Community Pharmacies

Melanie Onn Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David, and I congratulate my hon. Friend the Member for Halifax (Holly Lynch) on securing this important and timely debate on community pharmacies. Those are critical resources at the heart of all the communities in our constituencies and the first port of call for many of us who experience common or low-level health complaints.

In the North East Lincolnshire clinical commissioning group area, there are no fewer than 30 pharmacies, ranging from branches of Boots—we have already heard some discussion about that this morning—and pharmacies operating out of supermarkets to companies such as Periville, which runs three pharmacies on Cromwell Road, Wingate Parade and Ladysmith Road, two of those out of medical centres. Day Lewis Pharmacy, in Scartho medical centre, gave me my flu jab last year—thanks very much—while Cottingham Pharmacy on Wellington Street in the East March area has been run by the family for 60 years.

We talk about the community element of pharmacies, and Tim Cottingham recently joined me and the Labour campaign for drug reform in a community event hosting about 150 people to talk about the development of drug treatment, the lack of community drug and alcohol support, and the essential role played by pharmacists. Tim knows so many of his customers and provides an incredibly intimate service, working with them to improve their health and move them further away from the trappings of addiction. The tales he told the audience, with compassion and empathy for the human being behind the addiction story, were quite remarkable. That was something I had not seen or heard before, and I was not necessarily expecting it. It was very eye-opening, and we should recognise the important role that pharmacists play in people’s day-to-day lives. Pharmacists provide vital services to residents in Grimsby, and not only do they dispense medicines to those who need them, but they provide residents with advice and guidance to ensure they make a rapid recovery.

North East Lincolnshire pharmacies also take pressure off GPs by providing a minor ailment scheme for anyone who does not pay for their prescriptions, and by providing free advice and treatment for illnesses such as colds, coughs, flus, hay fever, dry eyes, athlete’s foot, conjunctivitis and many other complaints that might end up at a GP’s door without the presence of such an amenity. Given how important our pharmacies are to our health system, it seems counterproductive for the Government to say that they want to develop sustainability and transformation plans for the long-term needs of local communities, and then to cut nearly £300 million from the community pharmacy budget, thus harming those amenities that sit at the heart of our communities.

The impact of the cuts has been severe. The Pharmaceutical Services Negotiating Committee found that in the two years since the cuts were introduced in October 2016, more than 200 pharmacies across the country closed their doors. That includes E A Broadburn of Scartho, which operated and moved into a medical centre, but ended up closing due to loss of footfall.

Lloyds Pharmacy on Dudley Street is part of a much larger corporate structure, but presumably it was not making the returns from that site and decided to close. It sits right on the edge of the West Marsh, which is one of the most deprived communities in Great Grimsby, and that closure meant the loss of another service, including out-of-hours provision.

Independent, stand-alone stores are not necessarily inside medical centres, hospitals or supermarkets, and they can provide 24-hour pharmacy services much more easily than those that are co-located in medical centres. Such closures therefore mean the loss of another service and emergency access pharmacy on which communities rely. Both those shopfronts remain empty, which means another hole in the small parades of shops in which they sat. They were not quite on the high street, but they were certainly on community high streets, and such things make people feel that their communities are not being properly invested in.

In 2017, Ian Strachan, then chair of the National Pharmacy Association, pointed to pared-back services, reduced opening hours and lower morale in the pharmacy workforce as evidence of the pressure that all pharmacies are experiencing. Will the Minister confirm that the extra investment in primary and community care that was announced by the Government last month will not only cover the costs of any extra service that pharmacies might be expected to provide, but will reverse the cuts in real terms?

Great Grimsby contains a number of good medical centres that include multiple GP centres and often contain pharmacies. However, there are also an awful lot of empty spaces, and for a number of years the intention has been for some services to be offered in those community settings. Some things that are done in hospital could be done in the heart of the community, which would be much easier—and there is space available. If that happened, and if some of those services were to operate out of those community-based centres, that would increase footfall and aid some of those pharmacies by giving them the opportunity to reach more people who would otherwise go to hospital.

Pharmacies are often on the frontline when patients encounter wider problems in the NHS. For example, when the contraceptive Microgynon 30 went out of stock earlier this year, it was the pharmacists who spent time informing patients and trying to find solutions to get around the scarcities. All that takes far more time than simply dispensing the drug and can have an impact on pharmacies’ bottom line. The Operation Yellowhammer report told us that we might face many more drug shortages in the event of a no-deal Brexit, so have the Government involved pharmacies in no-deal planning and taken into account the pressures that pharmacies might experience due to drug shortages in the event of no deal?

Social Care Funding

Melanie Onn Excerpts

Tuesday 1st October 2019 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in a debate with you in the Chair, Sir Charles. I think that this is the first time I have done so. I join others in congratulating the right hon. Member for Twickenham (Sir Vince Cable) on securing this important debate.

