money; it is about taking rapid action to make sure there are stable services and that there is continuity of care.

[Mr Marcus Jones (Nuneaton) (Con)]

Will my right hon. Friend join me in congratulating the staff at George Eliot hospital on their hard work in the past year and on the excellent result they achieved in the CQC review? Does he acknowledge that we need to do more at George Eliot to keep that improvement going and agree that we have now built a very strong platform on which to build the future of George Eliot as an important district general hospital in my constituency?

[Mr Hunt]

I agree with my hon. Friend on both points. We have seen 31 more doctors there since special measures, 52 more nurses, a new acute medical admissions unit and better flow throughout the hospital, reducing the number of moves that patients make between wards during their stay, so lots has been done. When I did a stint in the A and E department at George Eliot, I was very well looked after by the nurses there, but they told me how bad the IT systems were—I think they said there were 16 different IT systems in the hospital—and how they were constantly filling out new forms. I therefore hope that the partnership with University Hospitals Birmingham, which has one of the best hospital IT systems in the country—a fantastic system, developed by the trust itself—will mean that George Eliot can move to having really good IT, so that nurses have more time with patients, which is what they want.