Children and Families Bill

Paul Burstow Excerpts

Monday 10th February 2014 Commons Chamber

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May we have less chatter during speeches. It is getting difficult to hear.

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

I rise to support the Government amendments to put the two regulation-making powers in the Bill, and to support the initiatives taken by Cross Benchers in the other House and by a cross-party group in this House. I speak as chair of the all-party group on smoking and health.

We have been asked to be clear about the evidence. One area in which the evidence is absolutely clear is that smoking is a childhood addiction, not an adult choice: 40% of smokers are addicted by the age of 16 and two thirds by the age of 18, while 200,000 children take up smoking every year. That is why I strongly support, and urge hon. Members on both sides of the House to support, the Lords amendment to provide for the power to regulate and standardise packaging. I do so not least because of the evidence from the tobacco industry’s campaign against it, and from documents released through court cases that have demonstrated that it knows that packaging is a way of driving market share, as well as of driving people to smoke in the first place.

On passive smoking in cars, both the NHS and the World Health Organisation are very clear about the dangers of second-hand smoke for children. Other hon. Members have already listed that evidence. I do not know where the hon. Member for North Antrim (Ian Paisley) was in relation to the data. Every week, 430,000 children aged 11 to 15 are exposed to second-hand smoke in their family cars. That is not their choice. The hon. Member for South West Bedfordshire (Andrew Selous) is absolutely right. This issue is not about a child’s choice, because they have no choice. They have to get into the car if their parents want them to do so.

The concentration of toxins in a car makes it a significantly different environment from a smoky pub or home. The evidence demonstrates the impact that that environment has on a child’s health. That is where the Millsian test applies. The harm to the child should trigger us to act in the way that I hope the House will act tonight. That is why I support the free vote.

NHS

Paul Burstow Excerpts

Wednesday 5th February 2014 Commons Chamber

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

May I start by agreeing with the right hon. Member for Rother Valley (Kevin Barron)? The issue of alcohol has been ducked by successive Governments for a very long time. He is absolutely right to campaign on it, and I absolutely agree that we need to see the introduction of minimum unit pricing. However, we should not in any way give the impression that that of itself is the entire solution to what is a broad societal problem. None the less, it most certainly would make a significant contribution. I hope that, at the next election, it will be part of my party’s platform on public health issues.

My hon. Friend the Member for Stafford (Jeremy Lefroy) was right to call for a debate on the Francis report. I hope we will be granted Government time to debate it. If not, I would certainly join him in an application to the Backbench Business Committee for a debate on the Floor of the House. We should have the opportunity to bring Ministers here to debate the report.

Before addressing some of the comments made by the shadow Secretary of State, I wish to place on the record my thanks to the staff at my local hospital, St Helier, for all the work they do not just over the winter period when the pressure is undoubtedly at its most acute, but right across the year. Having been in the hospital over the Christmas period singing carols, which hopefully did not discomfort people too much, I saw for myself just how that pressure can build. I also saw how well the staff are perceived by their patients.

I want to register a frustration with the Minister today about something that has been going on in my patch for several years now. For almost as long as I have been an MP, clouds have from time to time gathered over the future of my local hospital. In 2010, the previous Labour Government signed off an outline business case for the rebuild and refurbishment of St Helier’s hospital. That was great news, and a culmination of work by my right hon. Friend the Member for Carshalton and Wallington (Tom Brake), the hon. Member for Mitcham and Morden (Siobhain McDonagh) and me. We secured funding from the Government worth some £219 million. Then there was a change of Government; a coalition came in. Given the spending review and the desire to tackle the public borrowing problem, it was far from certain whether that funding would stay in the Budget. Again, the three of us lobbied hard, and we were delighted when my right hon. Friend the Chief Secretary to the Treasury was able to confirm the funding.

However, in the dying days of the primary care trusts, a review was launched of accident and emergency and maternity services in south-west London. It was called Better Services Better Value, but it offered neither. It has been an absolutely crystal clear case study of everything that is bad and wrong about NHS change management. There are some really good examples of change management, stroke care in London being the exemplar. However, we have to refer to that example too often, as there are too few other really good examples of change having been managed well. All too often the public feel left out of such processes, and it is no wonder they mount the barricades to oppose change of which they feel no ownership.

My right hon. Friend the Member for Carshalton and Wallington and I were repeatedly told during the process by the then chief executive of the primary care trust, Ann Radmore, that the rebuild of St Helier was a fixed point in the whole process. It was not to be touched; it was sacrosanct and the rebuild would happen regardless. I have to say, however, that the events of the past three years have left me feeling betrayed and lied to. As a result of the uncertainty caused by BSBV, three years on—despite GPs having now declared BSBV’s proposals unviable, and having gone back to the drawing board—my local trust and clinical commissioning group are saying they cannot proceed with that £219 million. They lack the will and vision to take it forward, and I hope the Minister can confirm today that the £219 million is still in the Department’s budget lines and that he will encourage my local NHS to work with my local councils and Members of Parliament to bring forward these plans.