The number of Members contributing in this debate makes clear the appetite to speak on the matter, and it is a pity that more Government time—or even an Opposition day debate—has not been allocated. It is appropriate that on this International Day of Older Persons we have talked largely, though not entirely, about older people. That should remind us all that growing old with dignity is a fundamental right that we should all enjoy.

By my count we have heard 12 Back-Bench speeches and six interventions, and by the time we get to the Minister we will have heard three Front-Bench speakers. Many have rightly focused on the cuts to social care budgets and the harm caused to people who rely on and need social care. We have heard powerful examples of the impact of those cuts. That harm, however, is not inevitable. If social care is properly funded and delivered well, it can be life changing. My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) gave an example of how life can be changed in the wrong way if social care is not available.

Social care can keep someone connected to their community rather than isolated and lonely. It can support people to live the lives they want to live, rather than just survive from day to day—sometimes not even that—when the care disappears. But that is not what our social care system looks like today. Over the past nine years nearly £8 billion has been taken out of local councils’ social care budgets as a result of cuts. Hon. Members have mentioned the swingeing cuts experienced by many local authorities. As a result, hundreds of thousands fewer people are receiving the care they need. That is the straightforward result of the cuts.

Age UK tells us that 1.4 million older people in this country are struggling with everyday activities. Whether that means getting washed or eating a meal, they are not getting the help they should be getting. Older people are being left trapped in bed all day and perhaps going unwashed all week because their children can visit them only on weekends. They are having only microwave meals, because that is all their neighbours or family friends have the time to buy in for them. That is not what this country’s older and disabled people deserve.

I am glad that many hon. Members have mentioned the immense pressure that the state of our care system puts on unpaid carers. Wherever the Government pull back from funding social care properly, the UK’s millions of unpaid carers have to step in. As we have heard, that includes young carers in the constituency of my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard). It is very important to identify and support those young carers. I have tried three times to bring in legislation, including to identify young carers. The Minister’s predecessor did not support it, but we could still do it. I might give the Bill to my hon. Friend so that he can resurrect it.

It is a dire picture, including for young carers. Half of unpaid carers now spend 50 hours a week providing care, while 38% spend 100 hours of every week caring. One quarter of carers have not received any support, either for themselves or for the person they care for. Two thirds of carers say that they do not get as much social contact as they would like with other people. More than eight in 10 say that they cannot spend time doing things that they enjoy or value, and 40% of carers say that they have not had a day off for more than a year. In fact, a recent Carers UK report noted carers saying that if they had a respite care break, they would use it to visit their own GP for a medical appointment, which is very sad.

Even for the smaller number of people who manage to get a social care package, cuts mean that the care provided will not be of the quality expected. One in five social care services has been rated by the Care Quality Commission as either “inadequate” or “requires improvement”. The number of complaints to the local government ombudsman about social care provision has trebled since 2010, rising to more than 3,000, and two thirds of those complaints are upheld. There is very much wrong with our system. I find it deeply concerning that one in five care homes, housing as many as 9,000 older and disabled people, are now rated as unsafe.

These are not services that any of us would like a family member to have to rely on. The situation can mean care homes that are so unclean that residents are at risk of infection, or residents being at risk of malnutrition because nobody is monitoring what they are eating. Care in one’s own home can mean visits by staff who have not been subject to basic checks or who have not completed any training. It can mean staff being so rushed that they do not have time to take off their coat while they are getting people up and dressed. The reality is that some care providers cannot provide high-quality services with the funding available; sadly, other providers choose to protect profit margins rather than the people who use their services.

That issue is clearest in the social care workforce. There are 1.4 million people—or there would be, if the vacancies were filled—working in social care. These people provide vital support day in, day out, but they simply do not get the respect they deserve for the work they do. More than a quarter of those care staff work for a minimum wage, and the same proportion of the workforce are on zero-hours contracts. It is no surprise therefore that there are 110,000 vacancies in the care sector. Those important issues have been touched on by many Members in this debate.

Rather than providing the empathetic care that they want to offer, care staff are often reduced to visits lasting 15 minutes or less. They must rush through their tasks with barely any time to talk to the person they are visiting. This deterioration in the quality of care is the result of nearly a decade of cuts, care staff stretched to breaking point and services that barely deserve to be called “care”. Hundreds of thousands of people have to go without basic support.

