Accident and Emergency Waiting Times

Margot James Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

That is part of my point. NHS England wrote to clinical commissioning groups on 9 May. What is going on here? They were all in the chaos of reorganisation until then—no one could have received a letter, because CCGs were not in place. In the crucial period between January and March, when the NHS was under intense pressure, primary care trusts were on the way out and CCGs were not in place. As a result, the NHS was in limbo; at the precise moment that it needed grip and leadership, it was drifting. That is absolutely shocking.

As I have said repeatedly, the Government must act to shore up social care in England, which is collapsing. Our solution is for the Secretary of State to use about half of last year’s underspend in the NHS, £1.2 billion, to provide emergency support to councils over the next two years to maintain integrated, home-based support. As he knows, the Budget revealed a £2.2 billion underspend in last year’s Department of Health budget. No use was made of the budget exchange scheme. In other words, he handed that money back to the Treasury. I call on him to reconsider his decision, reopen negotiations with the Treasury and act to prevent a social care emergency.

[Margot James (Stourbridge) (Con)]

Between 2005 and 2010, the population of over-65s grew by 730,000 and the population of over-80s—the very elderly—grew by 27%. Why did the previous Government increase the budget for adult social care by less than 1% a year to cope with that additional demand?

[Andy Burnham]

Oh dear, Mr Deputy Speaker. It is hard for this Government, who have decimated social care, to lecture us about it. Between 2005 and 2010, A and E waits fell. That was after the GP contract was signed. Let us have some facts. We did much to support social care and to deliver an NHS with the lowest ever waiting lists and the highest ever patient satisfaction.

The second point in our A and E rescue plan concerns safe staffing levels—another aspect that we have raised repeatedly with the Secretary of State.

Mid Staffordshire NHS Foundation Trust

Margot James Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

That is the kind of shocking practice that is totally unacceptable.

[Margot James (Stourbridge) (Con)]

I very much welcome the return of student nurses to the wards for a year of their training. Project 2000 has much to answer for. On the subject of resourcing and staff to patient ratios, may I remind my right hon. Friend that many of the reports we have seen in the last few years, criticising hospitals for poor care and lack of dignity in the care of older people in particular, have shown that wards in the same hospitals have had very different standards of care? How can that be about resourcing?

[Mr Hunt]

My hon. Friend makes an important point. It is important that these assessments are made not just at an organisation level, but drill down into the different parts of a hospital, and we have taken that message on board from the Nuffield report on ratings. She is right that it is not just about resources, but sometimes it is about resources. Parts of a hospital can be understaffed when it comes to people who are required to perform basic and important roles in terms of care. Because it is a complex picture—and because numbers can be part of the problem, but are certainly not the whole problem—we want a chief inspector who will take a holistic view of every aspect of the performance of a hospital and be able to give proper feedback that a hospital can use to improve its performance.

Social Care Funding

Margot James Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I think the hon. Gentleman needs to study these proposals with a great deal more care. If he had listened to them, he would know that we are extending dramatically the help available to people who have to pay up to £75,000, by increasing the threshold from £23,000 to £123,000 at 2017-18 prices.

[Margot James (Stourbridge) (Con)]

I warmly welcome the action that my right hon. Friend has taken today. To the critics who say that the cap should be lower, would he not say that the main purpose is to provide protection for those people who face catastrophic charges, which are roughly 10% to 15%? Is that not the main point? Does he agree further that this represents a fair resolution between the people’s responsibility to save for their retirement and the responsibilities of the community to protect those to whom catastrophic charges might apply?

[Mr Hunt]

My hon. Friend, as so often on health matters, is absolutely right. This is about a partnership between the state and the citizen, recognising that the state is not able to bear all these costs on its own, and trying to create the incentives and the certainty whereby private citizens are able to make provision for their own social care costs in the way that they make provision for their pension and, as such, is a very important step forward.

Business of the House

Margot James Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

I am grateful to the hon. Lady for her welcome. I am also grateful for her very warm tribute to my predecessor. I know that the House will very much appreciate the intention that he should be further honoured, as a Companion of Honour. It is a rare honour, but one that reflects the regard in which we all hold him.

The hon. Lady is quite right: I recall at the last business questions before the recess that the House was looking forward to the Olympics and Paralympics. In truth, I think all our expectations have been wonderfully exceeded. It has been a most inspirational event, and not only inspirational for a generation, as it was intended to be, but a fabulous showcase for what this country can achieve. We, the Government and the people of this country will be able to depend on that reputation across the world in years to come.

