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.

Diabetes

Nick Smith Excerpts

Wednesday 9th January 2013 Westminster Hall

[Nick Smith (Blaenau Gwent) (Lab)]

Thank you, Mr Crausby, for calling me to speak. I congratulate the hon. Member for Torbay (Mr Sanders) on securing this important debate.

Sadly, we had 23 amputations from diabetes last year in my constituency of Blaenau Gwent, despite having a valued specialist foot ulcer clinic run by an advanced podiatry practitioner. So last November I asked the Leader of the House for a debate on how to prevent amputations resulting from diabetes.

The Public Accounts Committee, of which I am a member, was given evidence that the NHS spends at least £3.9 billion a year on diabetes services. It is shocking that the lion’s share of that money is swallowed up in the treatment of avoidable complications. As we know, these complications are not minor; they include amputations, blindness and kidney disease. Such complications are extremely debilitating for the sufferer and extremely expensive to treat. In the worst cases, diabetes can lead to premature death. That is a waste of both precious lives and resources.

Health professionals say that there are 125 amputations weekly because of diabetes, yet 80% of those amputations are preventable. The National Audit Office says that we could save £34 million annually if late referrals to specialist teams were halved. So, it is in the interests of patients and NHS budgets to deliver effective services, with the emphasis—as ever—on prevention and early diagnosis.

The PAC’s report on diabetes services, which was published last November, found that fewer than half the people with diabetes receive the nine basic checks identified in minimum standards of care that were established more than 10 years ago. Unlike cancer, stroke and heart disease, there are no mandatory performance targets for diabetes.

The PAC report highlighted the postcode lottery in provision for people with diabetes, and it also said—to a chorus of consensus—what needs to be done. However, it is just not happening nationwide. Put bluntly, we found that money is being wasted. There is no strong national leadership; no effective accountability arrangements for health service commissioners; no appropriate performance incentives for providers, and no evidence to assure us that the new NHS structure would address the failings that have been identified.

The Leader of the House has told me that diabetes care is a Government priority. So I hope the Government will support a specific pledge that would be widely welcomed. The Putting Feet First campaign, the supporters of which include Diabetes UK and the College of Podiatry, wants there to be a realistic target of a 50% reduction in amputations because of diabetes by 2018. That is a crucial point, because the Health Minister, Earl Howe, told the House of Lords recently that

“Diabetic foot disease accounts for more hospital bed days than all other diabetes complications”.—[Official Report, House of Lords, 29 November 2012; Vol. 741, c. 331.]

Policies to deliver that target include having a multidisciplinary foot care team in every hospital. Shockingly, in 2011 31% of hospitals had no podiatry provision at all. We also need foot protection teams in every community, which will mean more, not fewer, podiatrists in post.

We need a strong message from Government that preventable amputations must be reduced, that local variations will not be tolerated and that precious NHS resources will not be wasted. In addition, as others have already said, the importance of patient engagement cannot be stated too often. In their current consultation on diabetes, the Welsh Government highlight the benefits of having more informed and more confident diabetes patients. Education is an integral part of personalised patient care.

I will now make some concluding comments about how we can turn the tide, given that current projections show that the number of people with diabetes will rise from 3.1 million to 3.8 million by 2020.

How can we improve diet, reduce alcohol consumption and encourage physical activity? Good ideas include: a reduction in the sugar content of soft drinks; a realistic minimum price for alcohol of 50p per unit; restrictions on advertising and sports sponsorship; action to maintain nutritious school meals; teaching our children to cook, and encouraging regular sport and exercise in schools. Together, these ideas are a promising mix of radical measures, unlike the Government’s “responsibility deal”, which is just another case of the triumph of hope over experience.

Last week, a report from the Royal College of Physicians called for a senior figure in Government to take charge of obesity issues across all Departments, covering every area from agriculture to work and pensions. In the US, we have seen the mayor of New York, Michael Bloomberg, ban the sale of “super-size” drinks at entertainment venues. Similar bold and symbolic action is now urgently needed from the coalition Government here.