[Melanie Onn (Great Grimsby) (Lab)]

My hon. Friend is making an excellent speech and paints a picture of social care in this country. On 15-minute visits, does she agree that the issue is not just the time limit but the ever-changing individual presence? With vulnerable people, consistency of care and the ability to build up a relationship are equally important.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 18th June 2019 Commons Chamber

[Jackie Doyle-Price]

I have to say, the hon. Gentleman does it very well: he continually makes noise about this important issue. He is absolutely right that adverse childhood experiences inform people’s future mental health, or mental ill health. We are currently looking at our provision for early years intervention and the first 1,001 days—the hon. Gentleman and I have discussed the importance of that—but we need to make sure that state organisations take advantage of every contact they have with children, to ensure that we pick people up when they are vulnerable.

[Melanie Onn (Great Grimsby) (Lab)]

My learning disabled constituent, who also has mental health and substance abuse issues, was placed in poor-quality housing and left without food and heating by a local care provider called Focus. What is the Department doing to ensure that subcontracted social care providers are fit for purpose?

[Jackie Doyle-Price]

The case that the hon. Lady mentions is clearly very concerning. It is for local authorities to make sure, when they commission care providers, that they are fit for purpose and discharge their responsibilities in the local care plan, but we also need to recognise that people with learning disabilities as well as mental health issues are particularly vulnerable. We need to make sure that local authorities and local NHS services work together more effectively to ensure that care needs are not neglected.

Non-surgical Cosmetic Procedures: Regulation

Melanie Onn Excerpts

Tuesday 12th February 2019 Westminster Hall

[Alberto Costa]

If hon. Members do not mind, I will make some progress and then give way again.

My constituent Rachael told me that a beautician had attended a party intending to administer some treatments to those in attendance. The beautician in question did not have any medical training, nor, to the best of my knowledge, did she have any formal recognised training in administering this type of injection. Rachael received, as many thousands of our constituents do, a lip filler injection while she was attending a social engagement with friends. As a direct result of the beautician’s mistake—it was not Rachael’s mistake—lip filler was incorrectly injected into Rachael’s artery, causing her lips to swell severely, requiring her to seek urgent medical attention, before being treated privately after the NHS was unable to help. Again, I commend Rachael’s bravery in talking so willingly about her experience, providing a multitude of younger people and others with a message of understanding and empowerment.

These types of procedures, which have been popularised by Instagram celebrities and reality stars such as the Kardashians, have experienced a huge rise in popularity, with more and more people seeking them.

[Melanie Onn (Great Grimsby) (Lab)]

Does the hon. Gentleman agree that although the vast majority of beauticians undertaking these procedures do so in a professional setting and manner and are concerned about the reputation of their businesses, maintaining that professionalism requires some form of regulation, which would stop these Botox parties where things go horribly wrong and people have no redress, and would improve the whole industry?

[Alberto Costa]

I thank the hon. Lady for her intervention. She is right to use the word “professional”, but the mark of a professional is somebody who is regulated, and in the private sector it is somebody who has professional indemnity insurance behind them. It is easy for someone to call themselves a professional, but a real professional is someone who is regulated. I am a solicitor and I am regulated by the Solicitors Regulation Authority, and behind me there is professional indemnity insurance. If I give advice negligently, a consumer has redress against the insurance product. We want a healthy, thriving industry in non-surgical cosmetics, where people can freely choose these procedures, but we have a duty as MPs to protect the health and safety of consumers, enabling them to make informed choices when seeking treatment from professional beauticians.

--- Later in debate ---

[Jackie Doyle-Price]

The hon. Lady goes to the nub of this issue. We need to achieve an appropriate balance between allowing consumers to choose to embark on procedures that will enhance their appearance, and identifying whether the issue is something deeper. Again, it comes down to how we regulate those practitioners, the codes of conduct that they will sign up to, and the policies that they will put in place themselves. To an extent, the hon. Lady is right: dysmorphia can only be diagnosed by a medical professional. However, there are signs that can be taken into account, that can lead to the person’s being asked, “Do you really want to do this? Is this an appropriate procedure for you?” Perhaps there should be cooling-off periods, with bookings being made properly, and customers being advised about the risks that such treatments involve, so that they can make an informed choice. The hon. Lady is right to highlight the growing issue of dysmorphia, which we need to be very alive to.

[Melanie Onn]

This is a really important point. Even in the realm of plastic surgery, which is a regulated industry, we see grotesque transformations of people’s bodies and faces: people having ribs removed, leaving their external organs exposed, or having their entire appearance amended to make them look like a human Ken doll. We know that regulation in that sector is not really working, so can we make sure that in the currently unregulated sector of Botox injections and dermal fillers, we keep a closer eye on such things?

[Jackie Doyle-Price]

The hon. Lady makes an extremely good point. The worst thing is that the media representation of those quite grotesque transformations encourages us to look on them as entertainment, yet the person we are looking at has no idea, because those transformations are symptomatic of dysmorphia. The media have to be a lot more sensible about their portrayal of these things. My hon. Friend the Member for South Leicestershire mentioned the adverts during “Love Island”; these artificially enhanced images of people are becoming entertainment. I am delighted that in this country we have banned the Brazilian butt lift, which aims to make people look like one of our friends the Kardashians, but even so, people still aspire to look like that.