The motion moved by the shadow Secretary of State today feels a bit thin, and a little like a re-editing of its previous two incarnations in an attempt to create the sense of a febrile environment of a looming and predicted crisis and calamity that is about to engulf us all. That tactic has been adopted by the Opposition time and again, and time and again it has not been borne out on the ground. The analysis of the right hon. Member for Leigh (Andy Burnham) is deeply political, and let me give just one example. He lays the blame for delayed discharges principally at the door of budget pressures on social service departments. That is not true. If he looks at the figures, he will see that the bulk of the pressure is caused by delayed discharges in the NHS, not social services. I do not pretend for one moment that there are not parts of the country where social service cuts are impacting on delayed discharges, but the picture is more nuanced and complicated, and I wish the shadow Secretary of State had the courage to say that, rather than repeating a uniformly gloomy picture that is not true.

[Barbara Keeley]

I refer the right hon. Gentleman to the Select Committee on Health’s report on the matter. The data were completely conflicted. Again and again, individuals from the NHS told us that social care was the problem, as Sir Bruce Keogh, whom I quoted earlier, said to me just a few weeks ago. Our report said that NHS England should sort this out. There are figures that the right hon. Gentleman could quote and figures that my right hon. Friend the Member for Leigh (Andy Burnham) could quote, and we should not be confused about this.

[Paul Burstow]

I entirely agree that if there is any doubt about the figures, it needs to be resolved, but there seems to be a disconnect between what people think is happening and what the figures show. I have been to events at which clinicians have said that the problem is the local social services, but when they are shown the figures they are surprised. Perhaps that is why we need, as the hon. Lady says, to ensure that there is an agreed way in which such things are reported, which is what, I think, was put in place by the previous Labour Government. These figures have been collected for a long time, and they have consistently shown that social care is not the principal driver of delayed discharges.

[Mrs Main]

I am sorry to have missed the beginning of my right hon. Friend’s speech, but as he knows there is a big lobby going on. That was the point I was trying to make to the Secretary of State, although obviously I did not make it very well. Under the previous Government, West Hertfordshire Hospitals NHS Trust had a significant number of delayed discharges—although that is coming right down now—and the figures were not on the books, so to speak, thanks to a very creative form of accounting. It is nuanced and there have been problems on all sides. To try to paint it as one-sided is totally wrong and it certainly is not a new phenomenon; it has been going on for a considerable time.

[Paul Burstow]

That is absolutely right. For example, in continuing health care there is often a great deal of contestability that leads to discharge delays, but they are NHS-caused delays. I am not saying that the NHS should be blamed any more than social services, but I want some honesty about how the figures are presented as they do not bear close scrutiny in the argument made by the right hon. Member for Leigh. His solution is simplistic, too. It is good to have a debate about competition policy—I remember Labour Ministers trumpeting the introduction of the first competition policies in the NHS and the establishment of the competition and collaboration committee in the Department of Health. Labour established those policies.

Monitor’s role is to protect the interests of patients—that is what it says in the Health and Social Care Act 2012—not to promote competition. The idea that we can solve the problem by sweeping away Monitor opens the doors to competition red in tooth and claw. Of course, the Competition Act 1998, the EU’s competition legislation and procurement law would still apply without any of the fetters, barriers or protections that Monitor can and should be providing in its role as the regulator of competition in the NHS.

[Kevin Barron]

It is interesting that the right hon. Gentleman says that, because he knows from his time on the Health Committee that European competition law is not used in any health care system across the European Union.

[Paul Burstow]

The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.

[Andy Burnham]

The right hon. Gentleman seems to be arguing that the Health and Social Care Act 2012 is perfect—[Interruption.] It was his Act; he was a Minister. I quoted him in my speech as saying that it now needs to be amended. Will he be straight with the House this afternoon: does it need to be amended to remove the role of the OFT?

[Paul Burstow]

The right hon. Gentleman must be reading my notes as that was my very next point. One thing about our politics is that it is very difficult for people to admit their mistakes, so let me do just that today. I regret that we included in the 2012 Act a provision for the OFT to deal with the specific issue of mergers. At the time, the argument was that the OFT had the expertise, but it clearly did not. Monitor should have that role. I want to address that issue either through agreement—the Secretary of State has suggested how that might happen—or by amending the legislation. That is my view based on how things have developed over time, and one cannot be more straightforward than that.

[Andy Burnham]

Fair enough.

[Paul Burstow]

I thank the right hon. Gentleman.

The right hon. Gentleman spoke about Hinchingbrooke hospital and the franchising arrangement. The process started and was two thirds of the way through by the time the previous Government left office. There were only private sector providers in the competition when the previous Government left office—

[Andy Burnham]

indicated dissent.

[Paul Burstow]

I hope the right hon. Gentleman has had the opportunity to go and see what is happening at Hinchingbrooke, because it is doing fantastically well. It is being led by clinicians and is making a huge difference as a result. We should take heart from that.

