A and E (Major Incidents)

Meg Munn Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I commend my hon. Friend for her tremendous interest in the Royal Cornwall hospital and for her campaigning to support its efforts. I spoke with the chief executive earlier this week about the particular challenges with discharging patients. I also spoke with the deputy chief executive of the South Western Ambulance Service NHS Foundation Trust about the dramatic increase in 999 calls this winter. My hon. Friend is absolutely right that the public can help us by ensuring that they use alternatives to A and E wherever possible.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

When I led an integrated health and social care team 20 years ago, we found that carers no longer being able to care was a key reason why people went into hospital and into care. Will the Secretary of State now look again at the eligibility criteria introduced under the Care Act 2014 and ensure that a much greater number of carers can get support, because at the moment the number is being reduced?

[Mr Hunt]

Under that Act we introduced national eligibility criteria to try to remove the postcode lottery that had existed previously. We have also introduced new rights for carers that require local authorities to take account of the pressures on them. I think that we are going in the right direction, but I accept that there is always more that can be done.

Obstructive Sleep Apnoea

Meg Munn Excerpts

Tuesday 2nd September 2014 Westminster Hall

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I congratulate my hon. Friend the Member for Bolton West (Julie Hilling) on securing the debate and thank her for allowing me to make a very short contribution. The link between OSA and road traffic accidents is well established, and I was alerted to that fact when the nephew of one of my constituents was killed by a lorry driver with undiagnosed sleep apnoea. According to medical experts, 10% to 20% of lorry drivers—that could be as many as 40,000 drivers—may suffer from sleep apnoea. The Royal Society for the Prevention of Accidents estimates that one third of road accidents are caused by somebody at work. In 2012, the number of people killed in road accidents was 1,754, so we are talking about approximately 600 deaths involving people who drive for work. [Interruption.]

[Mr Dai Havard (in the Chair)]

Order. I am going to have to stop you, because we have a procedure issue here. The Minister did not understand that you were going to make a contribution.

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

I am happy for the hon. Lady to make a contribution, but it needs to be brief.

[Meg Munn]

I am coming to the end, Mr Havard. In fact, I would have finished—

[Mr Dai Havard (in the Chair)]

If I had not intervened.

--- Later in debate ---

[Meg Munn]

The point that I want to make is that the Health and Safety Executive does not investigate such deaths. Will the Minister press his colleagues in the Department for Work and Pensions to get the Health and Safety Executive to look at road deaths and not to ignore a major concern about driving at work, in which OSA plays a significant part?

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

It is a pleasure to serve under your chairmanship, Mr Havard. I congratulate the hon. Member for Bolton West (Julie Hilling) on securing the debate. One of the great benefits of Adjournment debates is that they force Ministers to focus on one condition among the array of things that we have to deal with, and this debate puts an important spotlight on OSA. I will take up with Professor Mike Morgan, the national clinical director for respiratory disease, the issues that the hon. Lady has raised. In accordance with the request from the hon. Member for Sheffield somewhere or other—

[Meg Munn]

Heeley.

[Norman Lamb]

In accordance with the request of the hon. Member for Sheffield, Heeley (Meg Munn), I will write to the Health and Safety Executive. She made a good point, and I am happy to raise it directly with the HSE. Those are serious issues, and they deserve to be taken seriously.

The case studies provided by the hon. Member for Bolton West clearly demonstrated the benefit of accessing treatment, and the impact that treatment can have on someone’s life. I agree with the hon. Member for somewhere near Liverpool—

[Norman Lamb]

I apologise; I agree with the hon. Member for West Lancashire (Rosie Cooper) that that is a no-brainer. As other hon. Members have said, we must raise awareness and understanding not only among the general public but among clinicians and general practitioners, because a problem with diagnosis may arise because a GP does not recognise the need for a referral. As the hon. Member for Strangford (Jim Shannon)—I think I have got his constituency right, at least—has said, we must work with the devolved Administrations and ensure that we raise awareness of the condition across the United Kingdom.

As the case studies demonstrate, OSA can have a huge impact on the quality of life of those who suffer from the condition and their families, which the example of Steve demonstrates so graphically. OSA can contribute to other long-term health conditions, such as high blood pressure, stroke, diabetes and, critically, mental health issues. The hon. Member for Bolton West made a point about Steve contemplating suicide, and we often forget about the close connection between many long-term conditions and the mental health issues that can go with them. People suffer depression because of an inability to escape their condition.

As we have heard, OSA can also lead to serious, even fatal, accidents. The statistic that there may be 40,000 preventable road traffic accidents is extraordinary. The issue is driver fatigue. Sleep apnoea sufferers are thought to be seven times more likely to cause crashes than drivers without the condition. The challenges posed by OSA should not be underestimated. In the UK it is thought that some 4% of middle-aged men and 2% of middle-aged women suffer from OSA, which in many cases requires lifetime treatment of the sort described by the hon. Lady. A further complication is that, as she describes, OSA is often left undiagnosed because people with the condition usually have no memory of some of the key symptoms, such as interrupted breathing during sleep, so they may be completely unaware that they have a problem unless a partner happens to raise it with them.

The NHS outcomes framework for 2014-15 sets out the Department’s priority areas for the NHS and includes reducing deaths from respiratory disease as a key indicator. Additionally, the mandate sets out the requirement for NHS England to improve outcomes in a range of areas, including preventing premature deaths from the biggest killers, which include respiratory illnesses, and supporting people with long-term physical conditions such as sleep apnoea. Incidentally, it will be interesting to see the economic impacts that the report will set out. I am happy to take that up with the national clinical director, too.

