A and E and Ambulance Services

Paul Burstow Excerpts

Thursday 18th December 2014 Commons Chamber

[Martin Horwood (Cheltenham) (LD)]

rose—

[Paul Burstow (Sutton and Cheam) (LD)]

rose—

[Mr Speaker]

An absolutely delicious intellectual beauty parade. Mr Martin Horwood.

[Mr Hunt]

The hon. Gentleman is absolutely right to make that point. There has been a lot of support for the NHS today from Liberal Democrats. If they are ever considering which is the best partner to back the NHS at any hypothetical time in the future, they should know that there is only one party that can provide the strong economy to fund a strong NHS.

[Paul Burstow]

My compliments of the season to you, Mr Speaker.

May I draw attention to the fact that people with mental health problems have double the attendance rates in accident and emergency departments compared with the general population? Given that fact, is it not strange that successive Governments have not invested in the evidence? If we invest in liaison psychiatry, we can reduce the numbers needing to go to A and E and give them better results as well. Is it not time that this Government did that and did it even more than they are planning to do?

[Mr Hunt]

Yes, my right hon. Friend is absolutely right. I can reassure him that we are investing more in liaison psychiatry both this year and next year. The Minister of State, my right hon. Friend the Member for North Norfolk (Norman Lamb), has particularly championed that, as it is a very good way in which to reduce pressure on A and E departments.

NHS (Five Year Forward View)

Paul Burstow Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

I am always happy to confirm that a Guardian story is wrong. Let me tell the hon. Gentleman that there was no plan to downgrade the majority of A and Es. The plan is to invest in A and Es—to continue with broadly the same number of A and Es as we currently have but to recognise that some of them will need to specialise in different things. We will stick to that plan—it is a good one.

[Paul Burstow (Sutton and Cheam) (LD)]

I very much welcome the statement and, in particular, the Secretary of State’s ambition that Britain should become the best place in the world to grow old in. Given that home care is an essential part of maintaining frail older people and enabling them to remain in their own homes, and given that well-paid, well-trained and well-motivated home care staff enable people to stay in their own homes and families to juggle work with caring responsibilities, will he direct some of the extra £2 billion to the better care fund, so that it goes directly into social care so that these services can actually be provided?

[Mr Hunt]

First, I agree with the point that my right hon. Friend is making: home care is going to become an increasingly important part of what the NHS and social care systems deliver. I want them to deliver it in an integrated, joined-up way, and £200 million of the £1.7 billion going to the NHS front line is to help develop new models of care. I think that improved home care could be a very real way we do that.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 25th November 2014 Commons Chamber

[Norman Lamb]

Over the past decade and a half, there has been a very substantial reduction in bed numbers, and it is a trend that we should thoroughly support because we want to move away from institutional care towards supporting people at home in their communities. With children’s mental health, we have invested an extra £7 million this year to ensure that children get access to beds close to home when they need them.

[Paul Burstow (Sutton and Cheam) (LD)]

Will the Minister ensure that the taskforce he mentioned considers the evidence that one in five mothers suffers from mental health problems during pregnancy or within a year of giving birth because the costs of that to society are massive and three quarters of those costs are borne by the child and subsequent generations? Is it not time to make sure that we focus on perinatal mental health because it can make such a big difference?

[Norman Lamb]

I very much agree with my right hon. Friend. Accompanied by my hon. Friend the Member for Torbay (Mr Sanders), I visited a brilliant perinatal mental health service in Torbay recently. My right hon. Friend is absolutely right. The London School of Economics has done a lot of work, showing evidence that if we invest in perinatal mental health, we get a return on the investment, but most importantly, we change people’s lives. I am determined to pursue that.

Care Workers

Paul Burstow Excerpts

Wednesday 5th November 2014 Westminster Hall

[Paul Burstow (Sutton and Cheam) (LD)]

I congratulate the right hon. Member for Oxford East (Mr Smith) on securing the debate, and on the fact that he has pursued the matters in question for some time now, making progress in his own patch by raising them here and, I am sure, back in Oxfordshire. I agree with a lot of his remarks and want to underscore some of the points that he made, but I also want to draw out some opportunities to make progress with this terrible, thorny and long stuck-in-the-mud issue.

The Government published a White Paper in 2012, which acknowledged in stark terms the contracting practice that turns care workers into clock-watchers and that sees their function as purely a transaction in which they turn up, perform a set of tasks and leave—with far too little time given to them even for that. The White Paper made it clear that such commissioning practice had to end. We now have the vehicle by which that can happen. Parliament passed the Care Act 2014, which broadly speaking was supported by all parties. Recently—I am sure that the Minister will expand on this later—guidance covering the matter was issued for local authorities. I want to dwell briefly on that first. It is important to remind the House of it today, and to show how assurance checks will be applied to it, to ensure that it bites on what local authorities do.

The guidance states:

“When commissioning services, local authorities should assure themselves and have evidence that contract terms, conditions and fee levels for care and support services are appropriate to provide the delivery of the agreed care packages with agreed quality of care, that will not undermine the wellbeing of people who receive care and support, or compromise the service provider’s ability to meet the statutory obligations to pay at least minimum wages and provide effective training and development of staff.”

Everything that the right hon. Member for Oxford East has called for is encapsulated in that guidance statement, but how will local authorities assure themselves that it happens? Clearly, part of the answer is what they put in the contract, and part must be their contract monitoring. Another part is the local authority’s proactive role to assure itself and its citizens that the national minimum wage, at least, is being paid.

[Helen Jones (Warrington North) (Lab)]

Does the right hon. Gentleman remember supporting a Local Government Finance Bill that imposed the most draconian cuts on authorities whose populations were most in need of care? If he wants all this to happen, the finance must follow through.

[Paul Burstow]

I will come to finance, but I hope that when we have contributions from Front Benchers there will be some indication of commitments for the future and of what has been done so far. For many years under the previous and current Administrations, local government settlements have left local authorities in a difficult position when funding social care. No one disputes that, but we should be honest about the fact that that problem did not start in 2010, although the incoming Administration had quite a bit of difficulty in dealing with the deficit.

I want to draw attention to 15-minute contracts, which are another aspect of this debate that relates to the guidance. During the passage of the Care Bill, hon. Members on both sides of the House, particularly in the Public Bill Committee, were very clear with Ministers that we expected the guidance to be clear on that point, as it is. It says:

“For example, short home-care visits of 15 minutes or less would not routinely be appropriate for people with intimate care needs”,

and goes on to list what that would mean in practice. I hope that the Minister will explain how he intends to ensure that local authorities are both supported and encouraged to ensure that the guidance is put in place.

I wanted to speak in this debate because at a constituency surgery about a month ago, a home care worker came to see me wanting to talk through what was happening to them and the people they worked with concerning their time sheets and pay. They have to pay for work-related calls on their own mobile phone, and for fuel in the car that the organisation provides. That might be thought to be a good thing, but I was told that the care workers have to take the car to be MOT-ed, and if it fails they are encouraged to drive it without. There is some pretty shoddy practice going on, and care workers are at the front.