Let me end by drawing out one point about A and E pressures. The situation is complex and driven by a multifactoral set of problems. There are seasonal changes, with high-volume, less complex A and E attendance in the spring and summer, and a pattern of fewer but more complex cases in the autumn and winter that often drive up admissions. It is also important to note that it is a question not just of an ageing society but of a rise in co-morbidity, which drives the pressures in our A and E departments. There are also changes in behaviour as people regard A and E as the first point of access for any ailment, driven by the fact that nine out of 10 GPs opted out.

In conclusion, the motion is flawed and does not celebrate the successes of this Government, not least in driving integration in a way that the previous Administration failed to do. For that reason and many others besides, it should not be supported and the Government amendment should be supported instead.

[Several hon. Members]

rose—

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

We are very conscious of that, which is why we introduced the triple lock on pensions and protected pensioners from the brunt of the cuts that this Government, sadly, have had to make to deal with the deficit we inherited.

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

Dementia is the disease that people over the age of 50 say they fear the most and it is one of the biggest challenges for our society and for our health and social care systems. One of the ways to meet that challenge is through research, and the coalition Government is to be commended for the doubling of spending on research into dementia by 2015. However, it will take another decade, until 2025, for this Government or a future one to double it again. Will he reconsider that? Surely there needs to be greater ambition and greater pace to deliver the cures, the solutions and the prevention we need.

[Mr Hunt]

I commend my right hon. Friend for his work on dementia when he was working at the Department of Health. We are doing our bit as a country but we will not be able to do it on our own. Dementia is an incredibly difficult disease to crack, which is why, in December, the Prime Minister hosted a G8 summit to encourage other leading countries to increase their investment in dementia. We secured a commitment that they would significantly increase that investment and we want to encourage the private sector to do the same.

Accident and Emergency

Paul Burstow Excerpts

Wednesday 18th December 2013 Commons Chamber

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

I want to pick up on a couple of points that were made by the hon. Members for Mitcham and Morden (Siobhain McDonagh) and for Bracknell (Dr Lee) about reconfiguration. The hon. Gentleman said that all too often the experience of hon. Members is that reconfiguration feels as if it is being done on the hoof. I agree with the hon. Lady about the proposed reconfiguration in south-west London and about St Helier hospital. Whether that will ever happen is still up in the air—let us hope that it does not. A leap of faith was demanded of constituents across south-west London, not least because the plans did not contain any measures to improve out-of-hospital care, without which it would not be possible to achieve the changes to emergency services that were being proposed. Those points are part of this debate, which is primarily about whether there is a crisis and, if there is, what the nature and causes of it might be. Although the Labour motion acknowledges that there are many causes of the problem, it has a very simplistic solution.

The evidence shows that there is a mixed picture across the country. That is reflected in the allocation of the first wave of additional funding for the NHS to meet winter pressures. That funding went to the health economies that were the most challenged. Some are coping well with the seasonal change from the higher volume, but less complex A and E attendance pattern of the spring and summer to the winter pattern of fewer, but much more complex cases, which often involves more frail and older people, and leads to more admissions. That pattern is repeated year on year and the demographic changes continue year on year. The pattern is well documented and it is very sensitive to the weather. That is why I welcome the Government’s cold weather plans and their support for local government and other agencies to put in place the extra social support that is necessary to avoid admissions in the first place.

Where there are problems, the causes vary. Some of the pressure stems from changes in behaviour. People now see A and E as the easiest point of entry into the system for any ailment. Often, there is confusion about the access arrangements for out-of-hours care. Those behavioural changes are cumulative. They are a consequence of changes that were made some years ago, not least through the changes to the responsibility for out-of-hours care in the GP contract. The implementation of those changes undoubtedly sowed much of the confusion over how to access emergency care.

[Andrew George (St Ives) (LD)]

Does my right hon. Friend agree that a lot of potential patients are confused about what out-of-hours unscheduled care is available? There are A and Es, minor injuries units, out-of-hours GP services, GP walk-in centres, NHS 111 and so on. Many people cannot discriminate between those services and do not know what they are supposed to provide. They therefore need to be further integrated.

--- Later in debate ---

[Paul Burstow]

My hon. Friend is absolutely right. One of the good things that came out of the work by Keith Willett and Sir Bruce Keogh is the more coherent, communicable and understandable way in which emergency care can and should be organised. Indeed, in some cases there are also staffing pressures. Those are not helped by some of the unintended consequences of changing medical careers, as that has had an impact on the supply of medical doctors.

Labour’s answer seems to be that we should go back to the good old days—whatever they were—of a 48-hour target, but that target was flawed. When it was removed by the Government, the British Medical Association welcomed the change, which it said would give GPs greater flexibility to organise their appointments. Today we have heard—quite rightly—from the chair of the BMA, Dr Maureen Baker, who said the proposal was ill thought out and a knee-jerk response to long-term problems, and that it would make a bad situation worse.

[Andy Burnham]

Do not the views of patients matter most? The right hon. Gentleman is quoting the professionals, but perhaps it is sometimes inconvenient for them to have to do things. Surely the point is that people are ringing surgeries and cannot get appointments. If he does not like the 48-hour target, surely he and the coalition Government should put forward their alternative so that people can get to see their doctor.

