Leaving the EU: Financial Services

Debate between Norman Lamb and Liz Kendall

Thursday 3rd November 2016 Commons Chamber

[Liz Kendall]

It absolutely does. The right hon. Gentleman raises an extremely important point. This growing and developing sector is driven by skilled people from across the globe, and we do not want to miss out on those possibilities.

[Norman Lamb (North Norfolk) (LD)]

The hon. Lady referred to the rhetoric at the Conservative party conference. Does she agree that such rhetoric causes a reaction, and that the reaction across Europe was wholly negative? That makes the politics all the more difficult as we try to secure a good deal for this country.

[Liz Kendall]

The right hon. Gentleman is absolutely right. It was a huge strategic mistake for the Prime Minister and the Home Secretary to say what they did at the Conservative party conference. That has not helped us to work better with our EU allies, with whom we need to get a deal. It has made people across the world think that Britain no longer wants people to come here to live and work. It has put off many people who already work in this country and are now thinking about going home.

Businesses in all parts of our economy want certainty, above all. There are things that the Government could be doing to give businesses greater certainty during the inevitably complex, difficult and lengthy process of leaving the EU, and I shall conclude by outlining three of them for the Minister. First, Ministers should set out the broad framework and priorities for their negotiations. Is the objective to secure for financial services their existing rights to trade in the single market; or have Ministers already accepted the loss of passporting rights, as the Trade Minister said in his Bloomberg interview, and do they seek instead to secure a different or hybrid version of passporting or equivalence? What are their objectives on freedom of movement for people working in financial and related professional services? Is this a priority area for the Government in reducing the number of people coming into this country? Do the Government seek to set quotas in this sector, require people to have visas, or both?

Secondly, the Government must commit to a transitional agreement—this has been raised time and again by those who work in financial services—to ensure that there is no cliff edge at the end of the article 50 process. It took four years to reach an equivalence deal on one small aspect of commodity futures dealing with the United States, so it will be impossible to agree a deal covering all the many complex areas of the UK’s financial services industry with the remaining 27 EU countries within two years. Without transitional arrangements, companies may have their passporting rights suddenly removed with nothing put in their place, which would create legal doubt for huge parts of their business. A transitional agreement is therefore essential, and it must come soon. We need at least a joint statement of intent from the UK and the EU before article 50 is triggered to give financial services the certainty they need. That should happen before politicians in France and Germany inevitably start focusing on their own elections next year.

Finally, the Government must make it a priority that they ensure that the remaining EU countries understand the benefits of maintaining an integrated market in financial services. Some £1.1 trillion has been lent to businesses in the remaining 27 countries by banks based in the UK. Putting up barriers to trade would be a self-inflicted wound that would make us all worse off—not just in the UK, but in mainland Europe.

One of the most important complaints I have heard during the past seven years is that nurses and teachers did not cause the financial crisis. That is true, but it was also not the fault of the call centre worker in a big insurance company or the bank teller in the local building society. Plenty of British people do a decent job working in our financial services, and they could be on the front line when it comes to Brexit. The Government must provide more clarity about their plans so that businesses can plan for the future, and so that we protect jobs and growth, and get the best possible deal for Britain.

National Health Service

Debate between Norman Lamb and Liz Kendall

Wednesday 21st January 2015 Commons Chamber

[Norman Lamb]

No. I need to make progress, and I have very little time.

In a Guardian debate yesterday, in which I took part, Peter Carter, the respected chief executive of the Royal College of Nursing, spoke of the need for political consensus

“so that we stop this ridiculous points-scoring”,

which

“frankly is destructive and does nothing to enhance the quality of the debate.”

Let us take his plea on board. I have argued for a non-partisan review of NHS and care budgets this year —whoever is in power—which would engage the public. We should all commit to that.

Labour claims that it will increase funding, but its proposed way of doing so appears to be unravelling before our eyes. Lord Mandelson has described the mansion tax as “sort of crude” and “sort of short-termist”. In the debate, the hon. Member for Hackney North and Stoke Newington (Ms Abbott) cast doubt on how much the policy would raise.

Before I address the main issues, I want to pick up the remarks made by the right hon. Member for Kingston upon Hull West and Hessle, who raised important issues about mental health. He talked about the case of his constituent, Beth. It is intolerable that she has been shunted around the country. I have met the right hon. Gentleman, and I am happy to engage with him again. It is unacceptable for this to continue to happen. That is why there is an urgent need for children’s mental health services to be reformed, and our taskforce will soon report on the essential changes that are necessary.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

I do not have time.

I am pleased that the right hon. Member for Kingston upon Hull West and Hessle endorsed the case for access and waiting times standards in mental health, which I think will have the same transformative effect as they had in cancer care when his party was in government. As my hon. Friend the Member for Norwich North (Chloe Smith) said, why is mental health not in the motion? It certainly ought to be.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

Let me make this point.

I acknowledge that several Members, including the hon. Members for Penistone and Stocksbridge (Angela Smith) and for Barrow and Furness (John Woodcock), raised distressing cases. I offer my personal sympathies to everyone who has been let down by the system. Such cases should motivate us all to strive to do everything that we can to improve how our NHS operates and to address the areas where it falls short.

The Opposition claim that the move from NHS Direct to NHS 111 has increased the demand faced by accident and emergency departments. There is no evidence to support that claim. Only 8% of calls result in a recommendation to go to A and E, and 30% of callers say that they would have gone to A and E if NHS 111 had not been available.

An accusation has been made about the impact of local authority cuts on social care. I remind the Labour party that the Government were faced with a £160 billion black hole in the public finances and had to act to sort that out. There is still no proposal from the Labour party to increase the funding for social care. The claims that it makes are hollow, without the money to go with them.

Let us look at one of the key indicators: delayed discharges from hospital. From August 2010 to November 2014, delayed days attributable solely to social care decreased from 38,324 to 37,000. The position is not as simple as some people suggest. Social care is performing incredibly well under difficult circumstances. In Cambridgeshire, there is the brilliant development of a service for older people to address their needs in innovative ways.

It has been claimed that the closure of walk-in centres has led to the current pressures on A and E. Again, we need to look at the evidence. A report by Monitor found that the reasons why local commissioners decided to close walk-in centres included that they were replacing them with urgent care centres co-located with A and E departments or other models of integrating primary care staff in A and E departments. The situation is not as simple as is suggested by the claim that walk-in centres have been closed and A and E has been left to pick up the burden.

The Opposition have said that the ambulance service is failing. In fact, ambulance services nationally are delivering nearly 2,000 more emergency journeys every day than in 2010. Ambulances respond to the majority of life-threatening cases in less than eight minutes. The Government have provided an additional £50 million to support ambulance services through this winter. It is right to take clinical advice to ensure that target response times are clinically based to avoid the unintended consequences of ambulance crews being driven crazy in the pursuit of targets, when it is patient safety that should be prioritised.

I come to the solution. In the short term, the Government have made an additional £700 million available to the NHS to cope with the pressures this winter. The right hon. Member for Tottenham (Mr Lammy) did at least acknowledge that. In the longer term, we need to focus on stopping the crises from occurring in the first place. We need a much greater focus on prevention, better integration of health and social care, and the implementation of Simon Stevens’s forward view.

I thank NHS staff for the amazing work that they do, often under great pressure, and the tremendous commitment that they make. We owe it to them and to the public to ensure that our NHS is protected and enhanced. Most people who use urgent and emergency care services receive effective, timely treatment. That is as it should be. Patients and their families should get the right advice and should get a response when they need it. We set the toughest standards in the world, and rightly so. We all know that those standards are under pressure across the UK, so let us be open and honest about that.

Oral Answers to Questions

Debate between Norman Lamb and Liz Kendall

Tuesday 13th January 2015 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Ministers have been repeatedly warned about the impact that their social care cuts are having on elderly people and that that is a key cause of pressures on A and E. Today it has been revealed that public health officials have issued an alert about a statistically significant and “sustained” decline in life expectancy in parts of the north-west. They say it is extremely unusual and that

“central government driven reductions in adult social care budgets”

are a possible cause. Will the Minister confirm that alert, say whether life expectancy is declining elsewhere, guarantee that Public Health England will urgently investigate the matter and promise that its findings will be published in full?

[Norman Lamb]

Although there was a fall in life expectancy for those aged 85 in 2012, preliminary analysis shows that there was no further drop in 2013. Incidentally, let me pay tribute to the people who work in social care. The system has performed remarkably well. Statistics on delayed discharges due to social care show that the number of delayed days is almost exactly the same this year as it was in 2010—a remarkable performance.

Care Workers

Debate between Norman Lamb and Liz Kendall

Wednesday 5th November 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this debate on an incredibly important subject. I agree with him and the hon. Member for Strangford (Jim Shannon) that there are many great providers of care out there and vast numbers of extraordinarily dedicated care workers. Like the shadow Minister, I went out with a domiciliary care worker in London a while ago. He was from Sardinia, which makes the point that very large numbers of people from other countries, primarily from across the European continent, work in our care system. Without them and the dedicated work of care workers, the system would not survive. We should remember that in our debates about the movement of workers around Europe. Our health and care system depends on those dedicated workers, and the man I saw from Sardinia was a very impressive and dedicated man. He was earning a low income and not being paid for travel time between the stops in his working day, which I totally agree is completely unacceptable and a disgrace. I will come back to that issue a little later.

It is also important that we celebrate great care. I went to the first ever awards ceremony in my county of Norfolk that celebrates examples of fantastic care, and to see care workers who hitherto have never been recognised for the amazing work that they do was inspiring. Every part of the country should have similar exercises to acknowledge and celebrate great care.

Secondly, I wanted to comment on the point made by the right hon. Member for Oxford East that sometimes—indeed, quite often—the only companionship that people receive is from the paid care worker who visits their home once or twice a day. Does that not say that there is something profoundly wrong about our society, and if so, do we not all have to recognise that that must change? I have said this before, but we have inadvertently become a rather neglectful society. As our extended families have been dispersed far and wide, often older people are left rather stranded, living on their own, sometimes many miles—often, indeed, hundreds of miles—away from their loved ones. It is not a good society in which the only people seen by those older people are those who are paid to deliver care to them. The wider community and neighbours need to play a part in addressing this massive challenge that we face, whoever is in Government. There is absolutely a role for the total professionalism of paid staff, but the wider community must play its role, too.

There are amazing schemes such as the Cornwall pioneer project, in which volunteers work alongside GPs to combat people’s loneliness. There is also a brilliant community organisation called Friends and Neighbours in Sandwell, in the west midlands. That is a network in the poorest community in the west midlands, and yet volunteers give of themselves, and give companionship to people to give them their lives back. Those volunteers play a part in meeting this massive challenge we face.

Thirdly, part of the answer is for care workers to be far more embedded in joined-up and integrated teams of health and care workers. The work in Islington that the shadow Minister referred to is another of the brilliant and inspiring integrated care pioneer projects that join up health and care services and enable care workers to work alongside nurses, so that they recognise that they can possibly go on to become a nurse or a health care worker. Such projects give care workers a status and professionalism that they deserve, which can play an incredibly important part in this process.