The right hon. Member for Oxford East was right to highlight the issue of flu jabs, and I hope the Minister will say what is intended. The guidance is clear: health and social care workers should have access to the jab, but if it is not provided free to social care workers, it is likely that it will not be widely taken up.

[Mr David Anderson (Blaydon) (Lab)]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will give way, but I am conscious that I must keep my remarks short so that other hon. Members may speak.

[Mr Anderson]

The right hon. Gentleman was a Minister. Does he agree that it is wrong if people are not paid when travelling from one workplace to another?

[Paul Burstow]

A whole set of practices, of which that is one, result in people being paid less than the national minimum wage. That is why I wrote what I did very clearly in the White Paper on care and support and why, since leaving the Government, I have supported steps to have the guidance in place. I want to hear the Minister say in his response how that guidance will get traction on the ground in how local authorities behave.

The matter is important because we know that the care sector has among the highest rates of staff turnover of any part of our economy: 30% in some parts, and up to 19% to 20% in the care home sector. In the past 12 months, I have engaged with people from across the residential care sector while working with the think-tank Demos and looking at what we can do to address the issues that the right hon. Member for Oxford East has talked about. Domiciliary care workers are all too often hard done by, but we should not ignore those who work in residential care settings and are often paid barely above or even below the national minimum wage.

That is why we need HMRC to continue to engage proactively in this area and why I support the proposition that third parties, such as Citizens Advice, should be able to make referrals to HMRC so that it can trigger investigations when necessary. It is important to call out those who breach their obligations under the national minimum wage. When there is clear evidence that bad commissioning practices are making that happen, the Care Quality Commission should call out the chief inspector for those failures. I hope that Ministers will look at the powers available to allow inspections of local authorities in that regard.

We also need to pick up on the right hon. Gentleman’s point about how to raise public esteem for this work force. They have a deeply trusted role, even if the public are often sceptical because of the stories they hear. The role is important and responsible, and we do not properly honour and reflect that. That is why, in December, the Local Government Information Unit will publish further work looking at those issues and at what we can do to turn what is often seen as a temporary job into a permanent career with opportunities rather than one that goes nowhere, which is all too often how the sector is seen and treated.

There is an economic case for that, apart from the strong moral case that the right hon. Gentleman made. We have a generation in their 50s who are squeezed between caring responsibilities for their parents and their children. At the same time, they are expected to work and need to do so. We often stretch them beyond breaking point, and many leave the workplace. Supporting family carers more effectively and having reliable, cost-effective home care services is the right thing to do by them and by our economy. We recognise that in child care, but we have not recognised it in elder care. We now need to do so and to ensure that people want to work in the sector and see a future in it.

My final comments are about transparency. In my Demos work on the future of residential care, I and my fellow commissioners have said that several things need to happen. We need transparency in the way in which providers operate. There should be open-book accounting so we can see transparently how they are behaving in practice. We also need transparency in the CQC to provide clarity on the rates for care. There should be clear rates. The United Kingdom Homecare Association has produced a formula on its website, and it would be good if local authorities adopted it.

We also need more honesty about the long-term funding of the system, which is why we need the Office for Budget Responsibility to be given a new mandate for reporting on that so that there is more transparency and accountability in this place and we can hold Ministers to account on whether they are properly funding the sector.

[Dr Alan Whitehead (Southampton, Test) (Lab)]

During the right hon. Gentleman’s term as a Minister or in his work with Demos, has he reflected on the fact that reports have suggested that more than 1 million social care workers will be needed by 2025 to deal with increasing age and disability? Has he reflected on the impossibility of that goal being reached if the practices that we have heard about this morning continue—the turnover and loss of people in the sector and the inability to recruit people into it in future?

[Paul Burstow]

Yes and yes, which is why I made the point about the economic imperative and why we need to see the sector as an essential part of our economic infrastructure.

I wondered which Minister would respond to the debate. We tend to think of the matter as being about care, but it is also about the economy. It would be great to have Ministers from the Department for Business, Innovation and Skills engaged with the issue, given their responsibilities for the national minimum wage. It is a shame that BIS Ministers do not engage with the sector as much as they should to ensure that it develops as necessary, not least in terms of skills. The national minimum wage is where to start, but we must aspire to more. Demos’s work suggests that we need to move the sector to a living wage, which would mean real benefits for providers because it would drive down staff turnover, which would reduce the frictional cost of employing new people. That would be a saving for businesses and would reduce absenteeism. A study in London, where the living wage is being progressively introduced, estimated a 25% reduction in absenteeism, so there are real benefits to employers paying above the national minimum wage and actually paying a living wage.

For all those reasons, I welcome the debate. It is important, but it is also about recognising the overall quantum of funding going into adult social care—the hon. Member for Warrington North (Helen Jones) is absolutely right about that. I look forward to the Labour Front-Bench spokesman setting out what Labour’s spending plans are. We have heard about the plans for the health service, and the right hon. Member for Oxford East is right; we tend to talk about the health service and neglect social care. I hope that the shadow Minister will not neglect social care and will say what, within Labour’s spending plans, will deal with the funding issues in social care too.

[Several hon. Members]

rose—

--- Later in debate ---

[Liz Kendall]

My hon. Friend is absolutely right. I was going to come to that point. If someone is on a zero-hours contract, they will be too terrified to tell their employer that they are not paying the minimum wage. I am not yet convinced that the Minister is working closely enough with Ministers in the Department for Business, Innovation and Skills. According to an answer to a written question from my hon. Friend the Member for Stockton North (Alex Cunningham), the Minister has had just one meeting all year with BIS to discuss underpayment of the national minimum wage in the care sector. That is not good enough. We need more action.

Several of my right hon. and hon. Friends rightly said that £3.5 billion has been cut from local council adult social care budgets. Within that context, the pressures are building.

[Paul Burstow]

The hon. Lady and her Front-Bench colleagues want to convey the impression that in seven months’ time they will be in government and therefore making decisions about the allocation of resources for adult social care. Will she share her thinking?

[Liz Kendall]

I will, and I will come on to the extra money that we have committed to putting into health and social care. We are committed to a £2.5 billion transformation fund that will cover both the NHS and social care, and that includes money to pay for 5,000 home care workers. So we have said what we will do in addition to the ring-fenced money to try to kick-start the services in the community that patients and taxpayers need.

We have put care issues and exploitation in the care sector at the heart of our agenda. Baroness Denise Kingsmill conducted an excellent review for us on exploitation in the care sector. I encourage all Members to read it if they have not had a chance to do so already. She has set out tough, credible and realistic proposals, including on how to properly enforce the minimum wage, ban exploitative zero-hours contracts and end inappropriate 15-minute visits. She has called for better training for care workers and also for managers of care providers—that is essential—as well as support for ethical care charters such as that which Unison has promoted.