[Paul Burstow]

With all due respect to the shadow Secretary of State, when presenting arguments in support of his motion he set out a range of professional expertise and opinions for why there should be a 48-hour target. It is therefore not unreasonable for me to quote other professional opinion on why that would not be good for patients. I will come to some of the alternatives that I think are relevant to addressing the A and E problem, because I do not think that simply addressing it through a 48-hour target makes any sense at all.

The changes the Government are making to the GP contract will help—not least having a named person co-ordinating care for the over-75s. I hope the welcome focus on frailty and multi-morbidity will be extended to more people on the basis of their need, not simply their age. Figures show that the average number of diagnosed conditions for patients admitted from A and E has increased over the past five years. In other words, the medical needs of people attending A and E are getting more complex, and that impacts on the amount of time people spend in A and E departments. Therefore, the answer is not one simple solution but must be a combination of actions. Much of that needs to be centred in primary and social care, as well as mental health services. In primary care we must recognise that it is not just about GP services and that we need best practice around the country, for example in engaging pharmacies as first care centres or getting them to play a key role in managing long-term conditions—a big driver of pressure on A and E departments, particularly in winter.

We need concrete action to drive the integration of health and social care—that may be mentioned in the motion, but the Government are delivering it, not least with the £3.8 billion first steps for a better care fund, which is bringing health and social care together in a practical and unprecedented way that has not been achieved before. That must be welcomed as a first step which I hope will grow as more resources are pooled across the system. It is essential to delivering the integrated, co-ordinated care that people want.

Mental health was neglected by Labour, under which there were no access standards or targets for people suffering a mental health crisis. In fact, under Labour two thirds of people suffering from a mental health crisis waited for more than four hours to be seen. I applaud what the Minister is doing to improve that situation significantly by setting standards for the first time to drive improvement in that area.

I conclude with a quote from Dr Clifford Mann, president of the College of Emergency Medicine:

“While this winter will be tough for the NHS and A and E departments in particular—”

I think we should acknowledge that—

“I believe there is now cause for optimism and that the crisis is behind us.”

Yes, there have been problems, but the Government have been addressing them in a comprehensive way. That is why this debate is mis-timed, wrong, and does our constituents no good whatsoever. It does not identify the real problem, although this Government are getting on with sorting the issue out.

Care Bill [Lords]

Paul Burstow Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

The Secretary of State is nodding, but I hope he will be honest enough to admit today that that is simply not the case. In reality, the average pensioner could pay more than £150,000 for their actual residential care home bill—£300,000 for a couple—before they hit the so-called cap. I will explain why. It is because the cap will be based on the standard rate that local authorities pay for a care home place, not the actual amount that self-funders are charged, which is often much higher than the council rate. It is estimated that in 2016-17, when the cap is due to start, the average council rate for residential care will be £522 a week, and the average price of a care home place will be £610 a week. That is because self-funders pay more than councils. However, that will not be taken into account when the cap is calculated.

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

Will the shadow Secretary of State confirm to the House that the use of notional costs, which he is describing, was not a Government proposal but one of the Dilnot commission’s recommendations?

[Andy Burnham]

I remember that the right hon. Gentleman showed a good deal of support for the Dilnot proposals, as did we, but they worked as a clever package. They were carefully constructed to ensure that the system would work, be progressive and provide support to everybody. They have now been pulled apart and different figures have been introduced.

[Paul Burstow]

indicated dissent.

--- Later in debate ---

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

I want to echo the remarks made by the right hon. Member for Salford and Eccles (Hazel Blears): we must keep the dignity and well-being of those who need care and, indeed, their carers at the forefront of our thinking in this debate and as we seek to implement the Bill.

Like the right hon. Lady, the hon. Member for Worsley and Eccles South (Barbara Keeley) made a very interesting speech. I thank her for her service on the Joint Committee that scrutinised the draft Bill. I had the pleasure to chair that Committee, which had a very strong team from both Houses. It made some recommendations to which I will return in a minute.

What struck me during the speech from the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), is that if so much in the Bill appears to be wrong, surely he should have the courage of his convictions and go through the Lobby to oppose it. There is apparently so much awful stuff in it—so much of it is inadequate, does not reach far enough or does not do enough, or if it does enough, there will not be enough money—that the Opposition should perhaps have the courage of their convictions.

At the same time, we have heard really interesting examples of where social care should be celebrated. Too many speeches have suggested that the picture of what is being done on the ground is uniformly bleak, but examples have been given of dementia-friendly communities, Unlimited Potential and the “garden needs” scheme in Salford. Those are just a few examples, and I am sure that every hon. Member could go back to their constituency and find such initiatives. Many of the initiatives do not require substantial resources because, as the hon. Member for Sheffield, Heeley (Meg Munn) just said, they can lever in additional resources by enabling communities to respond to need. That is an essential part of the Bill.

[Barbara Keeley]

Will the right hon. Gentleman give way?