Fourthly, I commend to right hon. and hon. Members an example from my county. The GP practice in the village of North Elmham, in the middle of Norfolk, has set up a social enterprise that provides domiciliary care to a widely dispersed rural area. As it is a social enterprise, it is able to pay its staff better. When staff stay and demonstrate reliability, they receive more pay. The consequence is that people know who their care worker is, there is continuity of care, and there is not, as the shadow Minister suggested is too often the case, a situation in which someone different turns up each night. I had a case—indeed, it involved Care UK—of an elderly lady finding a different man turning up each night to shower her, which was an assault on her dignity. The concept of locally based social enterprises, tied in closely to GP practices, seems to be an attractive way forward.

Fifthly, there is the issue of pay. To start with, I will say that Unison is right to campaign on pay; I support it in doing so, and I am very happy to work alongside it. The right hon. Member for Oxford East and others made the point that it appears that 220,000 people in the care sector are being paid below the minimum wage. That situation is completely unacceptable, and I hope that all of us in Westminster Hall today acknowledge that we find that practice to be totally unacceptable.

However, it was this Government who decided that Her Majesty’s Revenue and Customs should carry out a dedicated push in this sector to root out employers who are breaking the law in that respect. Indeed, I can confirm to the shadow Minister that I have specifically asked for a further dedicated focus on the care sector, because it is absolutely needed.

[Liz Kendall]

I am glad that that work is continuing. However, the Minister has said several times in the newspapers that care companies that do not pay the minimum wage should be named and shamed, and yet that has not happened. Why not?

[Norman Lamb]

I am grateful to the shadow Minister for raising that issue. When I was a Minister in the Department for Business, Innovation and Skills, I specifically pushed for a change in the rules to make it easier to name and shame poor employers. That process was not completed by the time I left BIS to go into the Department of Health, but I continue to push for it. Indeed, the rules were changed, so that whenever there is a notice of underpayment of the minimum wage, the employer is named.

There is a complication in the care sector, in that arrangements are often quite complex and reaching a final decision often requires an investigation to be carried out. However, I can assure right hon. and hon. Members that I anticipate the naming of poor companies within this sector in the relevantly near future. I totally support that process; there should be no hiding places for employers who break the law in that way.

Regulatory Reform

Debate between Norman Lamb and Liz Kendall

Tuesday 9th September 2014 Commons Chamber

[Liz Kendall]

No. I will make some progress. The hon. Gentleman may want to listen to what the Secretary of State for Health admitted in a letter to the chair of Healthwatch England on 11 August:

“The Health and Social Care Act, when it established CCGs, did not make provision for CCGs to form joint committees and other CCGs. PCTs previously had this provision in legislation and many formed joint committees to progress partnership work.

Health organisations, including CCGs, have expressed concerns about CCGs’ inability to form joint committees that are able to make binding decisions. This inability has brought many practical challenges in working together on issues that cut across boundaries, such as continuing healthcare, patient specific funding requests and service change”

across the country. I do not know whether the Minister wants to explain why the Health and Social Care Act removed that provision, as the Health Secretary admitted in the letter to Healthwatch England. Does he want to stand up? If not, I will make some progress.

The Minister was fortunate not to be on the Committee that looked at the Health and Social Care Bill twice, so he will not know that Opposition Members repeatedly warned during its passage that CCGs would often be too small to secure effective changes to services across wider areas. We have consistently made it clear that the only way we can get the big changes we need to be able to improve care for patients, including by specialising some services in regional centres and shifting others out of hospitals into the community and towards prevention, is by working in partnership across larger areas.

In principle, we support the need for collaboration and for CCGs to come together both with one another and with NHS England, particularly in wanting to commission good services across primary, secondary, community and specialist care. However, serious concerns have been raised about the draft order by local healthwatch organisations, Healthwatch England and some of the organisations that responded to the consultation, and my hon. Friends may want to raise real concerns. I will go through the concerns in some detail.

The Minister has talked about the fact that CCGs will remain autonomous, but many of them are concerned that that is not written into the draft order. Many CCGs feel that they are coming under increasing pressure from NHS England and some of its local offices. They are concerned that the draft order might take away their autonomy, forcing them into committees and decisions that they do not think are in the best interests of local people.

[Norman Lamb]

Will the hon. Lady give way?

[Liz Kendall]

If the Minister will give me two seconds, before I allow him to intervene I want to read out what NHS Clinical Commissioners—the independent collective voice of CCGs—said in its response to the consultation. It said that it

“would not want the Legislative Reform Order to become a ‘back door mechanism’ for reconfigurations.”

It asked for

“some assurance the change will continue to respect the decisions of CCGs as statutory bodies”,

and it insisted that

“CCGs must not be pushed into shared arrangements with NHS England if it is not in the interests or needs of their population”.

I have heard the Minister’s words about that, but the draft order has not been changed. Perhaps he would like to say more about it.

[Norman Lamb]

It is worth putting it on the record again that this does nothing to change the legal duties of a CCG and nothing to put any pressure on a CCG to enter any arrangement, either with other CCGs or with NHS England. If a CCG feels under pressure, it has every right to resist it, if it feels that to do so is in its interests or those of its local community. This is entirely voluntary. With regard to the legal duties, nothing changes.

[Liz Kendall]

If one of the 22 CCGs in the east midlands, part of which I represent, decided that it did not want to come together to commission one body to perform NHS continuing health care, for example, because it did not like it, could it say no?

[Norman Lamb]

Absolutely. There is nothing in the proposed amendment that could force any CCG to do anything. I suspect that in such circumstances common sense might prevail, as everyone recognises that on something such as NHS continuing health care, collaboration makes a lot of sense, as the shadow Minister indicated, but there is nothing to force anyone to do that.

[Liz Kendall]

Will the Minister also clarify that if NHS England wanted to form a joint committee with CCGs in the area, it could not force them into it?

[Norman Lamb]

This is a good exchange of views. Again, I can confirm that this is about a voluntary arrangement between a CCG or CCGs and NHS England. There is no compulsion at all.

[Liz Kendall]

I am very grateful to the Minister, who has perhaps been much clearer on that point than the Minister in the other place was.

The Minister has been clear that CCGs will not be forced into joint committees, but the second concern relates to majority voting in the committees. He will know that the Regulatory Reform Committee’s report cites a couple of CCGs that have been concerned that

“Joint committees would be able to take majority decisions on behalf of their constituent CCGs and NHS England, and so individual CCGs might find themselves accountable for implementing policies that their members did not consider to be in the best interests of the local population.”

To put it bluntly, if one or two CCGs on the committee disagree, they can be outvoted. Is that the case, and would it be possible for NHS England to have the casting vote on a committee?

[Norman Lamb]

It is helpful to respond straight away on these specific points. Again, I stress, as I think I made clear at the beginning, that it is up to the participating CCGs to determine what voting arrangements should be in place. If they felt that unanimity was required in order to protect the interests of the community they serve, they could make that a condition of entering the joint committee. It is entirely up to the participating CCGs to agree the rules.

[Liz Kendall]

I am grateful to the Minister for that helpful clarification.

The third concern has been raised by the Association of Directors of Adult Social Services and by the Local Government Association. They are concerned that any joint arrangements between CCGs, or between CCGs and NHS England, must be fully aligned with the geographical boundaries and strategies of local health and wellbeing boards. That is not only because we have to get health and social care working together, with council care services and the NHS, but because of accountability issues. Perhaps the Minister will say something about that later.

The last two concerns about the draft order are, for me, the greatest. The fourth is about how the joint committees will be held to account for the decisions they take and how patients, the public, local healthwatch, health and wellbeing boards and Members of this House can know what decisions are taken and hold the joint committees to account, because I understand that they will not be required to meet in public. I raise that concern because it has been raised in two letters from the chair of Healthwatch England to the Secretary of State. In her first letter on 16 July, she wrote:

“I am concerned about the impact this reform could have on the statutory role of local Healthwatch, the integrity of local accountability mechanisms, and meaningful public involvement in decisions about service redesign.”

She goes on:

“Whilst I recognise the important role CCG collaborations can play in the effective commissioning of health and social care and the transformation of traditional service models, I am sure you will agree that it is vital they are accompanied by strong accountability and engagement mechanisms. This is of particular importance given the scale of decisions being made by joint committees, and our anticipation that many more of these joint arrangements will be put in place. Without these safeguards in place, the public are far less likely to understand, or be accepting of, the changes that happen in their community.”

She recommends that the draft order be strengthened, and makes four proposals:

“Ensure CCGs acting in collaborative arrangements have in place adequate mechanisms meaningfully to engage the…community.”

She suggests a

“mandatory non-voting constitutional seat on Committees…for local Healthwatch”

and a

“duty on all lead or co-ordinating commissioners to have due regard to existing local agreed priorities…(including Joint Strategic Needs Assessments and Health and Wellbeing Plans).”

Finally, there should be

“a duty on all lead or co-ordinating commissioners to act within existing local accountability mechanisms”

including local health and wellbeing boards.

When the Secretary of State replied to Anna Bradley, he said he felt that mechanisms for public accountability were in place and that there would be no proposed strengthening of the order. In her reply to him on 20 August, Anna Bradley stated:

“I do not yet share your confidence that the new joint committee arrangements will address our concerns about transparency and accountability.”

The Government said throughout the Health and Social Care Act 2012 and all their reforms that there should be “No decision about me without me”, but the patient and public voice, local and national Healthwatch, has said it does not believe that that strong patient and public voice will be effective under the proposed order. The Minister needs to respond to that.

Finally—this is a particular concern of mine—one decision that joint committees can take concerns individual patient-specific funding requests for things such as NHS continuing health care. Any hon. Member whose constituent has applied for that kind of funding, or funding for a number of different areas, knows that it can be difficult to get to the bottom of those decisions. I had a particular problem with Greater East Midlands commissioning support unit, which manages continuing health care for the 22 CCGs in the east midlands. I have barely been able to get any information out of it about the bad decisions it has taken, and that is a real worry because I am concerned that the joint committees will repeat that. How will we know how those decisions are taken or hold them to account?

[Norman Lamb]

Perhaps the hon. Lady will give me details of that concern in her local area. It is important that we hold the different parts of the system to account, and she should be able to establish the position. I am happy to pursue that matter for her if she would like.

[Liz Kendall]

I am grateful to the Minister. I will forward him my concerns, just as I have done to my local CCGs and the chief executive of NHS England.

To conclude, Healthwatch raised these concerns in relation to a particular issue in Greater Manchester and the Healthier Together project, where 12 CCGS have grouped together to reconfigure services. The local healthwatch is concerned that under the draft order some of the problems it has seen with Healthier Together could be replicated. For example, I understand that governance meetings for Healthier Together started to take place in public only in March 2014. That was after major decisions—such as the model for service reconfiguration—were discussed in a closed session of that committee. The local healthwatch remains concerned about the lack of clarity on planned public involvement in Healthier Together in future, and, like the local healthwatch, Healthwatch England is concerned that the joint committees will not be accountable to patients and the public.

Hon. Members across the House will say that previous primary care trusts were sometimes not open and accountable, and I may have shared some of those concerns. This is a chance to put things right, but I am concerned that the draft order is not strong enough and I know other hon. Members will also raise that point.

--- Later in debate ---

[Norman Lamb]

I am grateful to all Members for their contributions to this debate. Regarding the shadow Minister’s contribution, I am pleased to hear that she is supportive, at least in principle, of this capacity to facilitate greater collaboration at a local level. As my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) said, it is rather ironic that this is all about a reformed health system that has much better clinical and democratic legitimacy than the one we inherited from the Opposition. I notice that no one is out there waving banners demanding the return of the primary care trust. Ultimately, that body had no accountability to the local community—[Interruption.] No, it had no accountability. Its accountability was entirely upwards to the strategic health authority and to the national level.

