Oral Answers to Questions

Nick Smith Excerpts

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

My hon. Friend makes an important point, and he has been a strong advocate for local mothers and families in his constituency. But he will also be aware that there was a review of maternity services in the Greater Manchester area that recognised that, by changing the way in which services were delivered, there could be improvements and 25 young children’s and babies’ lives could be saved each year. There has been a review, and that review is saving lives, so I commend any similar service reconfiguration that delivers similar benefits to women and patients.

[Nick Smith (Blaenau Gwent) (Lab)]

13. What steps the Government is taking to reduce the amount of sugar in children’s diet.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Government’s focus is on reducing calories overall rather than focusing solely on sugar, and informing consumers so that they eat fewer calories, including sugar, is key to the responsibility deal. We have 36 companies cutting calories under the calorie reduction pledge, which is often through the reformulation of popular products, and our Change4Life campaign informs families how they can improve their diet and health. Some of the early evidence from Public Health England’s January smart swaps campaign is really encouraging.

[Nick Smith]

Blimey, what a cop-out! With a third of children under 18 either obese or overweight, what action has been agreed with the Secretary of State for Education to stop the consumption of sugary drinks in schools?

[Jane Ellison]

My understanding is that the consumption of sugary drinks is banned in schools. I have discussed that with the Department for Education, but I am happy to take up the point.

I must correct the hon. Gentleman on his point about childhood obesity. Let us give credit where it is due. Childhood obesity levels are for the first time levelling off and we are beginning to see some progress, although there is much further to go. We have a straightforward disagreement. The Government believe we need to give people information. The Opposition believe in a top-down, state-driven approach.

Care Bill [Lords]

Nick Smith Excerpts

Monday 10th March 2014 Commons Chamber

Those would be valuable added safeguards to clause 80. As we have seen, with the best of intentions and optimism, minimum humane standards have not been met. I believe that the proposals should be included in the Bill to provide a facility by which those who do not abide by such minimum care standard are held to account.

[Nick Smith (Blaenau Gwent) (Lab)]

New clause 27 would establish an offence of corporate neglect. The problem needs to be tackled following police Operation Jasmine in south-east Wales. That six-year investigation of care-home abuse cost £11.6 million. Three care workers were prosecuted, but the owners—in my view, they were the real culprits—escaped punishment owing to legal hurdles. That is not acceptable. One patient had appalling sores. They were so infected that the bone underneath was visible. I was deeply shocked at the photographs of neglect I was shown from the case. The then deputy chief constable of Gwent police said:

“There is a likelihood that there are cases like this occurring every day…across the country”.

New clause 27 would ensure that care providers are in no doubt that their primary responsibility is the care of their residents. It is supported by Age UK and was recommended by the Joint Committee on the draft Care and Support Bill, which conducted pre-legislative scrutiny.

I accept that the Government’s proposals to strengthen the Care Quality Commission will go a significant way to preventing horrific abuses such as those at Winterbourne View, but without the offence of corporate neglect, the proposals do not do enough. In the Winterbourne View case, the longest sentence for a staff member—they pleaded guilty to nine charges of ill treating patients—was two years. That sentence is mirrored in other cases. It is only fair that an equal sentence is available in cases of corporate neglect.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

I have listened with great interest to my hon. Friend, as I did to the hon. Member for Bristol North West (Charlotte Leslie). Given that many such awful incidents involve people with learning disabilities, will he assure me that he has very much in mind their views as well as those of their advocates and families, and that they will be embraced by the legislation, particularly if his proposals are agreed to?

[Nick Smith]

I assure my right hon. Friend that the new clause refers to all adults, so takes on board the people he mentions.

Subsection (4) of the new clause seeks to strengthen protection. It would ensure that, if abuse were found to have an element of corporate responsibility, and if systems or the approaches taken by the care provider are a contributory factor in the abuse or neglect, the new offence would allow the prosecution of a registered care provider. The Government have the opportunity to shape the culture of the care sector in the Bill tonight.

[Grahame M. Morris]

In Committee, the Minister said that he supported the sentiment of the proposal. Does my hon. Friend accept that, although the new fit and proper person test and the new fundamental standards are important, they do not make provision for a custodial sentence for proprietors, managers and directors of such establishments in such cases?