I want to say a little about what I saw yesterday, which was an inspiring example of a Labour council in Islington putting ethical care into practice. Yesterday I helped to launch and celebrate its new home care service contracts. Those will ensure that all home care staff are paid the London living wage—£8.80 an hour now, rising to £9.15 in January—including for travel time. Exploitative zero-hours contracts have been banned, and people are guaranteed a minimum of 16 hours a week.

The council is also giving far more say to the users of services so that they can decide how and when their hours of care will be provided, and, unless they specifically request a 15-minute visit, such visits will be ended, too. The changes to the contracts will benefit more than 500 home care workers, 9 out of 10 of whom are women. I met one yesterday, called Mary. When I talked to her about the difference the changes will make, she said, “It might not sound a lot for some people, but it means I can pay for my kids’ school lunches and make sure they have a decent hot meal in the evenings.” The changes will also benefit the 900 people whom the home care workers care for.

A Labour Government will back the actions of councils such as the Labour council in Islington. We will increase the fines for non-payment of the minimum wage to £50,000. We will champion the payment of the living wage through “make work pay” contracts, which give a tax break of up to £1,000 per worker to every company that signs up to the living wage. We will end the exploitative use of zero-hours contracts, too. As part of our £2.5 billion transformation fund, we will provide extra funding to support changes in the community and the services provided there, including 5,000 more home care workers.

I will end on a point that Islington council made. The changes cost the council more, but we have to think about the cost of not doing it: the cost to the NHS of avoidable emergency admissions and delayed discharges, and the cost to the taxpayer of people having to have their pay topped up when they want to be earning a decent living wage. There is a different way. Islington has shown the way. We will back its efforts and make sure we have a decent care system for those who work in it, those who use it, and all the families that rely on it.

Ovarian Cancer (Gene Testing)

Paul Burstow Excerpts

Tuesday 4th November 2014 Westminster Hall

[Ms Ritchie]

I thank the hon. Gentleman for his intervention. I agree that early diagnosis of ovarian cancer is the key for women.

UK survival rates for ovarian cancer are among the lowest in western Europe, with one woman dying every two hours from the disease. Sadly, according to the Department of Health in Northern Ireland, survival rates for the cancer have not improved significantly since the early 1990s. Dr Miriam McCarthy of the Public Health Agency in Northern Ireland pointed out at a recent hearing in Stormont that the northern European and Scandinavian countries have five-year survival rates above 40%, so we could clearly do more to combat the cancer.

Anybody who has personal or familial experience of this dreadful illness knows the devastating impact it has. In Northern Ireland, a lady called Una Crudden courageously documented her fight with the disease and inspired many others to do the same. I know of a young lady, a teacher in my constituency called Oonagh Carson, who died last year shortly after diagnosis, which took her a long time to get.

[Paul Burstow (Sutton and Cheam) (LD)]

I congratulate the hon. Lady on securing this debate. My aunt died of ovarian cancer some years ago.

One of the areas that I am sure the hon. Lady wants to highlight is the role of genetic testing for ovarian cancer and the BRCA gene. Is she aware of the work that is being led by the Institute of Cancer Research in conjunction with the Royal Marsden on mainstreaming genetic testing in this area? That programme has already produced a free-to-access pathway that has already enabled 200 women to be tested and could be rolled out to other hospitals. It has been shown not to cost any more, but it can save many lives.

[Ms Ritchie]

I thank the right hon. Gentleman for his useful intervention, which highlights the need for genetic testing and the good pilot work that is being done at the Royal Marsden. It is a pity that that work cannot be rolled out in England, Northern Ireland and Wales. We must not forget that such work has already been executed in Scotland.

By better informing the public and GPs and implementing modern genetic testing techniques we can prevent many more women and their families having to live through the trauma of ovarian cancer. I want to focus on genetic testing techniques that have become available and will have a key role in the battle against this dreadful disease. Genetic techniques have rapidly moved out of the realms of science fiction and are having a significant impact on the way we approach and treat illnesses. Without overstating scientific advances and promising miracle cures, we have a responsibility to utilise those groundbreaking new techniques in everyday medicine. As we learn more about the genetic basis for diseases and certain cancers, this becomes not only a medical issue but an issue for society as whole.

There is an onus to manage and develop new information in a responsible, morally sound way that informs people, rather than distressing or panicking them. The public have been made more aware of those techniques by high-profile figures telling their stories. For example, Angelina Jolie has spoken about the tragic death of her mother from ovarian cancer and her decision to have preventive surgery. Mainstream awareness can only be a good thing, but we must harness it positively to empower women to make informed choices about their treatment. Speaking about her experience of genetic testing and of dealing with the illness, Angelina Jolie said:

“Wherever I go, usually I run into women and we talk about health issues, women’s issues, breast cancer, ovarian cancer. I’ve talked to men about their daughters’ and wives’ health. It makes me feel closer to other people who deal with the same things and have either lost their parents or are considering surgeries or wondering about their children.”

In the same way, women in Northern Ireland and elsewhere in the UK who have or are at risk of the disease are desperate to have access to the information that advanced genetic testing can reveal. The genetic testing normally involves having a sample of blood or tissue taken. The sample will contain cells containing DNA, which can be tested to find out whether someone is carrying a particular mutation and is at risk of developing a particular condition or illness.

Specifically, BRCA1/2 gene testing, which was referred to by the hon. Member for Strangford (Jim Shannon), has emerged as the leading genetic test related to ovarian cancer. We all have these genes, but a mutation on them can increase the risk of developing ovarian cancer from one in 54 to approximately one in two. Evidence shows that one in five women with non-mucinous epithelial ovarian cancer, which accounts for 70% of all cases, carries the BRCA1 or BRCA2 mutation, which dramatically increases their risk of developing the disease. The BRCA gene test at a time of diagnosis offers patients the best guidance for their treatment and should be a matter of priority to ensure that the optimal treatment pathway is selected, whether that is drugs or preventive surgery.

Critically, a BRCA test at a time of diagnosis can change the management of their treatment and save the lives of relatives, who can also be guided toward taking the test. Women in possession of this knowledge are able to make better decisions on their own treatment, as can their close relatives. They can make better informed decisions on surgical and drug treatment options. Indeed, the presence of the mutation points to a form of the disease that responds better to PARP inhibitor drugs, such as the new drug Olaparib, on which the European Commission is considering a recommendation for approval. Dr Sadaf Ghaem-Maghami, senior lecturer and honorary consultant in gynaecological oncology at Hammersmith hospital in London, has stated:

“PARP inhibitors are more effective at killing cancer cells and shrinking tumours in patients with BRCA 1/2 than those without. They are particularly important for BRCA1/2 patients who have a recurrence of ovarian cancer, and for whom there might not be many options.”