[Liz Kendall]

That is completely over the top. Sometimes I have had great trouble getting any answers out of my CCG. Sometimes they have been good and sometimes they have been bad. I have also had great trouble getting anything out of the commissioning support unit. The Minister should not paint some super rosy picture of fantastic accountability and patient involvement, as there are still some real issues.

Oral Answers to Questions

Debate between Norman Lamb and Liz Kendall

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

That is absolutely right, but Sir Simon Stevens took the view that it was essential to get the voluntary sector much more involved in the whole process. There are brilliant organisations such as Mencap and the Challenging Behaviour Foundation which are absolutely committed to achieving change, and the more we can work with them to achieve that change, the more likely we are to be successful.

[Liz Kendall (Leicester West) (Lab)]

After the appalling scandal at Winterbourne View, the Minister promised to stop people with learning disabilities being sent to assessment and treatment units for long periods. He has spectacularly failed: 2,600 people are still in ATUs, including 150 children; more people are now going into these units than are coming out; and half are still on anti-psychotic drugs or subject to physical restraint. Change will only happen with real leadership, but in answer to a parliamentary question, the Minister said he had not even met one of his colleagues at the Department for Communities and Local Government. He must now set a clear, non-negotiable deadline to end this practice in two years’ time and to secure public commitments from the Health Secretary, the Communities and Local Government Secretary and NHS England’s chief executive to make sure it happens.

[Norman Lamb]

I caution against sanctimony, because this scandal continued under the last Labour Government, who did nothing to get people out of institutional care. At least this Government are absolutely committed to changing that. What we discovered is that changing the culture is a lot more difficult than I had hoped, but we are absolutely determined to achieve the change, which is so necessary.

Oral Answers to Questions

Debate between Norman Lamb and Liz Kendall

Tuesday 1st April 2014 Commons Chamber

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

The evidence from Winterbourne View was utterly shocking. The Mind survey subsequently revealed that restraint is used far too much across the health system. We committed to reviewing the guidance, and I am pleased to say that we will publish new guidance later this week to address the very point my hon. Friend raises.

[Liz Kendall (Leicester West) (Lab)]

The Government’s damaging reorganisation has weakened the grip on NHS finances. Figures slipped out the day after the Budget show that NHS hospitals are in deficit for the first time in eight years, hospital trust deficits are three times higher than they were a year ago and twice as many foundation trusts are in the red. Will the Secretary of State now commit to publishing the final year-end figures for all hospitals in one annual account so that the House can hold him to account for his mismanagement of public money?

Oral Answers to Questions

Debate between Norman Lamb and Liz Kendall

Tuesday 25th February 2014 Commons Chamber

[Norman Lamb]

I mentioned earlier that the rapid review that is being undertaken by NHS England will report in March. It is essential that we have sufficient beds available, as close to home as possible, for children and young people. As I also said earlier, as far as possible children should be cared for at home, and only as a last resort should they go into in-patient care.

[Liz Kendall (Leicester West) (Lab)]

The pressure on children’s mental health beds is now intolerable. Earlier this month, the 14-year-old daughter of one of my constituents desperately needed a bed but the local trust’s chief executive told me that not a single bed was available anywhere in the country in the NHS or the independent sector. The Minister has said that this is unacceptable as though it is nothing to do with him, but he voted for an NHS reorganisation that is wasting time and money as vulnerable children are forced on to adult wards or transported hundreds of miles across the country. When the review reports, what action will he take and by when will it be implemented?

[Norman Lamb]

For a start, we now have 15,000 more clinicians working on the front line than when this Government came into office in 2010. Also, in the reforms that the hon. Lady mentions, we legislated for parity of esteem so that mental health is treated equally with physical health. However, I have accepted her case and agree that the situation is intolerable. We have to make sure that beds for children and young people are available when they are needed.

Care Bill [Lords]

Debate between Norman Lamb and Liz Kendall

Monday 16th December 2013 Commons Chamber

[Norman Lamb]

Of course we have made it clear that people can choose to spend more, but I can say absolutely that by 2024-25, far more people—100,000 people—will be getting more financial support than under the system we inherited from the Labour Government. Everyone will be protected from catastrophic costs through the reassurance provided by the cap on care costs.

[Liz Kendall]

rose—

[Norman Lamb]

I need to press on.

Many people will pay significantly less for care than they do now. People will not be forced to sell their home within their lifetime to pay for care because we are introducing a universal, nationwide system of deferred payments to prevent that.

On deferred payments, there is total confusion about what Labour stands for. Lord Lipsey in the other place, apparently supported by the shadow Secretary of State and the shadow Minister, has attacked the threshold for our deferred payment scheme, which is currently under consultation. He argued that the threshold should be lowered so that those with bank accounts or shares worth considerably more than £23,000 will have access to the scheme. In the previous Government’s 2010 White Paper, however, the same £23,000 threshold was considered acceptable under the universal deferred payment scheme. Which is it—do the Opposition support a low threshold of that sort, or do they want to give more help to people with money?

[Liz Kendall]

I thank the Minister for giving way because I want to press him again about the care cap. On 11 February, the Health Secretary told The Guardian in relation to the cap, that

“that is the maximum anyone will have to pay.”

Does the Minister agree with his Health Secretary?

[Norman Lamb]

It is the maximum people have to pay once they have reached the threshold for care, but they can choose to pay more if they wish. The hon. Lady has refused to answer the question about what Labour Members believe is the right threshold. They have been utterly inconsistent. The shadow Secretary of State has also attacked our plans to charge interest to cover the costs of the deferred payment scheme, yet his 2010 plans proposed exactly the same thing. The only difference was that Labour’s plan was hidden in the impact assessment, not set out in the consultation for everyone to see.

Throughout these reforms we have worked alongside people involved in the care system, and tried to address the needs of people receiving services, their carers, local authorities, the NHS and voluntary groups. We wanted to build a consensus around the future of care and support in England and we have been willing to amend the Bill in the other place to address the concerns raised. The result is a powerful reform package that includes the well-being principle, legislation for personal budgets, incredibly important new rights for carers that have been widely welcomed, and legislation for adult safeguarding for the first time.

Many hon. Members have recognised the powerful case for integrating and joining-up care, and the hon. Member for Sheffield, Heeley (Meg Munn) highlighted the fact that many councils do not place integrated care high on their agenda. That is why the Better Care Fund is so important—it gets every local area talking now about the importance of joining up care and preventing ill health. Around the country we have 40 pioneers in integrated care, demonstrating how things can be done differently and how we can provide better care with less money.

I visited Barnsley, Torbay, Greenwich, Worcestershire and Islington—all have inspiring local leaders who are redesigning a dysfunctional system to provide better care for their citizens. This is a quiet revolution in care, but the changes will resonate across the country. I am immensely proud and grateful to my right hon. Friend the Member for Sutton and Cheam for producing the original draft Bill and for his support since then. Colleagues in the Lords have made important improvements to the Bill, and when—I hope—it becomes law next year, the Care Bill will be the most valuable legacy in health and care reform for a generation.

Question put, That the amendment be made.

Care Quality Commission

Debate between Norman Lamb and Liz Kendall

Thursday 5th December 2013 Ministerial Corrections

[Liz Kendall]

To ask the Secretary of State for Health how much the Care Quality Commission has spent on consultancy services in (a) 2010-11, (b) 2011-12, (c) 2012-13 and (d) 2013-14 to date.

[Official Report, 18 November 2013, Vol. 570, c. 825-26W.]

Letter of correction from Norman Lamb:

An error has been identified in the written answer given to the hon. Member for Leicester West (Liz Kendall) on 18 November 2013.

The full answer given was as follows:

[Norman Lamb]

The Care Quality Commission (CQC) has provided the following information:

Social Care Reform (Disabled People)

Debate between Norman Lamb and Liz Kendall

Thursday 11th July 2013 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Clark. I thank the Backbench Business Committee for giving us time to debate this very important issue, and I congratulate the hon. Members for Bradford East (Mr Ward) and for South Derbyshire (Heather Wheeler) for sponsoring the debate. It is a great pleasure—this is the first time that it has happened to me—to follow my right hon. Friend the Member for Stirling (Mrs McGuire), who made a very powerful speech.

This subject is hugely important. One in five adults in Britain has a disability of some kind, and that figure is rising due to medical advances and better survival rates. As my right hon. Friend says, it could happen to any of us, so this is not a side topic but an essential issue. Britain will not be a fair country if disabled people are denied the opportunities that many of us take for granted, and we will not be a successful country if we miss out on the talents and contribution of disabled people, not only in economic terms, but in our communities and wider cultural and social life.

Good social care is essential to enable disabled people to be full citizens and live full and fulfilling lives. As hon. Members have said, that is about not only the basics of life—help getting up and getting washed, dressed and fed. It is about what I call the very stuff of life—ensuring that disabled people can spend time with their family and friends; learn and get new skills; find a job; contribute to their local community; take part in sport, art, culture and music; and have fun. In other words, it enables disabled people to have the same aspirations as every other citizen. That is why today’s debate, the joint report from the all-party groups on local government and on disability and “The other care crisis” report are important.

This is not about a particular public service, but about what kind of society and country Britain should be in the 21st century. Despite all the economic challenges, we are one of the richest countries in the world. What kind of country and society do we want, to ensure that we have genuine fairness and opportunity for people of all kinds? The debate is therefore about not only social care, but wider life, which is why it is so important.

As hon. Members have said, there is a growing crisis in social care for working-age adults with disabilities, and services have now reached breaking point. That is eloquently spelled out in the joint report of the all-party groups and “The other care crisis”, the report by Scope, Mencap, Leonard Cheshire Disability, Sense and the National Autistic Society. It rightly says that social care does not only affect older people: one in three people who use social care are working-age people with disabilities. It also says that local authority budgets for adult social care have been under pressure for many years, but have now reached breaking point, as councils have lost a staggering 28% of their budgets so far under this Government, with even greater reductions announced in the latest spending review. As a result, councils are reducing the number of disabled people eligible for free care and support.

The report says that 40% of disabled people are failing to have their basic needs met. They are unable get the help that they need to eat, wash, dress or get out of the house, and their mental health suffers. There are some terrible, upsetting and distressing quotes from people with disabilities. Disabled people’s families also suffer huge stress and strains.

[Norman Lamb]

I agree with the points the shadow Minister makes, but she mentions cuts to local government budgets and I hope that we can all be realistic and honest about the situation that we face. Is she saying that a future Labour Government would substantially increase funding for local government? Alternatively, does she recognise that, collectively, we must all think about different ways to make the money go further?

[Liz Kendall]

I believe that we must fundamentally rethink how our care and support system works. The Minister knows that my right hon. Friend the Member for Leigh (Andy Burnham) and I have called for a far bigger and bolder response, by fully integrating the NHS and social care. I shall come to the Government’s proposals for the £3.8 billion of pooled resources. With the greatest respect, I think that the Government should be bigger and bolder in their response, with full and true integration that goes beyond the NHS and social care. If we really join up local services and support and bring together support from the Department for Work and Pensions, there is huge potential to do much more to give better care, better outcomes and better value for money. I will say more on that in a moment.