Our “Living Well for Longer” report, which was launched in April 2014, sets out what the health and care system will do to achieve the Government’s objective to be among the best in Europe at reducing levels of premature mortality. The report brings together in one place the national actions taken by the Department and the wider Government, NHS England and Public Health England on prevention, early diagnosis and treatment, focusing on the five big killers, including lung diseases, and showing how they will support local leadership and interventions.

Local clinical commissioning groups are responsible for assessing the needs of their local populations and for commissioning services to meet those needs. For patients with OSA, NHS England expects CCGs to take the NICE guidelines into account when deciding what services should be made available. NICE has recommended continuous positive airway pressure as a treatment option for adults with moderate or severe symptomatic OSA or hypopnoea syndrome, where certain clinical criteria are met. NHS commissioners are legally required by regulations to fund that treatment, where clinicians wish to use it.

Continuous positive airway pressure is currently the only technology recommended for OSA in NICE technology appraisal guidance. The hon. Lady mentioned a referral to NICE for a quality standard, and I am happy to write to NICE. She will understand that NICE is independent, and it is important to respect that independence, but I am happy to ask NICE where that issue is in the work stream of quality standards that are waiting to be addressed. That work will be completed by 2017, which is the long-stop date. I will check, and I am happy to write to her to confirm the position.

Although it is not always possible to prevent OSA, making certain lifestyle changes may reduce a person’s risk of developing it. Those changes include losing weight, limiting alcohol consumption and stopping smoking. The Government are acutely aware of the damage being done to the population’s health through smoking and harmful drinking, which is why we have set out clear ambitions for driving down the prevalence of smoking and reducing the incidence of alcohol-related disease in our tobacco control plan and our alcohol strategy respectively.

We have ensured that NHS health check, a key programme to address systematically the top seven causes of preventable mortality, includes identifying and helping people to take action to quit smoking, maintain a healthy body weight and reduce alcohol consumption. All those issues, of course, have an impact on a range of conditions, including vascular dementia and heart disease, but they are also relevant to sleep apnoea, and we ought to be doing more to address the issues that could prevent the condition.

Through the responsibility deal, we are actively working with business to take voluntary action on calorie reduction and food labelling to help people make healthier eating choices. That is already delivering change and making a real difference. The Change4life social marketing campaign is encouraging individuals to make simple changes, such as reducing their calorie consumption and being more active. One of the key challenges in tackling OSA, as several hon. Members have said, is raising awareness of the condition. It can be difficult for sufferers to detect OSA themselves, and it often goes undiagnosed as a result. In fact, it is estimated that in this country up to 3% of adults across all age groups have undiagnosed OSA, which is an extraordinary number. There are then the associated accidents.

Surveys carried out by the British Lung Foundation in 2011 and 2014 to measure awareness of OSA show that awareness of the condition has risen significantly, which we should applaud. Awareness has especially risen among men, who are most at risk, and in areas with a high risk of OSA. I pay tribute to the British Lung Foundation, which has worked collaboratively with the hon. Member for Bolton West, and the important work of its obstructive sleep apnoea project that aims to improve diagnosis and raise awareness of the condition. The project’s successes include the largest survey of OSA sufferers ever undertaken, a UK-wide mapping tool of sleep services and prevalence of known OSA risk factors and a media campaign that reached at least 48 million people.

It was a privilege for me to attend the recent opening of the Breathe Easy North Norfolk group. Breathe Easy groups have the potential to be incredibly powerful, and they are run by their members with help and support from the British Lung Foundation. Breathe Easy groups provide support and information to people living with a lung condition, as well as those who look after them.

Those are all examples of highly valuable initiatives led by the British Lung Foundation that have a huge impact on the lives of a great number of OSA sufferers in the UK. The effects of sleep apnoea are potentially devastating, and the condition affects thousands of people in this country, many of whom are not aware of the problem even when they are feeling its effects. It is vital that the NHS continues to work hard not only to reduce the number of premature deaths from all respiratory illnesses, including OSA, but to support people with long-term conditions better, regardless of where they live. I assure the hon. Lady that the Government will continue to work hard to improve outcomes for all those in society who have, or are at risk of, a long-term condition such as sleep apnoea.

I reiterate the point made by other hon. Members that the analysis of the economic case demonstrates that much better preventive work ultimately saves money, as well as having a massive impact on individual lives. I strongly feel that we need a shift of emphasis to focus much more on prevention.

[Meg Munn]

As there is a bit of time remaining, may I press the Minister on the Health and Safety Executive? We do not currently know how many accidents involve sleep apnoea, and we might need to consider not only more action on the health side but more action to ensure that employers are screening drivers who are particularly at risk.

[Norman Lamb]

I indicated earlier that I am happy to write to the Health and Safety Executive, and I will ensure that the Hansard report of this debate is referred to it so that the hon. Lady’s point can be taken up. I will also write to the national clinical director and NICE. I hope those actions will contribute to the objective, which we all share, of raising awareness and getting the system to be much better at intervening earlier to help people with conditions. Such intervention can have a massive impact on people’s lives and, with a bit of support and access to treatment, can completely transform the lives of those individuals.

Oral Answers to Questions

Meg Munn Excerpts

Tuesday 15th July 2014 Commons Chamber

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

The fascinating thing is that street triage is spreading across the country because forces and mental health trusts see the enormous value of it. The really exciting news is the significant reduction in the number of people who end up in police cells. That is in part due to the standards that we set through the crisis care concordat for the first time for mental health crisis care.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I welcome the Secretary of State’s commitment to getting rid of as much bureaucracy as possible, so will he look into what is happening with NHS England in south Yorkshire that is delaying approval for a much-needed GP surgery in my constituency? Given that it is in partnership with the local authority, the delay risks us losing the surgery altogether.