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Paul Burstow]

I give way to the hon. Lady because she tried to intervene first.

[Barbara Keeley]

It is about a year since the right hon. Gentleman and I started four months’ work on the Joint Committee, and I was prepared to commit that time although I still find some aspects of the Bill disappointing. The reality of our situation in Salford now and over the next year is that—week in, week out—I, as a local MP, will find that people and their carers have lost care packages. I invite him to think about the situation of the very many MPs who now see the heart-breaking decisions that families face when they suddenly find themselves without care, respite care or support.

--- Later in debate ---

[Paul Burstow]

I entirely understand that, and I see it in my constituency, where my local authority is grappling with those budget choices, but there is still scope for innovation. There are good, bad and ugly local authorities when it comes to grappling with the resource constraints that the deficit has led to, and I will come back to that in a moment.

I believe that the Bill deserves to be described as landmark legislation, because it will provide a new governing purpose for our social system—the idea of well-being, to which I will return—new rights for carers and, for the first time, parity of esteem between those who are cared for and family members who provide care and support. The new national eligibility threshold will end the postcode lottery for access. We can debate where the line is drawn, but for the first time that will become a national debate rather than simply a local one.

There will also be new obligations on local authorities on behalf of the whole population that they serve. There will be obligations to prevent and postpone the need for care, to ensure quality and choice of services and to ensure that there is good information and advice about the whole range of choices that people might need to make as they approach the point at which they need care. Importantly, the Bill is foundation legislation upon which a more co-ordinated and integrated system of health and social care can be built.

I could stop there, but the Bill will do more than that. It will simplify and clarify entitlements to state-funded support and put personal budgets into law for the first time. That is all before I have even mentioned the Dilnot reforms, about which it is important to give some context. Social care in this country today is not free. That is the nasty little secret that families discover when they are tipped into crisis and have to negotiate with their local authority over whether they will have access to any means-tested support. Most people do not know that, and it comes as a shock and creates anger and dismay in many families. While I was a Minister, Members from both sides of the House showed me letters of anguish from people who felt that the system was letting them down. To understand the value of Dilnot is to make a true comparison not with what people hope the system will be but with what it actually is today—a nasty, mean system that is means-tested. That is why the Government deserve to be commended for having the courage to start to put in place the principles that Dilnot proposed.

The right hon. Member for Leigh gave no direct quotation from Andrew Dilnot in opposition to what the Government are doing. I know why—it is because there is no direct quotation of that sort. Andrew Dilnot supports the changes and sees them as a much-needed step towards implementing all the principles that he recommended in his report.

Of course, it is important that we recognise that not everyone will ever need formal care. A minority of our population will need formal support, no matter where the threshold is drawn. Perhaps some will need it right at the end of their life. Those who do will want the Bill to give them peace of mind, and that is what Dilnot provides to everyone. Some people are confused by the idea of catastrophic costs based on all people needing care, but the reality is that most people will never reach the cap wherever it is drawn, because they will never need to draw down that much resource to pay for care costs. Moving the means test threshold from £23,250—the meanest of means tests in our welfare state—to £118,000 is a huge step forward.

For all those reasons, the Bill can be marked out as a comprehensive reform of our social care system, and it deserves the House’s wholehearted support today. There are other reasons why it deserves support, too. The draft Bill was consulted on extensively and has been subject to pre-legislative scrutiny, of which I am a great fan. As the Minister at the time, I actively sought permission for it to be subject to that approach. By a curious twist of fate, I then found myself chairing the very scrutiny Committee that I had advocated. I was lucky to have cross-party support from both Houses in doing that job, and it was a strong Committee. We made 107 recommendations, the vast majority of which the Government accepted before introducing the Bill. Many of the others have been persuaded upon them through their lordships’ scrutiny, and I am grateful to colleagues in the Lords for what they have done.

All of that will be worth nothing if the Bill is not well implemented. As the debate has demonstrated powerfully, there is a huge knowledge gap that leaves people struggling in a crisis. It means that people do not plan or prepare for care, financially or in other ways. We need not just local information and advice services but a multi-channel, multi-media campaign to inform and educate the public, hon. Members and the people who work in the system. We need to ensure that we manage changes well, such as deferred payments, about which I hope the Minister will say more later, not least because it is not a sufficient defence to say, “Because Labour did this when it was in government, we will do it as well”. I hope the Minister will have a better answer on that point.

I want to give one example of why the implementation challenge is big. There are 300,000 to 400,000 people in this country who already pay for their care. It would make no sense for them all to be told to line up on 1 April 2016 to get their care accounts sorted out. The change needs to be phased and planned so that we do not overwhelm local authorities in April 2016. I hope that the Minister will be able to reassure us about that.

The hon. Member for Sheffield, Heeley, said that the Bill was a look back to 20th-century models of care. I disagree, because at front and centre, in the Bill’s first clause, is the disruptive idea that we should promote individual well-being. It states that well-being is about quality of life, work, leisure, study, the right to be an active member of the community, being in control and maintaining and recovering physical and social function—all things that were anathema to many of the paternalistic models of 20th-century care.