In short, I contend that it is clear that we need to implement a system across the UK and Northern Ireland where women diagnosed with ovarian cancer automatically receive a BRCA gene test and have the option for close relatives to take that test as well. I have no doubt that that would save lives and put women in a position where they can make decisions based on all the available scientific evidence. What is the Minister’s position on that?

On cost and commissioning, such techniques have unfortunately not received the attention or funding they deserve from NHS commissioners or the Department of Health in England and Wales or the Department of Health, Social Services and Public Safety in Northern Ireland. Despite qualifying under National Institute for Health and Care Excellence guidelines and despite the introduction of mandatory testing in Scotland, the tests are not uniformly available across the UK. It is also evident that clinicians and practitioners in Northern Ireland and England are unclear who is responsible for commissioning BRCA testing. Can the Minster provide clarification on those arrangements and confirm that testing qualifies under NICE guidelines?

BRCA testing has been highly selective and based largely on family history, which risks missing out on three out of four people with the gene, according to the charity Ovarian Cancer Action, which I commend on its work. It published a report some time ago and has been at the forefront of this campaign. It argues that all women with non-mucinous epithelial ovarian cancer should be considered for the test on diagnosis. It should be clarified and reiterated that the procedure is already in place in Scotland. Trials at the Royal Marsden hospital, which were referred to by the right hon. Member for Sutton and Cheam (Paul Burstow), show that such testing could be extended in a cost-effective manner to England, Wales and Northern Ireland.

[Paul Burstow]

The hon. Lady is absolutely right to emphasise that point. The research evidence shows that productivity is increased by doing the testing as part of an oncology appointment, rather than as something separate. The trials are delivering that in a way that is not costing the NHS more, and it is having huge benefits.

[Ms Ritchie]

I totally agree with the right hon. Gentleman. It is estimated that a BRCA1/2 gene test for someone already diagnosed with ovarian cancer costs the NHS between £600 and £850. Associated counselling can cost between £250 and £500. Together, that can amount to approximately £1,000 a patient. Some 15% to 20% of those tested are likely to receive a result that shows they have the gene mutation. There are likely to be additional costs for resulting tests on close family members, but the early diagnosis and treatment of those individuals will be especially beneficial. The evidence shows that BRCA gene testing is cost-effective in other countries. Modelling conducted in association with NICE guidelines on familial testing suggested that BRCA1/2 gene testing versus no gene testing was particularly cost-effective in women aged 35 to 55.

In conclusion, this disease is one of the most prominent threats to women’s health. It is particularly difficult to diagnose and treat early, and it is obviously devastating and very sad for sufferers and their families, but we are on the cusp of being able to treat it more effectively. Through the introduction and implementation of genetic testing on diagnosis, we can make a significant impact on survival rates and familial guidance. Will the Minister inform us what the Department’s position is on automatic BRCA gene testing for women diagnosed with ovarian cancer? What discussions has she had with NHS Scotland about its existing programme? What discussions does she plan to have with counterparts in Northern Ireland and Wales about such measures? It would be welcome if she could provide clarification on who is responsible for implementing BRCA testing, as there is a degree of confusion over the current arrangements.

In bringing forward modern genetic testing techniques, we can improve survival rates for this terrible and sad illness and put us, as women, in a more empowered position where we can make the best informed decisions on our treatment and the well-being of our close relatives. I look forward to the Minister’s response to the various issues I have outlined.

Five Year Forward View

Paul Burstow Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I welcome the hon. Lady to her place. This report says something with which this Government very strongly agree, which is that we need to reverse the shift that there has been over many decades of investment away from community care towards hospital care. It is really important that we focus on the role of GPs. We do not want to force all GPs to become employees of hospitals, but we would like to back them, so we have brought back personal responsibility for GPs for every single NHS patient as an important first step in that direction.

[Paul Burstow (Sutton and Cheam) (LD)]

This is an important report, which must not turn into another political football. We should focus on what it says and make that the basis for a real debate about our NHS. There are 23 references in this report to mental health. Parity of esteem is an established idea, but it has not yet been incorporated into NHS practice, so we still have further to go. Does the Secretary of State agree that another area in which we need to go further is perinatal mental health, where the cost to society, to mothers and to generations runs into billions? If the NHS could do a bit more in that regard, it would make a big difference.

[Mr Hunt]

My right hon. Friend is absolutely right. We know that perinatal mental health problems have a big impact on the child as well as on the mother. This report says that we must stop looking at conditions such as mental health as separate to physical health conditions. We need to look at people’s whole condition in the round. If we start to do that, we will make the NHS sustainable by making the kind of investments that will bring down the overall cost of treatments. Putting mental health centre-stage in that approach will be an important part of our strategy.

Oral Hormone Pregnancy Tests

Paul Burstow Excerpts

Thursday 23rd October 2014 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I congratulate the hon. Member for Bolton South East (Yasmin Qureshi) on securing this Back-Bench business debate, which is a great example of such debates being used purposefully to pursue a passionate commitment of a Back Bencher. I also congratulate all the hon. Members who have applied for this debate and participated in it on the basis of constituency experience. What has emerged palpably is a deep sense of injustice, and Nichola’s story, mentioned by the hon. Lady, is telling in that sense. These families’ lives have been marred by a sense of not knowing, of grief and, in some cases, of guilt, as was mentioned by the hon. Member for Aberconwy (Guto Bebb). Clearly, there is a strong belief that oral hormone pregnancy tests—primodos and others—taken between 1953 and 1975 did lead to children born with serious deformities.

It has been interesting to hear the evidence that has been gradually ferreted out of the system. It has been reluctantly given but persistently chased by those who believe that a deep injustice has been done. Some of the material that has come to light from the national archive as the relevant periods of time have elapsed demonstrates that. The hon. Member for Enfield North (Nick de Bois) and others have cited it, but it is worth saying that the director of the Medical Research Council—that is who this person was, so we are not talking about a small, insignificant organisation—said in June 1967:

“It looks as if this could be another thalidomide story”.

That should have rung alarm bells at the time, and it raises questions as to why if the bells did ring, they did not get heard and why the necessary steps were not taken for a considerable time after that.

It is interesting to look at this April’s report by the Medicines and Healthcare Products Regulatory Agency. Although it acknowledges that a number of the studies do identify concerns about an association between hormone pregnancy tests and abnormalities in children, it goes on to dismiss them, and that is a cause for concern. I was struck by the fact that the Committee on Safety of Medicines in the 1970s—the independent body that advised at the time—did advise on the safety of these drugs, albeit slower than many others when it did so. It advised that pregnant women should not be using these drugs. We have heard compellingly about how other countries acted sooner, presumably on the basis of the same evidence, and it behoves us to try to understand why we did not act sooner. We know from freedom of information requests that the MHRA did write to doctors in the 1970s—in 1975—warning GPs of its concerns about the congenital defects.