[Mr Jeremy Hunt]

I am happy to look into the details of that case and be as much of a bureaucracy buster as I can.

Oral Answers to Questions

Meg Munn Excerpts

Tuesday 10th June 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question. Another reform that we are introducing is universal access to a deferred payment agreement for everyone who would otherwise be forced to sell their home to pay for care—something of which we should be very proud. That will be introduced in April 2015 and it will mean that no one has to sell their home during their lifetime to pay for their care.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

For the avoidance of doubt, will the Minister list the care costs that will not be included?

[Norman Lamb]

The amount that will count towards the clock running to reach the cap will be based on what the local authority determines will be the cost of meeting a person’s eligible care needs. That is exactly the model that Andrew Dilnot recommended, and we are implementing it as he recommended.

Care Bill [Lords]

Meg Munn Excerpts

Tuesday 11th March 2014 Commons Chamber

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I want to make one brief point. Care in our society is delivered largely by friends and family, for free. It is done willingly, because the people involved want to do it, and we should support that. I remain extremely concerned that not enough attention is being paid to the mechanisms by which that informal care could be better supported. I ask the Secretary of State not only to look at clause 18, which covers the duty to meet needs for care and support, but to commit to drafting guidance that will make it clear to local authorities and health services that clause 19 gives them the power to meet needs for care and support.

When people are in difficult circumstances, providing low-level care such as shopping and cleaning—the kind of thing that supports people with a lot of needs that are being met by someone else—is the way forward. That is what we need to see happening. I remain extremely concerned that because local authorities are under such budgetary pressure, they will focus only on the most severe needs and that the opportunity to adopt a preventive approach, which would help to provide real care and support and keep people at home, will be missed.

[Several hon. Members]

rose—

Care Bill [Lords]

Meg Munn Excerpts

Monday 10th March 2014 Commons Chamber

[Paul Burstow]

I hope that the House will forgive my having a number of new clauses to explain in the time available to discuss part 1 of the Bill. I will try to crack on as quickly as possible to explain the thinking behind each of them. I will do so not in numerical order, but in order of importance, starting with the new clauses on which I particularly want to hear the Minister’s response.

First, I wish to discuss new clause 11, which deals with the Human Rights Act 1998 and its application to social care. The Act has enormous potential to improve the lives of those most vulnerable to human rights abuses in social care settings. People who are being provided care in their own homes or in care homes face risks in respect of their privacy, their family life, being safe and not suffering degrading treatment. Such matters are all very much at the heart of how we ensure that we provide dignified care.

I am sure that the Minister knows, as do other hon. Members, that a loophole has opened up in our law as a consequence of a judgment made by the courts some years ago. It arose in 2007 following the decision by the House of Lords in the YL v. Birmingham city council case. The Law Lords held that a private care home providing residential care services under contract to a local authority was not performing a “public function”, so its residents were excluded from the protections of the Human Rights Act. In practice, that means that domiciliary care users, or their families or carers, can complain to the care company, depending on the terms of their contract, but in many cases they will not be able to take their complaint any further. Contractual terms and conditions are important, but they can often fail to give the protection that we would want to see, and residents in care homes have no security of tenure and are often afraid to complain because of fear of eviction. Many people with care needs face additional challenges asserting their contractual rights, particularly if they lack the capacity to do so because of dementia or learning disabilities.

The decision that private and third sector care home providers were not directly bound by the Human Rights Act meant that thousands of service users had no direct legal remedy to hold their providers to account for abuse, neglect and undignified treatment, even though the public body commissioning those services remains bound in law by the Human Rights Act. There is need for change in this area. The loophole was partly closed by the previous Government, with cross-party support, through section 145 of the Health and Social Care Act 2008, which covers residential care services. However, under changes that this Bill will introduce, it will need to be reinstated by order, but there is a far better and more elegant way in which that could be done—by implementing new clause 11.

New clause 11 seeks to clarify the law so that all providers of publicly arranged or paid-for care are within the scope of the Human Rights Act. Service users who experience serious human rights abuses will then have direct means of legal redress. However, this is not just about going to law; it is about what goes on in the hearts and minds of those organisations and the attitude they take towards how they provide services, so the Human Rights Act has a part to play in culture change as well. For example, the Act has been successfully invoked in an argument about a local authority’s refusal to place a married couple in the same nursing home.

The Government have accepted that there is a loophole, and we very much welcome that. We raised the matter during consultation on and scrutiny of the draft Bill, and we offered up a suggestion, which their lordships adopted. In response to the Joint Committee, the Minister told us that organisations that were not covered by the Act should none the less consider themselves bound by it. Lord Hope, the recently retired Deputy President of the Supreme Court had this to say about that:

“Comments of the kind that were made, that people should consider themselves bound by a convention right, however well intentioned, do not have the force of the law”.—[Official Report, House of Lords, 16 October 2013; Vol. 748, c. 549.]

That is why we need to give it the force of law, which is what new clause 11 attempts to do. It puts back the law to where Members of all parties expect it to be, and ensures that a poor judgment by the court is corrected.

New clause 1 deals with the issue of power of access. Last week, I handed in a letter to the Prime Minister, setting out the case for the measure. It was signed by 602 organisations and individuals, including Age UK, Mencap, the National Autistic Society and many others with expertise in the area of adult safeguarding. They all share a common concern that there is a gap in the law when it comes to protecting vulnerable people who have the ability to make decisions for themselves but who are living in a home with someone else who is abusing them or neglecting them and who is denying them, because of their ability to exert their authority over that person, the ability to get the protection that they need. The Law Commission took that view in its review of mental capacity legislation, and the Equality and Human Rights Commission also took that view in its analysis of the legislation.