We need only compare current care plans for older people with those for active and working-age people to see the stark difference. The plans for working-age people are about their being engaged with their communities, but for far too many years the plans for older people have too often been about “task and finish”, with tasks being burned down to just 15 minutes or less. That cannot be right, and it has to change. That is why I welcome the fact that the Secretary of State will also be subject to the well-being principle in discharging his obligations under the Act to regulate the system.

I would welcome some clarification of the term “beliefs” with regard to well-being. It would be helpful if the Minister said whether it applies to religious and spiritual beliefs, and whether that point will be covered in guidance.

On prevention, which has an important link to the well-being principle, can the Minister confirm that the duty set out at the beginning of the Bill will be outside the consideration of national eligibility, and that it will be a universal obligation that will not just apply to those who qualify for care? Will the local authority actively have to secure it?

[Norman Lamb]

I pay tribute to my right hon. Friend for his amazing work in launching the Bill and in its pre-legislative scrutiny. I can confirm that the prevention duty will be universal and have no relation to the criteria for eligibility.

[Paul Burstow]

That is very helpful, and I am grateful. The fact that the prevention duty will be outside the eligibility criteria gives the lie to the idea that it will be curtailed. That is important to understand. There has been some dispute about that, and the Association of Directors of Adult Social Services now suggests that the change in eligibility will be more generous than many people have thought.

Several Members have touched on the issue of carers. Progress has been made in the Children and Families Bill, and I hope that there will be progress on the identification of carers as well. One of my deep frustrations as a Minister was that, even when I had pulled all the levers available to me to try to get the NHS to do more on carers, it still did not get it. It did not do enough, and although there are beacons in the NHS, the whole thing has not been set afire so that the NHS really changes how it engages with carers. We need seriously to consider legislation on that, and I look forward to the Minister setting out how that might be achieved.

I want to touch on the role of the Care Quality Commission. It might be right to remove its duty to do periodic reviews, but it is important that it can exercise its power to conduct special reviews of commissioners without reference to Ministers. Where it finds that there a provider’s failure is attributable to commissioning failures, it should be able to inspect the local authority in question without having to seek Ministers’ permission. In that way, the special inspection powers could be used much more creatively.

A lot has been said about integration in this debate. I hope that we can make more progress on the matter to include it in all parts of the Bill during its passage through the House. I believe that the Bill deserves a Second Reading tonight, because it offers a transformative vision of how care is delivered in this country. By making well-being the central organising principle, we can deliver a much better quality of life for those who need care.

--- Later in debate ---

[Nick Smith]

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

[Paul Burstow]

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

[Nick Smith]

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

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

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

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

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

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

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

--- Later in debate ---

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

I had to leave the Chamber earlier, Madam Deputy Speaker, for an hour or so, but I assume we have been approached by similar groups and organisations that no doubt will have been quoted in previous speeches, so I might be able to curtail my remarks.

I begin by paying tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has been heavily involved in this issue from day one, with the inception of the White Paper. I thank him for coming to Bradford and talking to people there about local issues, and I welcome his contribution tonight. This is probably the most important Bill we will be considering this Parliament, because it deals with one of the most important areas of public policy that we have to face. There is no choice about it; it is something we have to face. It has been referred to over the years as a ticking time bomb. The good news, of course, is that people are living longer, but that will be accompanied by an enormous cost if we are to ensure that people are provided with the quality of care that they are entitled to and desperately need. It is hugely important.

Like the hon. Member for Gloucester (Richard Graham), I am confused by the reasoned amendment. I come from a place where people say what they mean and mean what they say, so I find it difficult to read a so-called reasoned amendment that is so scathing of a Bill and then listen to people say, “Well, actually, we’re not opposed to it and will not necessarily vote against it.” I do not understand that. Perhaps this is just a really strange place that I still need to spend more time in before I understand those things.

As I understand it, a Second Reading debate is about the principles, which is why I will avoid going into too many details. From my experience of working with many organisations and groups in the past few years, including very closely in the past 18 months or so, it seems to me that the principles in the Bill are pretty well applauded out there. There is a general acceptance that something needs to be done and that this is a pretty good attempt to lay down some basic principles. That was why the initial skirmishes and exchanges were disappointing.

[Paul Burstow]

My hon. Friend has taken a close interest in, and campaigned on, the Bill during its passage through the other place, and he said how widely welcomed it was outside the House. Would he be interested to know, therefore, that in almost every session of the scrutiny of the draft Bill—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Will the right hon. Gentleman face the rest of the Chamber and address the Chair, and while I am on my feet, I should remind him of two things: interventions should be brief, and handheld devices in the Chamber, before or after interventions, should be used with due decorum.

[Paul Burstow]

I apologise to you, Madam Deputy Speaker. I have been here long enough to know that I should speak through the Chair.

I simply wanted to say that during consideration of the draft Bill, when asked, many people told us they had nothing by way of criticism of the Bill, although they saw areas where it could be further improved.