The MHRA made it clear that primodos was not licensed as a pregnancy drug from the early 1970s, so it was being prescribed off licence. If we look at the current codes of conduct within the General Medical Council about prescribing off-licence drugs, it is very clear what needs to be done. Extra obligations are placed on those prescribing, and I cannot believe that those obligations did not and should not have applied in the 1970s. That alone warrants this panel having a chance to ask questions. Thousands of prescriptions were still issued right through to 1977 despite the warnings and those extra obligations on doctors when they prescribed off-licence drugs.

In April, the review of the 36 studies that have been undertaken concluded, rather disappointingly, that the evidence was inconsistent and not sufficient to reach a conclusion. I cannot help feeling that there is something missing from the MHRA’s work. Indeed it says itself that something was missing. All it could rely on was the available published evidence. My question today is: what about the unpublished evidence—the evidence that sits in the vaults of the companies that manufactured the drug? I hope that, as an act of good faith, those companies that protest their innocence in all of this are now prepared to put into the public domain and fully disclose all of their information about trials, so that that can be taken into account as well.

The motion that has been tabled today is perfectly reasonable—some might say almost too reasonable—in what it is asking for. It is not an unreasonable request of the Government to have a panel to examine the evidence and to look at what is in the national archives, the MHRA files and the Department. I hope that Bayer, the pharmaceutical company that owns Schering, which manufactured the drug, co-operates as well. This is about learning lessons, ensuring that these things cannot possibly happen again and shining a light on to a very dark period in our medical history and understanding that even things that happened a long time ago continue to have real consequences in people’s lives today. Although I fear that action will not bring closure, we should at least take it because it might, and I hope that the Government will listen to the representations that have been made today, because the case for a review is compelling.

Hospital Car Parking Charges

Paul Burstow Excerpts

Monday 1st September 2014 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

To pick up the last point made by the hon. Member for Bolton South East (Yasmin Qureshi) about perhaps abolishing such charges outright, later this week the King’s Fund will publish the conclusions of the Barker commission. It is looking at several questions about the future of our health and social care system, and I am sure that it will say things about charging issues and how we pay for parking. It seems to me that such questions must be looked at in the round, and in the context of the overall resources available to the NHS, by asking how to make the best use of those resources to deliver the best possible outcome for patients.

I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on bringing this matter to the House, as she is absolutely right to do. Hard-working families face difficulties because of the inconsistent way in which different NHS trusts go about applying their policies, and it is right to highlight those that chose to see car parking as another cash cow at the expense of their patients. Hon. Members have spoken about the issue of the PFI and how it further complicates the picture—indeed, it ties the hands of NHS trusts—which is an incredibly important point. The Government need to do more to deal with the mess around PFI so that these things can be sorted out.

[Roger Williams (Brecon and Radnorshire) (LD)]

My right hon. Friend will know that hospital parking in Wales is free, but many of my constituents go to Hereford county hospital, which is a PFI hospital. A radiotherapy facility has just been opened there, but that fact is dampened by my constituents having to pay large parking fees.

[Paul Burstow]

Other Members have already quite rightly intervened to point out how exceptionally high and punitive car parking charges are in that area. If this debate does nothing else, I hope that it make that trust understand that it needs to look to its laurels, review its parking policies and perhaps introduce fairer charging for the future.

That matter relates to why I wanted to talk about what has been going on in my own patch. Back in 2010, the consumer organisation Which? published a study highlighting my local trust as a particularly bad one, including as one that was quite willing to use clamping regularly as a way to enforce its charging policies. I am pleased to tell the House—this is a model of what others could and should be doing—that the work by Which? spurred my Epsom and St Helier University Hospitals NHS Trust into action: it undertook a review, which involved its patients and carers, and its policy now reflects much of the good practice that we have already heard about in this debate. There is a discounted rate of £5 a week for out-patients who visit three or more times a week, those who are going in for dialysis, cancer patients who visit two or more times a week, cardiac rehabilitation patients and immediate family members of patients receiving intensive care or high dependency coronary or neonatal care. In other words, there is an effective policy that makes it affordable for people to visit their loved ones or to get the treatment that they need. More parking for disabled people also came out of the process. There is also a recognition that some people do not want to stay for long, but want to drop someone off or pick someone up. The trust has therefore introduced more short-stay dropping-off places. If the trust delivers an appointment an hour or more late, the parking fee is refunded. Those are the sorts of policies that other trusts could copy.

It is clear from the work published by Macmillan and others that too many trusts are not even following the guidance, let alone striving to be leaders in the field or to follow best practice. As the Care Quality Commission rolls out and refines its inspection regime for hospitals, it could do more in this area. Perhaps the Minister could ask the chief inspector of hospitals to ensure that car park charging policies are examined. For hospitals that are striving not just to pass muster in inspections, but to be leaders in their field, this is another area in which they could do so.

Finally, concessions and discounts are only part of the solution. They are only as good as the publicity about them and the public awareness of their existence. It is difficult for people to access something that they do not know exists. It is therefore important to ensure that there is information at the point of use so that people do not wind up paying more than they need to. Will the Minister look at the idea that I and others have put forward recently of a carer’s passport? Some hospital trusts already have it. It is about actively identifying more carers so that they and their families can benefit from concession and discount rates, as well as other facilities to support and ease the burden on family carers.

The hon. Member for Thurrock and her colleagues who secured this debate are absolutely right that punitive car parking charges and car parking being seen as a cash cow within the NHS cannot be acceptable, as Members on both sides of the House—judging by what has been said so far—are clearly indicating. I hope that in responding to the debate, the Minister will ensure that the NHS gets that message and changes in the ways that hon. Members are suggesting.

Care Home Top-up Fees

Paul Burstow Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Paul Burstow (Sutton and Cheam) (LD)]

It is a pleasure to have the opportunity under your chairmanship, Mr Sanders, to debate an issue that is of growing importance and will increasingly find its way into the mailbags of hon. Members on both sides of the House. The issue is how much people pay for care in the 10,000 or more care homes up and down England and, in particular, whether the top-up payments that some residents and their relatives make to secure care home accommodation are fair and transparent. With the Department currently consulting on draft guidance for the Care Act 2014, this is a good time to turn the spotlight on these issues.

The legal framework setting out what local authorities need to do when a resident who qualifies for means-tested support enters a care home has been fairly clear for a long time. The “Charging for Residential Accommodation Guide” and the 2004 choice of accommodation directions are straightforward, at least in so far as they clarify that, if local authority-supported residents would like to move into more expensive accommodation—for example, they might want to secure a place in a home nearer their family—they can, provided that a third party, normally a relative, can pay a top-up payment, make that choice. The rules are also clear that if, for whatever reason, no care home places can be provided at the rate that the local authority would normally pay, it is the responsibility of the council, not the resident or their relatives, to pay more to secure reasonable care home accommodation.

