Health and Social Care

Norman Lamb Excerpts

Monday 13th May 2013 Commons Chamber

[Paul Burstow]

I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

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

I agree that the quality of commissioning needs to be addressed as well as the quality of provision if we are to get better care for the people who need it.

[Paul Burstow]

I welcome that comment from the Minister and look forward to seeing more detail.

My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

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[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

[Norman Lamb]

I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

[Barbara Keeley]

Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.

The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?

I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

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[Kate Green (Stretford and Urmston) (Lab)]

It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I, too, want to talk about social care. First, however, let me reinforce the comments made by my right hon. and hon. Friends about the announcement on compensation for sufferers of mesothelioma. That devastating illness affects a number of families in my constituency, as well as many workers in Trafford Park over many decades. Work was begun by Labour on a system of compensation for asbestos-related illness where employers and insurers cannot be traced, and we now at last have a proposal from the Government although it is disappointingly limited in its reach.

The proposed scheme will apply only to diagnoses made after 2012, and it completely misses half the victims of asbestos-related cancers because it is limited to mesothelioma sufferers and a cap is imposed on the level of payments. The deal favours insurance companies; it is not good enough for victims or for the public purse because many sufferers will continue to rely on payments from the Department for Work and Pensions as they will not be eligible for the compensation scheme. Although the proposals in the Queen’s Speech for a system of compensation are welcome, I hope we will be able to improve the legislation as the Mesothelioma Bill passes through the House.

On social care, everyone agrees that people would prefer to be cared for in their own home for as long as possible, but community-based provision must be in place for that to happen. As many right hon. and hon. Members have said, a lack of community provision is placing excessive strain on the NHS with regard to A and E and bed blocking, and my local authority in Trafford has received repeated reports that a lack of access to rehabilitation, physiotherapy, speech and language therapies—for example, after a stroke—and to support and care packages means that it is often impossible to discharge someone, even when they are medically fit to go home. That backdrop is of particular concern at a time when a significant reconfiguration of our national health service is being proposed in Trafford. There must be real concern about a squeeze on NHS services when community provision is not in place.

I am pleased that the Secretary of State has recognised the need for a single named professional to have oversight of an individual’s health and social care needs, but the fragmentation and contracting of NHS services does not help. Competition works against the integration of primary, secondary, tertiary and social care and, as many colleagues have said, cuts to local authority budgets are having a massive effect. Trafford is cutting nearly £3 million this year from social care budgets, which means cuts to day services, for example, or increased costs for meals. Curiously, the local authority intends to achieve a large part of those savings through the introduction of personalised budgets, which we understood were not intended as a savings measure.

Families want to help and keep loved ones at home, but they are under great pressure and rely particularly on day services and respite care. They tell me that assembling a personal package is complex. One constituent —a highly resourceful and articulate businessman—told me of his struggle to use a personalised budget to assemble a care package for his partner. He called seven potential providers, but most could not cope with assembling the package she needed to meet her complex needs. If my constituent could not put together that package, how—as he rightly asked me—will the more marginalised and excluded manage? He pointed to the importance of decent brokerage services, yet at the same time we are seeing cuts to advocacy services. There is already evidence that personalised budgets do not work so well for elderly people or those without family and friends to help.

It is not clear what the long-term effects of spreading personal budgets will be, but they could lead to further fragmentation of services or exacerbate inequalities. For example, there is evidence of a lack of cultural awareness among brokers and providers, and the complexity of putting together a personal care package may leave the most excluded even further behind. I invite Ministers to tell the House what steps they will take to monitor the impact of personal budgets on inequality and outcomes for the elderly and most vulnerable.

[Norman Lamb]

rose—

[Kate Green]

I am pleased the Minister is seeking to intervene.

[Norman Lamb]

Does the hon. Lady accept that there has sometimes also been a lack of cultural awareness in the traditional way of delivering services when people make assumptions about someone’s care needs and the right way to deliver them? Putting the individual in charge and letting them determine their priorities gives us a better chance of getting it right and meeting the cultural choices that are so important to people.

[Kate Green]

I accept what the Minister is saying but evidence suggests that for certain more disadvantaged and vulnerable individuals, articulating those needs is very difficult and so culturally appropriate advocacy, representation and brokerage services will be of huge significance. Evidence from research carried out so far suggests that the effects of personal budgets are patchy. I am sure the Minister will wish to raise standards across the board, and I look forward to the further work that we—collectively and with local authority colleagues—can do to ensure that that is the case.