[Nick Smith]

My hon. Friend has got to the nub of the issue. Managers and directors of organisations such as care homes have to accept that they set the culture of those places, and that they are responsible for looking after the residents in their care, and for avoiding neglect and abuse. If they get it wrong, they should face the possibility of a jail sentence. That is what the new clause would do.

We must go that extra mile to ensure that our safeguards deliver for care home residents. New clause 27 would greatly help that cause. I intend to divide the House on the measure.

[Mr Dorrell]

I want to speak primarily to the new clauses moved by my right hon. Friend the Member for Richmond, but first I wish to comment on the speech by my hon. Friend the Member for Bristol North West (Charlotte Leslie), who has been a consistent advocate of the importance of ensuring that we have a culture in our health and care system that creates space for whistle- blowers, not because we want a world full of whistleblowers, but because we want an open culture—as she rightly says—in which the whistleblower is redundant.

The example often cited in this area comes from the US Navy. A junior rating prevented flying from an aircraft carrier because he was concerned about a safety element. As it happened, the concern was misplaced, but the rating was celebrated because he had the courage to raise it. The culture of the ship was such that it allowed that individual to take the steps necessary to cover the risk. In a sense, the story is most telling because the concern was misplaced but the individual was celebrated for having had the courage to take action. That is the kind of culture that we should have in the health and care system.

I do not agree that we need a candour commissioner: it is part of the core function of the Care Quality Commission’s inspections of health and care provider institutions to make an assessment of whether that culture exists in an institution. If that culture does not exist, it is hard to see how that institution can deliver the standards of care that we would all want to see.

My main reason for speaking is to pick up the points raised by my right hon. Friend the Member for Richmond—

Care Bill [Lords]

Nick Smith Excerpts

Monday 16th December 2013 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow).

There are many challenges for the social care sector as we continue to live longer. In Wales, 20% of our population of 3 million is over 65, and that figure is predicted to rise to 25% over the next 20 years. It is essential that our older people live their lives with dignity, respect and in safety. Other Members have mentioned the costs of care and improving hospitals, but I want to concentrate my remarks on regulation and safeguarding in care homes.

The rising number of elderly people, some of whom need residential care, has led to significant private equity investment in the social care market. In 2011, many Members were troubled by the billion-pound collapse of Southern Cross Healthcare, whose quick-buck business model caved in when the global recession arrived. The media have now reported that care providers NHP and HC-One are expected to be put up for sale soon with US private equity interest.

Private and voluntary providers now account for 92% of all residential care and nursing home places, and 89% of care home care hours are outsourced by local authorities. The Care Bill gives the CQC in England extra powers to oversee the social care market, in particular companies that are deemed “too large to replace”. I welcome that, but we may need to oversee better business models at a more local level. The Association of Directors of Adult Social Services budget survey 2013 showed that more than half of directors expect providers in their areas to face financial difficulty, given the squeeze on local authority budgets that other Members have mentioned. Perhaps those oversight powers should better cover small and medium providers too. I hope the Minister will reassure the House that the CQC will have the resources and expertise to assess whether all care home owners are fulfilling their obligations regarding their financial viability. My constituents who went through anxious times with Southern Cross would like more stable care home operators and better financial scrutiny by regulators.

The other issue I wish to address is adult safeguarding. I have previously told the House about the horrendous instances of historic neglect and abuse in care homes uncovered by Gwent police’s Operation Jasmine. The £11.6 million investigation started in 2005 and gathered 10,500 exhibits and 12.5 tonnes of documents. It led our police to brand the negligence discovered as “death by indifference”. There were 103 alleged victims of care home abuse and neglect, yet, like their relatives, I was dismayed that Operation Jasmine secured just three convictions for wilful neglect by carers. Worse, charges brought against a care home owner did not directly relate to poor care for residents in his homes, but instead to breaches of health and safety legislation and false accounting. That cannot be right.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

At a time when children’s safeguarding boards are subject to so much scrutiny and questions about their performance, does my hon. Friend share my fear that the Government may be adopting a model that is flawed and needs a great deal more work? If that model is replicated for older people and adults in need of care, we may see a repetition of the same problems.

[Nick Smith]

My hon. Friend makes a good point.

I was struck when speaking to victims’ families in south Wales that although many were regular or even daily visitors to their loved ones’ homes, they were not informed about bedsores or concerns that their relatives were not eating or drinking properly—such concerns were just brushed aside. Yes, individuals must be responsible for their actions, but what was uncovered was institutionalised neglect, with instructions on cutting back on food and incontinence pads coming from the top.