We can discuss regulation and ensuring that consumers understand the risks, but there is a wider challenge to society in how we celebrate learning to love ourselves. We have talked generally about the pressure that social media creates, which is becoming much more intense, but there is a hell of a lot more to do. Sadly, we could probably debate this issue for quite some time—we do not have the opportunity to do so today—but the debate about cosmetic regulation and making cosmetic procedures safe brings out these questions, which we as a society need to be better at addressing. If we do not address them, these issues about dysmorphia will only get worse, because our young people are faced with an intensity of images that make them want to change their bodies. It is just not good for them.

As there is limited time left, I will bring hon. Members up to date about what has happened since the Keogh review. Sir Bruce Keogh’s report identified several areas for change: the principles that underlined it were those of high-quality care, using safe products, administered by skilled professionals and responsible providers to an informed and empowered public. We still have a long way to go in both empowering the public and ensuring that all such procedures are administered by skilled practitioners. I wholly endorse the demand by my hon. Friend the Member for South Leicestershire that such practitioners should have professional indemnity insurance. It is important that the NHS has the opportunity to recover the costs of repairing procedures carried out by those practitioners, who should bear the risks. As I say, this is not like going to the hairdresser’s for a haircut: there are risks associated with such procedures, and those engaged in them should bear those risks.

Updated guidance for doctors about this area has been issued by both the General Medical Council and the Royal College of Surgeons. We have introduced a voluntary certification scheme for surgeons working in the cosmetic sector, and Health Education England is developing a training and qualification framework for providers of non-surgical interventions. A key outcome of the Keogh review was setting standards that anyone who wishes to perform non-surgical cosmetic procedures should meet. To that end, the Joint Council for Cosmetic Practitioners was established, and in April 2018 it launched a register for both medical and non-clinical cosmetic practitioners. That register will provide a framework for regulation, but we need to do much more to encourage non-clinical cosmetic practitioners to sign up to it.

Alongside the Cosmetic Practice Standards Authority, the JCCP released an updated competency framework last September, and launched its education and training register. To receive accreditation on that register, providers offering education and training in these procedures must meet rigorous standards set by the JCCP. We need to work closely with the JCCP to develop hallmarks that people who wish to undergo these procedures can look for, so that they can be sure that they are obtaining treatment from a regulated practitioner. We have heard references to Save Face, which also holds a register for clinical cosmetic practitioners who provide non-surgical cosmetic treatments. Some 600 practitioners are currently covered by these registers, but I am sure that hon. Members from across the House will appreciate that significantly more than 600 practitioners offer these treatments. There is some way to go in ensuring that all those involved in this industry perform to the standards that we can legitimately expect, and that those who are not doing so exit the industry. However, I am sure that my hon. Friend the Member for South Leicestershire will agree that those registers are major steps forward in enabling consumers to make informed choices about cosmetic procedures.

I am grateful to my hon. Friend’s constituent for coming forward and telling her story, because probably the best way of helping consumers protect themselves is to have a visual illustration of the risks and someone who can demonstrate their experience. I am very grateful to her for her courage in sharing her story. We need to do much more in the area of public education, to ensure that consumers fully appreciate that there are risks involved in injecting substances into one’s face, and to ensure that the person doing so has appropriate qualifications. Botox is obviously a prescription drug, but the person injecting it does not have to be the person who obtained the prescription. That is another thing that we need to address. I can also advise my hon. Friend that we will be making dermal fillers a regulated medical device, which will remove some of the risks associated with them. However, as I have said, there is plenty more to do.

Motion lapsed (Standing Order No. 10(6)).

Mental Capacity (Amendment) Bill [Lords]

Melanie Onn Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Caroline Dinenage]

The Bill is very clear about the skills and qualifications necessary for those carrying out the assessments, but the code of practice that goes alongside the Bill will be carried out in partnership. We already have a working group made up of third sector organisations that are working to ensure that the statutory document that goes alongside the Bill is as robust as we can make it.

[Melanie Onn (Great Grimsby) (Lab)]

I would like to thank the Minister for meeting me earlier to discuss the Bill. She was very generous with her time. On the question of the code, does she envisage that there will be training on the code for these professionals? If so, how long does she think the training will take, and when will it be properly in force for local authorities to utilise?

[Caroline Dinenage]

Yes, we envisage that there will be training and we will be working with partners such as Skills for Care to look at the best ways of implementing that sort of support.