The rules are clear. The trouble is that evidence is mounting that they are being broken. Local authorities are confused about how to apply the rules consistently, so that families can be informed about the rules on choice and choose more expensive accommodation, knowing that that will involve additional costs, while at the same time being protected from paying a top-up payment for essential care that it is the council’s responsibility to pay for and meet.

An estimated 54,000 local authority-funded adults are part-paying their care home fees. That is 28% paying top-up fees. Just over one in 10 of all care home placements involve someone paying a top-up fee.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I congratulate the right hon. Gentleman on securing the debate, because up and down the country and certainly in my constituency of Huddersfield, there is real concern about this issue. Does he agree with the finding of a recent survey that many councils do not know what is going on? It is not that it is malign; they just do not know what is going on.

[Paul Burstow]

That is really the thrust of this debate. Whether it is malign or not, it is ignorance, and when it comes to a local authority, that ignorance is not acceptable.

The problem is that the people I am talking about are often out of sight and out of mind. We do not know how many of the 54,000 people who pay a top-up know that a top-up is intended to allow relatives to pay a little extra for a care home place that is above and beyond the “standard” level available from the council. We do not know how many of the 54,000 people know that their council or care home should not be requesting a top-up for any care; it should request it only for a higher standard of accommodation.

Based on the evidence that I have seen, I believe that we need to examine whether the rules governing choice and charging for residential accommodation are working as intended and that we need to look again at what we can do to clarify local authorities’ responsibilities now that the legal framework is being strengthened by the Care Act. We need to get this right because top-ups look set to grow in number, not least with 35,000 more care home residents qualifying for some level of means-tested support when the upper capital threshold is increased to £118,000 from 2016. It is in councils’ interests to get it right because, again thanks to the Care Act, there will be a new appeals process for each local authority. Unless the often grey area of top-ups is sorted out, it is likely that a growing number of residents will be challenging the decisions that councils have made about care home fees. Councils can take steps to minimise the risk of legal challenges, but they need the Government to provide clear and practical guidance on what they are required to do and, crucially, what they cannot do.

[Mr Sheerman]

Will the right hon. Gentleman give way, just on that point?

[Paul Burstow]

I cannot because—

[Mr Sheerman]

May I intervene very quickly just on that point, because it is very important?

[Mr Adrian Sanders (in the Chair)]

Order. It is for the Member who secured the debate to give way.

[Paul Burstow]

I will give way, but I need to stress to the hon. Gentleman that this is a half-hour debate and I need to make quite a few points myself.

[Mr Sheerman]

I was trying to intervene on this point only because it means so much to some of my constituents. Some of them have said that the trade association for care homes, which is a very powerful one, should have a charter of rights. As someone goes into a home, it should be there and should show the clear responsibilities and clear duties of care.

[Paul Burstow]

That is a very good point and one that I am sure Care England and other organisations representing care homes would want to take on board.

It is important to understand the scale of the problem. Research carried out last year by the charity Independent Age highlighted the fact that 72% of local authorities—there was a very high response rate to this freedom of information request—were unable to demonstrate that they met their legal obligations with an overview of top-up payments in their area. In other words, they were not routinely monitoring and reviewing whether third parties remained “able and willing” to make top-up payments. That is a core requirement of the existing guidance. The onus is on councils to check that families are not unwittingly making top-up payments for care that should be paid for and met by the council as part of its duties to meet assessed, eligible needs. Those payments can range anywhere from £31 a week to perhaps £131 a week. In some cases, it is probably even higher than that.

The research also found that just under 30% of councils said that they did not hold or collect information about top-up fees in their area. This was a typical quote from a council:

“As a Council we’ve never had any involvement in top-up care home fees...The Council does not know how many top-ups are in place, in any financial year”.

Perhaps most disturbing was that so few councils knew what was taking place in terms of top-up fees arranged between care homes and families in their area. Almost 80% of councils did not routinely check up on the health of top-up payments as part of their annual reviews, and 75% of councils did not signpost families of care home residents to independent advice before entering into third party top-up agreements.

[Mr David Ward (Bradford East) (LD)]

Will the right hon. Gentleman give way, just for two seconds?

[Paul Burstow]

It will have to be two seconds.

[Mr Ward]

Very few Members are present at the debate. What we are discussing is an enormous problem. Why do so many people not know about it? It is such a serious problem, yet that is not reflected in the number of Members here today. Why do people not know about it?

[Paul Burstow]

I hope that this debate will help with that. The hon. Member for Huddersfield (Mr Sheerman) and my hon. Friend the Member for Bradford East (Mr Ward) are here and will, I am sure, help to spread the news about the debate. My hon. Friend makes a good point. I attempted to get a 90-minute debate. We have a half-hour debate, and I am very grateful that other hon. Members are here, supporting me on this very important issue.

What is driving an increase in top-up payments is the key question. I think that an issue of funding is at the heart of this. More specifically, personal budgets are being set at a rate that simply does not reflect the actual costs of purchasing large numbers of care home places. My right hon. Friend the Minister will know that, in the three years from 2010, local authority baseline fees fell by almost 5% in real terms and rose by 1.8% in 2013-14. It is hard to imagine that that has not had some impact in terms of the numbers of requests for top-up payments during this period.

The problem affects large numbers of people across a wide range of local authorities. The local government ombudsman has said as much. She found Southampton guilty of maladministration causing injustice in the situation of an older woman. The council had sought, wrongly, additional fees beyond the assessed contribution, because no care home places were available within the council’s usual rate. The ombudsman published her report. She considered that that was in the public interest, because

“councils across the country are faced with similar situations”.

The LGO also carried out an investigation into a council near me, the London borough of Merton, in which a contracted private home asked a family to pay a top-up fee that the LGO says it had no right to demand. The report from the LGO serves as a stark reminder to councils that they cannot contract out their legal responsibilities. It was hoped that these reports by the LGO would stop councils turning a blind eye to care providers taking payments from relatives, on the basis that that is outside the agreed care contract. However, the practice continues to affect families up and down the country, which makes the need for today’s debate all the more urgent.

In her report on complaints in relation to adult social care, the LGO revealed that she receives complaints that

“providers have sought to charge…‘top-up fees’ in circumstances where the person’s care needs should be fully covered by public funding.”

The investigations have shown that 17% of all complaints received last year included concerns about the financial elements of care provision; that more than half of those complaints in 2013 raised issues about fees being charged where they should not be; that in 50% of these cases the LGO is upholding complaints; and, specifically in relation to top-ups, that people are

“not being given clear and comprehensive information about their financial liabilities.”

Let us not forget that we are talking about an increasingly frail care home population. The Alzheimer’s Society estimates that eight in 10 residents live with dementia or significant cognitive impairment. Given that, what is the Minister’s assessment of the LGO’s most recent report on all complaints made in 2013, which concluded that complaints about local authority social care increased by 16% and that the LGO often finds fault with top-ups being charged when they should not be? Does the Minister agree that the problem seems to be getting worse?