As I said at the beginning of my speech, there were 23 amputations in Blaenau Gwent last year because of diabetes, and across the UK there will have been many thousands of such amputations, many of which were preventable. The Government need to up their game.

--- Later in debate ---

[Anna Soubry]

Indeed. I was going to end this part of my speech by saying that my constituent, Mr Dawson, paid tribute to what he described as his brilliant diabetic nurse at the Queen’s medical centre in Nottingham. He highlighted, as the hon. Gentleman has done, that it is all well and good having wonderful, great technology, but if people have access to it they need, critically, the support to be able to use it themselves. We must ensure that they have the highest-quality support, not just from their GPs, but from diabetic nurses and others who are trained and specialise in this condition.

Diabetes is common and is increasing, as hon. Members have mentioned. It is estimated that, by 2025, 4 million people will have diabetes.

[Nick Smith]

What are the Minister’s views of Mayor Bloomberg’s plan in New York to ban super-sized soft drinks in cinemas? Does she agree that that could be a good symbolic action that would help bring down diabetes?

[Anna Soubry]

It could be, but I make it clear, as I said on Monday in various media interviews, that at the moment the responsibility deal is working, which is why we have some of the lowest salt levels in the world. Other countries are coming to us to find out how we have achieved that by working with industry, retailers and manufacturers to reduce salt levels. On the reduction of trans fats, under 1% of our food now has trans fats in it. Again, we have done that by working with the manufacturers and retailers.

My natural inclination is against legislation, and I say that as an old lawyer. At the moment, I am confident that the responsibility deal is delivering in the way that I want it to. I make it clear that, if there is a need to introduce legislation, we will not hesitate to do that. I am almost firing a warning shot across the bows of the retailers and food manufacturers and saying, “Unless you get your house in order and accept responsibility, we will not hesitate to introduce legislation or regulation, because we know that we in this country have an unacceptable rise in obesity, to levels that are second only to those in America.” I will therefore consider everything. I always have an open mind. I am currently content, however, that the responsibility deal is delivering, but it has a great deal more to do. I hope that those who are signed up to the calorie reduction scheme later this month will encourage more manufacturers and retailers to sign up to the responsibility deal on calories. I want to ensure that we make some real, serious and tangible progress.

Ultimately, however, as the right hon. Member for Leicester East and the hon. Member for Strangford (Jim Shannon) identified, the responsibility is ours. Nobody forces us to eat the sugar buns or whatever it may be. When we go into the Tea Room and we are faced with the choice between fruit or a piece of cake, my natural inclination might be for a piece of cake, especially since I have developed a sweeter tooth as I have got older and since I have stopped smoking. We all make the choice whether to eat a piece of cake. The ultimate responsibility lies with us as individuals and as parents, but I always have an open mind.

Diabetes is a growing problem and a major factor in premature mortality with an estimated 24,000 avoidable deaths a year—10% of deaths annually are in people with diabetes. A variation exists in the delivery of the nine care processes, with a range of 15.9% to 71.2% achievement across PCTs, which is not acceptable. However, 75% of diabetes sufferers receive eight out of the nine care processes, which is a huge improvement. In 2003-04, only 7% of sufferers received all nine care processes. In 2010-11, that figure was at 54.3%, but there is much more to be done. In the coming months, several documents will be published to guide the NHS in delivering improved diabetes care, including the response to the Public Accounts Committee report, the work undertaken on diabetes as a long-term condition and the cardiovascular disease outcome strategy.

We must ensure that people get an early diagnosis. I must commend again the work of Diabetes UK. Other hon. Members have mentioned how it is raising awareness of the early signs and symptoms of diabetes with its latest campaign on the 4 Ts, which has my full support. One in every two people diagnosed with diabetes already has complications. I thank the hon. Members for West Lancashire (Rosie Cooper) and for Blaenau Gwent (Nick Smith) for their contributions. I will not be able to answer their points specifically in my speech, but I hear what they say and will write to them if necessary to answer their questions. I am acutely aware of the complications and the devastating effects that those can have on people’s lives.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Anna Soubry]

It is my understanding that that is already part of the formula, but my hon. Friend makes a good point, and I am sure that he joins me in wanting to make sure that the formulas are fair, so that we reduce health inequalities. I am happy to discuss the issue with him further.