Work force issues relating to social care are also a concern. As others have pointed out, many of those working in social care earn the national minimum wage and contract pressures mean that they have little time to do more than rush in and out of appointments and provide the basic physical care that clients need. There is little time to stop for a chat or a cup of tea, or for some of the social interaction that is so valued by those in receipt of social care. Many providers have told me they are anxious and that they are being screwed down on pricing as a result of local authority spending pressures, which could lead to their contracts becoming unviable. Poor levels of pay— as my hon. Friend the Member for Bridgend (Mrs Moon) said, staff are often not paid as they move from one appointment to the next—mean that they will not be motivated to provide the best care in those circumstances, and some will be forced to give up their jobs.

Finally, I welcome the development of extra care for those in need of residential care, and some good projects are under development in Trafford. I hope the proposed development in Old Trafford will receive approval. As colleagues have pointed out, the Dilnot recommendations, as taken forward in a more limited form by the Government, will leave many families in my constituency with substantial costs but without liquid savings with which to meet them, meaning they are still likely to be forced to consider the sale of the family home.

Overall, the Queen’s Speech needed a much bolder approach to prepare us for an ageing society, including policies for maximising saving in working age—difficult when the Government are putting family budgets under such pressure—and a bolder approach that looks at combining health and social care budgets, investment in primary and community health provision to keep people out of hospital longer, integration over competition, personalisation accompanied by a service investment programme, and serious attention to work force development. I regret the many missed opportunities in those areas in the Queen’s Speech.

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[John Woodcock]

That is a good point, and it remains to be seen. We hope so, but the system has yet to be put to the test.

I am disappointed that no move towards genuine localism was outlined in the Gracious Speech. It is time for a people’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto that ought to be heeded. That would require a step change in our NHS away from a model that, yes, might have helped deliver improvements in health outcomes of which the country should be proud, but which has done so—

[Norman Lamb]

Will the hon. Gentleman give way?

[John Woodcock]

I will give way, if the Minister is quick, because I do not have much time left.

[Norman Lamb]

I am interested in what the hon. Gentleman is saying, and I accept the point about the importance of accountability. [Interruption.] He has just realised that he has got an extra minute of time, so I have done him a favour. Does he accept, however, that the old NHS, which we reformed, had no local accountability at all and that we have introduced some accountability through the health and wellbeing boards, bringing together local authorities and the NHS?

[John Woodcock]

It is an interesting point. I am not claiming that the system operating now is fundamentally different from that of three years ago, but around the country people who were promised a say in local decisions have been devastated to find out that they have none. Unquestionably, what has been put in place is not adequate. It is a sop to localism that does not do what it says. It would be a step change to move away from the current model.

Following the current model has meant alienating many local people who understood the trade-offs, but nevertheless fervently desired to keep services local. Whatever happens, surely the current tension between national planning and local unrest is unsustainable in the long term. In opposition, the Conservative party told the public that it understood that and pledged to end local hospital service closures, but of course its promises turned out to be a cheap election con trick. Instead, Ministers have forced through an expensive, chaotic and divisive health reform package that ultimately has pushed NHS decision making still further from the people it serves. We need a change of direction. Local communities pay for the health service they receive, and they deserve to be treated with greater respect.

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

I thank hon. Members for their contributions to the debate.

Despite all the knocks that Opposition Members like to give it, the NHS is performing remarkably well, with 3.3 million more out-patient appointments, more than 500,000 operations, 1.5 million more diagnostic tests, the number MRSA infections halved and record low numbers of people waiting more than a year for their operations—just 665 people, down from 18,000 in 2010. These are real achievements for the NHS, and we should applaud and pay tribute to a really remarkable work force who have achieved these things despite tough economic times. The last Government rightly set in train £20 billion of efficiency savings, and those savings are being achieved despite the tough challenges.

Despite the doom and gloom heard during the debate, some brilliant things are happening in social care, including in some Labour authorities. In Leeds and Barnsley, for example, great things are happening, with people looking at new ways of doing things and redesigning services, recognising that times are tough and that, even under a Labour Government, they would face the same challenges. I recognise, however, that the system is facing real pressures, so it is disappointing that the Opposition, including the shadow Secretary of State and shadow Minister, the hon. Member for Leicester West (Liz Kendall), sought to polarise the debate by making exaggerated claims about the state of the NHS, when we all know the truth, which is that pressures are growing and have been for a long time. We have people living with long-term conditions, often for many years, and with a mix of mental and physical health problems. Those are the difficult cases sometimes clogging up our A and E departments, so let us have a mature debate about how we deal with the challenges.