Mental Capacity (Amendment) Bill [Lords]

Melanie Onn Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

Has the Secretary of State had any discussions with the Justice Secretary about the application of the measures in this Bill upon those who are serving prison sentences, particularly indeterminate sentences?

[Matt Hancock]

I have had some discussions on that subject, and I am happy for the hon. Lady to take up that point in more detail either directly with me or with the Minister for Care, or in Committee, because there are significant interlinkages between the two areas.

The Bill builds on the extensive work and recommendations of the Law Commission. It has been fully scrutinised by the Joint Committee on Human Rights and then improved by the other place, as has been discussed. I am grateful for all that work. Ultimately, it is about striking a balance between liberty and protection.

Hospice Funding and the NHS Pay Award

Melanie Onn Excerpts

Wednesday 31st October 2018 Westminster Hall

[Liz McInnes]

There is a theme developing on recruitment and retention. We have shortages of particular groups of staff, and a two-tier pay arrangement for different NHS providers will only exacerbate those problems.

[Melanie Onn (Great Grimsby) (Lab)]

The points that colleagues have made seem to reflect the situation around the country. The hospice in my constituency, St Andrew’s, provides end of life and respite care for adults and children. The chief executive spoke to me when I went to the opening of its new garden, and expressed exactly the same concerns and fears about future staffing arrangements. The hospice has an incredibly dedicated team of staff, but fears losing them if they can get better pay elsewhere in the NHS.

[Liz McInnes]

My hon. Friend highlights the problems that hospices up and down the country are experiencing with the recruitment and retention of staff. I will explore those issues further in my speech.

--- Later in debate ---

[Melanie Onn]

The chief executive of a social enterprise that provides social care in my constituency under the Care Plus Group TUPE-ed out several staff in order to continue to provide those services. Those staff are on Agenda for Change contracts, but they will not receive the Government uplift in pay, because as the chief executive says:

“The plan is to fund only NHS trusts and foundation trusts, to pay the uplift directly to them.”

The issue goes much wider in the healthcare sector than hospices. It will affect providers of health and social care in our communities, as well as those staff contracted out from the NHS, including porters, orderlies and caterers. I know that Unison is campaigning for those staff who have been privatised within the NHS. Does my hon. Friend think that all those staff are integral to providing healthcare for all of us, and should be included in the uplift?

[Liz McInnes]

My hon. Friend is absolutely right: this goes wider than hospices. It applies to non-statutory, non-NHS organisations that provide essential services to the NHS. Staff being TUPE-ed out is difficult, and I hope the Minister will consider it in her remarks. The pay award has to be funded from somewhere, and it is extremely unfair if NHS staff are TUPE-ed out to a non-NHS provider and lose out on the pay award as a result.

The chief executive of Springhill talked to me about the role of the clinical commissioning group, saying she hoped that

“the CCG will recognise this significant additional burden when agreeing our annual contract”,

and that it will

“not be expecting us to reduce our costs this next financial year.”

I know, and the interventions I have taken show, that the problems experienced by Springhill Hospice are replicated up and down the country, and I am grateful to hon. Members for sharing their experiences from their own communities.

Hospice UK estimates that, over the course of the three-year NHS pay deal, charitable hospices will face an additional bill of between £60 million and £100 million. It says that the Department of Health and Social Care’s criteria for non-NHS providers to access the additional funding set aside to support the implementation of the NHS pay award exclude the majority of the country’s charitable hospices from that essential support. The Department itself has acknowledged that most charitable hospices do not employ staff on NHS terms and conditions, as the staff working in hospices are not NHS employees. However, as hospices recruit their staff from the same local pool as the NHS, they have little option but to mirror the pay award made to NHS staff in order to recruit and retain the staff they need. As a consequence, hospices face a difficult choice: they must either ask their local communities to donate more to fund the pay award or look at options to reduce services proportionately to cover the cost. Neither is a palatable option for the hospices or for the communities that they serve.

The Department maintains that hospices should look to their clinical commissioning groups for additional support, yet research by Hospice UK shows that in recent years two thirds of hospices in England have seen their NHS funding cut or frozen—in many instances, for several consecutive years. In the absence of tariffs reflecting the costs of care, the NHS currently makes a contribution towards the costs of providing hospice care. It is on average just 30% of the costs of providing adult hospice care services and just 15% for children’s hospice services, although that funding varies widely around the country.

Hospice UK has suggested a solution to the problem, which is to follow the precedent set in 2004, when the employer contribution to the NHS pension scheme was doubled from 7% to 14%. At the time, the Labour Government acknowledged that charitable hospices would face an additional cost that they could not recover from elsewhere, so they set aside a national pot of funding to be distributed centrally to mitigate the impact. That worked very well and is a model that would work well in relation to the NHS pay increase by recognising the unintended consequences for charitable hospices while maintaining the integrity of the deal negotiated and agreed with the NHS trade unions.