[Nick Smith (Blaenau Gwent) (Lab)]

The Public Accounts Committee says that 11 of the 144 foundation trusts across England are now in serious financial difficulty. What contingency funding is in place for those trusts, to protect patients?

[Mr Jeremy Hunt]

We have a clearly set out programme for all those trusts, to make sure that they get back to the proper financial controls and proper governance structures that they need. We do not want to get into the business of bailing them out; we want them to stand on their own two feet. That is the vision of the Health and Social Care (Community Health and Standards) Act 2003, passed by the hon. Gentleman’s party when it was in government.

Business of the House

Nick Smith Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

I will perhaps now become more familiar with early-day motions than I have been in the recent past. I will certainly pay attention to the one that my hon. Friend mentions, and he might like to reiterate his important point about tourism at the soon-forthcoming Department for Culture, Media and Sport questions.

[Nick Smith (Blaenau Gwent) (Lab)]

The “rockets and feathers” strategies employed by oil companies are crucifying motorists in Blaenau Gwent, so I welcome the Office of Fair Trading plans to investigate petrol pricing. May we have a debate on how to help our road hauliers and logistics industries to get our economy moving again?

[Mr Lansley]

I, too, take an interest in this issue, and welcome the OFT call for evidence. I note that the Backbench Business Committee has selected the oil market as a subject for debate, and it would probably be entirely in order for the issues the hon. Gentleman has just raised to be discussed in the course of that debate.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

As my hon. Friend knows, trusts and NHS employers are responsible for the terms and conditions of their staff, and for ensuring, as “Agenda for Change” intends to, that staff who effectively have the same knowledge and competences have the same pay banding, wherever they happen to be across the country. That is the objective of “Agenda for Change”. As I said yesterday, and will continue to say, “Agenda for Change” can be improved—we made that clear to the pay review body—but we think it is possible, if the staff side works with us, to enhance “Agenda for Change” and increase its flexibilities, so that NHS employers can recruit, retain and motivate their staff, with local flexibility, in a national pay framework.

[Nick Smith (Blaenau Gwent) (Lab)]

Given that every year, 1.2 million admissions to accident and emergency units are alcohol-fuelled, when will the Government help the NHS and legislate for a minimum alcohol unit price?

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am sure that the hon. Gentleman is very familiar with the alcohol strategy and has read it in detail. It is one of the things that we need to do. Brief interventions, specialised treatment, the NHS alcohol check and, of course, changes to licensing will all make a difference. As I say, the alcohol strategy, a cross-Government document, is out. We will respond further in due course.

Young Offender Institutions (Speech and Language Therapy)

Nick Smith Excerpts

Thursday 28th June 2012 Commons Chamber

[Seema Malhotra]

I thank the hon. Gentleman for his contribution. He makes an important point about the inability to understand what is going on in the justice system through an inability sometimes to read and, certainly, to understand what is being said. An important part of the argument is that we need better speech and language therapy services in order to reduce reoffending.

Statistics from the Royal College of Speech and Language Therapists show that 10% of school-aged children and 1% of adults in the general UK population have speech, language and communication needs, but that 55% of children in deprived areas are affected by such needs. They suffer from a “word gap” of an estimated 30 million words when compared with children in wealthier households, and that limits their ability to use language to communicate effectively.

It is estimated that more than 60% of young offenders have speech, language and communication needs, and there is evidence of a vicious circle—of deprivation leading to reduced language development, leading in turn to communication difficulties. Children with speech and language difficulties are more likely to become frustrated at school, to play truant and to get involved with crime. Once they are involved, they struggle with the formalities of courts and of police interviews, and they come out worse because of it.