I am pleased that in Wales the First Minister has agreed a review of Operation Jasmine, led by Dr Margaret Flynn, who wrote the excellent Winterboume View hospital report. Although it will not report in time to amend this Bill, I hope the Government will consider any additional measures that that crucial review may highlight because we know that such issues are not just a problem for Wales. Information supplied by the House of Commons Library shows that, in 2011-12, 65,580 allegations of abuse of vulnerable adults aged 65 or over were made at different locations in England. Of those, 29,555—about 45%—were alleged to have taken place in care homes. This is a big national issue.

Looking to the future, we must improve the law on wilful neglect. If a patient does not die from poor care and does not have a loss of capacity under the Mental Capacity Act 2005, guidance from the Crown Prosecution Service states that a criminal offence is difficult to identify. Given that, respected groups such as Age UK support the proposal that organisations—not just employees—found to have contributed to abuse or neglect in a care setting should be liable to criminal prosecution.

[Norman Lamb]

The hon. Gentleman is making some serious points. Does he welcome the fact that the Government have consulted on a change so that we introduce fundamental standards of care, and that those providers of care—the organisations, and indeed their directors—can be prosecuted for failures of care? That has not been possible until now due to a flawed regulatory system.

[Nick Smith]

I welcome that but I am not sure it goes far enough. I think the issue needs to be teased out further in this debate and possibly in the Bill Committee.

[Paul Burstow]

I know that the hon. Gentleman is campaigning hard on these issues at the moment. Does he agree that we need a clear criminal offence of wilful neglect in respect of people who have capacity, so that they are not left behind, as in the current position? If the Government cannot be persuaded—although I hope we can persuade them—of the case for a power of entry or power to interview a suspected victim of coercive abuse, they should at least adopt some sort of regulatory powers so that they can introduce such a measure later when they are finally persuaded by the overwhelming evidence.

[Nick Smith]

I thank the right hon. Gentleman for his suggestion. That seems possibly a good idea and something we should pursue in the future.

I congratulate my Gwent colleague, Lord Touhig, who tabled an amendment to the Bill in the House of Lords to introduce the offence of corporate neglect. If we do not get what is needed this time, I would like to table an amendment on the same topic in this House. I hope that following the welcome consultation on strengthening corporate accountability in health and social care that the Minister mentioned, the Government will now make our law fit for purpose.

I support clause 48, which was inserted in the other place and provides equal protection to all users of regulated social care, regardless of where that care is provided and who pays for it. As Age UK says,

“for those at the sharp end of indifference and abuse, it is essential that both the provider and the regulator have clear legal duties to protect human rights.”

As we know, social care and health are devolved issues in Wales, and last week the Welsh Government published a draft “Declaration of the Rights of Older People” to be considered by our older people’s commissioner and an advisory group. I warmly welcome that initiative and think the Government would be well advised to follow the example of Wales and appoint an older people’s commissioner for England—again, I know that the right hon. Member for Sutton and Cheam agrees.

Last Friday I visited the Rookery care home in Blaenau Gwent, now run by Four Seasons after the collapse of Southern Cross Healthcare. I saw how the implementation of the “Pearl” model of care for those suffering from dementia has seen medication levels plummet from around half to just 17% of residents. The staff were dedicated and caring; residents were comfortable and respected. That is the great care that everyone should receive.

A growing, complex market and tightening finances means that effective regulation and oversight is necessary. If neglect or abuse is found, those responsible must be held to account for their failures because the vulnerable and the frail have the same right to justice as everyone else. Older people should feel safe and secure in the place they call home.

Podiatry Services

Nick Smith Excerpts

Wednesday 4th December 2013 Westminster Hall

[Nick Smith (Blaenau Gwent) (Lab)]

I congratulate my hon. Friend on securing this debate. I recently visited the foot clinic at the Aneurin Bevan hospital in Ebbw Vale in my constituency about a fortnight ago, and I spoke to the fantastic podiatrists there. They told me about the huge and growing demands on their services because of diabetes. Does he agree that raising awareness of diabetes and the effect that it can have, particularly on people’s feet, is really important?