In our debates in Committee, my hon. Friend the Minister of State said that when officials were asked to provide the evidence behind their advice that the new power was unnecessary, there was an opaqueness surrounding the issue. There was not the necessary level of clarity to understand what powers could be used and in what scenario. I must say to the Minister that the scenarios that have been offered up to justify the position that there is no need for legislation do not address the circumstance that I and my new clause 1 seek to address. I am talking about someone who legally has capacity but who is under duress and unable therefore to exercise their individual right to seek protection. As a consequence of that, we need this power.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I added my name to the right hon. Gentleman’s new clause. Does he agree that the Bill is putting in place a range of measures on new safeguarding boards, and that this power would complement the work that is now being done to raise the whole issue and to ensure that vulnerable people get the protection they need and their circumstances properly investigated?

[Paul Burstow]

The hon. Lady is right, and with her own experience in social work practice, she will know why this matters so much. She is right to say that in the Bill, for the first time, many aspects of adult safeguarding are put on a statutory basis, which is welcome. None the less, there is still a gap, which the Government with this Bill should seek to fill. We have had a lot of back and forth between the Minister of State and his officials, and I am grateful to him for the patience that he has shown. I just hope that the patience translates into something else. However, he has told Members that there is a balance of risks, and his judgment is that the powers are not needed. I say to him and to officials that if that is the case, why, in the scenario that I have described, can he not produce the evidence?

I welcome the fact that the Social Care Institute for Excellence has been commissioned to do work on this issue, but if there is a gap in the law, that will not fix it. It has been suggested that the problem is that practitioners are ignorant of the law. Again, I have to ask where the evidence is for that. Thanks to Action on Elder Abuse, which instituted a freedom of information request, we know that the evidence does not support that line either. So far, 84 out of 152 local authorities have responded. Twenty-nine councils have reported at least one instance in the past 12 months in which they have been unable to gain entry because a third party had denied them access. In 21 of those cases, they never gained access. Therefore, all the arts of negotiation and relationship building that are essential to good social work practice did not gain those people access, and who knows what happened to those individuals. Let us hope that they do not find their way on to the front page as a tragic story.

Not a single one of the 84 authorities that responded to that request have suggested that a failure to gain access was the result of a lack of knowledge. It is really about a lack not of knowledge but of that backstop power, which the new clause provides. In a survey of front-line practitioners, 365 of whom have responded, 82% believe that the power is necessary.

New clause 1 provides a proportionate power for a circuit judge, approved by the Court of Protection, to determine whether an entry warrant should be granted where a person is believed to be under duress and a victim of abuse. Let me be clear that the measure should be rarely used, but it is required for those circumstances in which a person is in the situation that I have described. I agree with the Minister about good social work, but just talking about good social work is not an adequate answer.

--- Later in debate ---

[Hazel Blears (Salford and Eccles) (Lab)]

I shall do my best not to be grumpy and to be as quick as the right hon. Member for Banbury (Sir Tony Baldry). I wish to speak in support of new clauses 9 and 19. New clause 9 has support across the breadth of organisations from the Association of Directors of Adult Social Services to the Care and Support Alliance. It makes fundamental good sense, when setting up a new system, to have the ability to have an annual report about whether there is sufficient money in the system. Whichever Government are in charge, we need to know that. We are in danger of willing the ends but not the means for social care, and we have to make sure that this issue is kept under close review.

We all support the two fundamental principles of the Bill, which are about promoting individual well-being and moving towards a more preventive system. Those are commendable and high ideals, but if we do not have the funding in the system to be able to deliver them, the Bill will not achieve the potential that we all know is there.

I spoke on Second Reading about transformation, and I look forward to welcoming the Minister to Salford on Wednesday to show him how we are transforming the system for dementia care in the city by bringing together £97 million of our total health and social care budgets to try to squeeze every bit of impact out of every last penny to give better care for people with dementia. I hope he will be impressed, but more than that I hope he will help us to do this with his better care fund. That fund should be used for the transformation of our services at a time of austerity when we need more money in the system.

The second part of the new clause is about having a five-yearly review of eligibility criteria, which is essential—to be frank, I would like to see that happen more often than every five years. Eligibility criteria are now set at “substantial” instead of “moderate”, which means that in Salford 1,000 fewer families are being helped, and the heartache and misery that that causes are enormous. It also goes against the second fundamental principle of the Bill. If we do not have eligibility criteria at the right level, how can we transform the system to be preventive? If we only pick up people when they are in crisis, they are escalated into the acute sector, which costs a fortune. If we invest in lower level community-based interventions by social enterprises and voluntary groups, we can save money in the acute sector.

[Meg Munn]

Does my right hon. Friend agree that even when people’s needs are substantial, they are often not getting the support they need because the local authorities are not recognising that low level services, such as shopping and cleaning, help to support the care that is being provided by families? The Government need to have clear guidance on this.

[Hazel Blears]

My hon. Friend, as ever, makes an extremely worthwhile and practical point. Simply having the words in statute does not always portray the real position on the ground. A small intervention can often help to stop things becoming a crisis.

Oral Answers to Questions

Meg Munn Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

I do agree, and I congratulate my hon. Friend on his work. I know that he is meeting Alzheimer’s Research UK next month in his own constituency. This matter is something in which we can all be involved in our own constituencies. There is a lack of willingness to talk about dementia. Many people are frightened of it, and the more we can do to raise the profile of this condition, the more we can give people hope that something can be done about it.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

Although I support the principles of the Better Care Fund, does the Minister recognise that, in the context of severe cuts to local authorities and cuts in the NHS, the top-slicing of existing budgets is not sufficient? To encourage the kind of innovation that we need to get better integration, we must have additional funding.