[Nick Smith (Blaenau Gwent) (Lab)]

I, like my hon. Friend, have visited young people with communication disabilities in prison; I did so in Park prison, near Bridgend. Does she agree that it is essential to recognise as early as possible, at the point when young people enter the criminal justice system, whether they have communication difficulties? Does she agree further that the Asset tool should be updated so that needs can be identified without delay and the right help delivered?

[Seema Malhotra]

I thank my hon. Friend for his comment. He makes an important point about early identification within the justice system—particularly if somebody’s needs have been missed earlier in life—in order to help an individual to facilitate the rehabilitation that we hope is possible for them.

There is an important debate about the standards of provision in the education system, and I shall speak about that tomorrow at an excellent training conference on developing oracy and literacy, organised by Hounslow Language Service in my constituency.

My concern in this debate, however, is about the access to speech, language and communication needs assessment and services once young people have reached prison. When I visited Feltham young offenders institution recently, I met a 15-year-old boy who has been receiving speech and language therapy, and learning a few speech exercises had already made him more confident in speaking to his family on the phone—with a clear impact on his personal confidence.

The boy’s vocabulary was like that of a child, but this is not so surprising when we discover that 35% of offenders have speaking and listening skills below national curriculum level 1, equivalent to those of a five-year-old. A further 26% of offenders are estimated to have national curriculum level 2 speaking and language skills, which compare to those of an average seven-year-old.

I also heard the story of a young man who was recently at Feltham. He had a lisp, and when he was three his GP had told his parents that this was because he had a small tongue and nothing could be done. He proceeded to do poorly at school. He was laughed at, including by his own family; his mother would force him to speak when friends came round as a source of entertainment. When in prison, this young man came to accept some speech and language support, and within a matter of weeks he was becoming a more confident speaker, with an almost instant change in attitude to turning his life around. An ability to communicate better has been increasingly associated with reduced violent behaviour of young offenders, and that was indeed the case with this young man.

We know that it works to invest in communication skills and in the training of staff and officers in the justice system. The Royal College of Speech and Language Therapists’ briefing on youth crime of June 2012 quotes statistics from Red Bank secure children’s home in Liverpool. Five out of seven young offenders in one section had challenging behaviour. Staff were involved in physically restraining these young offenders on two to three occasions per day. After communication training and guidance from the speech and language therapist, staff were able to reduce the number of restraints to two per week. The Communication Trust has published in its booklet, “Sentence Trouble”, some useful suggestions about how youth justice professionals can positively interact with young people with speech, language and communication needs. It identifies an awareness and training gap in the youth justice work force, who are much better prepared to deal with mental health issues and substance abuse than with speech and language difficulties.

I am concerned that dealing with the speech, language and communications needs of young offenders is falling through the cracks between the Departments for Education, Health and Justice. It is probable that many young people in prison may not have been there had the education system or health system intervened effectively earlier in their life. In 2010, research with therapists conducted by the royal college in four areas of the country suggested that over 90% of young offenders with communication difficulties had not been known to speech and language therapy services prior to their contact with the criminal justice system. Yet the benefits of these services are clear in improving justice outcomes and reducing reoffending. It is feared that current education and rehabilitation measures in prison require a higher level of language comprehension than many young offenders possess. However, current provision of these services in young offender institutes is limited and patchy. Of the 21 young offender institutes, only Feltham has a full-time speech and language therapist, while four others—Hindley, Wetherby, Polmont and Cornton—provide some support on one to three days a week.

There have been moves to make this case and improve provision in the past. In 2006, Lord Ramsbotham, formerly Her Majesty’s chief inspector of prisons, said in a Lords debate:

“in all the years I have been looking at prisons and the treatment of offenders, I have never found anything so capable of doing so much for so many people at so little cost as the work that speech and language therapists carry out.”—[Official Report, House of Lords, 27 October 2006; Vol. 685, c. 1447.]