Additionally, I have been contacted by my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who tells me that he has secured an agreement for 3,000 healthcare workers in his constituency who work for a social enterprise to receive Government funding to finance the pay rise, so clearly a precedent has already been set. I would be interested to hear the Minister’s comments on that.

The pay deal that has been agreed is a pay deal for NHS staff and is welcomed. Since this debate was announced, I have also been contacted by the Chartered Society of Physiotherapy.

[Melanie Onn]

It has taken me a little while to catch up, but did my hon. Friend just say that a colleague has managed to secure an independent agreement that the pay deal will be honoured for some workers in a hospice setting? If so, how is it possible that one person can get such an agreement from Government but everyone in this Chamber who is raising issues cannot?

[Liz McInnes]

I thank my hon. Friend: that is exactly the point that I wanted to make. A deal has been done in Plymouth for a social enterprise provider that is not a hospice but a provider of mental health services. Obviously, smaller deals are being done. My hon. Friend the Member for Plymouth, Sutton and Devonport is not able to be with us today, but I was very interested in the evidence that he sent me. The Department of Health and Social Care needs to look at the smaller deals that have been done and ask itself what on earth is going on.

To return to the issue of physiotherapists, they are clinical staff whose role in hospice care is sometimes forgotten. The CSP told me that its members overwhelmingly backed the pay changes when consulted earlier this year. It pointed out to me the importance of the physiotherapist’s role in enabling people with a terminal illness to stay active as long as possible—a really important role—and went on to say that with the current shortage of physiotherapists, it is relatively easy for staff to change roles if they wish to do so, and that employers who cannot broadly match NHS pay rates will find it increasingly difficult to recruit staff.

There is clearly real concern that the NHS pay award will have an unforeseen but damaging impact on charitable hospices and other organisations that are already at a significant disadvantage compared with other non-NHS providers in not receiving reimbursement for the costs of the care that they provide to NHS patients. A sustainable hospice movement is an essential component of delivering the improvements in end of life care that the Government have rightly sought. The Government must look again at the conditions imposed on non-NHS providers and consider how funding may be made available to prevent a diminution of the end of life care service.

--- Later in debate ---

[Derek Thomas (St Ives) (Con)]

I thank the hon. Member for Heywood and Middleton (Liz McInnes) for securing the debate. “Fantastic” is probably the wrong word to use, but this is an important opportunity for us to speak about the great work that hospices do, the part that they play in all our local communities and how they help people and their families at the most difficult times of their lives. It is an honour to take part in the debate. I want to talk about the role of hospices, how they contribute to the desire to integrate health and social care and, as a result, how they must be funded to deliver the great work that they do.

This may seem a strange thing to say, but I have spent my most special moments at the bedside of someone in a hospice. Over the years and even as an MP, I have taken the opportunity to sit alongside people and their families in our local hospice, St Julia’s, which is just on the edge of my constituency, and I always leave with an incredible sense of gratitude for the work that the hospice does and how it helps people at that difficult time. It helps people to live and die well, which is what I am sure we would all love to be able to do when the time comes.

Let me explain what I have learned in recent years. Even now, the word “hospice” assumes that that is where we will die if we have—dare I say it—the right kind of illness to justify that, but I am learning that hospices are actually far from just places to die. People can go into one when they are very sick and come out a week or two later, having had various things done to help them, to get their body working again and to identify the right medicine. Hospices can give people time to work out what medicine or drug is really the right one for them. My mum was ill for a very long time. She was given a few weeks to live, but actually lived for more than a year. She spent 10 days in a hospice when we really thought it was the end and then she went on for a good six or seven months after that, simply because the hospice was able to correct her medication and—well, “flush her out” is probably the way to put it. It was lovely to come together as a family and sit alongside her, and to give my dad a break; he had about 10 days of really important respite. The hospice movement across the country, in my constituency and across Cornwall is fantastic. When I go there, it is a different experience from when I go to sit beside the bed of someone in an urgent care setting who is also reaching the end of their life.

In Cornwall, we are learning that hospices are not just about taking people in the closing days or months of their lives, but about alleviating pressure on urgent care by taking people out of a ward where it is not really appropriate for them to be in their last few days, and on community care. In response to trying to get the money it needs, our hospice has done a great bit of work by going out to homes and supporting people there in their last few days and weeks.

The point is that, by properly funding hospices and all the work they do, I am convinced that we would create a saving for the wider NHS as well as the beds that are needed for other people. That is important in my constituency, because our main hospital is in special measures—“requires improvement” is where we are at the moment—and one area of that is about palliative care. The frustration is that there is a desperate need for beds in the hospital, but in the hospice, beds are available all the time. It is simply about a lack of commissioning joined-up thinking and working together, and not having enough money in the hospice system.