The hon. Lady asked a number of questions and made a number of points. Let me tell her that the changes in the Government are all about ensuring that we take forward our reforms and our focus on growth. All of us, as the Prime Minister absolutely said, recognise the difficulties that we encountered when we came into government. We know—and have known for two and a half years—how difficult they are. In a sense, they have been added to by the problems in the eurozone and the international economic situation. We are not alone in the problems we have to face, so we are focused on growth, and that will be true, as the Prime Minister has rightly said, in every Department—whether in the Department for Education, in developing the skills, the qualifications and the standards that are required; in the Foreign Office, which has been focused on delivering trade and investment, and business relationships across the world; or in the Department for Communities and Local Government, in using the powers that the Localism Act 2011 gave to local authorities and the new planning arrangements to deliver increased growth and build jobs. That is what it will mean in all those Departments. The difference between the Government and the Opposition is that the Labour Government were responsible for the mess that the country was in in 2010, whereas this Government are focused on getting the country out of that mess.

[Margot James (Stourbridge) (Con)]

Millions of law-abiding citizens will be outraged that Mr and Mrs Ferrie spent three days in custody after defending themselves against burglars, one of whom turned out to be a violent career criminal out of prison early on licence. May we have a statement from the Home Secretary on the urgent need to include common sense in the training of police officers, and may we have a debate about the rights of householders to defend themselves and their property?

Adult Social Care

Margot James Excerpts

Monday 16th July 2012 Commons Chamber

[Liz Kendall]

I always respect the hon. Gentleman’s interventions, but he seems to forget that we faced up to those difficult decisions and choices on adult social care in “Building the National Care Service”. We tried to get cross-party agreement on those proposals, but they became a political football at the last general election. The hon. Gentleman should be encouraging those in his Front-Bench team to engage seriously in cross-party talks and to take the difficult decisions that need to be taken.

[Margot James (Stourbridge) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

I want to make some progress, then I will give way.

Labour proposed better information and national minimum standards to tackle the postcode lottery in care. We also proposed that everyone should have the right to have a personal budget—which we introduced—that people should be able to take their care package with them if they moved to a different area, and that carers should have the right to have their own needs assessed and met independently of the person for whom they cared.

The difference between the Labour Government and the present Government is that we set out the difficult decisions about how those changes would be paid for. The absence of that information is the gaping hole at the heart of this Government’s plans. There is a risk that their promises of new rights and services will be meaningless without the ability to fund them properly. Indeed,

“this White Paper is not worth the paper it's written on.”

Those are not my words, but those of the Alzheimer’s Society, which has damned the White Paper as a massive failure. Similarly,

“the key test for this White Paper was to deliver an urgent timetable to reform social care funding. The Government has failed this test.”

Again, those are not my words. They are the words of the Care and Support Alliance, which consists of more than 65 organisations that represent and support older and disabled people.

--- Later in debate ---

[Margot James (Stourbridge) (Con)]

I will start my contribution with some points that I wanted to make earlier in the debate about the origin of the problems. I accept that there are severe problems with adult social care. I do not know where the hon. Member for Leicester West (Liz Kendall) got her figures about the last Government’s record on adult social care spending, but according to local government figures, between 2004 and 2010, spending increased by 0.1%. Meanwhile, the population of over-65s grew by 7.7% and the number of over-80s by 11.6%.

[Liz Kendall]

I am grateful to the hon. Lady for being more generous with her time than perhaps I was. I got my figures from an independent assessment of Labour’s record in Government that was produced by the King’s Fund before the last general election.

[Margot James]

I am grateful to the hon. Lady for clarifying that. According to local government statistics, in the six years up to 2010, the spend was flat, and I have mentioned the demographic pressures. Interestingly, the same analysis states that over the same time, NHS expenditure rose by 27%, expenditure on the police rose by 20%, and even expenditure on schools rose by 12%.

A picture is emerging of the deprioritising of adult social care under the last Government. That is the origin of the problem that we are debating. That is what gave rise to the restrictions of the eligibility criteria for care. Long before this Government came to office, many local authorities started to restrict eligibility to those in moderate need of care and then to those in critical need of care.