[Andy Sawford]

I thank my hon. Friend for his supportive intervention. He is absolutely right that diabetes can cause problems for people’s feet. Also, by examining people’s feet, the podiatrist can diagnose cases of diabetes and ensure that people get the treatment, help and support that they need. I am concerned that some of the estimated 850,000 people who are undiagnosed might continue to go undiagnosed if podiatrists are not able to provide proper, professional attention to people’s feet when they come into contact with them.

The National Institute for Health and Care Excellence clinical guidance on the prevention and management of diabetic foot complications sets out a foot care management plan to reduce the risk of problems occurring in those with diabetes. It is the clear view of the Society of Chiropodists and Podiatrists that there are not enough podiatrists to comply with the NICE clinical guidelines. We might expect the society to make that argument, but it chimes with my concerns locally that we have lost 16 podiatrists in our area. At a time of increasing diabetes, a reduction in podiatrists gives me real cause for concern, because the society’s view might be right.

Some 500,000 hospital beds in England each year are occupied by people with diabetic foot ulceration—more than all other diabetes complications combined. Only breast and prostate cancer have a higher mortality rate than diabetic foot ulceration. The number of amputations in England has risen from 5,700 in 2009-10 to more than 6,000 in 2010-11. It is reported that, given the increasing incidence of diabetes, more than 7,000 amputations will be performed on people with diabetes in England alone by 2014-15, unless urgent action is taken. If we look at our acute hospital budgets and compare the costs of a bed and of performing an operation and amputation—not to mention the impact on the individual concerned—we see that an increase in amputations in our area could prove far more expensive than continuing to provide the podiatry services that people have come to expect.

Does the Minister accept that the prevention and management of foot disease in people with diabetes is an essential component of every commissioned diabetes pathway, and does she share my concern that 80% of amputations each week are preventable? That is a stark figure. Can she give me an undertaking that clinical outcomes for vulnerable older people, including those with diabetes, will not worsen in Northamptonshire?

I wish to mention briefly some other issues in the short time I have left. By standardising best practice in the work of podiatrists in the UK, there is the potential to make net savings and reduce the number of accident and emergency admissions and amputations. NICE clinical guideline 119 looks at best practice. I hope that the Minister will consider how we can make sure that that guideline is followed in Northamptonshire with the resources available.

Finally, there needs to be greater parliamentary and public attention to podiatry issues. I very much welcome hon. Members’ attendance at this brief debate, and their interest and support. The subject is not particularly glamorous. Toenails, amputations and ulcerations are not things we want to think about over our breakfast, but they are important issues, particularly for some of the most frail and vulnerable people.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for highlighting this important issue. The Medicines and Healthcare products Regulatory Agency regularly reviews the evidence relating to anti-epileptic drug use, particularly sodium valproate products, and we check what information is available to doctors so that it can be passed on to patients. I am concerned about the issue my hon. Friend raises, so I have asked NHS England’s national director of patient safety, Dr Mike Durkin, to look into it carefully and get back to me.

[Nick Smith (Blaenau Gwent) (Lab)]

New York has raised the age for buying tobacco products to 21. As a public health care policy, has the Department considered that matter?

Mid Staffordshire NHS Foundation Trust

Nick Smith Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is right that it is absolutely shocking that we spend more than £1 billion a year on litigation claims in the NHS. The only long-term way of reducing that bill is to improve the safety record of the NHS, so that we do not have the terrible incidents that lead to high claims. The only way to do that is through openness and transparency, which is why today’s measures will make a big difference.

[Nick Smith (Blaenau Gwent) (Lab)]

I welcome the proposal on legal sanctions for those found guilty of wilful neglect. In south Wales, police Operation Jasmine has looked at the alleged abuse of elders in care homes. I understand the difficulties, but will today’s announcement help us to hold to account those responsible for corporate neglect in private sector care homes?

[Mr Hunt]

Absolutely. The Minister of State, Department of Health, who has responsibility for care services, has been very focused on making sure that there is proper corporate accountability. Today, we have announced the new fit and proper persons test that will apply to all organisations delivering care to make sure that directors of companies responsible for care homes and domiciliary services in which poor care happens are properly held to account. That is vital, because there should be no hiding place for people who send signals to their staff that lead to our reading the horror stories that, sadly, we have read.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right to highlight some of the concerns that have been raised by the Royal College of Surgeons and other groups about the impact of the European working time directive in medicine. That is why we have tasked the royal college with investigating and doing some work on exactly what the impact is on surgical trainees and elsewhere in the health sector. We look forward to its reporting back, and I hope that that will be very informative for future discussions on other work force regulations.