Hon. Members have given various quotes about how much NHS funding hospices receive. Some time ago, my first question in Prime Minister’s questions, when the then Chancellor was replying, was about how little Cornish hospice care was funded. At that time, about 11% of the money came from the NHS. That is in a part of the world where there is a lot of deprivation and average earnings are low, so the rest of that money was being found by people who were not awash with cash. I do not know that it has improved much since; we are still one of the areas that receives the least money for our hospice care.

That is frustrating, because people are dying in the urgent care centre who should be in a hospice. Three weeks ago, I spent time with a family who were desperate to get their mum out of my local hospital, which is part of the urgent care set-up. I do not want to be unfair to the hospital team, but unfortunately, they were so keen to get the lady home that they waited for care packages that did not arrive, and she died in the hospital when she could have been in the hospice.

[Melanie Onn]

I thank the hon. Gentleman for making that important point, which raises an issue that I have had with a constituent. His wife was sent home supposedly well after going into hospital for urgent treatment but sadly she died two days later. Going to the local hospice, St Andrews, would probably have been a much better option for her, but it had not been thought of in that process.

[Derek Thomas]

The hon. Lady is absolutely right, and I have heard several stories where that has been the case. Separate to the debate, there is an obsession—I use that word because it might get the Minister’s attention, although it may be the wrong one—with getting people home at every possible opportunity. When I sit with those people, some of whom are desperately lonely, I ask whether that is right for them or whether hospices, community hospitals and other settings would be more appropriate. I want us, as leaders and politicians, to be careful not to create an assumption that home is always the best place, because I do not believe that. It certainly was not for my mum in the last days and weeks of her life.

Addressing some of the challenges requires an uplift in the funding available to hospices across the board, and we must pass on pay increases to nursing staff. I say again that when I go into my hospice, the working environment is very different from that in the urgent care centre, but I have already said that Cornwall is a low-wage area with a high cost of living due to the beautiful environment that we live in, which attracts people and pushes up the cost of housing. It is expensive to live in my part of the world, so nurses are not choosing to leave the hospice setting because they prefer urgent care—obviously, we need them there as well, so I am not trying to discourage that—but because they need the money to live. We should not be saying, at any stage, “It is okay, because hospices are a different environment to work in and they might prefer it there, so they will settle for lower wages.” I hope that we would never assume or expect that.

I met the chief executive of Cornwall Hospice Care soon after the pay award, and he expressed concern that the money being offered to NHS nurses and staff would have a negative impact on hospices and other parts of the system where people are not directly employed by the NHS. I agreed to raise that in the House at the first opportunity, which I have done, and I am grateful for this opportunity to do so as well.

I know that I am among friends when I say that the value of hospice care is not underestimated. The work that hospices do for children and adults is fantastic. They are an essential part of bringing health and social care together and ensuring that people are cared for in the right setting and as close to home as possible. We all know that it is better to be near our families, whatever our health situation, and certainly during the last moments of our life.

As I have said, people are dying in my urgent care centre, which has already been judged as poor for palliative care, when there are beds in the hospice not far away. That must be addressed, and I want the Minister to intervene to put pressure on the system—or systems, at the moment—on the question of why we cannot do more. There has been progress in the last three years towards working better together, but making the right decision is painfully slow for somebody who does not actually have the time for that decision to be made. There have been improvements in working together, and the managers in all the systems in Cornwall, including the hospices, have healthy relationships, but things seem to be getting stuck at ward level, so patients are potentially not getting the best care.

As I have said, hospices now do fantastic work in the community, which has been a response partly to funding but also to need. They are going out into people’s homes to help families and individuals to manage their care properly. I have made fairly clear the two things that are needed to help hospices to deliver that vital role. In the discussions around the NHS pay award, what engagement opportunities have the Minister and the Department had with hospices? Have they been included in discussions about how that can be addressed and passed on? I would love the Minister to look closely at the situation in Cornwall, which will be true elsewhere too, where the money available for hospices is not enough. That is a choice made at a local level by commissioners, not the Department.

We should also assess whether we are making full use of what is available in hospices. If there are 12 beds with people in who are being cared for in the right place, that care is far more cost-effective than if there are eight beds, as is the case in my local hospice. It is not just about throwing more money at hospices, but about making better use of resources. That will reduce the cost of care while ensuring that those people, who have such a challenge ahead of them in the days and weeks to come, are given the care, love and attention that they absolutely deserve and that we would expect in the great nation in which we live.