[Norman Lamb]

The Government are getting on and implementing integrated, joined-up care. I remember talking about it constantly when the hon. Lady’s party was in government, and nothing ever happened. We are taking concrete steps to join up the system with the benefits of the £3.8 billion Better Care Fund.

Care Bill [Lords]

Meg Munn Excerpts

Monday 16th December 2013 Commons Chamber

[Hazel Blears (Salford and Eccles) (Lab)]

I should like to begin by quoting one of the Alzheimer’s Society’s ambassadors, Arlene Phillips. Talking about her father, who had Alzheimer’s, she said:

“I did everything I could to care for my dad when we discovered he had dementia. Unfortunately, the efforts of one person—or even a family—aren’t always enough. It soon became clear to me that while I could keep Dad safe when I was by his side, I couldn’t be there every minute of every day.”

The words of Arlene, and thousands like her, should provide all of us in the House, irrespective of party, with the greatest incentive to act to support those people who are suffering and need care and, crucially, their carers and families, who are the backbone of the social care system in this country.

A society should always be judged by the way in which it looks after the most vulnerable people in its communities, and it is safe to say that, over the years, we have all failed that responsibility. Today is an opportunity for us to acknowledge that, and to point out that, even today, in a modern 21st century developed industrial nation, we are still failing the people who ought to get a great deal more support and care from us than we are currently in a position to give.

The Bill is a small step forward, rather than the giant leap for mankind that I would have liked. One of the central issues is a lack of ambition. We face the biggest social challenge that any of us could possibly see, yet the Bill’s provisions, some of which are well meaning, do not, when taken together, add up to a whole system’s series of changes that result in a basic reconfiguration. The right hon. Member for Charnwood (Mr Dorrell) spoke about that, and I pay tribute to his championing of integration, change, re-engineering and being ambitious. I do not see that in this Bill.

Instead, I see some perverse incentives. If we are talking about the well-being duty and the duty to prevent, reduce and delay somebody’s need for care, how can we say that we are going to support only people with substantial and critical needs? How are we going to engage the system further up the chain, with people who are beginning to suffer, perhaps beginning to have memory problems and beginning to need social care? How are we going to incentivise the system to invest in the new commissioning in clause 5, which talks about diversity and shaping the market? How are we going to get the system to focus on that if all the focus, after £2.85 billion-worth of cuts in social care, is on how we might manage to look after the people with substantial and critical needs? We should be focusing far more upstream in the system.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

As my right hon. Friend has said, the backbone of care in this society is provided by friends and family. Should we not be moving towards a system that incentivises the people currently giving care to continue to do so for as long as possible by supporting them at the lowest level, not at the highest level?

[Hazel Blears]

My hon. Friend makes an extremely powerful point. I am pleased that the Bill strengthens support for carers. I draw the House’s attention to the Bill introduced by the other Member for Salford, my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), which seeks to make sure that carers have the right to stay in work and the support to be able to do that. We must consider the cost to our economy of people having to give up work in order to care. We have talked a lot today about perverse incentives and false economies, and that has absolutely been a false economy for a long time.

I wish to say a word about diversity of provision and commissioning new models of care that can help with prevention. In my city we have been working on that for a long time, and I look forward to showing the Minister some of our examples when he visits. Social adVentures is a social enterprise that helps people with mental health problems, and one of its projects is “garden needs”. It has taken control of a garden centre, and people with dementia and people with mental health problems are now attending. The way it is keeping people active in the community and able to do many more things than they would if they were isolated and at home is amazing. Unlimited Potential is another fabulous social enterprise, which stands on its own two feet, is not grant-dependent and is able to invest more money back into the community. Last week, I had the pleasure of launching a website called Really Useful Stuff, which is just what it says on the tin—it is a website where people can get aids, adaptations and kinds of social care that are modern, innovative and creative. Those are just a few examples of what is already happening in the community.

I say to the Minister that at a time when money is tight, and will be, no matter which Government are in power, the imperative to innovate and be more creative with the funds we have has never been greater. Therefore, investing, in particular, in the social enterprise sector, which often has these great ideas, and in enabling those ideas to get to scale so that provision can be made across the country, is really important. Another company in my constituency, 2ergo, has recently developed an app for the iPhone where people can see what provision is available in Salford for care, respite care and activity, and how to book it. They can book it over their iPhone—families can do that; they can help the people they are caring for. So this use of new technology is now developing apace, and, again, we have to take advantage.

I commend the Government for organising the G8 summit last week in London—an amazing event where we gathered support from countries across the world. I hope that next year we will be able to expand that to a global event examining dementia, not just one involving the G8 developed countries. Part of that G8 meeting was about how we get more research. I would like to see far more research on the quality of care. There is a lot, but not enough, research on the bioscience, but hardly any research on the interventions we do, particularly for people with dementia. We all know that “singing for the brain” has a great reputation. It helps cognitive development, as do art, drama and reminiscence work. There is no evidence base behind that, so if we are to have a better system of social care, we need better research into therapeutic interventions that work. That will enable commissioners to commission packages of care that they know will make a difference. If money is tight, we need to spend it on things that we know will be effective, and I ask the Minister to support that.

The Alzheimer’s Society has also done a lot of work on dementia-friendly communities. That is not expensive. It is a matter of mobilising the good will of local people, shops and arts centres. In Salford, a taxi firm has trained 400 drivers to look after people with dementia. Such care does not cost a lot of money if we can mobilise ordinary people in their communities. In Japan, 4.5 million people are signed up to be dementia friends. Our ambition is to have 1 million such friends. Again, I push the Government to be more ambitious to see what more we can do.