The Bercow report recommended that the youth crime action plan and work on young offenders’ health should consider how best to address the communication needs of young people in the criminal justice system, including those in custody. The youth crime action plan of 2008, produced under the previous Government, included recognition of the Bercow review’s recommendations. However, I am not certain whether any action has yet been taken by this Government, nor has the Under- Secretary of State for Justice, the hon. Member for Reigate (Mr Blunt), who is responsible for youth justice, commented on speech and language therapy.

The royal college has called for at least one full-time specialist in every young offender institute. The Prison Reform Trust supports this recommendation, and its report, “No One Knows”, recommended that

“prison healthcare should have ready access to”

learning disability expertise and

“speech and language therapy.”

Arguably, on the current evidence, there is a strong economic case for this. Secure children’s homes and training centres cost about £200,000 a year, while placement in a young offender institute costs £60,000 a year. This, the House may be interested to hear, is twice the cost of a year at Eton, which is £30,981. I thank the Minister for providing these up-to-date figures following my written question last week—excluding the Eton figure, of course, which were obtained from Eton’s website. In comparison, a full-time speech and language therapist employed under NHS “Agenda for Change” band 7 costs £30,460 a year—marginally less than a year at Eton. The funding of speech therapy is surely cost-effective, compassionate and necessary for an effective and intelligent youth justice system.

To conclude, I would be grateful if the Minister updated the House on a number of matters. First, what is the Government’s policy on the provision of speech and language therapy in young offender institutions, and on the call for there to be at least one full-time speech and language therapist at every institution? Secondly, will he clarify which Department is accountable for the provision of speech and language therapy in young offender institutions, and how the Department for Education, the Department of Health and the Ministry of Justice work together on this issue? Thirdly, is it true that Asset, the assessment tool used by police and the justice system, does not include a section that enables staff accurately to identify speech, language and communication needs? Fourthly, what assessment of speech, language and communication needs takes place when a young offender is sentenced to prison? Fifthly, is the existing funding secure and are there plans to increase the provision in young offender institutions? Finally, how do Ministers currently measure and review the effectiveness of such services?

I thank the House for the opportunity to speak on this topic today.

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the hon. Member for Feltham and Heston (Seema Malhotra) on securing the debate and on setting out the issues so clearly. I note that, curiously, my noble Friend Lord Addington is debating this matter with Ministers in the other place. It is clearly of importance to parliamentarians in both Houses. The work of the all-party parliamentary group on speech and language difficulties underscores that point.

It is important to recognise that speech, language and communication difficulties are part of a complex and multi-layered range of needs that young people between the ages of 15 and 21 may have, particularly those within our criminal justice system. I understand the concerns about speech and language therapy that the hon. Lady has raised and will try to address them.

There have been a number of studies, mostly small-scale studies, on the prevalence of speech, language and communication needs. They place the prevalence of such needs in custodial settings at anything between 60% and 90%. One recent study found the 60% of young offenders screened on entry to custody had speech, language or communication needs. As has been said, among the general population the figure stands at 1%, although there are regional and local variations.

Much attention has been given to these issues over recent years. The hon. Lady made reference to Mr Speaker’s work on behalf of the last Government. The coalition Government are taking forward a number of the actions in the Bercow review. First, we had the Green Paper on special educational needs and disability, and the follow-up report that was published recently. Secondly, there have been pathfinder pilots to develop unified plans covering health, education and care needs, supported by the use of personal budgets. Thirdly, we have had the review of the early years foundation stage. The Department of Health is working closely with the Department for Education to join up health and care, sorting out one of the oft-stated criticisms of SEN provision for so many years.

I assure the House that speech and language therapy is available to young people, and in particular to those in the custodial estate. Currently, it is commissioned in the custodial estate through primary care trusts. It is meant to be commissioned according to local need. That means that in-house services are provided in some larger young offender institutions—not just in Feltham, but in Wetherby and Hindley. I urge the hon. Lady to look at the provision in those two other institutions.