[Mr Anderson]

Will the hon. Lady give way?

[Margot James]

I will give way one more time.

[Mr Anderson]

I appreciate it.

May I suggest that in criticising the last Government, the hon. Lady needs also to look at the record of the Government before that? Throughout the 1980s and 1990s, the social care and health service budgets were drastically reduced to a degree that was an embarrassment to this country.

[Margot James]

I welcome the hon. Gentleman’s intervention, but I will move on to the present day, relevant though the NHS and social care budgets of 20 or 30 years ago no doubt are.

We are beset by problems, although I was pleased to hear the Minister confirm that according to ADASS, social care spending has gone down by just 1% in the past year. Given the incredibly difficult economic situation that we are in, much of which we inherited from the previous Government, that is an achievement. However, we do have problems.

People value their independence, and most older people want to stay in their own home. With the right support, many can. To a large extent, the White Paper proposals will provide the support that is needed to enable more people to stay at home. Carers are a vital source of people’s ability to maintain their independence at home, and the 5 million carers who do an incredibly important job in our country do not get enough support at the moment. I welcome the extra money that is being put towards enabling them to have respite, because carers tell me that a break is what they need first and foremost. I am sure that no amount of money would ever be enough to give them the breaks and support that they need, but at least the White Paper proposals will provide some support.

Many people do not realise that social care is means-tested until they get to the point in their lives at which they need it. That means that we need more information to be available. We need to be honest with people about what is possible, what is available and what is not. All Governments are guilty of putting the best picture forward, which is sometimes misleading. I applaud the Government’s decision to commit £32.5 million to improving information, but perhaps I can make a plea on behalf of some of my older constituents: that investment should not all be online. Many older people do not communicate in that way, so we must allow for some leaflets in GPs’ surgeries, libraries and day centres, and for other traditional forms of communication. Otherwise, we will make older people who do not engage with new media even more dependent on other people to get information for them.

[Fiona Bruce]

Will my hon. Friend give way?

[Margot James]

No, I promised not to take any more interventions, because I know other Members want to speak.

Then there is the dreaded assessment. Older people often try hard at their assessment to suggest that they can do more than they really can, especially when their carers are present. At the moment, assessments are conducted inconsistently not just around the country but within communities—it depends on who conducts them. I applaud the initiative to make them far more universal and consistent. The Dilnot proposal of making them portable around the country is certainly a huge step in the right direction.

As Members of all parties have indicated, the quality of care needs to improve. I welcome the emphasis on dignity and respect that runs through the White Paper. It is important that we have better training for care workers and an end, if possible, to the terrible business of contracting by the minute, which flies in the face of dignity. I quite agree with other hon. Members that it is impossible to get an elderly person out of bed and dressed in the amount of time that is allocated these days.

Dignity and respect are at the heart of a good-quality care system, and I am pleased that that has been given the prominence that it deserves in the White Paper. Of course we would like to do more, but I applaud the Government for making a very good start and, if I may say so to Opposition Members, they have done so within two and a half years of coming to office, which is a great improvement on the previous Government, who took 12 years before they got round to the same point.

Care and Support

Margot James Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

The total number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not. Some 29% of the delays in discharge from hospital are due to the inability to access social care. Most of them arise because people are awaiting further assessment or treatment in the NHS. We have all the details of delayed discharges and are working actively to reduce them.

[Margot James (Stourbridge) (Con)]

I very much welcome many of the measures that my right hon. Friend has announced, particularly on the improvement that he wishes to see in the dignity and respect accorded to those in our care homes and NHS hospitals, especially older people. Will he say a little more about the minimum standards for staff working in the care sector, and about the qualifications that people who apply for care apprenticeships might require to provide the right quality of care?

[Mr Lansley]

Yes, I am glad to do so. Through the work that we are doing with Skills for Health and Skills for Care, we will set out more clearly the training requirements for those undertaking care work and care assistance in the NHS. In addition, we set out in the White Paper that there should be a code of conduct, and I hope that across the service the philosophy of commissioning for quality, not simply commissioning or contracting by the minute, will help push us towards improvements in the dignity and respect with which care users are treated.