In “The other care crisis”, organisations raised concerns about the number of people—105,000 in total—who will lose out if the Care Bill goes ahead as it stands, given where the eligibility criteria will be set. The report warns that the huge strides made over recent years in promoting independence and personalising care and support will go backwards, as councils and other providers revert to more traditional service models—salami slicing services separately—thus restricting peoples’ independence. That specific crisis in social care for adults with disabilities will lead to a far bigger crisis: a crisis in opportunities for disabled people to live the life they want, which other citizens have; a crisis for taxpayers, because failing to invest in up-front preventive social care services will lead to more expensive NHS and social security bills; and a crisis for our country as whole, as Britain misses out on the talents and contribution of disabled people and we all end up paying more as the price of failure.

What should happen instead? The Care Bill could and should be a profound opportunity to establish a framework for social care that could be truly transformational for disabled people. The Bill is the result of the Law Commission review of adult social care legislation, initiated by the previous Government.

[Norman Lamb]

Give us some credit for it.

[Liz Kendall]

I give much credit to the Minister, but the Bill is the continuation of a process that Labour established when we were in government—I want that on the record. [Interruption.] I fully and readily acknowledge that local council budgets have been under pressure for many years. He knows better than anyone that towards the end of Labour’s time in Government we tried to reach an agreement on a social care funding system, which I will come back to in a moment. [Interruption.]

[Katy Clark (in the Chair)]

Order. I ask the Minister to intervene formally if he wishes to say anything, for no other reason than it would assist the Hansard writer.

[Katy Clark (in the Chair)]

No problem at all.

[Liz Kendall]

I never mind interventions in debates; I warmly welcome them.

I shall make five specific suggestions to the Minister about how the Care Bill could be developed. First, the definition of well-being in the Bill is important. I welcome how broad it is. It covers mental, physical, social and economic well-being; personal relationships; and a person’s ability to contribute to society. The definition also includes ensuring that individuals have control over their day-to-day living, but I question whether the definition is as strong as it could be. The joint report from the all-party groups asks why it could not specifically include promoting independence, to strengthen the definition further.

An issue raised by my right hon. Friend the Member for Stirling relates to my point about definitions. The duty to co-operate in the Bill says that local councils will need to work with a range of partners. I understand that Ministers usually do not want to specify lots of organisation types, but I am concerned that although local councils would, we hope, know that they had to co-operate with the NHS, there is a real issue about the DWP. There is not that link-up locally, and if people’s ability to get training and to participate in the work force is so important, will the Minister consider whether, either in the Bill or in guidance, there needs to be more detail about who local councils should co-operate with? I am concerned that that local relationship might not be there.

Secondly, the eligibility criteria are, as the hon. Member for Bradford East said, the most crucial aspect of the social care system because they determine who is and is not eligible for social care support. We absolutely welcome the commitment to clear national eligibility thresholds, but the Minister knows that disabled people, organisations that represent older people and many of the groups involved are hugely disappointed that the draft regulations have set the thresholds at substantial rather than moderate. I am fully aware of the cost pressures on the system, but has the Department done a true cost-benefit analysis, to consider the potential saving? The hon. Member for South Derbyshire made a point about how investing up front can save money further down the line. Has the Minister discussed with his Treasury colleagues whether, if a longer time frame were used for assessing the costs, we would end up saving money for taxpayers if the moderate level was set?

My third point relates to the so-called capped care costs model—aka Dilnot. The Minister knows that I am concerned that the so-called cap on care costs is not really a cap. I am concerned not only because it does not cover hotel accommodation, but because it covers only what someone’s local authority would pay rather than the amount they might actually pay in residential care and because no one will benefit from the cap until 2020.

[Norman Lamb]

Does the hon. Lady accept that if the cap were to cover all someone’s care costs, however much they chose to pay, wealthy people who chose to live in much more expensive care homes would be at a substantial advantage?

[Liz Kendall]

The Minister will know that my point is that I warn Ministers, including the Prime Minister and the Deputy Prime Minister, that going around the country strongly saying that it is a cap on care costs will create confusion—that is the best word I can use.

I do not want to focus on older people; I want to come to the point that the APPGs raised. The joint report states that the majority of working-age people with disabilities will not benefit from the so-called capped social care costs model, because they will not have had the chance to acquire assets. How many disabled people will benefit from the model? Why does the Minister believe that it is more important to put in excess of £1 billion into implementing the Dilnot model rather than into the current system, which is being increasingly squeezed?

My fourth point is about personalisation. I am a huge champion of personal budgets. I have seen them transform many of my constituents’ lives, not just because they promote genuine independence by giving people a say in how they live their lives rather than the system telling them how they should, but because they are essential to integration. The people themselves know best about how to join up their needs and support, because they do not see the two things as separate. However, I have heard the concern expressed in many different places across the country that personal budgets are getting a bad name. People feel that they are increasingly not based on their needs and that less money is being given than is needed, because of how the resource allocation system works.

Another important recommendation in the joint APPG report is about considering whether the resource allocation system should go on to a statutory footing, supported by new duties on councils to be transparent about decisions. I do not want personal budgets to get a bad name, with people feeling that they are a cover for cuts, rather than being based on what people need.

My final point is on the absolutely essential issue of prevention and integration. The Government announced in the spending review that there will be pooled budgets across health and social care totalling £3.8 billion, including £2 billion transferred from the NHS. The joint APPG report states that much of the previous transfer of money from the NHS to social care never reached the front line, and there is a concern that just continually transferring money in that way is not sustainable. How will the Minister ensure that the money gets to the front line? Will it be available, as I think the hon. Member for South Derbyshire said, for working-age adults with disabilities, rather than just for older people? Finally, will the Minister acknowledge that if this keeps happening year after year, it would be far better to have much fuller integration, such as the whole-person care approach proposed by Opposition Members?

--- Later in debate ---

[Norman Lamb]

I will come on to the work that we intend to do on a more sophisticated way of assessing eligibility and responding to assessments. I absolutely accept the current danger that the system in effect says, “Go away, become more ill or more disabled, and when there is a real crisis, we might help you.” I want us to be more sophisticated and to intervene in ways that will help to build capacity and resilience and to stop the deterioration of health. I genuinely believe that the Care Bill will give us the foundations for a much more rational approach.

[Liz Kendall]

May I take the Minister back to the £3.8 billion pooled budget? He said that it was absolutely available for care and support for working-age people with disabilities. Will he explain, when the money goes down to clinical commissioning groups and local councils, first, where it will go to, and secondly, how he will ensure that it actually goes to working-age people with disabilities? I know how the NHS works, and all the focus is on the frail elderly because they are in hospital. The NHS wants to get them out of hospital—that is its prime focus—so unless there is something specific in what the Minister sets up, the money will not go to working-age people with disabilities.

[Norman Lamb]

We will publish further details about how the system will work. To deal with the hon. Lady’s challenge to our approach, we could go for another massive re-organisation, which in a sense is what she is advocating—

[Liz Kendall]

indicated dissent.

[Norman Lamb]

Well, it is. To bring health care and social care together structurally would be a massive re-organisation, and there is no way of avoiding that. The smart way is to focus on the care that an individual receives. The issue is not just about bringing health and social care together and integrating those two systems but about the health service itself and the fact that, institutionally, we have separated mental health from physical health and primary care from secondary care, which is crazy. The whole thing is fragmented, but we should shape services around the needs of patients. The Government’s approach, based on the duties to integrate in the Health and Social Care Act, is the smart, fast way of achieving much more joined-up care for the patient, whether individuals are elderly or of working age. I want to make some progress with my speech.

The Government are committed to improving the lives of disabled people and to supporting them in their independent lives. In very difficult financial circumstances, we have done much to achieve that through the disability strategy, welfare reform—it is incredibly controversial, but any Government would have to pay attention to the extraordinary growth in welfare spending—and a whole raft of condition-specific initiatives.

One outstanding issue still needs to be addressed—social care reform. The importance of care and support for disabled adults cannot be understated: it is the enabler of independent living. We hear much about the ageing population as the driver for care reform, but a third of all health and care users are working-age disabled people, so it is vital that the social care reforms address their needs. The fact that my hon. Friend the Member for Bradford East and his colleagues have secured this debate is valuable because it ensures that we focus on the needs of working-age disabled people. I repeat that there is a risk of their being forgotten, which must not happen.

Earlier this year, I read with interest the “Promoting Independence, Preventing Crisis” report into making social care reform work for disabled adults. It was a joint inquiry by the all-party groups on local government and on disability. I congratulate them on an important piece of work, and I will attempt to address some of the points raised in a moment. I first want to talk about some of the things we have done.

We know that disabled people face a number of challenges. They are far less likely to be in employment than non-disabled people. In fact, shockingly, only 46% of disabled people are in employment compared with 76% of their non-disabled counterparts. Some 19% of individuals living in a family with a disabled member are in income poverty, although I am pleased to say that that has been falling over time. Progress is being made, but much more needs to be done.

The first thing to say about all the Government’s reforms is that we are committed to the UN convention on the rights of disabled people, which includes the right of disabled people to independent living. The Department of Health has been working closely with the Office for Disability Issues on the new cross-Government disability strategy, “Fulfilling Potential”, which was published last September. It is about making the UN convention a living reality for disabled people in Britain. It describes the rights that disabled people—just like anyone else—have in all areas of life, and the duty on Government to ensure that those rights are met.

The shadow Minister made a point about co-ordination with the DWP. There is scope for much more joined-up working at a local level to bring disparate public services together and to achieve far more bang for our buck than we presently manage.

Carers

Debate between Norman Lamb and Liz Kendall

Thursday 20th June 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to follow the excellent speeches made by Members on both sides of the House today. I thank the Backbench Business Committee for giving us the opportunity to debate this crucial subject, and I particularly congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Banbury (Sir Tony Baldry).

One in 10 of all adults are now caring for an older or disabled person—6.5 million in total, up 600,000 from 10 years ago. The biggest increases are among those aged over 65 and those caring for more than 50 hours a week. This is a huge change in society that we all need to do more to understand and get to grips with. Our care system simply would not function without the vital support family members provide for their loved ones; as many Members have said, their financial contribution is estimated at more than £100 billion every single year. Despite that, all too often, carers go without the support they deserve and desperately need to look after the people they love. That is why today’s debate is so important.

The last Government made important progress in improving support for carers. We introduced new rights for carers, including the right, for the first time, to request flexible working. We improved information and advice, and had training programmes for carers such as the expert carers programme, the benefits of which I have seen in my own constituency through the brilliant work of CLASP, the carers centre in Leicester. We funded breaks for carers. Many Members have spoken powerfully about how important breaks are. If carers who are caring for many hours a week have a bit of a break in sight, it really helps them to carry on. We also introduced financial incentives for GP surgeries to identify carers and refer them to local councils for support. That was part of the quality and outcomes framework, which was introduced as part of the 2004 GP contract, and was the very first step in providing a specific financial incentive for GPs to identify carers.

However, as all Members have said, far, far more needs to be done. Like many Members, I have seen in my constituency and within my own family the often desperate daily struggle that is still faced by too many people who look after a loved one who is disabled, physically frail or has dementia—sometimes all three. I pay tribute to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who powerfully explained her own experience of the physical and emotional demands of caring for a loved one. As she said, there are the physical demands of helping someone to get up in the mornings. Carers can be exhausted from getting up two, three or four times in the night to help someone go to the toilet, and from helping them move around the home. There are also the emotional demands. When a carer sees the person they fell in love with become frail and perhaps lose some of their pride and strength, it is terribly upsetting. If a son or daughter sees the parent who brought them up and taught them about the world—for good or for ill—begin to fade as a result of dementia, and they begin to feel as if they themselves are becoming the parent, it changes something essential in the nature of that relationship. I have always believed that relationships are essentially what make us human. If someone has dementia and begins to forget the relationships they have, it takes something away from the carer, as well. Caring for a loved one is physically and emotionally demanding. Many Members have talked about the role of public services. Health professionals are taught to understand physical and mental illness, but not necessarily the wider emotional and social issues.