From next April, the responsibility for commissioning prisoner health will move from primary care trusts, as they are abolished, to the new NHS Commissioning Board. That will help to ensure that people with health needs in custodial settings receive care comparable with that received by those in the wider NHS. Offender health lead commissioners will act for the board and determine the right level of service to be provided to meet the identified needs within the prisoner population. They will work at local level with health and wellbeing boards, children’s services, and police and crime commissioners.

[Nick Smith]

May I press the Minister? How many young people’s custodial settings have speech and language therapists working at them? Do some or all settings have them?

[Paul Burstow]

The hon. Gentleman will have heard me say that there is specific in-house provision at three settings, but there will also be referrals through NHS pathways for speech and language services, meaning that any young person in need of speech and language therapy should have access to it. That is one of the requirements of the commission—its responsibility is commissioning appropriate services to meet identified needs. I shall come to the identification of needs in a moment.

Speech, language and communications needs are just one part of an often complex picture. It is important that we acknowledge that there are complex interactions with, for example, mental health problems, learning disabilities, substance misuse and alcohol problems. Therefore, psychiatry, psychology, community psychiatric nursing, psychotherapy, and occupational and creative therapy can all play a valuable part—a bigger part in some cases—in treating and meeting the needs of young offenders.

The hon. Lady was right to highlight the contribution that speech and language therapies make not just in direct services, but in supporting colleagues in a multi-disciplinary team to ensure they have the necessary skills to provide the right communications support and so on.

Adopting a personalised approach is at the core of that. The hon. Member for Blackpool North and Cleveleys (Paul Maynard) rightly said that we need to ensure that people have the communications skills and understanding both when they are in prison or youth offending services and when they are released. That was an important point.

The hon. Lady spoke powerfully of her visit to Feltham and the conversations she had with the 15-year-old lad about his experience of speech and language therapy—he said it gave him more confidence. That is another reason why such therapy is an important component of the right health interventions to meet identified needs.

The hon. Member for Blaenau Gwent (Nick Smith) said in an intervention that early intervention is relevant as well as the change in commissioning responsibilities. Early intervention is a key part of the Government’s approach. Continuity of care and treatment is key. The average period of detention for a young offender is very short—80 days, often including remand. Custody therefore provides opportunities for health assessment and for identifying problems and needs, after which referrals can be made. It is therefore important that we have systems that allow those follow-ups to take place. It was right that the previous Government decided that the commissioning of prison health services should be an NHS responsibility, enabling those systems to be properly joined up, and this Government have maintained that.

We need to look right across the whole criminal justice pathway to provide health interventions that are appropriate to the individual presenting needs. In 2010-11 there were 2,040 10 to 17-year-olds in the secure estate at any one time on average. Sometimes, four times as many were on remand or awaiting sentence to custody, and 85,300 were being supervised by youth offending teams. There is a similar pattern in the 18 to 20 age group.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Burns]

I congratulate West Cheshire and other CCGs on the progress that they have made by aspiring to CCG authorisation. We expect first-wave applicants to be informed of the outcome of their authorisation applications by November. Once the outcome is known, the focus will be on ensuring a safe and managed transition from primary care trusts to CCGs on 1 April 2013.

[Nick Smith (Blaenau Gwent) (Lab)]

12. What assessment he has made of the effectiveness of the public health responsibility deal.

[The Secretary of State for Health (Mr Andrew Lansley)]

The responsibility deal has brought together 392 partners, a doubling in number since its launch a year ago. Working together, we have removed artificial trans fats in foods, reduced salt content, put calories on high street menus, improved alcohol labelling, set out ambitious future plans for calorie and alcohol reduction, promoted enhanced physical activity and strengthened employers’ support for health in the workplace. Transparent monitoring and evaluation are vital, and our partners’ assessment of the delivery of their pledges will be published on our website. We are making up to £l million available to fund an independent evaluation of the responsibility deal.