We have a completely fragmented system and we are not spending money effectively to achieve the best possible care. Mental health is institutionally entirely separate from physical health, health care is separate from social care, and primary care is separated from hospital care. The whole urgent care system is under significant pressure. [Interruption.] I tell the shadow Secretary of State that on some of these issues we in fact agree more than he would sometimes like us to believe. The system is dysfunctional and we have to change it. We have had 4 million more people visiting A and E since the disastrous renegotiation of the GP contract by the last Labour Government. The hon. Member for South West Devon (Mr Streeter) talked about the significant pressures on A and E. Let me reassure him that Monitor and NHS England have issued a call for evidence on how the tariff system is working, with a view potentially to reforming it.

[Liz Kendall]

Does the Minister agree that in 2009, five years after the GP contract was agreed, 98% of patients were seen in A and E within four hours?

[Norman Lamb]

What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

[Barbara Keeley]

The Minister is back on his point about the Bill creating a single statute, but it will not do that for young carers, who will be left with the protection only of the private Member’s Bills I mentioned earlier. It is not good enough for young carers to face a higher threshold than other carers before their needs are assessed. That has to be looked at. The children’s Minister has let the House down on this issue; I hope that this Minister will not do that.

[Norman Lamb]

I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

[Frank Dobson]

Does the Minister accept that a generalised rating for a hospital is not going to be valuable because, within one hospital, some departments might be doing a brilliant job while others are not? It would be stupid if an overall rating persuaded people not to go to a particular hospital for treatment if the specialty they required was being practised brilliantly.

[Norman Lamb]

I disagree. We brought in Jennifer Dixon of the Nuffield Trust to advise on this matter. There will be ratings for specific services within hospitals to identify areas of great care, but the single rating will give the hospital the incentive to bring up to a proper standard those areas that are falling short, and that will be a good thing.

[Alison Seabeck]

Will the Minister give way?

[Norman Lamb]

I want to make some progress; I am conscious of the time.

The Bill will introduce a single failure regime, so that, for the first time, a trust can be put into administration because of quality failure as well as financial failure. Until now, it has been only the finances that can put a trust into administration. This Government recognise that quality failure is just as important, if not more so, and that such failure must carry consequences.

The stories recounted by the right hon. Member for Cynon Valley (Ann Clwyd) and the hon. Member for Bridgend (Mrs Moon) reinforce our determination to make improvements and to ensure that people get the best possible care. I again pay tribute to the impressive work carried out by the right hon. Lady, and I thank her for her work on complaints procedures. The hon. Member for Mid Bedfordshire (Nadine Dorries) also talked about the importance of compassion in good nursing care.

The Bill will make it a criminal offence for providers to provide false and misleading information. My hon. Friend the Member for Stafford (Jeremy Lefroy), who has done great work representing his constituents in the most honourable and responsible way, drew our attention to the importance of mortality statistics being accurate so that we can rely on them. Alongside this Bill, we will introduce the statutory duty of candour—something of which I am personally proud. It does not require primary legislation, but the Government will introduce it.

The funding of care is to be reformed so that there will be a cap on the care costs that people will pay in their lifetime. This is long overdue. Reform has been in the long grass for too long. Several hon. Members, including the hon. Members for Worcester (Mr Walker), for City of Chester (Stephen Mosley) and for Lancaster and Fleetwood (Eric Ollerenshaw), made the point that people will no longer have to sell their homes during their lifetime to pay for care. So often people have had to sell their homes in distress at the moment they go into a care home. When they cannot organise their affairs properly, they have to sell up to pay for care. No longer will that be the case. They can delay all those issues because of the right to deferred payments.

It is this coalition Government who have bitten the bullet on a very important reform. I am very proud of the fact that we are doing this, introducing a long overdue reform. Andrew Dilnot himself has strongly supported the Government’s action. That is happening together with a very significant extension of support—I take on board what the hon. Member for Leicester West said—to help people of modest means with their care costs. Each one of those measures would be significant by themselves. Together, they provide real optimism that we can shake off the shackles of the past and look towards the future, not with fear, but with optimism. The Opposition are wrong to dismiss the importance of this Bill. They should recognise just how much it could improve the lives of some of the most vulnerable people in society.

[Liz Kendall]

rose—

[Norman Lamb]

I am going to conclude.

We are two thirds of the way through this Parliament and we have already addressed big challenges that were ignored during Labour’s three terms in office. We have been and will always be 100% committed to an NHS that is not satisfied with mediocrity, but is always searching to be better, more focused, more helpful than ever before. Society is changing, drug costs are increasing and expectations are higher. The NHS and the social care system must change to meet those challenges and we are helping to make that happen, safeguarding the NHS now and in the future.

Ordered, That the debate be now adjourned.— (Mr Swayne.)

Debate to be resumed tomorrow.