I want to talk about three critical areas where we need to make progress, the first of which is identifying carers. If we do not know who they are, we will not get them the help and support they need. The second is ensuring they get the right information, advice and support from the NHS as well as social care. The third is helping carers to stay in employment, which many Members have talked about. That is particularly important as we all live longer and need to work for longer. If the public finances are to remain stable, we must do everything we can to help people in that regard. My hon. Friends the Members for Worsley and Eccles South and for Birmingham, Selly Oak (Steve McCabe) talked about the importance of identifying carers. The hon. Member for Ceredigion (Mr Williams) said that there is a great deal of awareness of carers and of the use of that term, but lots of people still do not realise they are a carer or think of themselves as such; they are simply trying to be a good daughter, son, husband or wife. Others do not ask for support because they worry that people will think they cannot cope; there is a lot of associated guilt. We need to identify these hidden carers.

There are many examples of good practice, but perhaps the best I have seen is in Torbay, where the issue of identifying carers in GPs’ surgeries and hospitals has been closely examined. If someone who has had a stroke comes in with a family member, it is recognised that that family member is likely to be a carer. A great range of support is provided. The approach taken in Torbay starts with the person who may need health care; as a result, they immediately talk about their family member.

I want to offer some practical suggestions to the Minister on how to make further progress. Will he consider amending the quality and outcomes framework? At the moment, it provides a points incentive and a financial incentive for GPs to refer carers to social care services; but why not to other health services, if carers’ health needs are so important? Secondly, will he give guidance on the best questions used to indentify carers? When I recently registered with a new GP, the leaflet provided asked, “Are you a carer?” I knew what that meant because I am familiar with the policy debate, but most people would wonder what that meant—paid carer, unpaid carer?

I spoke at the event that launched the research into attendance allowance claimants by the Strategic Society Centre and Independent Age. There are 1.3 million older and disabled people in England with very high levels of need. The research shows that 35% of attendance allowance claimants are cared for by a son or daughter, 30% by a partner, and 15% by another family member. The DWP has that information. I hope the Minister will talk to his DWP colleagues about drawing up a proper action plan.

Thirdly, I want to join my hon. Friends in pressing the Minister on what action will be taken through the draft Care and Support Bill to identify young carers. Will he update us on his meeting with the Education Minister? What is the obstacle to amending the Children and Families Bill, the draft Care and Support Bill, or both? I tell the Minister that the Opposition will table relevant amendments if the Government do not.

I turn now to improving information and advice for carers. Carers UK says that a third of those caring full time for an older disabled or seriously ill friend or relative receive no practical support, and those who do often find that services do not fit around their particular needs, especially if they are struggling to hold down a job. As many Members have said, these services still too often end up offering last-minute help and support, when families have already reached crisis point. I pay tribute to my hon. Friend the Member for Corby (Andy Sawford), who talked about his nan. Before she got any support, a crisis point had already been reached. That was no good for her, and it is no good for taxpayers. More than one in five carers who have been admitted to hospital as an emergency case in the last three years say that it could have been prevented, had they been helped to look after their own health, or been given a break from caring or other forms of support. Given that money is so tight across the NHS and council care services, we have to get those up-front preventive services and support in place.

I have another practical suggestion for the Minister. As he knows, there is a brilliant national GP patient survey, run by Ipsos MORI, which provides detailed information about the needs of patients registered at a surgery. The last time I looked through it, I do not think there were any questions about whether the respondent was a family carer. It was about the needs of the individual patients, not carers. Such a question would provide us with some brilliant data that could be given back to individual surgeries as the basis from which to start developing support.

[Norman Lamb]

The GP survey is absolutely something that we can consider. If we can demonstrate how individual surgeries are performing against their responsibilities towards the whole family, and not just towards the person who is receiving medical treatment, we might well drive changes of behaviour in the surgery.

[Liz Kendall]

I am very pleased to hear that from the Minister and I will continue to follow it up with him. Including such questions in the survey would not cost any more and the data are collected by individual practice, so we would all be able to look at the GP surgery data in our own constituencies and ask what action plans were being followed. Clinical commissioning groups could be required to follow that up.

The third issue that many hon. Members have talked about is helping carers to stay in paid work. Families need the income carers get from paid work and our economy needs the skills and talents of carers. That challenge will only increase as our population ages and as more people live for longer and have to care for longer.

The biggest group of carers are people aged 50 to 65, many of whom still want and need to work. Many are women who, as hon. Members have said, are stretched at all ends. Some are looking after their children or grandchildren, or sometimes both, as well as caring for a frail partner or elderly relative and trying to hold down a job. To have one in three carers being forced to give up work or reduce their hours because the right services and support are not available does not make sense for our economy as a whole. The right hon. Member for Sutton and Cheam talked about the LSE and Age UK research that shows that that is costing more than £5 billion a year in lost tax revenues and increased benefit bills.

I strongly urge the Minister to talk to his colleagues in the Department for Business, Innovation and Skills about how the Government can do more to promote flexible working among family carers. We have made great progress in arguing that child care is part of our economic infrastructure, and, as the population ages, social care must be too. I believe that from cradle to grave, child care and social care must be the twin pillars of a reformed welfare state.

In conclusion, the draft Care and Support Bill is an important step forward and is very welcome. It builds on the recommendations of the Law Commission’s review into adult social care legislation, established and initiated under the previous Labour Government. Indeed, many of its recommendations were set out in our White Paper on social care, produced just before the general election. On its own, however, the Bill will not be enough.

Rights in law simply will not be delivered on the ground if the services are not available locally to make them a reality. Local council budgets for adult social care have been under pressure for many years, but they are now at crisis point as council budgets have been cut by a third under this Government. The Local Government Association says that councils have had to reduce their adult social care budgets by £2.7 billion over the past three years—that is a staggering 20%. The LGA says that

“eligibility thresholds cannot be raised much higher, 87% of councils are now at the substantial/critical threshold”.

That affects not just the statutory services, but the voluntary organisations that several hon. Members have rightly championed. Cuts from Leicestershire county council mean that CLASP carers centre in Leicester wonders whether it will even be able to survive. Many Members have talked about the important role of the voluntary sector, but without state funding many such organisations will not exist in future.

Will the Minister back calls from Opposition Ministers for £1.2 billion of this year’s NHS underspend, handed back to the Treasury in March, to be given to social care to ease the short-term funding crisis over the next two years? What representations has he made to the Chancellor on council care budgets for the spending review? Has his Department made the clear economic and social justice cases for preventing them from being slashed further? If any NHS funds are to be transferred to local councils in next week’s spending review, will they be specifically ring-fenced so that money gets through to the front line?

Ultimately, we need a bigger and bolder response to meet the needs of our ageing population and to help Britain’s carers. We need a fully integrated NHS and social care system with one budget. We should take the £15 billion spent on social care and the more than £100 billion spent on the NHS and join them together so that we get better care and better value for money for taxpayers. I believe that that is what Britain’s carers deserve.

--- Later in debate ---

[Norman Lamb]

The hon. Lady asks whether I have taken that message on board—I could not have missed it. I totally agree with what has been said and I am going to discuss the role of health professionals.

I know that there is a lot of concern about young carers, and it comes particularly from the hon. Lady. I said in the Queen’s Speech debate that I would meet the Under-Secretary of State for Education, my hon. Friend the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children and families, and I have done so. I appreciate that until something concrete happens the hon. Lady will, rightly, keep pressing. I give her my assurance, again, that I understand and accept the case she is making. My hon. Friend the Minister and I are entirely clear that our joint aim is to ensure that young people are protected from having to undertake excessive and inappropriate caring responsibilities. During debates on the Children and Families Bill, he confirmed that he and I are of one mind on the need to protect young carers by using a whole-family approach to the assessment of adult care needs.

The Care Bill itself is not the place to go into the detail of how assessments should be conducted; that will be set out in regulations and statutory guidance. A whole-family approach will undoubtedly benefit children, but I am keen that it also encompasses other significant family relationships. We need to look genuinely at the whole family, whatever the relationships are between those receiving care and those giving it.

In last week’s debate, my hon. Friend the Minister confirmed that his Department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need, and how we can ensure that children’s legislation works with adult legislation to support the whole family. I am clear that we have to address the concerns, and while we significantly advance the position of adult carers, we cannot leave young carers behind. The approaches do need to be different, because we need to recognise philosophically that children should not be caring inappropriately. Of course sometimes they have to do that, but we want to relieve the caring burden as far as is possible, while recognising that sometimes there will be a caring role for some.

[Liz Kendall]

Does that mean that there will be a requirement on schools, and on further and higher education bodies, specifically to identify young carers?

[Norman Lamb]

It is not my job to speak on behalf of the Department for Education, and the hon. Lady will have to be a bit more patient in waiting for further news on that subject.

Key principles to inform that work and discussion over the summer are, first, that the starting point should be assessing the needs of the adult or child who needs care and then seeing what remaining needs for support a young carer in the family has. The presence of a young carer should trigger either an assessment or the offer of an assessment to the person needing care. Secondly, a whole-family assessment is key when assessing an adult needing care where children in the family are providing care to the adult or undertaking wider family responsibilities. The adult’s assessment and eligibility for support should take into account their parenting responsibilities and the functioning of the family. Thirdly, assessments should establish why a child is caring and how to prevent—this is the crucial point—excessive or inappropriate caring responsibilities which could have an adverse impact on their education, social activities, emotional development or health. As much as possible we ought to be enabling a youngster to grow up like any other youngster can, without having inappropriate burdens on them that impact on their education and social life.

Health and Social Care

Debate between Norman Lamb and Liz Kendall

Monday 13th May 2013 Commons Chamber

[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.

--- Later in debate ---

[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.

Thalidomide Trust (Grant)

Debate between Norman Lamb and Liz Kendall

Thursday 20th December 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank the Minister for the advance copy of his statement.

Thalidomide survivors waited far too long for Governments over many years to address the appalling physical and emotional difficulties that they faced as a result of thalidomide prescribed by the NHS from 1958 to 1961. The last Government took the first steps towards addressing this unacceptable situation. In January 2010, the then Minister of State rightly offered our sincere regret and deep sympathy for the injury and suffering endured by all those whose expectant mothers took the thalidomide drug. I want to repeat that sincere regret and sympathy today.

The previous Government also acknowledged the urgent need for extra help for thalidomide survivors to meet their care and support needs, by putting in place a three-year pilot scheme. The pilot, as this Minister said, has helped survivors to improve the quality of their lives and to cope with their increasing loss of mobility and independence as they get older by helping them to buy and put in place the things that they say make the most difference to their lives.

I welcome the Minister’s announcement that the Government will continue the scheme for 10 more years with a grant in the region of £80 million. That will mean a huge amount to the 431 thalidomide survivors living in the UK today. As the Thalidomide Trust says, the money will allow one survivor with no arms to buy the special adaptations she has been unable to afford, and a man with no legs to make a down payment on a van adapted so that he can drive it from his wheelchair. It will allow a deaf thalidomide survivor to continue to employ someone to be her signer when she goes out so that she can retain her confidence and ability to remain active and mobile.