[Mr Ward]

I thank my right hon. Friend.

Acceptance of the principles—certainly acceptance of them by myself—is there, but as the Minister knows only too well, as I have bent his ear on the subject so many times, I have some serious concerns, particularly about the FACS—free access to care services—criteria. He will probably not know—it is a recent decision by Bradford council—that the Labour council has decided to move from “moderate” to “substantial” in respect of the criteria. It has to go into a budget process; unfortunately, this will happen. We campaigned hard against that, with a 1,700 names on a petition opposing it, but it is going to go ahead.

What was unfortunate about earlier exchanges was a certain degree of dishonesty. This thing did not happen all of a sudden three years ago. Conservative, Labour and possibly some Liberal authorities—I do not know—up and down the country were from 2005 onwards moving away from “moderate” to “substantial” FACS criteria way before the change of Government and way before the vicious cuts took place as part of the austerity programme. Indeed, it was before the recession really bit, and I regret that. What seemed to be happening was a “follow my leader” approach—“Every other authority seems to be doing this, so why shouldn’t we?” It was seen as a way of reducing the budget. What I argued, continue to argue now and will continue to argue all the way through until this Bill becomes an Act, is that this is a false economy. I have made all those points to the Minister several times, including, in detail, in a Westminster Hall debate.

I believe that eligibility is the gateway to care, but I am not convinced by the proposed savings that are supposed to be made. We worked closely with various organisations, including Scope, which has done a fantastic job of looking at the issue of working age disablement, which accounts for one third of benefit recipients. People desperately need care to live a more fulfilled life, whether it be in education or work. This is just one example—there are many others—where savings can be accrued, but taxation can also be generated if people are given just a small amount of support to become economically active.

Other charities and organisations have raised serious issues. Principles are most important, but data collection is crucial. Charities that exist to help people with Parkinson’s and other neurological conditions identified the fact that they had no idea how many people with Parkinson’s actually received social care. How can that be the case? How can that happen? Something must be sadly going wrong with data collection. Macmillan Cancer Support pointed out that free social care at the end of life needs to be a crucial element of any changes we are looking to make and that, if we aim for true integration, we must have proper identification of carers within their health settings. We should not wait until people are turned out of hospital and go home before identifying who is going to look after the person and provide support. Leonard Cheshire Disability provided further useful information, and I ask the Minister to look further into some of the issues it raised.

Important principles are at issue here. On the national criteria, I may not like the level, but it is important to have standardisation. On the carers assessment, we should be applauding the fantastic proposal to make carers the centre of attention, as they are so often forgotten. How many times have carers ended up being the people who need care because of the lack of support they receive? A young person I know has come to my office on a regular basis to express serious concerns about the people he was caring for, but I have seen with my own eyes that person deteriorate over the last 12 months or so as a result of the lack of support that he has received. The Bill introduces a wonderful innovation, which we should all appreciate.

I have already mentioned the principle of integration. We have the framework: the health and wellbeing boards are still in their early days, but this way of bringing together the different parts of social care, public health and the national health service is so important. The links between health and social care are crucial. I cited a case in the Westminster Hall debate of a man in his 50s who had an accident at work when reversing his vehicle. He had no seatbelt on, as he was just backing into the car park, yet he became tetraplegic. He was in Pinderfields hospital for five months. He received superb support and everyday attention, but when he went home in the ambulance, he could not get into the house because there was no ramp. He had to go away again. Then the local authority provided the money for a ramp and the hospital brought him back again, but he could not get in because it was a wooden ramp and they did not dare take him on it because that would have broken it. That is madness in this day and age, and it needs to be dealt with.

On the cap on lifetime payments, we do of course need to discuss in detail what it should be and how it should be operated, but please let us not talk it down, because an incredibly important new public policy is being put forward here, which we should applaud.

Let us try to forget what happened earlier. It was unpleasant to see and I do not think it truly represents the true passion and commitment of people on both sides of the House to improving social care for the people of this country.

G8 Summit on Dementia

Paul Burstow Excerpts

Thursday 28th November 2013 Commons Chamber

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

It is a great privilege to take part in this debate and to be presided over by you, Madam Deputy Speaker, for the first time. I congratulate the hon. Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Salford and Eccles (Hazel Blears) on their tenacious pursuit of these issues and on ensuring that we have had two Back-Bench business debates on the subject in less than a year. That gives notice of the fact that this is an issue about which the House and its Members feel passionately and to which they want more attention paid.

Last Thursday, I took part in a local dementia forum in my constituency, which was organised by the Sutton Alzheimer’s Society. It brought together a range of organisations to listen to and engage with people who are experiencing dementia—either as carers or as sufferers who have the diagnosis and are living with its consequences. That was an incredibly powerful experience. At the heart of this issue is how we ensure that people have a good life and maintain good relationships, because dementia can rob them of that. We need to think about how we can ensure that people, whether they be a professional, a carer or someone who is working in another part of the public or private services, understand and are aware of the issues about dementia. We need to build a community that is more friendly towards those who suffer from dementia. Good communication is at the heart of that. The one message that all of us who were speakers at the event got from both the carers and the people with dementia was to slow down. We were gabbling and talking at great pace, because we were trying to get across too much in too little time. With just over three minutes left, I will not manage to achieve that requirement now.