Clause 5 is about not just diversity and shaping the market, but quality, and that is an area about which we all feel passionate. How can we in this country tolerate a situation in which those who do the most difficult job in caring for our friends and family are actually some of the least regarded workers? It is utterly unacceptable to have zero-hours contracts in the social care sector. The carers who care for my dad come in for 15 minutes. They will do more if they can. They have to ring up to be assessed when they have done 12 minutes. They get no payment for travelling and no expenses for their petrol. They came out one Sunday. They started at 8 o’clock in the morning and went home at 9 o’clock at night, but because they only had five hours of 20-minute slots, they got paid only for five hours. Members should try being out on a Sunday for 13 hours and going home with five hours of minimum wage payment. It is an absolute disgrace and a scandal that we tolerate that in this country. I hope the Minister will assist in bringing such practice to an end.

I want to say something about my own local authority. My hon. Friend the Member for Worsley and Eccles South mentioned the fact that Salford has recently had to change its eligibility criteria from moderate to substantial and critical. We were the last authority in Greater Manchester to have to make that decision, and it was heartbreaking. Our social services have always merited four stars. When I was a councillor 30 years ago, cuts were bad, but we always prioritised social care and nursery care for children. The decision to change the criteria was not made lightly, and the cuts have been absolutely horrendous.

Let me again say to the Minister that we need creativity and imagination to deal with this matter. I want to draw the House’s attention to my unpaid interest in social finance, which appears in the Register of Members’ Financial Interests. We have a real opportunity to draw extra funds into the social care system. If we could have a social investment bond that aimed to keep people with dementia in their own homes for longer, we would save the NHS a fortune. People with dementia are admitted to hospital more often. They stay longer in hospital and many more of them die there. If we could mobilise social investment to offer a reward for keeping people in their own homes, funded by the savings to the NHS, we could bring in some new money, not just what we are getting from local authorities.

--- Later in debate ---

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

Members on both sides of the House agree that we need to reform and improve how we provide care to those who need it. In the words of the Law Commission, our current legal framework is a complex and confusing patchwork of legislation that is in desperate need of modernisation. However, the premise on which part of the Bill is based is simply outdated. It tries to focus the debate on residential and nursing care costs, which directs our view of care on to issues of the previous century when this should be a Bill for the landscape of the 21st century.

Only a small percentage of older people need to be in residential or nursing care and, thankfully, most of them for only a relatively short period at the end of their lives. Most people want to stay in their own homes if they can. Consequently, it is right to develop care services that make that happen, such as ExtraCare homes, whose options for meals and support for residents can change as their needs change.

Our care system is there not just for when people hit crisis point; it should be preventive, ensuring that those who need moderate care and support can receive it in their own homes. Yet, as we have heard time and again in this debate, because of the Government’s savage cuts to local authority funding, 85% of local authorities now provide care only to those whose needs are assessed as substantial. If the level is also set at substantial in relation to the proposed national eligibility criteria in clause 13, people with moderate care needs will continue to be ignored. Their needs will inevitably move to severe, which will mean even greater cost to both the individual and the state. My hon. Friends have given examples of that.

As has already been said, the vast majority of care in this country is given by family and friends, who provide not just physical care but emotional support. Most do so willingly, but many would benefit from some support through the provision of low-level services, such as a sitting service to allow them time to themselves, or a cleaning service to allow them to concentrate on providing more personal help. Put simply, a small amount of support for those whose needs are at a lower level would lever in a large amount of care by families, who would also be enabled to continue to provide support over a longer period, so saving on much more expensive services.

[Robert Flello]

On the theme that my hon. Friend is developing, quite a lot of carers are almost borderline in their need for care themselves. What is her view of the fact that without that extra bit of support for carers’ needs, there may be the double hit of two people needing care from the state?

[Meg Munn]

My hon. Friend is absolutely right. I managed care services when, not the previous Government but the one before that, brought in a health and social care Act. Within the first six months, we found that every single person who ended up in residential care did so because of carer breakdown, as the carer was not getting support. That is why this support is such an important part of what we should deliver.

Care services must be personalised: they have to be about choice, as well as need. If we are to make such personalisation a reality, we need further integration of our health and social care services. The duty on local authorities under clause 3 to promote the integration of care and support with health services does not go far enough in that respect. Indeed, a recent survey of health and wellbeing boards found that most local authorities have not identified integrated care as a priority. Clearly, we must do more to drive forward the development of integrated care. Without such an approach, we will return to the days that I remember well, when there were fruitless arguments about whether a service such as bathing was required on social or health grounds.

The integration of health and social care services is crucial to ensure that we provide carers with sufficient support. As a patron of Sheffield Young Carers, I feel privileged to have seen at first hand the selfless role that even very young carers undertake in our communities, and they should be valued.

As has been said by the right hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), the Bill places a duty on local authorities to have regard to the importance of identifying carers, but that is not good enough. Some 80% of carers have contact with a health care professional, and it makes absolutely no sense to leave the NHS out of the duty to identify carers.

That matter is especially worrying as regards young carers, who quite often need a lot of support. The Children and Families Bill will strengthen young carers’ rights by providing that when a child is identified as a young carer, the needs of everyone in the family should be considered. That of course presupposes that young carers will be identified in the first place. If we do not place a corresponding duty to identify carers on health authorities, we risk young carers falling through the gaps, and we cannot continue to leave them without support.

My remarks would be somewhat lacking if I did not refer to the funding or, perhaps more accurately, the lack of funding that underpins our social care system. The proposals outlined in the Bill primarily concern redistributing the costs of care, and they will not bring any extra funding into the system.