[Nick Smith]

The Mayor of London supports a ban on the sale of mega-sized sugary soft drinks at entertainment venues, which will help fight obesity. Will the Government consider such a measure as part of their nationwide responsibility deal?

[Mr Lansley]

As I said to the hon. Gentleman, as part of the responsibility deal we are considering an ambitious programme of removing 5 billion calories a day from the diet in England. A range of programmes, such as behaviour change programmes and the reduction of saturated fats and sugars in foods by the industry, will make that happen. All those issues will be considered as part of how we can deliver that ambitious programme.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 27th March 2012 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

16. What recent assessment he has made of the performance of services for older people.

[The Minister of State, Department of Health (Paul Burstow)]

A number of inspections, reports, independent audits, and investigations have revealed long-standing and unacceptable variations in the standard of care that older people receive in the NHS, and in social care. The Government are determined to root out poor-quality care wherever it is found. We have established the national Nursing and Care Quality Forum to work with patients, carers and professionals to spread best practice.

[Nick Smith]

The British Geriatrics Society’s “Quest for Quality” report identified that too many people in care homes were without access to NHS services, including psychiatric, physiotherapy and continence services. What action are the Government taking to ensure that care home residents get the high-quality NHS care that they deserve?

[Paul Burstow]

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

--- Later in debate ---

[Mr Lansley]

I am grateful to my hon. Friend for making a good and important point. My right hon. Friend the Home Secretary will be subjecting these drugs to greater control under the Misuse of Drugs Act 1971, restricting their illegal import into this country. Controlling supply is one part of the effort. Prevention is also important; people need to be fully aware of the risks to their health. The FRANK service, which provides advice to young people and parents about drugs misuse, will make it clear that the misuse of steroids is dangerous. I would encourage local areas to work with local businesses, such as gyms and fitness centres, to publicise those risks.

[Nick Smith (Blaenau Gwent) (Lab)]

T2. The Department’s latest estimate shows that alcohol misuse costs the NHS £3.5 billion every year. Will the Secretary of State now champion a 50p minimum unit price? That would save more than 3,000 lives a year, rather than 1,000 a year, which is what his public health responsibility deal is expected to secure.

[Mr Lansley]

The hon. Gentleman should have welcomed the alcohol strategy that my right hon. Friend the Home Secretary published last Friday. Not only did we see the Government’s intention to introduce a unit price, but on that day 35 business organisations across the country collectively, under the responsibility deal, pledged themselves to take 1 billion units of alcohol out of the UK market in the course of a year.

Adult Social Care

Nick Smith Excerpts

Thursday 8th March 2012 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), and the Backbench Business Committee, on securing this debate. Adult social care is one of the most important social issues of our time.

The announcement by Ministers that the social care White Paper is coming soon—or soonish—is well timed. Given that there are an estimated 400,000 older people resident in UK care homes, I wish to concentrate my remarks today on residential care. The Dilnot report of last summer was well received. It struck the right balance between what an elderly person, their family and the state should pay and contribute to long-term care. Equally important for many were the report’s key premises that the current system of social care was underfunded and that additional funding and better targeting were urgently required. As Dilnot said, this is a price worth paying.

We all want to see a UK in which old people are respected and valued and can make the most of their final years. Alfred Morris, who became a Minister in the 1970s, said that

“if years cannot be added to the lives of the chronically sick, at least life can be added to their years”.—[Official Report, 5 December 1969; Vol. 792, c. 1863.]

People might want to move nearer to relatives or downsize as they grow older, so a national system makes sense. Dilnot was right to recommend the delivery of that objective. It would be unfair to call it a weakness of Dilnot, in that it was arguably beyond his remit, but he concentrates on the demand side of social care and how it is to be paid for. He does not consider the supply side and how it is commissioned and, importantly, how it is delivered.