I have a number of questions about the scheme that I hope the Minister will answer. He will be aware that Scotland, Wales and Northern Ireland made proportionate contributions to the fund set up by the previous Government. Will the devolved Administrations make similar contributions to the fund he has announced today? He says that the grant will be reviewed annually, but there might be concern that that is not as stable as some survivors would like. Will the Minister guarantee that the views, needs and concerns of survivors will be at the heart of those reviews, and will he explain why we need an annual review, and not a three-year review as under the previous Government?

Will the reviews look specifically at the increasing needs of thalidomide survivors as they get older? Evidence collected over the past two years confirms that their health and mobility is deteriorating rapidly now that they have reached their 50s. Because of those increasing needs, will the Minister commit today to ensuring that there will be no less funding in the years ahead?

I will conclude, as the Minister did, by thanking and paying tribute to the work of the Thalidomide Trust, its national advisory council, and all campaigners who have fought to make successive Governments face up to their responsibilities. Members across the House sincerely regret how badly thalidomide survivors were let down, and we will strive to ensure that that never happens again.

[Norman Lamb]

I appreciate the shadow Minister’s support for today’s announcement and she is right to say that people have waited far too long for an acknowledgment of the tragedy and for practical action. I acknowledge—as I did in my statement—the actions of the previous Government in initiating the pilot scheme, and the expression of regret made by the former Health Minister. One powerful thing about the scheme, as designed in the original pilot, is that it gives maximum power to the individual to determine and respond to their priorities and needs. That means that the money can be used in a host of different ways, as the hon. Lady described.

The hon. Lady raised a fair point about the devolved Administrations, and we must be equally concerned about thalidomiders in Scotland, Wales and Northern Ireland. The devolved Administrations did not feel able to commit to the 10-year period here and now, but they are fully committed to continuing that help and we will work closely with them to ensure that individuals in those Administrations are not left behind in any way.

The hon. Lady rightly mentioned the annual review, which is a question of proper accountability. The trust has done a brilliant job and I acknowledge its work. It is a completely responsible organisation that knows better than anyone how best to deploy the available resources, but as it acknowledges, it is right for it to be held to account for how public money is spent. There is no intention at all to question the purpose of the grant, and we want to give the certainty provided by the 10-year period. The fund will be index linked so that the value of money from the pilot scheme is maintained throughout that period. The review is simply to ensure that the scheme still makes sense and that we are using the available resource in the best possible way. I have every confidence that that will be the case and, as the hon. Lady requested, the needs of the thalidomiders who benefit from the money will be put at the heart of the reviews. We will not let those people down in the commitment that we are making today, and the funding will be maintained.

The hon. Lady rightly talked about deteriorating health because the body has been under such extraordinary strain. I spoke to thalidomiders earlier today. It is remarkable what their bodies have been able to do, often in the absence of limbs, but that puts an enormous strain them, and the wear and tear is now having its effect. We do not know what the prognosis is going forward. It is therefore right to take stock and see what their needs are after a 10-year period, but the commitment to those people must remain.

Winterbourne View

Debate between Norman Lamb and Liz Kendall

Monday 10th December 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I would like genuinely to thank the Minister for advance sight of his statement and the briefing I received earlier today. Members on both sides of the House were appalled and angered by the terrible incidents at Winterbourne View, and we share a determination to ensure that all necessary steps are taken to prevent a similar tragedy from happening again. Our goal must be to ensure that everyone with a learning disability or autism, including those with challenging behaviours, receives high-quality, decent and humane care and support, and that we finally end the practice of sending people to long-stay institutions, far away from their family and friends.

The Minister has announced a number of welcome measures that are a step in the right direction, but I remain concerned that some of the proposals are not clear or strong enough to guarantee the fundamental changes that people with learning disabilities urgently need. The NHS mandate published two weeks ago states there should be

“a substantial reduction in reliance on inpatient care.”

Can the Minister give a figure for that reduction? Without one, that laudable aim will be open to such wide interpretation that it risks appearing meaningless. Similarly, the Government say they want every local area to provide “appropriate” care and support. Will the Minister tell the House who will define what care is “appropriate” and how that will be measured?

How will the Minister ensure that all local commissioners have the necessary skills to make these changes? That was a problem with 150 primary care trusts, yet in future there will be 212 clinical commissioning groups. Those can, of course, draw on expertise in local councils, but the authorisation process for CCGs does not even mention learning disabilities as an area in which competence is required. If this is such an urgent national imperative for the Government, will the Minister explain why that is the case?

Some parts of the country continue to use long-stay institutions because they have not developed alternative care in the community and at home. In a time of constrained resources, when we need to make the best use of taxpayers’ money, there should be one budget for people with learning disabilities, not separate budgets for NHS and council care. Will the Minister explain how he will make that happen on the ground? For example, will he require the NHS Commissioning Board to instruct CCGs to provide funding to local councils if they are slow to do so or if they refuse?

The serious case review of Winterbourne View said that light-touch regulation by the Care Quality Commission was not appropriate for closed establishments, and that they should be treated as high-risk institutions, requiring frequent, unannounced probing investigations. The review says that the investigations should involve speaking to residents’ families and patients, and in particular to people who have left the institution, who may feel more able to speak out. The CQC recently completed a focused programme of inspections of long-stay institutions. Will that specific programme continue along the lines the serious case review recommends? Will the Government, in their review of the use of restraint, consider banning t-supine restraint, as the serious case review recommends?

One of the most disgraceful aspects of Winterbourne View is that vulnerable people were neglected and criminally abused while the hospital’s owners, Castlebeck, charged huge fees and made huge profits. The serious case review says that Castlebeck made decisions about profitability, including shareholder returns, over and above decisions on the effective and humane delivery of treatment. The average weekly fee for residents at Winterbourne View was £3,500—the fee rose to £10,000 for one patient. The review could not determine how much of that money went back into the hospital and how much was creamed off for profit because of the company’s complex financial structure—Castlebeck is owned by private investors based in Jersey and Geneva. That has made it virtually impossible to hold the company to account. Will the Minister confirm that the company has so far failed to meet two of the serious case review’s key recommendations —that it should fund therapeutic services for all ex-Winterbourne View patients, and that it should pay for the costs of the serious case review, which have so far been borne entirely by the taxpayer?

I welcome the Government’s commitment to examining how corporate bodies and their boards of directors can be better held to account. As a first step, will the Minister consider requiring private companies to publish the names of their owners, the members of their boards, and the details of their financial structures, before they can be licensed and registered to provide publicly funded care? The excuse that such information is too commercially sensitive should not be acceptable when the care of vulnerable people is at stake, and when it is paid for using substantial amounts of taxpayers’ money.

How we care for the most vulnerable people is the hallmark of a decent society. I do not doubt the Government’s commitment to addressing this issue. I hope they listen to our concerns and strengthen their proposals, so that people with learning disabilities get the decent and humane care and support we would all wish for our families and friends.

[Norman Lamb]

I thank the shadow Minister for her contribution and appreciate the welcome she gives for the main thrust of the Government’s response. This is a moment when everybody must come together to be clear that a change of culture is necessary from top to bottom. This is not a party political issue. The culture must change, and everyone within the system—from top to bottom—must recognise their personal responsibility to achieve that.

The shadow Minister raised a point about the mandate. One very good thing about the mandate is that it gives us accountability and transparency in the system for the future, and enables us to hold the NHS Commissioning Board and other parts of the system to account on delivering what is in it.

The hon. Lady asked how we will measure success in relation to the reduction in numbers in long-stay institutions. There must be a focus on assessing an individual’s personal care needs—that is what counts. The arbitrary setting of a target on numbers would be completely inappropriate when we should be focusing on the needs of individuals. The guidance we have received is that while there are 3,400 people in in-patient facilities of one sort or another, we are talking about probably reducing that down to 300 or 400 people. That is the best assessment that has been made, but I stress again that it must be based on assessment of individual needs.

The hon. Lady rightly makes the point about the skills of commissioners. One of the big failures has been that of commissioners properly to look after the interests of highly vulnerable people. The programme, which will be led by the Local Government Association and the NHS Commissioning Board and funded by the Department with between £2 million and £5 million of support, will be there to provide support and guidance to ensure that local commissioners get this right. We should applaud the parts of the country where this is being done brilliantly at the moment. They can demonstrate best practice to areas that need to change.

The hon. Lady asked whether the Commissioning Board will hold CCGs to account. The answer is, absolutely. This is part of the transparency of the new system and they must deliver on what they will be required to do.

I agree with what the hon. Lady said about the budget. The report makes it clear that the starting point should be that pooled budgets are the appropriate way forward. This is patchy at the moment. If there are not pooled budgets, they should explain why. In my view, there is no good justification for not pooling the resources of the NHS and social care to ensure the best and most appropriate care for individuals. There is also a duty for the two sides—social care and NHS—to work together. The health and wellbeing boards help to bring them together, and that is valuable.

The hon. Lady asked about Care Quality Commission inspections. Unannounced visits will continue, and they will include people with learning disabilities and their families, so that their perspective is gained. This is not a time-limited programme—it will continue. I think that the CQC recognises that this is an area that requires focus because of the vulnerability of the individuals concerned.

On physical restraint, we will look at all elements, including those mentioned by the hon. Lady, so that the best possible guidance is given to ensure that the excessive use of restraint, which currently happens in too many places, comes to an end.

On Castlebeck, I absolutely agree that it should consider financial support for the costs incurred following the scandals uncovered in its care settings. The hon. Lady rightly points out the responsibility that goes with charging an average of £3,500 per week per patient. One of the great failures of the current system is that there is not sufficient corporate accountability to ensure that people are held to account when things go wrong. When we consider proposals to address that lack of corporate accountability, we will look at the hon. Lady’s transparency proposal on publishing a lot more information about financial structures. Indeed, in the consultation we announced a fortnight ago on the follow-up to Southern Cross, we are proposing that there should be transparency regarding financial structures and that that information is shared to ensure that we avoid being caught by surprise, which is what happened under the system in operation when Southern Cross crashed, leaving many people in an unacceptable state of anxiety.

Winterbourne View

Debate between Norman Lamb and Liz Kendall

Tuesday 30th October 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

(Urgent Question): To ask the Secretary of State for Health to make a statement on the steps the Government have taken to ensure the safeguarding of former Winterbourne View residents.

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

The review into the abuse at Winterbourne View hospital, established by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), set out 14 actions to transform care and support. Central to the review is ensuring the safety and well-being of these very vulnerable people. I shall publish the final report before the end of November.

When Winterbourne View closed, NHS commissioners put in place independent clinical and managerial supervision and commissioned an independent assessment of every patient. The Care Quality Commission worked with commissioners to relocate Winterbourne View patients to suitable alternative placements.

In March, the Department of Health review team commissioned NHS South of England to follow up the 48 patients who had been in Winterbourne View, and there was a further review in September. The first review in March revealed that 19 former patients were the subject of safeguarding alerts. In response to this, officials asked commissioners to take appropriate action and confirmed that a follow-up would take place in six months’ time. I was extremely concerned to be informed that this follow-up had revealed that there are current safeguarding alerts for six former patients. I am assured that these are all being followed up to ensure the safety and well-being of the individuals concerned. That is extremely important. Furthermore, the September follow-up exercise revealed that 32 Winterbourne patients were now living in the community in their own family homes, in supported living or in a residential care home, with 16 still living in hospital settings.