[Bill Esterson]

My hon. Friend is making an absolutely crucial point. Does she agree that unless investment in social care is made now, it will end up costing far more in the cost of the NHS, as well as that of social care? It is the lack of ambition, as well as the lack of finance, that is really disappointing in what the Government are introducing in the Bill.

[Meg Munn]

I agree. The demand for services is now greater than ever. Our social care system is being cut to the point of breaking. As has already been discussed, should the proposed health funding reallocation for clinical commissioning groups be implemented, the situation will only get worse. South Yorkshire is due to lose £150 million by April 2014. That is staggering given that, under the proposals, other parts of the UK that already have better health outcomes and longer life expectancy will receive an increase in funding. This Bill seeks only to ration scarce resources; without a completely different approach, we will fail to meet proven need.

As a former social worker, I welcome clauses 42 to 47, which introduce a duty on local authorities to make inquiries when they suspect that an adult is at risk of or is experiencing abuse or neglect. Yet no duty is placed on care providers to report suspected abuse or neglect to the local authority. The Government contend that the present guidance is sufficient, but I disagree. In the light of Winterbourne View and Mid Staffordshire, we cannot afford to have such gaps in protection.

A recent Care Quality Commission report stated that our accident and emergency departments see 500,000 elderly victims of neglect. I am therefore far from convinced that enough has been done to address the issue. Where victims of abuse are imprisoned in their own homes by a perpetrator who denies access to adult safeguarding staff, there are no current legal means by which access can be achieved. An amendment was tabled by the noble Baroness Greengross in the other place to enable a social worker to apply for a court order to access an adult at risk. Between now and the Committee stage, will the Government reflect on that matter and introduce something to address that gap?

The Bill is an opportunity for much-needed reform of our health and social care system, but in its current form it does not make the changes that we need. For that reason, I fully support my right hon. Friend the Leader of the Opposition’s reasoned amendment.

I apologise, Madam Deputy Speaker, that I will have to leave very shortly to read in a carol service.

--- Later in debate ---

[John McDonnell]

I think Mr Kaye would like me to press that at some stage during the Bill’s progress. His view is that they should be regulated in the same way as others, and that there should be appropriate inspections as well. I understand the difficulties, particularly in terms of family relationships with regard to carers. I understand the subtleties of that, but there does seem to be a gap in the Bill as it stands. I might want to look at that in Committee, and certainly on Report.

The second point is that I believe that in the other place Baroness Greengross or Lady Greengross—I am never sure of the titles of the bourgeoisie—moved an amendment to cover the whole range of abuse. That was partly a response to the lobbying for abuse by carers to be properly covered by this Bill. I hope the Government’s attitude is that the amendment will remain in the Bill. I am happy to give way again to the Minister if he wants to respond; perhaps he will do so later.

The third point Jonathan wanted me to raise was about assessment and reassessment. I do not know what other Members find in their constituencies, but I find that the process of assessment can be extremely difficult—first, getting an appropriate person who can do the assessment, then getting that appropriately skilled person to do the assessment, and then the bizarre continual reassessment after reassessment that amounts almost to harassment. Some people with severe disabilities —with permanent conditions who, to get a cure, would need a trip to Lourdes, to be frank—get reassessed time and again. That becomes worrying for them, and some individuals can lose some element of their benefit through this process.

[Meg Munn]

I have a great deal of sympathy with what my hon. Friend is saying. In my experience there seems to be a tendency of wanting to assess people and then reassess them, rather than putting effort into providing services for them. If we quantified the time that goes into assessment as opposed to provision, I think we would see some way in which we could shift some of these very scarce resources into helping people properly.

[John McDonnell]

I was with a constituent last Friday and the issue under discussion was disabled facilities grant. Again, there seem to be more assessments and more spent on assessment than on getting the work done at times. There needs to be a clear understanding of the issue of permanent conditions and how we can make sure people do not have to go through the trauma of assessment

That brings me on to the issue that was raised by Age UK—I apologise if others have raised it before—which is about the individuals who will do the assessments and the level of their qualifications and of their specialisms. My whole community has been traumatised by what happened with the Atos assessments, and I would not want to see another process implemented in the same way under this Bill. Age UK wants us to ensure that appropriate assessments are carried out by appropriately skilled and qualified assessors.

That leads me to a further point, and I apologise if others have already raised it. Part of the issue for people who have to undertake the assessments is ensuring that they have the right advocacy support. In my area, we have DASH—the Disablement Association Hillingdon—which provides excellent support and advocacy, but it is struggling, as is every other voluntary organisation in the area, as a result of local government cuts and the demands and challenges that are placed on it. It is important that, as we introduce this legislation, we look at the role of advocacy and the importance of supporting it through appropriate funding from local government and elsewhere.

I want to talk briefly about the report from the personal social services research unit. It was mentioned by my hon. Friend the Member for South Shields (Mrs Lewell-Buck), whose superb speech set out, drawing on personal experience, exactly how many of us experience the services of carers. I am not sure whether other hon. Members have gone through this matter in depth in the debate today. If they have, please will they intervene to tell me, so that I do not need to go through it again?

The report has usefully confirmed all that we have experienced and understood anecdotally in our constituencies. Even I was shocked at some of the statistics that it contained. The report was produced by the personal social services research unit of the university of Kent and the London School of Economics, and it is an objective assessment of expenditure and of the numbers of people receiving services from local authorities between 2005-06 and 2012-13. Its findings confirm what most of us have experienced in our constituencies—namely, that there have been

“widespread reductions in the period 2005/06 to 2012/13 in both the observed and standardised estimates of number of adults receiving state-funded social care services”.