We have recently seen too many examples of care for the elderly in residential care homes and hospitals that have been shameful. As many have said, we have to ensure that care is compassionate and respects the dignity of elderly residents. The care home business—and it is a business for many providers—has been a target for the quick-buck strategies of venture capitalists. Following the collapse of Southern Cross, another massive care provider, Four Seasons, has expanded. It now operates two homes in my constituency, but residents and staff are still worried about the outstanding debt liability of its parent company, Four Seasons Health Care. The Association of Directors of Adult Social Services has said:

“Care wouldn't have got the level of investment it has had without the use of private money…But in these very complex business structures, good governance is key.”

So, measures to ensure the effective oversight of the social care market to ensure stability and continuity are important for residents and relatives.

I would also like to emphasise the issue of NHS support for care homes. The British Geriatrics Society has published “Quest for Quality”, which identified

“unmet need, unacceptable variation and often poor quality of care provided by the NHS to older people resident in care homes.”

While some homes are well served by the NHS and “Quest for Quality” gives examples of good practice, it records:

“No model of coordinated health care has been developed to meet the needs of care home residents.”

Some residents in residential care have no access to key clinicians such as geriatricians or to community health services such as physiotherapy, podiatry and continence services for their long-term conditions. We have to ask how such expertise can be inaccessible to care home residents? This cannot be tolerated.

The solutions that have been proposed are familiar, and I have heard them several times this afternoon. They include co-ordinated teams of health professionals working together, patient and relative involvement and a partnership approach between health and social care workers. We know what works, but have failed to deliver the best care nationwide. We know, too, that early interventions cost less and emergency treatment costs more. Experts say that £40 million could be saved by a reduction in emergency admissions on hip fractures alone. Some care homes report that out-of-hours GPs tend to say, “Send to hospital”. In 2012, we should be doing much better than that. The report recommends that statutory regulators should scrutinise the provision of NHS support to care homes and the achievement of quality standards.

The Care Quality Commission currently has responsibility for regulating and monitoring care homes in England, with NHS health services providing support to such homes. The Care Quality Commission conducted its special review of the health needs of care home residents, which was published last week, although it was originally expected in 2010. When the CQC came to the Public Accounts Committee in January, I asked it when the report would see the light of day and why it was so far behind schedule. The chief executive told me:

“I suspect because of the complexity of the data collection and, to be honest, the fact that we have been focusing on trying to get the basic inspection processes up and running and right.”

Basic inspection processes are crucial but so, too, is the promotion of residents’ basic health care. This is not good enough.

Finally, in January I was co-signatory to a letter calling for doctors to record whether an injury from a fall, a pressure sore or an infection was present when a patient was admitted to hospital or developed while they were there. This is a simple and cheap mechanism for identifying in hospital a sub-standard quality of care.

Dilnot says that the care system is confusing, unfair and unsustainable, and that reform is urgently needed. I hope that the social care White Paper will build on good practice and deliver the reforms and the investment we need. Worry over the funding of residential care or over poor health care in the place they call home should be a thing of the past for our pensioners.

Oral Answers to Questions

Nick Smith Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend will be aware of the difficulties involved in the contracts that we inherited; that is true for PFI, as well as for the NHS IT contracts and many others. We have to try to use PFI contracts more cost-effectively; on average, the Treasury exercise demonstrated a 5% saving on their costs. Beyond that, we have to ensure that from now on the NHS delivers a much more value-for-money approach to using private sector expertise, including proper transfer of risk.

[Nick Smith (Blaenau Gwent) (Lab)]

PFI enabled the building of many new hospitals and brought benefits to millions of patients. However, the Public Accounts Committee has found that lengthy procurement timetables led to increased costs. What will the Department do to sharpen its capital funding procurement model to get a good deal for the taxpayer?

[Mr Lansley]

That is a sensible question, and precisely why we are pursuing, as we said in November last year, a new approach to public-private partnership that does not entail the extreme costs, delays and burdens that past PFI projects have left. We are working with projects—for example, one at Alder Hey in Liverpool—to ensure that they demonstrate enhanced value for money compared with past PFI projects.