The priority is to improve commissioning to develop the good local services that will prevent people from being sent to hospital inappropriately. We are working closely with the NHS Commissioning Board, the Local Government Association and directors of social services on what support local services need. Although a small number of people will need hospital treatment, we expect to see—and, indeed, must see—a substantial reduction in the number of in-patients.

We intend to strengthen safeguarding arrangements to prevent and reduce the risk of abuse and neglect of adults in vulnerable situations. Where there are safeguarding concerns, the local safeguarding adults boards need to be closely involved. The boards will be placed on a statutory footing for the first time, ensuring a co-ordinated approach to local adult safeguarding work.

The Government will put in place the necessary legislation for safeguarding adults boards, and local councils should bring clarity to their roles and responsibilities, but it is the responsibility of the care provider—we must remember this—to ensure a culture of safety, dignity and respect for those in their care, including stopping abuse before it happens. Those providers must be held to account for the care that they provide.

--- Later in debate ---

[Liz Kendall]

I thank the Minister for his statement, but there remain serious concerns about whether the Government have taken all necessary steps to ensure that the former patients of Winterbourne View are now receiving safe and effective care. Last night’s “Panorama” programme revealed that 19 patients have been subject to safeguarding alerts since leaving Winterbourne View. Not all those alerts mean that someone has been harmed, but “Panorama” said that one was due to an incident of assault and another had resulted in a criminal investigation. Is that an accurate reflection of the picture?

Have the families of all patients with a safeguarding alert been given the full details? What specific action has been taken as a result of the alerts, and can the Minister guarantee that the patients in question are all no longer at risk? Can he also guarantee that all local commissioners responsible for all the former Winterbourne View residents now have a proper plan in place to ensure that they receive good-quality care?

Has the Care Quality Commission recently inspected all the providers that former Winterbourne View patients were moved to, and are the Government confident of the CQC’s findings? Last night’s programme raised particular concerns about Postern House, which the CQC inspected in January this year following the Winterbourne View scandal. The CQC said that it met all the essential standards of quality and safety, and that suitable arrangements were in place to ensure that people were safeguarded against the risk of abuse, yet “Panorama” revealed a number of problems at Postern House over several years and the fact that a former Winterbourne View patient had a safeguarding incident there in June this year. Is the Minister confident that all patients currently in Postern House are safe from the risk of abuse?

The Minister rightly said that responsibility for the care of people with learning disabilities lies with providers, commissioners and the CQC, but it is Ministers who set policy and have responsibility for ensuring that it is implemented. The Government have a particular responsibility to ensure that former Winterbourne View patients never have to suffer from such appalling abuse again. Organisations such as Mencap are also very concerned that the Government are not moving quickly or strongly enough to end the practice of sending patients with learning disabilities to long-stay institutions far away from their family and friends.

The Minister must answer our questions about whether former Winterbourne View residents are all now guaranteed safe care, and he must urgently bring forward proposals to reform learning disability services properly for the future.

[Norman Lamb]

I thank the shadow Minister for asking the urgent question. The view is shared on both sides of the House that what “Panorama” exposed is utterly intolerable and has to come to an end. I am absolutely determined that when I make the Government’s final response by the end of November, it will be robust and clear so that everybody understands what has to happen.

When I came into my job, I heard briefings about the whole saga and how long it has gone on. For years and years, public money has been spent on putting people into inappropriate settings, often putting them at risk of abuse. That is a national scandal, and it has to end. I will be very clear about ensuring that we take robust and effective action.

The hon. Lady is absolutely right that Ministers are here to set policy, and that is what I intend to do. Since my appointment, I have been working to ensure that we set the right policy to protect vulnerable individuals. She is right that they must never suffer from abuse. Of course, there is always the risk of rogue individuals who behave very badly, and they must be dealt with through the criminal law, as has been seen with Winterbourne View staff. I have also made the point that the corporate owners of such organisations must be held to account for things that go on in their homes if those homes have been neglected. I want to meet the parents of those who were at Winterbourne View to hear from them directly, and I will seek to make arrangements for that.

The hon. Lady mentioned the 19 safeguarding alerts. In fact, that intolerable figure was in March but by September, the number was down to six. She is right, of course, that not every safeguarding alert means that something awful is happening. It means that concerns have been raised, and it is important that people raise their concerns. I assure her that I will do everything I can to end this scandal and ensure that we have proper safeguarding arrangements in place.

Social Care (Local Sufficiency) and Identification of Carers Bill

Debate between Norman Lamb and Liz Kendall

Friday 7th September 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) for bringing forward this excellent Bill, and warmly congratulate her on doing so. She is a long-standing advocate and champion of unpaid family carers and wider social care issues. Today, she has again displayed her invaluable contribution to these issues and the House.

The Bill is important because it seeks to change in two fundamental ways the way in which we support disabled people and the family members who care for them. First, it seeks to shift the care system away from focusing predominantly on the needs of people whose care is funded by the state, to recognising the millions of individuals and families who fund their own care. The vast majority of those people are not hugely wealthy, but live on low or modest incomes. When a person whom someone loves becomes frail or ill, it comes as not only an emotional shock, but a financial one, because they have to pay for the care. When they then ask for advice, information or support, they do not get it. People do not even receive the information that is available. That is a big and important change that the Bill seeks to achieve.

Secondly, the Bill seeks to shift the nature of the support that is available to disabled people and their family carers, so that people’s broader needs are met as individuals, not just as carers. That includes their health needs and their needs for skills and training, so that they can build a full and fulfilling life. Crucially, it includes their need or desire to get work and to stay in work. The Bill would make a significant difference in allowing disabled people and their carers to achieve a better quality of life. It would also provide better value for money for taxpayers.

There have been big improvements in the care system over the past decade, with new rights for carers to have their needs assessed, new rights to request flexible working, improvements in respite care, a training and support programme for carers, and strengthened rights for carers in their entitlements, for example to the state pension. However, like many hon. Members, I know from my constituents and my own family that a desperate daily struggle is still faced by too many people who are looking after someone whom they love and who is disabled, is physically frail or has Alzheimer’s—sometimes even all three.

As hon. Members have said, many people do not think of themselves as a carer, but are just trying to be a good daughter, son, husband or wife by looking after the person they love. They therefore do not realise what support is out there. Often, it is only when somebody reaches crisis point and can no longer cope that they look for support. However, people do not know where to go and often the right services are not available to them. The result is that millions of carers see their own health suffer. One in three unpaid family carers of working age has to give up work or reduce their hours, adding financial worries to their already stressful lives.

As has been said, that often happens to women aged 50 to 65, or even older, who still want, and may need, to work. Indeed, as the population is ageing, they will need to work for longer. They face the awful double whammy of having to care and work for longer, and may be unable to balance the two. Any kind of social life or leisure time—something that many people look forward to when they retire—is nothing but a pipe dream. That is not good for carers, and it costs us all more through increased costs to the NHS and a higher benefits bill.

One issue to consider is the statutory framework within which local councils work. Particularly when they are under intense financial pressure, as they are at the moment, they understandably and inevitably focus on delivering their statutory duty to provide care for those in the greatest need. Indeed, they are focusing more and more on a small number of people with intense needs, because of the financial pressures that they face. The bigger agenda of prevention and early intervention is going by the wayside. The Bill’s provisions are intended to change that framework so that councils have a duty to assess the range of care needs in their area and then stimulate the market to ensure that services are available to meet those needs.

The Bill also includes important provisions to ensure that schools and further and higher education bodies identify young carers. Many Members have spoken about that issue, and I will not go into detail because I want to give others time to come in. However, the idea of involving further and higher education providers is groundbreaking and very welcome.

The Bill also addresses how we can get NHS bodies to better identify people who are, or are about to become, carers so that their health needs are assessed too. Many Members have talked about changes that are already being made in some parts of the country to achieve that. My hon. Friends have talked about the work that is taking place in Stockton and Salford, and the hon. Member for South Thanet (Laura Sandys) mentioned Torbay care trust, which I visited earlier this year. It is doing brilliant stuff in schools, but also in hospitals. Its staff know that if an elderly person who has had a stroke comes in with a husband, wife or partner, the latter will probably end up being a carer. It has a package of measures in place to identify such people.

In my constituency, Leicester city council has recently set out its plan for improving support for carers. As far as I remember, the plan says a lot about what schools can do, but I do not believe it mentions Leicester college, Leicester university and De Montfort university. The Bill would ensure that such issues were considered in every area, which would make a big difference.

I want to take a few moments to talk about something that we have not focused on so far in the debate but that is critical, which is how the Bill could help our economy. Creating jobs and growth is the biggest challenge that the country faces at the moment. As my hon. Friend the Member for Worsley and Eccles South said, the business forum Employers for Carers has clearly spelled out the mounting costs not just to families but to businesses of a care system that is not helping families to juggle their work and caring responsibilities. As our population ages and people have to work, and probably care, for longer, we have to understand that changing our care system is as important as continuing to make improvements in child care in helping families balance those responsibilities.

Using research from the London School of Economics, Age UK has shown that the cost to the economy from carers’ inability to balance their working and caring responsibilities is now £5.3 billion in lost earnings and more than £1 billion in lost tax revenues and benefits bills.

[Norman Lamb]

Does the shadow Minister agree that extending the right to request flexible working is also important? It will enable people with all sorts of caring responsibilities to enter into a discussion with their employer to see whether there might be flexibility for them to be able to work in a different way.

[Liz Kendall]

I have always been a champion of the right to request flexible working, which has made a big difference. I hope the Minister will not listen to the voices of some Members sitting behind him who want employment rights, including the right to request flexible working, removed from those working for a business employing three or fewer people. That would be a mistake and would not help us to address the issue. Employers for Carers has stated that if we stimulate the care market, as measures in the Bill seek to do, that could—as my hon. Friend the Member for Worsley and Eccles South said—deliver a triple economic win: better services for families, infrastructure to help employers retain skilled staff, and a boost to economic growth.

The Bill introduces the big challenge of flipping the care system on its head. Instead of seeing the ageing population and growing care needs and demands as a drain and burden on the country, we should see it as an opportunity for growth. The population is changing; it is ageing. Demand for care and support services will grow, and there is a huge opportunity to develop and stimulate jobs, companies and growth in that area, as has been done in France. In 2005, the French Government launched a plan to develop what they call services à la personne—a range of home care services, home visits and domiciliary care, and different types of services such as those provided by handymen and handywomen, drop-in services and support.

Between 2005 and 2007, 100,000 jobs a year were developed through the different incentives introduced and, as my hon. Friend said, even after the financial crash, 50,000 jobs a year were stimulated in that way. I urge hon. Members to read the report by Carers UK, “Growing the Care Market”, which sets out an important challenge. As we seek to develop and rebalance the economy, growing the care market will deliver better services for families who desperately need them, and a better, bigger, vibrant care market in the future, which is vital.

My hon. Friend’s Bill builds on many of the previous Government’s improvements and on recommendations in the Law Commission’s review of adult social care legislation. That review began under the previous Government, and reflects many aspirations in the current Government’s White Paper and draft Bill on care and support. There is much cross-party consensus that we must move forward on these issues.

[Norman Lamb]

Does the hon. Lady also agree with the Law Commission’s view that it is best to get everything codified in one place so that one piece of legislation addresses all issues of care and support?