Rare Disease Strategy

Margot James Excerpts

Monday 30th April 2012 Commons Chamber

[Mr Timpson]

I am grateful to the hon. Gentleman for raising a particular issue in his constituency in Northern Ireland. He is absolutely right that we need to ensure that the strategy we develop for rare diseases supports not just those who suffer from the disease, but the families who every day, for every hour, have to cope with it and support them. We need to ensure that that is a central part of the strategy.

Such diseases—especially those, including the one to which the hon. Member for Strangford (Jim Shannon) refers, that are particularly rare—are no less important, however, and therein lies the problem. Most rare diseases are under the medical and public radar—too exceptional to attract the attention, recognition and resources required and, above all, the coherent plan needed to tackle the fragmented, inefficient and often inequitable services on offer.

That is why I welcome the Government’s current consultation on the development of a UK strategy for rare diseases and why this debate is so apt. For too long, rare diseases have been placed in the “too difficult to do” pile, but with the onset of changes to health care commissioning and the refocus on putting patients at the heart of the NHS, there is a real opportunity to do things more effectively and much smarter. That means that the consultation must be ambitious, provide strong leadership, and be unambiguous about how the core vision that it reveals can be successfully implemented practically and realistically on the ground across all four home nations.

I have taken the time to read the consultation document, and although it makes many of the right noises, there is a nagging doubt as to whether it meets all the challenges faced by those with rare diseases. I am told by those working in the field of rare diseases that Lord Howe, the Minister who, together with his colleagues in the devolved nations, is responsible for the document, genuinely appears to understand the importance of getting this right. I trust, therefore, that he and they will listen carefully to the submissions they receive, including mine this evening and those of other hon. Members.

So what needs improving? It is clear from my many conversations and my correspondence with clinicians, patient groups and charities working on and living with rare diseases that the ad-hoc nature in which services have developed has led to the principal problems of delays in diagnosis; misdiagnosis; lack of information, communication and awareness; limited research; scarce and unequal access to orphan medicines; poor commissioning and care co-ordination; and a failure to monitor outcomes.

That is not to say that it is all bad news. There is, as ever, some fantastic best practice already taking place. The TREAT-NMD—Translational Research in Europe: Assessment and Treatment of Neuromuscular Diseases—network for neuromuscular diseases, the European Huntington’s Disease Network’s REGISTRY, and the Tay Sachs walk-in clinic at Guy’s hospital are all good examples of innovative, effective and efficient service delivery on which any strategy should seek to build.

[Margot James (Stourbridge) (Con)]

I congratulate my hon. Friend on this very important debate. Does he agree that some rare diseases at least have a high profile, which is advantageous in garnering research and funding? I should like to draw his and the Minister’s attention to a rare disease that has a very low profile—FOP, or fibrodysplasia ossificans progressiva, which is a tragic condition where bone grows in muscle. The funding and research that are required for this condition are set back due to its low profile. Will my hon. Friend join me in wishing to raise the profile of this rare condition and many others with such a low profile?

[Mr Timpson]

My hon. Friend has done just that. I know that she has recently become patron of the charity FOP Action. I believe that this disease affects only one in 2 million people. I congratulate her on taking up that task and wish her and the charity well in raising awareness and the profile of that disease so that even the very small number of people who are affected by it receive the best possible care and support throughout their lives.

In the short time that this debate allows, it is not possible to dig down into the detailed analysis of where the system is currently failing to meet patients’ needs, but I urge the Minister to concentrate on six specific areas, the first of which is diagnosis and screening. As I have said, diagnosis is a major issue. Rare Disease UK has found that nearly half of all patients wait over a year for an accurate diagnosis following the onset of symptoms, with 20% waiting over five years and 12% over 10 years. Misdiagnosis is also a key problem, with almost half of patients being misdiagnosed and almost a third being so three times or more—an avoidable waste on many levels.

One lady who contacted me was Kay Parkinson. Kay set up Alstrom Syndrome UK, a support group for people affected by the same rare genetic disorder that so tragically took the lives of her two children, Charlotte and Matthew. Their desperate story of misdiagnosis, unnecessary and delayed medical interventions and ultimately the most terrible heartache lays bare the consequences of a failure to diagnose early and to diagnose accurately. Through Kay’s dedication, Alstrom Syndrome UK has set up multidisciplinary clinics, funded by the NHS national specialised commissioning group, to help inform patients and professionals of the specialised clinical services available. Its frustration is that it is still unable to find out who and where diagnoses of Alstrom syndrome are made so that it can link them to the specialised NHS services available.