Social Care Funding

Melanie Onn Excerpts

Wednesday 17th October 2018 Commons Chamber

[Barbara Keeley]

It is really up to the Secretary of State, whose party has not produced any proposals, to answer that. On the point about cross-party working, it is the Conservative party that has no proposals. The only proposals it has come out with are the damaging ones that have now been abandoned.

[Melanie Onn (Great Grimsby) (Lab)]

My hon. Friend is doing a very good job of reminding the Government that they are the ones in power and the ones with the decision-making powers. If they support the Select Committees’ report, they should bring forward their Green Paper and adopt them all in full. They have the opportunity to do that.

I want to ask my hon. Friend about unmet need and the growing gap between social care funding and continuing healthcare funding. I am increasingly seeing severely disabled individuals in my constituency with very high levels of need being bounced from pillar to post between continuing healthcare funding and social care funding, neither of which is meeting their needs. What does she suggest the Government do to bridge that gap?

[Barbara Keeley]

I suggest that the Government start with the cash injection that our social care system needs. The Labour party promised a £1 billion injection upfront to ease us out of the crisis and £8 billion across this Parliament. I suggest that that would be a starting point and that the Conservative party then tell us how it will fund social care in future.

--- Later in debate ---

[Matt Hancock]

Through the Barnett formula, we have made available funding for Scotland today, which in England we are spending on adult social care. I very much hope the SNP Government in Holyrood will make sure they do the right thing by this funding and ensure that it goes to helping people get out of hospital when they medically can leave hospital but need care once they get out. I think we are agreed between us that the SNP Government in Holyrood should spend this money wisely.

[Melanie Onn]

I am keen to learn how much extra my constituency is getting, given that the Secretary of State is doing a roll call of all that. I also wish to ask him about the comments he made about the streams of funding for social care and healthcare. Is he proposing that funding would be ring-fenced? There is a concern that when we try to integrate the two, urgent healthcare will always come before social care.

[Matt Hancock]

That need not necessarily be the case. It was slightly disappointing that the hon. Lady, who is normally a great champion of cross-party working, did not welcome the £780,000 extra for Grimsby, but you can’t win them all. The people of Grimsby need to know that we are there to support them and to support their local NHS.

I now turn to the long-term funding pressures. The lifetime care costs of a 65-year-old today are about £45,000 on average, but those total average costs that people face are not distributed evenly. Some people face no care costs at all, whereas the care costs for someone with dementia who lives into their 90s can run into hundreds of thousands of pounds. As a society, that is the challenge we face, yet right now there is no way to predict or insure this potential financial burden. We are committed to ensuring that everyone has access to the care and support they need. However, as has always been the case, that must be based on the principle of shared responsibility. With sensible planning, people should not have to fear the risk of losing everything. The adult social care Green Paper, which will be published later this year, will bring forward a range of ideas to address the long-term challenge. We want to learn from what has been proven to work, with one example being the auto-enrolment pension reforms, which have been taken forward on a cross-party basis over a decade. The rate of opting out has been remarkably low, and this has put in place the foundations for the strengthening of our pensions system over time. The Green Paper will propose a range of options and ideas, learning from both the UK and from around the world.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 24th July 2018 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

What action is the Minister taking to ensure that the National Institute for Health and Care Excellence guidelines on equal access to IVF are adhered to, so that people such as my constituent Rebekah Hambling, who sadly lost her IVF baby to group B strep, are not denied further rounds of IVF in North East Lincolnshire because they would still have been eligible in other CCG areas?

[Jackie Doyle-Price]

I agree with the hon. Lady. It is unacceptable that seven CCGs offer no IVF treatment at all, which is establishing a postcode lottery. We keep reminding NHS England and CCGs of the NICE guidelines and we expect them to follow them.

Learning Disabilities Mortality Review

Melanie Onn Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right that the workforce in our health and social care system is absolutely fundamental to the way we look after people in our country. We must be able to attract, recruit, retain and bring back into the system people who have left it. We are currently compiling a workforce strategy jointly between Skills for Care and Health Education England, and it will be reporting later in the year.

[Melanie Onn (Great Grimsby) (Lab)]

Parents come to me all the time expressing their grave concerns about what will happen to their children with learning difficulties and disabilities if they are not around to support them. In my constituency I have had reports of instances of bullying from other people in the community, of targeting by drug dealers and of exploitation by private companies such as mobile phone providers and utility companies, and that there are difficulties accessing mental health support. If the Minister is truly keen to show the Government’s desire to improve on the current appalling state of affairs, do not early support and state responsibilities need to be looked at more closely as well?

[Caroline Dinenage]

The hon. Lady is right to make the point more broadly, rather than just about the healthcare outcomes for people with learning disabilities. We need to look at how we protect people more broadly, and this issue must particularly be a terrible worry for the ageing parents. I take on board what the hon. Lady said, and we will definitely feed it into the system to see what more we can do in support.