Soon-to-be-published research by Independent Age based on in-depth interviews with 13 councils reveals a wide variation in local authorities’ practices for arranging top-up fees, in terms of who the contract is with, the terms of the third-party agreement, what and how much information and advice is provided, and how the affordability of a top-up payment is assessed. It is essential that the regulations and the statutory guidance that are being developed in the Department address each of those issues. Perhaps the most striking aspect of that research, which I believe will be presented to the Department later this week, is that none of the councils that participated in the research had any openly agreed or consistent approach to reviewing whether third parties remained willing and able to pay top-up fees. That is a serious problem, which risks becoming bigger still when own-resource or first-party top-ups are permitted much more widely from April 2016.

There are many stories about the subject, and I suspect that other hon. Members who are present have stories from their constituencies. I want to refer briefly to two stories, one from the Alzheimer’s Society and one from Independent Age. The Alzheimer’s Society has told me that it was recently contacted by the daughter of an 84-year-old mother who has dementia and is virtually bed-bound. The mother lives in a nursing home, and the daughter agreed to pay a top-up payment of £35, but that payment keeps being increased and now stands at £75. The daughter feels that the payment is becoming unsustainable, but she is worried about the consequences of not paying and the impact of moving her mother to another care home. Families have to make such hard, emotional and often distressing choices every day.

The example from Independent Age is no less typical. The organisation was contacted by a daughter whose 87-year-old mother has only £7,000 in savings. The mother has Alzheimer’s and has been in a hospital for a month, and she has now been assessed as needing residential care for her own safety. She wants to live near her daughter in Gloucestershire, because her daughter is the only child. The council in London, where the mother lives, has explained that it will pay £441 towards the mother’s care but it has only found one placement at that rate, which is nowhere near where she wants to live. The local authority is trying to achieve a quick outcome, because it wants her to be moved out of hospital as soon as possible, and it is asking for a top-up payment as part of the process. The 87-year-old mother is being informed that she will be moved to the local home at the local authority rate, regardless of her wishes.

Clearly, the guidance on that point needs to be strengthened. Let me offer the Minister some suggestions on what might be done to strengthen the guidance on which the Department is consulting. I hope that my contribution to the debate will be treated as a formal contribution to that consultation. Local authorities must meet their legal obligations, so third-party top-ups are only ever a matter of choice, not a necessity. The best way to ensure that that happens is to make sure that all top-up agreements are agreed in the open between residents and their relatives, the local authority and the care home provider in a genuine three-way written agreement. It is good to see that that is set out in the draft regulations.

Will the Minister ensure that the guidance underpinning those regulations, to which people will refer to find out what scope, discretion and flexibility there is, states that residents should be offered more than one care home place within the amount of their personal budget? At the moment, the draft guidance simply states that at least one setting should be offered that could meet the person’s needs within their personal budget. If that were interpreted in a mean way—not all councils will do this, but I am certain that some will—the council would offer one home at the rate at which it will pay, and that would be that. In the worst case, an individual might be offered a place in a home rated by the Care Quality Commission as poor or inadequate. Provisions should be put in place to ensure that a person has a genuine choice, particularly if the home that they are offered has been rated as failing some of its fundamental standards.

Will the Minister ensure that the new framework actively enables residents to access independent information and advice, so that they can make a decision about whether to pay a top-up and what level of top-up they can afford? How will the new framework actively support residents to understand their entitlements? Does the Minister share my concern that simply calling on councils to consider

“when it is in residents’ best interests”

to signpost them to information and advice is not sufficient? Three quarters of councils do not signpost residents to independent information and advice now, so what will change unless the guidance signals that there should be a change? That is how the draft guidance is currently framed, but surely it would be better if councils routinely signposted people to information. That could be achieved by including a generic statement or section in a model agreement developed by the Department that checks with the local authority, the care home and the third party whether there has been a signpost to independent information and advice. That is a simple, honest check that could be built into the contractual arrangements. I emphasise that information and advice should be independent.

Should it not be incumbent on local authorities to review annually whether top-up arrangements remain affordable and whether people remain willing and able to pay them? Surely that should happen at the same time as the annual review of care needs and an adult’s finances. The draft guidance is too vague on that point; it states that local authorities should review top-ups “from time to time”. It should be made clear that at a minimum, the arrangements should be reviewed annually.

We have to consider the rates that local authorities pay care providers, and whether those rates really keep pace with the real market costs of care. The guidance should make it clear and unambiguous that, where a personal budget needs to be adjusted to meet an adult’s assessed eligible needs and top-up arrangements are not possible, a local authority must always adjust the amount of the personal budget and not seek a top-up to cover the shortfall in local authority funding. That point is absolutely fundamental, but the relevant section of the draft guidance merely states that the local authority should consider adjusting the amount of the personal budget. If a local authority chooses not to do so, it is breaking the law, but it is invited to consider doing something that would be unlawful. There should be no discretion.

Families are being separated. Vulnerable older and disabled people, together with their families, are not being informed of their rights. People who can ill afford hundreds of pounds in top-up fees are unwittingly paying out extra money for essential residential care that is really the council’s responsibility. That is why the guidance should be strengthened.

--- Later in debate ---

[Norman Lamb]

I agree with the hon. Gentleman. He will find that the Care Act has a much greater focus on transparency, and it strengthens the legal obligation by providing that personal budgets must reflect the cost to the local authority of meeting the adult’s needs. That is a legal requirement in the Care Act, whereas previously it had been guidance.

[Paul Burstow]

Will my right hon. Friend give way?

[Norman Lamb]

Yes, but I will not be able to respond to all the issues.

[Paul Burstow]

I understand, and I am grateful to my right hon. Friend. The guidance allows local authorities to consider whether to make an adjustment to a personal budget, but guidance should not give such discretion. If it is about care costs to meet eligible needs, an adjustment should be made.

[Norman Lamb]

I take that point. I do not want to pre-empt the outcome of the consultation, but I am happy to ensure that the Hansard report of this debate is counted as part of the consultation exercise. The comments of all right hon. and hon. Members will be included in that report.

Although we all agree that, in an ideal world, local authorities would be able to fund a person’s chosen accommodation, that is simply not possible in every circumstance. We are in a tough financial situation, and local authorities need to take great care in how they spend their resources to ensure that they can meet the care and support needs of the whole population that they serve. There are clear rules in place on the operation of top-up fees, which we are strengthening to achieve greater clarity and force under the Care Act. It is important that everyone is aware of those rules, as my right hon. Friend said.