To improve diagnosis, there needs to be: an increase in health care professionals’ knowledge and awareness of rare diseases through initial and ongoing training, particularly for paediatricians; improved links between specialist centres and local services to help with that education, and consideration of the inclusion of appropriate rare diseases in newborn screening, which has proved so successful in the case of MCADD.

The criteria that the National Screening Committee uses should be reviewed to ensure that rare diseases are not being treated unfairly. It is disappointing that the UK lags well behind many other countries in the number of rare diseases for which it screens. For example, in India, the figure is 39; in Poland and China, it is 25; and in the UK, it is just five. Improved access to diagnostic and carrier tests is necessary for even provision across the UK.

Secondly, we need better information. I have spent time between late night votes productively, you will be pleased to hear, Mr Deputy Speaker, in navigating my way around Orphanet in the Library. Orphanet is the European portal for rare diseases and orphan drugs. It provides pretty comprehensive information for patients, professionals, the public and the industry, but is not widely known. Lack of reliable, up-to-date information that helps rather than hinders the prospects of diagnosis remains a significant barrier.

The development of a UK-wide, trusted single portal of information, which has listed against each condition a named clinician who can act as a source of advice and information, would be a major step forward. It would be further enhanced by implementing the international classification of diseases—ICD-11—in 2015. That will bring about the capture of data on the incidence and natural history of rare diseases that are currently poorly understood. The Government should be preparing for such implementation as we speak. I hope that the Minister can give me and other hon. Members assurances that that is the case.

Thirdly, we need research. According to Sir John Burn, professor of clinical genetics at Newcastle university, who was kind enough to contact me, the 80% of rare diseases that have a genetic basis can now be solved using the latest DNA techniques. However, until the 23 regional genetics centres are honed into a single approval structure, huge barriers to research will continue.

Without clinical research networks, the problems of duplication and the perceived lack of impact of research will remain. The knock-on effects are continuing poor relative funding levels and holding back the development of diagnostic tests and treatments.

To ensure that clinical research networks are effective, disease registries need to be established that bring together all clinical information from all patients with a particular condition or type of condition. That will help to deliver more robust research as well as providing more co-ordinated planning and service delivery for the patient.

Fourthly, we need co-ordination of commissioning and care. I have already alluded to the disconnect between the pockets of expertise at regional level and the lack of any real cadre of experts in commissioning locally. That leaves many patients being bounced around the system, with no tangible results or benefits.

Developing a hub-and-spoke model between centres of excellence will help bridge that gap and create meaningful clinical networks. However, ultimately, the new national commissioning board provides a perfect vehicle for ironing out disparities in provision throughout the country. I therefore ask the Minister to explain exactly how the national commissioning board will help create models for cluster-type service delivery for rare diseases.

To ensure that that objective is reached, a national champion for rare diseases, with the necessary clinical clout, is essential in the form of a national clinical director. Bearing in mind that that was a recommendation by the former chief medical officer in his 2009 annual report, I ask the Minister to set out as far as he can the Government’s thinking on that.

The consultation also talks about each patient having a designated care co-ordinator in the same way as cancer patients have now. That is eminently sensible as it fulfils the objective of delivering patient-centred care, and I would be amazed if the Minister felt unable to agree to it in principle.

Fifthly, on access to orphan medicines, the evaluation and appraisal of orphan medicines is different from that of most others. Decisions on whether or not to fund treatments are often made on an individual basis and are very much dependent on which home nation, or indeed which primary care trust, the patient is from. To improve equality of access to orphan medicines requires a proper and consistent appraisal based on the issues specific to them. At the moment, that is lacking, and it follows that a reassessment of the criteria for access is necessary.

Finally and sixthly, on implementation and outcomes, ultimately any strategy is not worth the paper it is written on if it does not deliver significantly improved outcomes for patients. In the case of rare diseases, that could not be more relevant. Processes are important, but the outcome for the patient is the lasting legacy. Effective implementation of the strategy and the monitoring of outcomes flowing from it are crucial. Clear lines of responsibility for delivering the UK plan must exist and the national commissioning board has a big role to play. Without that accountability, we may never truly know whether this has all been worth our effort.