[Liz Kendall]

Opposition Members, myself included, want to ensure that the draft Bill on care and support covers all the issues that we wish to see progress. However, we also want to see the provisions in my hon. Friend’s Bill on the statute book. I welcome the Minister’s commitment to engage with my hon. Friend on the draft Bill, but when he rises to speak will he go further and commit to including those clauses for which he has specific responsibility in the Department of Health? Those will include the duty on local authorities to assess people’s needs, ensuring sufficiency of provision, and for NHS bodies to identify carers. I understand that the Minister needs to engage with colleagues in different Departments—notably the Departments for Business, Innovation and Skills and for Education—but it would be a welcome step forward if he committed to including in the Bill those clauses for which he has responsibility as a Health Minister.

I should, of course, welcome the Minister to his new role. He has a track record—certainly before the previous election—of commitment to social care. He will also know, however, that we cannot deliver the vision of a transformed system of care and support that Ministers claim to want in their White Paper and Bill, and which Opposition Members certainly want, without the money to deliver it. My hon. Friend’s Bill will make a big difference, but we cannot deliver without getting more money into the system.

As the Minister will know, there are two key challenges. First, we need to address the current funding gap in social care. Because local councils’ budgets are being cut by a third, social care services are being reduced and cut. That is inevitable. Adult social care makes up around 40% of local councils’ budgets, and up to 60% in some areas—it their biggest discretionary spend. When their overall budgets are being cut by a third, it is inevitable that those services will be cut. We need to address that immediate challenge and the immediate care crisis.

Secondly, we need to reform care funding in future. The Minister will know that the Opposition called for and initiated cross-party talks with his predecessor on the recommendations of Andrew Dilnot’s commission on the future funding of care and support. We remain completely committed to trying to achieve cross-party agreement and consensus on that vital issue. Will the Minister tell the House whether the quad of the Prime Minister, the Deputy Prime Minister, the Chancellor and the Chief Secretary to the Treasury have agreed to fund Andrew Dilnot’s recommendations, as was reported in the newspapers over the summer recess? I hope they have made such a commitment. We could then work with the Minister to secure the cross-party consensus on both the current gap and the future funding of care. That will enable us to make the vision that Opposition Members have of a better and fairer system of social care a reality.

The provisions in my hon. Friend’s Bill, which I hope will become legislation, would ensure that we deliver that better system of care and support for all those disabled people and family carers, whether they are funded by the state or self-funding, and whether they are younger or older carers. They will also ensure that we give people the decency and dignity they deserve when they are looking after frail, vulnerable and elderly relatives whom they love and whom they want to have a better life.

--- Later in debate ---

[Norman Lamb]

The hon. Gentleman raised those points earlier. Yes, of course I am keen to engage with Scotland and Wales, and I would certainly be happy to meet the all-party group. I want to be as open and inclusive as possible in this process.

As I have said, there is also a concern that the Bill would impose a range of new, additional burdens on public and private bodies at a time when we are committed to reducing such legal duties. We agree with much of the intent of the Bill, but there are a number of ways in which we can pursue our common goals effectively. In July, the Government published the draft Care and Support Bill, which will undergo pre-legislative scrutiny later this year. That is information on the timetable for the hon. Lady. We can use that process to discuss the provisions relating to adult carers. In addition, earlier this week the Department for Education published draft legislation on the reform of provision for children and young people with special educational needs. That will also present an opportunity to consider how we might improve the identification of and support for young carers. I urge the hon. Member for Aberavon (Dr Francis) to engage with that process as well.

Private Members’ Bills have played a central part in the history of carers legislation. I would like to take this opportunity to pay tribute to the hon. Member for Aberavon for the significant contribution that he made by promoting the Carers (Equal Opportunities) Act 2004. He has been involved in these matters throughout the period since, and I want to express my gratitude to him for that. I also want to thank other parliamentarians, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), the right hon. Member for Croydon North (Malcolm Wicks) and Lord Pendry. Their contributions to the development of carers’ rights date back to the mid-1980s.

I also want to thank my predecessor, my hon. Friend the Member for Sutton and Cheam (Paul Burstow). He has championed carers, both from the Back Benches and while Minister with responsibility for care services, and I am certain that he will continue to do so. I want to take this opportunity to pay tribute to the work he has done as a Minister. He has shown utter dedication to the cause, and I know that that has been widely appreciated.

Carers make a vital contribution to society, as many Members have said, and we are taking concerted action to support them. We set out our priorities in “Recognised, valued and supported: next steps for the Carers Strategy”, in November 2010. Between 2011 and 2015, we will provide an additional £400 million to the NHS to support carers, including through the provision of carers’ breaks. My hon. Friend the Member for Bury North mentioned this earlier. The White Paper commits to over £125 million of additional resources being allocated to carers.

Carers are central to the Government’s proposals for care and support. For the first time, carers will be placed on the same legal footing as the people they care for. That is an incredibly important breakthrough. We will extend the existing right to a carer’s assessment and provide carers with a new entitlement to support to meet their needs. The hon. Member for Aberavon mentioned Scotland and Wales. Both are planning new legislation, but neither is proposing to require councils to meet the eligible needs of carers for support, as our draft Care and Support Bill does. That should be acknowledged. I understand that Wales and Scotland are proposing a discretionary power to provide services to carers. We are taking groundbreaking measures to improve the position of carers. We are providing resources to the Royal College of General Practitioners. In opening the debate, the hon. Member for Worsley and Eccles South referred to GPs in her own constituency and some of the interesting, innovative things they are doing. I accept that this is not widespread enough at the moment, but interesting things are happening around the country, which we should acknowledge. We are providing resources to the voluntary sector as well as to the Royal College of General Practitioners to help increase awareness among health professionals of the importance of supporting carers to identify themselves as such and to direct them to relevant information, advice and support.

Our care and support White Paper, “Caring for our future”, together with the draft Care and Support Bill published in July, set out the Government’s plans for the biggest transformation of care and support in England since 1948.

It is vital that carers are able to take a break from their caring responsibilities. To help support them to do this, the Government have made available an additional £400 million to the NHS between 2011 and 2015 to provide carers with breaks from their caring responsibilities to sustain them in their caring role. Under the White Paper proposals, carers would benefit from a diverse range of supportive personalised interventions. This might take the form of providing additional support for the care user either through respite care or in their own home; it might give the carer the opportunity to take a short break, perhaps a weekend away to see friends; it might mean being free to get a hospital appointment to look after the carer’s own health—a point raised by many hon. Members.

[Liz Kendall]

Will the Minister clarify how we will be able to keep track of the money allocated for respite care? It is often given out nationally but not ring fenced, which can be a problem when it sort of disappears. How will we know where the money is going? Is it going to clinical commissioning groups, for example? How will we keep an eye on it and how will we know that it has been spent effectively?

[Norman Lamb]

The hon. Lady makes a very good point. I remember challenging the Labour Government on similar grounds when I was in opposition. Money had apparently been allocated to primary care trusts to provide carers with support, but nothing ever happened. I made that point as strongly as I could at that time. I will come on to explain how we shall deal with the legitimate point that the hon. Lady raises.

This extra support might mean the carer and the cared-for person taking a day trip together, so they can spend time outside of the confines of the caring relationship. It might also be through a direct payment—pursued under the Labour Government and now developed under this Government—that could be used to buy a laptop so that the carer can keep in touch with family and friends. In all these matters, we need to be as open as possible to the different ways in which the money can be spent.

There are some excellent examples of good practice in the area of carers’ breaks. In Surrey, the new GP carers’ breaks pilot has been running since 1 December 2011. So far, 80% of the 136 practices in Surrey have signed up and over 250 breaks have been provided, with 75% to parent carers. Surrey has been working with Carers UK on the evaluation of the pilot to tie up with its work on the GP carers’ champions project. In Cambridgeshire, Crossroads Care is part of a very good scheme whereby PCT money for supporting carers is used to support a GP prescription service. This is really good, innovative stuff. The GP can simply prescribe a carer a break, send a request to Crossroads, which will quickly contact the carer to discuss what sort of break they would like, and then arrange it. I urge GP practices across the country and the emerging clinical commissioning groups to look at this best practice that is emerging around the country and to implement it in their own areas in a way that suits their own local circumstances. We must do more to spread the best practice that is starting to emerge.

Let me say a few words about the mandate. In July, we published for consultation the first draft mandate for the NHS Commissioning Board. The mandate will be at the heart of the accountability relationship between the Department of Health and the Commissioning Board from April 2013. The draft mandate contains a specific objective: to improve the support that carers receive from the NHS by early identification of carers—that is dealt with in the Bill—by signposting to advice, and by working collaboratively with local authorities and carers’ organisations to enable a range of support to be provided. The consultation on the mandate is currently taking place, and I welcome Members’ engagement in that process.

[Norman Lamb]

Four days into the job I am not entirely sure of the details, but I will ensure that the answer to the hon. Lady’s question is included in the letter to her. I certainly want the process to be as transparent as possible.

The NHS operating framework for 2012-13, published last November, contains stronger requirements for supporting carers, and is more specific about the plans of PCT clusters. Those plans should be in line with the “Recognised, valued and supported: next steps for the Carers” strategy. Plans should be explicitly agreed and signed off both by local authorities and by PCT clusters. Local authorities and PCT clusters should identify the financial contribution for supporting carers. They should identify how much of the total is being spent on carers’ breaks—this deals with the point raised by the shadow Minister—with an indicative number of breaks that could be made available within that funding.

PCTs or PCT clusters should publish their plans on their website by the end of this month, so we shall be able to see which areas are doing the job well and which are failing. Area authorities need to be held to account, whether they are PCT clusters or commissioning groups. People need to know what is available in their areas. A number of PCTs have already put resources into support for carers, significantly enhancing their existing support for them.

The current legal framework for care and support is out of date, complex and confusing. More than a dozen Acts of Parliament relate to adult care and support, and four relate specifically to support for carers. We can imagine how hard it must be for people out there, beyond this place, to understand what their rights might be. People who need care, carers, and even those who manage the system find it difficult to understand how statutes operate and interrelate. That is why one of the overarching objectives of the Government’s draft Care and Support Bill is to consolidate the existing law on care and support into one clear Act, making the law far easier to navigate. Introducing yet another stand-alone Act would only prolong fragmentation and militate against the thrust of the draft Care and Support Bill, which is to consolidate provision for carers in Government legislation. That point has been made by my hon. Friend the Member for Banbury (Sir Tony Baldry).

As I said earlier, the Government’s Bill has been published for pre-legislative scrutiny, which we expect to begin later in the autumn. We should view that process as an opportunity to explore how we can make legislation fit to support carers in the 21st century.

I am afraid I must disagree with the assertion by the hon. Member for Worsley and Eccles South that her Bill will be cost-neutral. Placing new duties on public and private sector bodies inevitably involves cost. New processes must be developed and operated, and will surely be a potential drain on the already tight social care, NHS and education budgets. That goes against the Government's commitment to reduce the overall regulatory burden. Inevitably, organisations confronted with a new legal duty must establish processes enabling them to demonstrate, when challenged, that they are observing it, and that means costly bureaucratic processes. As other Members have pointed out, it is much better to ensure that the money is being spent on the front line. We are committed to spending significant amounts on carers in the coming years, and we should be spending that money on supporting people, not on expanding bureaucracy.

[Liz Kendall]

The Minister seemed to be coming to the end of his speech, but I hope he is going to reply to my question about whether the quad has agreed to fund Andrew Dilnot’s recommendations, as has been reported over the summer.