[Nick Smith (Blaenau Gwent) (Lab)]

4. What estimate he has made of the number of NHS Trusts forecasting a financial deficit at the end of 2013-14.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The Trust Development Authority and Monitor, for foundation trusts, indicate that there will be a financial surplus across the health care provider sector in 2013-14.

[Nick Smith]

With so many NHS trusts in deficit and many missing their A and E targets, when will the Minister stop blaming everybody else and get a grip on the A and E crisis?

[Dr Poulter]

I am disappointed that the hon. Gentleman used a pre-prepared question and did not listen to my answer. Throughout the health care provider sector, over 80% of trusts and foundation trusts are in financial surplus, and the overall end-of-year forecast is pointing to a surplus of £109 million across the sector. To support hospitals through what can be very difficult winter periods, with flu and other seasonal problems, we have put in place measures including a £500 million fund for winter pressures. That will take the pressure off A and E—unlike in Wales, where the Welsh Administration are cutting the budget for the NHS. In Wales the NHS has failed to meet A and E waiting targets since 2009.

Tobacco Products (Plain Packaging)

Nick Smith Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Nick Smith (Blaenau Gwent) (Lab)]

I, too, congratulate the hon. Member for Harrow East (Bob Blackman) on securing this debate and on his principled support for plain packaging.

It bears repeating that the costs of smoking are huge. The cost to the NHS in Wales alone is estimated at around £400 million. A Welsh health survey in 2012 showed that 23% of the population smoke and, sadly, in my constituency that figure is 28%. The Welsh Government’s commitment to reduce it to 16% by 2020 is a massive challenge.

The smoking ban has made our pubs and cafés healthier and more pleasant places in which to relax, but young people are still being recruited to the habit and more than 200,000 under-16s start to smoke every year. We expected that by now the message that smoking is bad for you would have ended the recruitment of new young smokers. Yet in the summer of 2012, when ASH Wales had a campaign road show around Wales to talk to schoolchildren about the impact of tobacco marketing on them, when shown the marketing currently on the shelves, they described cigarettes as looking like perfume boxes, posh tissues and even Lego.

ASH Wales estimated that 40 teenagers every day try smoking cigarettes. Cigarette packs come in a wide range of shapes, sizes and designs that are fashionable, colourful and attractive to young smokers. I have been told that slimline feminine packets are perfect for small handbags, and such comments underline why plain packaging is supported by the chief medical officer for Wales and the Children’s Commissioner for Wales. It has majority public support of 63% and is widely supported by parents in my constituency.

I am pleased that the Welsh Minister for Health and Social Services is looking at our devolved powers to see what unilateral action might be taken to introduce plain packaging, but I have no doubt that concerted action throughout the UK is the best option. We must defeat the mantra that those who want to up the pace of reform are advocates of the nanny state and greater regulation. Instead, we must show that plain packaging will save lives and money, and is clearly right.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 26th February 2013 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

On performance data, what plans does the Minister have to expand the friends and family test so that it provides the reasons for patients’ views and real-time feedback on their experience of services?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I thank the hon. Gentleman for his question. The friends and family test will give real-time feedback about patient services, but we need to ensure that the data from the test are used effectively by local trusts and scrutinised by the Care Quality Commission and other organisations so that they can go in if there are problems to ensure that they stand up for the rights of patients.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

We are reducing investment in the back office so we can put more money into the front line. The result is that there are 219,000 more cancer treatments every year than there were under the last year of the Labour Government.

[Nick Smith (Blaenau Gwent) (Lab)]

8. When his Department plans to publish its proposed new sexual health policy document.

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

We plan to publish our policy document on sexual health and HIV shortly. Improving sexual health is very important for individuals and communities.

[Nick Smith]

Can the Minister explain why the sexual health policy has been delayed for almost two years? Does he accept that this delay is affecting the ability of PCTs to deliver effective sexual health services?

[Norman Lamb]

From April, local authorities will be responsible for commissioning services. Because we have seen this really impressive increase in funding for public health, local authorities will have the ability to maintain and indeed improve sexual health services for their local communities. That is something of which we should be proud.