My greatest personal challenge so far this year has been to haul my body round 26 miles, but it is small beer compared with the challenges faced by the 3.5 million people in the UK who continue their battle with a rare disease. However, perhaps the greatest challenge is to our NHS, which over the years has had no choice but to adapt to the changing health needs of, and treatments available to, its patients. For people with rare diseases, the NHS needs to adapt once more. It can do it, and I hope this strategy will ensure that it does.

EU Working Time Directive (NHS)

Margot James Excerpts

Thursday 26th April 2012 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this important debate. Why it matters so much is summed up well by Sir John Temple, in his report, “Time for Training”:

“Training is patient safety for the next 30 years”,

and that is absolutely right.

My own experience is as one of the junior doctors who worked those catastrophically long hours, having qualified at Guy’s in 1986. Before coming to the House, I was involved in teaching and training junior doctors and medical students, including F2—foundation year 2 —doctors, so I have the advantage of seeing the system from its very worst through to the current practice. What we had in 1986 was entirely unacceptable. I was routinely working 100 hours a week, and sometimes up to 120 hours a week. I often worked very long shifts, from Friday morning at 8 am through to 6 pm on a Monday, sometimes without any sleep. It was catastrophic, demoralising, dehumanising and, frankly, dangerous. Training was acquired simply through saturation exposure to techniques. Often the training was ad hoc and the supervision was not ideal. There was an ethical practice that we would find unacceptable today. Often the attitude was: see one, do one, and teach one. Sometimes the see-one stage was omitted.

I remember—I hope that this never happens now because it would be, and it was then, entirely unacceptable—having to insert a chest drain into a patient for the first time. I had a telephone propped on my shoulder and a terrified patient on the bed, but there was no alternative to carrying out the procedure. I am happy to report that the patient survived that experience, but it was not enjoyable for either of us. Both of us were half scared to death as the process went ahead. It was the equivalent of being bayoneted by someone who looks about 12 years old. As I have said, extra time was no guarantee of better training in those days. Happily, the NHS today operates to far higher ethical standards.

However, the firm structure that existed then guaranteed a continuity of care. There was not an issue about contacting the junior doctor because the junior doctor never left the hospital. Professionalism was affected in some ways, especially in the attitudes that were engendered. Sometimes there were very paternalistic attitudes from senior doctors, and certainly attitudes towards consent were not as high as they are today. That was engendered by very long hours and not enough attention given to the quality of training for junior doctors. In addressing this matter, we have to be cautious about referring to the old days as the good old days.

We now have a situation in which there simply are not enough staff to cover shifts. Clinics are routinely cancelled as a result of the inflexibility of compulsory rest periods. For example, if a consultant is called in to carry out an emergency endoscopy, they might then be forced to cancel their clinic for the next day, whereas if we had a little more flexibility about the timing of the rest period—perhaps it could happen within 48 hours—we would not see our patients being unnecessarily inconvenienced.

The availability of experienced staff is poor, as has been highlighted in many reports. Nor are we addressing issues of staff fatigue, to which other Members have referred. I want to read out an e-mail that I received this week from a junior doctor who did not wish to be named, who says, “I regularly do seven 13-hour nights on the trot. The argument is that we are given time off to average out our hours over a six-week period. However, we all end up doing the extra hours anyway, partly by covering for colleagues who are off or who do not exist, or simply by staying on after our shift’s end because there is so much more to do. So we foundation years are doing the long hours but we are just not being paid for them.”

Professionalism faces two problems: either junior doctors work the extra hours and are not paid for them, and are told not to record them sometimes by management; or we develop a clocking-off mentality, which I started to encounter towards the end of the time that I was training junior doctors. For the first time in my career, I heard junior doctors openly talk about clocking off and something not being their problem because they had handed it over to the next doctor on the next shift. That was unheard of when I was a junior doctor: we left when the job was done. We have to be cautious about some consequences in that regard.

Staff absenteeism, which is almost unheard of—I remember one of my colleagues getting tuberculosis and it being a great source of excitement for him, because it meant that he would have some time off for treatment—is increasing. According to a survey by the Royal College of Physicians, the absenteeism rate has increased from 0.8% to 3.5% since the implementation of the directive in 2009. Therefore, the changes towards exhausting shift patterns have not only not resulted in doctors who are less tired, but have led to increased absenteeism. Whether that is due to sickness or to a change in professional attitudes to taking time off is a fine point, but the implementation of the directive has led to serious consequences.