It also found:

“Across all user groups, approximately 320,000 fewer people received local authority brokered social care in 2012/13 than in 2005/06. This represents a 26% reduction in the number of recipients of care.”

If we look at the standardised assessment, we see a

“decrease of 453,000 (36%) individuals being served”.

That reflects what I am finding in my constituency. People who should be receiving a certain level of care and who would previously naturally have received it are no longer doing so. The report goes on to state:

“Reductions in the number of clients are particularly acute for older people; 260,000 or 31% fewer older people received services in 2012/13 than in 2005/06…The standardised estimate of reduction was greater: 333,000 or 39% fewer clients.”

That means nearly 40% fewer older people are receiving services now than five years ago. The report goes on:

“Approximately 37,000 or 24% fewer adults aged 18-64 with physical disabilities received social care support in 2012/13 than in 2005/06. The standard estimate showed a reduction of 50,000 or 33%. A reduction of 30,000 (21%) was observed in the number of service recipients aged 18-64 with mental health problems.”

I find that staggering but, at the same time, it reflects what is happening in our constituencies. Why is this happening? It is fairly straightforward, really. It is a result of the cuts that local government is experiencing.

Although the report covers the period between 2005-06 and 2012-13, it emphasises that the vast majority of the cuts have been made in the past two years. The coalition Government have brought forward this level of service withdrawal over a very limited period of time. According to the report,

“our analysis suggests a drop in need-standardised net social care expenditure between 2005/06 and 2012/13 of approximately £1.5 billion…Moreover, almost all reductions in expenditure are concentrated in 2010/11 and 2011/12.”

That is a cut of £1.5 billion overall. It goes on:

“The largest reduction in expenditure levels is concentrated on services for older people”.

That again reflects the anecdotal evidence that we can bring back from our constituencies. The report suggests that there has been a £1.6 billion cut in services to older people. This is not a party political point; this is independent, objective research, which we should all take on board in the debate as it goes forward.

The report continues:

“For adults 18-64 with learning disabilities”—

there has been—

“a significant increase in observed and standardised expenditure in 2012/13 relative to 2005/6 worth just above £1 billion”.

So there has been some increase in some areas but dramatic cuts in others. Worryingly, the cuts seem to be focused on older people and those with mental health problems. The interesting thing is the point made by my hon. Friend the Member for Edinburgh East (Sheila Gilmore) and others about how this is disproportionate; it is not being done right the way across the board, and the impact on areas is geographically uneven. It appears that the most deprived areas are being hit the hardest.

The report said:

“Approximately 95% of local authorities in England were observed to have reduced the number of older people receiving services in the period…Of these, the number of older people receiving services had fallen by 40% or more in approximately a third…of authorities.”

So this is focused on a limited number of local authorities, and again it appears that they are the most deprived. I find that extremely worrying.

Although we welcome the Bill as a first step, as others have said, Dilnot did make it clear to all of us that the social care crisis has to be addressed before we move on to other changes in legislation, or at least simultaneously. Introducing new legislation when the Government are introducing this scale of cuts will completely undermine the credibility of the new legislation. That is why I hope that as part of the debate as the Bill moves forward we can reach a consensus on not only the legislation—where I hope we can take on board some of the points made in the reasoned amendment—but on the level of investment required over the coming period if we are to support the most vulnerable in our society.

The study I mentioned is objective and it reflects what I am experiencing in my constituency surgery on a weekly basis—I believe it is the same for other Members of all political parties. The social care services in our areas are under intense stress and, as a result, people with even critical and substantial needs are not being addressed—those with moderate needs, which are still significant and should be within the system, are being ignored completely. We need to address this matter with some seriousness now and try to reach some all-party agreement on the way forward, not only on the Bill, but on the investment strategy for care needs.

Oral Answers to Questions

Meg Munn Excerpts

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

I would be very happy to meet my hon. Friend to discuss that case and the commissioning arrangements for the procedure, and indeed other treatment for patients with cerebral palsy.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

T7. The guidance that the Government have produced on transferring funds from the NHS to local authority social care makes it clear that the money can be used to plug gaps in social care caused by cuts. Does that not just mean that the local authorities that are under most pressure because they have had the biggest cuts will not be in a position to develop the integrated health and care services that we would all like to see?

[Mr Jeremy Hunt]

I hope that I can reassure the hon. Lady, because the conditions for accessing that £3.8 billion fund are absolutely clear. Local authorities will not be able to access it unless they can promise to maintain services at their current levels. They are allowed to make financial efficiencies, as is the NHS, and everyone needs to look at that, but not if it means a deterioration in services.

A and E Departments

Meg Munn Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I recognise my hon. Friend’s clinical background. When I talk to clinicians in A and E wards, they tell me that the long-term drivers of the pressures they are under are an increase in the number of older people and an increase in the acuteness of the conditions of people coming through the doors. That is why at the heart of our long-term solution is a vulnerable older people’s plan that ensures we look after them with the dignity, compassion and respect they deserve.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

Why does the Secretary of State not increase access to primary care during normal working hours by reintroducing the requirement on primary care services to see patients within 48 hours, as happened under the Labour Government?

[Mr Hunt]

That target led to many problems, as the hon. Lady well knows. She might remember, from the 2005 general election campaign, the issues of people being denied appointments for three, four or five days because GP surgeries were being paid to meet specific 48-hour appointments. That is one issue. Too often, if people call GPs for an appointment, they are told that the earliest they can have one is in two, three or four weeks, which makes them think, “What are my alternatives?” and leads them into A and E. We must think about how we can change that and alter the incentives in GP contracts so that they can give the kind of service to their lists they would like to.