We are aware of concerns about top-ups, particularly the concerns raised in the research by the charity Independent Age. That is why in March 2014 the Department wrote to all local authorities in England to remind them of their responsibilities under existing regulations and guidance, let alone the rules coming in through the Care Act. We reminded them that the existing guidance is clear that a top-up fee should be sought from a local authority-supported person only where they have chosen to go into more expensive accommodations and a third party or, in limited circumstances, the person themselves, is willing and able to pay the additional cost.

The person should not be asked to pay a top-up fee where it is necessary to arrange care in a more expensive home to meet their assessed eligible needs, nor should a top-up fee be sought where accommodation is not available at the local authority’s expected rate due to a failure of commissioning. In such cases, the local authority must meet the full cost of care and should not seek to make a top-up arrangement.

Where a local authority arranges care it is responsible for the full cost of that care, including any top-up fee to the provider. That ensures that, if a top-up fee is not paid for any reason, the person can continue to receive care and support in their accommodation while a decision is made about their future care. A care home, therefore, should never ask a local authority-supported resident for a top-up fee without the involvement of the local authority, but it appears that that sometimes happens.

The local authority is responsible for the full cost of care, including the top-up, so it should not arrange more expensive care unless it is satisfied that the person paying the top-up has the resources to keep paying the fee. Local authorities should regularly review the position to ensure that a person will continue to be able to make those payments—that is another point raised by my right hon. Friend. It is in a local authority’s interest to do that, as it will be liable to pay the full costs if the person is unable to pay the top-up.

We are maintaining people’s right to choice in the accommodation where they receive care under the Care Act. As part of that we will give people more rights to top up their own fees from 2016. We would have liked to have been able do that from next year, but we need to ensure that extending the right to self top-up is sustainable and that those receiving care are not adversely affected. We are working with stakeholders to resolve those issues.

Currently, as I am sure my right hon. Friend knows, the circumstances in which people can top up their own fees are restricted. People can top up during the 12-week period only when their main or only home is disregarded, or when they have a deferred payment agreement—in effect, where they have a property to sell that can meet the cost of the top-up fee. People should be able to decide how to spend their own money, and they should be able to pay more for care if they wish. Under the Care Act we will enable people to self top-up using other assets, not just property, from April 2016 at the same time as we implement the cap on care costs that, for the first time ever, will protect people from the risk of catastrophic care costs—protection that my right hon. Friend fought for before I took over this role.

We are also strengthening the regulations and guidance on top-up fees, which will apply from April 2015. That will make the position on top-up fees even clearer and provide additional protection to cared-for people and their families. We will make further changes in April 2016 to give people greater scope to self top-up. The draft regulations and guidance currently out for consultation set out that the local authority must ensure that the person paying the top-up is willing and able to meet the cost for the likely duration of the arrangement. The local authority must also ensure that the person enters into a written agreement, thereby ensuring that all involved are fully aware of their responsibilities and any consequences should the arrangement break down. Again, my right hon. Friend referred to the written agreement in his speech. The local authority must review top-up arrangements from time to time.

[Paul Burstow]

Will my right hon. Friend give way?

[Norman Lamb]

Very quickly.

[Paul Burstow]

“From time to time” are classic words that can be wriggled out of—they mean nothing. It is important that the guidance is clear that “from time to time” means at least annually.

[Norman Lamb]

I note my right hon. Friend’s point, but I will complete my comment.

The local authority must set out in writing details of how the arrangements will be reviewed, what may trigger a review and when any party can request a review. Although the regulations and guidance do not set a specific review period—my right hon. Friend’s point is now in the consultation responses, as I indicated—we expect top-up arrangements to be reviewed at the same time as the local authority reviews the financial assessment of what the person can afford to pay for their care. That normally happens at least annually, around the time when changes are made to the charging regulations.

Additionally, the local authority must make clear in writing the consequences should the top-up arrangement break down. That may result in the resident’s having to move to alternative, less expensive accommodation, where such accommodation is suitable to meet their needs. As with any change of circumstance, the local authority must undertake a new needs assessment before considering that course of action, including an assessment of health needs and having regard to the person’s well-being, which is the central principle of the Care Act. Local authorities should already be monitoring all top-up arrangements for the people they support because they are ultimately responsible for the full cost of accommodation. Local authorities should also discourage arrangements for top-up payments to be paid directly to a provider.

The new regulations and guidance under the Care Act are being consulted on at the moment, and I encourage all right hon. and hon. Members to contribute to that consultation alongside their contributions today. The consultation closes on 15 August, and we will consider all the responses that we receive. We are aware that, although our approach has been welcomed as a big improvement, there is always a desire to do more. We are continuing to engage with stakeholders and will await the close of the consultation before making any decisions on further changes.

The intention of the Care Act is to enable self top-ups in other circumstances, which is entirely right, but also to ensure that top-ups are not inappropriately used and to strengthen the rules on top-ups.

[Paul Burstow]

In the past 12 months I have been leading work with Demos on the future of residential care, and we will publish our report in September. Will the Minister meet me and colleagues from that commission in the autumn to discuss our recommendations?

[Norman Lamb]

That sounds like an interesting session in principle. I would like to attend that meeting if possible, but I cannot guarantee it at the moment because of the nightmare that is my diary.

I hope my comments have been helpful. The points that have been raised today are an incredibly important part of the consultation process.

Special Measures Regime

Paul Burstow Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

The right hon. Gentleman makes some important points. I will start with the point that provides a broader lesson for the NHS. Not taking our foot off the gas is really important. This is the start of a very long journey. I said last year that it would take about three years to turn around a hospital where the wrong culture has become entrenched.

I pay tribute to the leadership at East Lancashire Hospitals NHS Trust. The CQC report said that the staff on the front line now feel more supported, more empowered to take decisions and more able to raise concerns. If there is one thing that we have learned, it is that successful hospitals make it easy for their staff to speak out and support them in speaking out. The hospitals with problems are the ones where people feel bullied and intimidated when they speak out. I am delighted with the progress that has been made.

In respect of finances, this is a challenging time for finances across the NHS. I simply say that, as I am sure the leadership of the right hon. Gentleman’s trust recognise, the most expensive thing of all is delivering poor care. The most important way of saving money is ensuring that the care that is delivered is safe.

[Paul Burstow (Sutton and Cheam) (LD)]

I very much welcome the changes the Secretary of State has announced on social care inspections. However, standards and enforcement alone are not sufficient. Does he agree that we need to look at the support that is provided to organisations so that they can change before they get to a point of crisis? If so, will he look at the work of My Home Life, which runs programmes to transform the lives of people in care homes and improve their quality of life by working with staff in a different way? I commend that work and hope that he looks at it.

[Mr Hunt]

I am happy to do that. I agree with the right hon. Gentleman. I would like to see a lot more innovation. Even in the best care homes, which deliver good care by today’s standards, there is room for much more innovation and imagination in seeing how we can make people’s last years ones that they really enjoy. I have seen some amazing dementia care homes that break the mould. I am very happy to look at the work of that organisation. I am sure that there is a lot we can all learn.