In my area, we have heard about some rotas starting at unacceptable times. I do not think that any hon. Member here would accept that starting a shift at 2 am is acceptable, but it is going on.

As hon. Members have said, we are hearing in our surgeries and postbags that patients and their relatives are noticing changes in continuity of care. The other serious issue is handovers, particularly where senior doctors or consultants are not present. The fact is that shifts do not tally up between junior and senior doctors. Again, referring to the e-mail that I received, on continuity of team, where senior doctors are in different shift patterns there is no sense of a team structure or possibility of handovers being carried out professionally.

[Margot James (Stourbridge) (Con)]

My hon. Friend is making an eye-opening speech. Does she agree that there are implications for health inequalities? For a patient who is well educated and knowledgeable about medical matters and/or has a supportive, informed family around them, the issue of handover is perhaps not as serious as for a patient who is not similarly advantaged.

[Dr Wollaston]

Yes, I agree. But even articulate families of patients tell me that sometimes they find it impossible to track down the doctor who has been looking after their relative. It is not just relatives, but general practitioners, who are having this difficulty. I am afraid that, as a result of this loss of continuity, the times have gone when GPs could phone and be guaranteed to have some feedback regarding patient care. Handovers have been identified, time and again, as a significant source of mistakes in the NHS, leading to incorrect diagnoses and treatments, often repeated, unnecessary or even inappropriate investigations and poor communication between patients, relatives and medical colleagues.

The directive results in poor team work, a loss of training opportunities and is, as we have heard—I will not repeat it—expensive, not only in terms of staff time, but in the penalties that are applied to trusts if they breach it. Finally, it does not stop doctors working at other hospitals, so it does not necessarily even address the problem that it was designed to address.

That is enough about the problems. What about the solutions? Nobody here advocates a return to dangerously long hours for junior doctors, because tired doctors are dangerous doctors. We want the safest care for our patients. I should like the Minister to respond to the idea that the definition of “on-call” is overly restrictive. Doctors should be able to sleep on site and be available for occasional emergencies without that counting towards the 48-hour week. The requirement for compulsory rest periods should be far more flexible on timing, and we need special consideration of the problems facing district general hospitals. The directive is one thing for staff in a metropolitan centre, but it is causing a particular crisis in many of our district general hospitals. We should maintain individual opt-outs.

The point about the European working time directive, as has been made so eloquently by the hon. Member for Vauxhall (Kate Hoey), is that European time is not the same as human normal time. Being realistic, the possibility of a rapid change in the directive is small, so we must look at the alternatives. What progress are we making towards a consultant-delivered service? There is no doubt that the directive does not affect all specialities, and its effect can undoubtedly be mitigated by moving towards a consultant-led service and taking up many of the points raised by Sir John Temple in his report.

There is no doubt that consultant-led care is the safest care for our patients. Much more can be done to make use of existing training opportunities. Not all specialties are affected, but when they are the effect can be mitigated by greater use of, for example, simulation, better design of rotas to enable the shifts and working patterns of seniors and juniors to dovetail so that there are better opportunities to train, using hospitals at night, and separating the emergency model from the routine model so that we have far more emphasis on juniors being able to get the training they need.

Real problems are facing juniors now with getting assessments signed off by senior colleagues, and in the level of their daytime routine supervision. The problem is also that they are not having enough experience signed off, so many doctors have to extend their training, which is a huge source of extra cost for the NHS. Some of that could be addressed with better rota and service design.

We all recognise that the NHS functions as a result of the dedication of its staff, and I pay great tribute to all my former colleagues, and recognise what an excellent job they do on our behalf.

Oral Answers to Questions

Margot James Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

In England, one of the things that we are doing is making sure that a programme of special inspections of care homes, conducted by the Care Quality Commission, looks at those issues to ensure that we provide the right range of support services for people in care homes. In addition, the National Institute for Health and Clinical Excellence has produced quality standards; in particular, it has been working on quality standards relating to issues affecting older people—incontinence, nutrition support for adults, patient experience, delirium, dementia, and many others. All that is critical to delivering really good-quality care in care homes.

[Margot James (Stourbridge) (Con)]

22. Russells Hall hospital, which serves my constituency, has reviewed recent reports, and done its own research, on dignity and care for older patients. It has elevated the qualities of care and compassion to the top of its criteria for recruiting health care assistants. Does my hon. Friend agree that the Nursing and Midwifery Council should apply similar learning to nurse training?

[Paul Burstow]

It is important that that is applied to all who have direct responsibility for delivering care, and hands-on care in particular. The work that Russells Hall hospital is doing on care and respect, and in its responsibility programme, is a good example of that. On issues such as dementia, we are clear that we need to ensure good advice, training and support for all nursing staff—we are working with the Royal College of Nursing on this—so that they treat people who have dementia with dignity.

Adult Social Care

Margot James Excerpts

Thursday 8th March 2012 Commons Chamber

[Sarah Newton]

My hon. Friend makes a very good point, which has been addressed in the carers strategy.

Each year we should aim to use more NHS money on social care, and more money from the NHS budget could be given to councils for the integration of services led by health and wellbeing boards. Eventually, I would like to see the pooling of budgets. Social care has never been free at the point of need, and we know that the NHS will always be free at the point of need irrespective of anybody’s ability to pay. That is enshrined in the Health and Social Care Bill. Despite that, however, most people do not think they will have to pay for care and it can come as a dreadful shock, especially to the one in 10 people aged over 65 who end up paying more than £100,000 for care. Dilnot came up with a framework of shared and capped costs for individuals needing social care—shared costs between the individual and the state. I am sure that framework is receiving a great deal of attention from the Front-Bench teams, but I expect that however well the cross-party talks are going, it will take several years to introduce such a system if agreement can be reached. In the mean time, there is an urgent need to design a fairer system based on shared responsibility to pay.

There are uncontroversial steps that would not require substantial new resources and that could be taken now as part of a longer term plan. The legal framework and assessment processes that are used to decide who is entitled to what help could be sorted. We also need to fix the means test that we use to decide what we expect people to pay. That would help families to understand what help will be available and who needs to pay for what. Families would then be able to plan accordingly. The Government could ensure that people had access to independent advice on the best way of planning and paying for care and they could bring in a universal deferred payment scheme that would tackle the issue that so many people dread—selling their home to pay for residential care during their lifetime.

[Margot James (Stourbridge) (Con)]

I congratulate my hon. Friend on securing this debate and on all the work she does on this issue. Under the present system, people do have to sell their homes sometimes; does she agree that in such cases it would be far better if some of the accommodation were available to purchase on a leasehold basis so that the individual would still have an asset to pass on?

[Sarah Newton]

That is an extremely interesting idea, and I would expect no less from someone with such knowledge in this area. I am sure the Minister will want to take that point on board.

Going back to means-testing, we really need to face up to one of the biggest problems facing families—the meanest of means tests in this country: the test for residential care. Making the simple change of raising the upper threshold of the means test to £100,000 would benefit those on modest incomes who are heavily penalised under the current system. It would enable families who have worked hard all their lives and accumulated relatively modest assets—often the first generation of their family to do so—to have something to pass on to their children and grandchildren. It is an understandable and human desire to want to help the next generation. That change would cost £100 million. In this economic climate, such a figure might be too much all at once, but a staged increase in the upper limit would be a step in the right direction.

We are taking this approach to delivering the excellent policy of increasing the personal allowance for taxpayers to £10,000. Apart from spending NHS money more efficiently, there are other sound economic reasons for redirecting public money into social care. While the vast majority of care is given freely, more than 1.5 million people are employed in providing care. We need to recognise better the valuable and challenging work they do. I know that the Minister is doing good work on training and quality standards. Many care workers are paid low wages, so investment in this sector would have the direct impact of putting more money into the pockets of some of the poorest paid workers.

We also need to enable more working age informal carers to combine their caring responsibilities with paid employment. This is even more important as the pension age rises. Much emphasis is put on enabling working age parents to care for their children and remain in paid employment—with flexible working, help with child care costs and financial support through the tax system. We need to put as much emphasis on enabling working age people with other caring responsibilities to remain in employment. Otherwise, we are going to have ever-increasing out-of-work benefit costs to pay.

While I do believe that the Government are starting to develop the processes that could deliver better and fairer access to services and higher quality care, bolder and more determined action is needed to enable more rapid change. I hope that the Minister and the shadow Secretary of State for Health will listen carefully today and bring back to Parliament a shared vision and a clear plan on how together we as a country and as a society are going to create a good place for us all to grow old in.