I want to take a slightly different tack from the contributions we have heard so far and argue that the G8 summit on dementia needs to address the impact dementia will have on the development of low and middle-income nations across the planet. As Dr Margaret Chan, the director-general of the World Health Organisation, says:

“The need for long-term care for people with dementia strains health and social care systems, and budgets. The catastrophic cost of care drives millions of households below the poverty line. The overwhelming number of people whose lives are altered by dementia, combined with the staggering economic burden on families and nations, makes dementia a public health priority.”

That is why having a G8 summit on it is correct.

We are living through an extraordinary time in human history. A revolution is taking place on this planet, which is remaking societies, the state and so much that we have taken for granted. It is really a revolution in terms of human survival. We are living longer, which is something that we should celebrate. It is a triumph of human ingenuity that is all too often portrayed as some sort of disaster. It is not a disaster, but something that we should celebrate.

Let me put some numbers into my argument. In 2010 it was estimated that, across the world, 35.6 million people had Alzheimer’s disease and other dementias. That number will increase to 66 million by 2015 and to 115 million by 2050. The majority of that increase will not fall in the developed world; it will be in low and middle-income countries where more than 70% of people with dementia will be living by 2050.

As I have said, the number of people with dementia in 2050 will rise to 115 million, but the number of people who will develop dementia worldwide between now and then is estimated to be 600 million, which is roughly one new case every four seconds. In the UK, the national dementia strategy, which, as we have heard, runs out next year, and the Prime Minister’s dementia challenge, on which I had the privilege of working when I was care Minister, recognise the challenge posed by dementia, that dementia is not a normal part of ageing and that concerted action is required.

The G8 summit requires a focus that is not just about the developed world’s research spend; it must also understand the impact of dementia elsewhere in the world.

[Oliver Colvile]

Is my right hon. Friend aware of the stigma of dementia in black and ethnic minority communities? I recently took part in an inquiry in which it became apparent that that is an issue.

[Paul Burstow]

The hon. Gentleman’s point is spot on and leads me on to my next point about an example of research in India. It is estimated that in 2010 there were 3.7 million people with dementia in India, which will rise to more than 14 million by 2050. Approximately half those people will be over 75 and almost 2 million will be over 90. There is a serious lack of awareness about the issues in low and middle-income countries, especially those in Africa. Almost three quarters of people with dementia will live in those countries and that is why I want to ensure that the Minister, as he feeds back into the process of preparing for the summit, will make sure that such issues are on the table.

[Hazel Blears]

The hon. Gentleman is bringing a new perspective to the debate and he has made me think about the commitments made on AIDS and HIV. We need only think how ambitious the world was in tackling HIV at a time when many of us thought that it was an irresolvable problem. The promises on antiretroviral drugs were hugely ambitious and the progress we have made has been tremendous. Will he join me in urging the Minister and Prime Minister to be just as ambitious on this agenda as we were on HIV/AIDS?

[Paul Burstow]

As a number of us have made clear, the global scale of the challenge is such that it requires the galvanisation of a global response. The summit is a unique opportunity to do that, but it must have the reach and ambition that the right hon. Lady is talking about. It could take as its model the successful work that has been done so far on HIV.

Although epidemiologists often say that the figures I am citing are undercounted, the disease is none the less regarded as the second-most burdensome chronic disease and, among all those with chronic non-communicable diseases, accounts for almost 12% of years lived with disability.

In most developing countries, the problem with dementia is hidden. I have mentioned India, and the “Dementia India Report 2010” was published by the Alzheimer’s and Related Disorders Society of India, helped partly by funding from the UK Alzheimer’s Society. It has provided invaluable insight into the prevalence of the disease and ways in which India can respond to the challenge.

Let me ask the Minister a couple of questions. The first is about the research spend. The hon. Member for Chatham and Aylesford asked about the ambition of doubling that spend every five years, but it is not good enough for just our Government to do that. We need other Governments to agree to the same thing at the G8 summit. We need to know how much is being spent in the G8 on such things. There is no published figure—that is extraordinary—and when I tried to find a figure for the debate, I could not. We need a baseline to know whether we are making progress.

This country’s leadership on such issues will be in doubt if we do not hear soon that the Government intend to have a new dementia strategy. I hope that the Minister will be able to give us some indication of when that will take place. Finally, in having such an ambition on research, we need to learn from the journey that cancer has gone on. Cancer research has for many years had ambition, reach and strategy. We have an Institute of Cancer Research and it is time this country had the same for dementia. That could deliver such a big prize for all our citizens.

Tobacco Packaging

Paul Burstow Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

The hon. Lady is right to say that many charities feel strongly about this issue and I was pleased that the chief executive for Action on Smoking and Health said this morning:

“This decision is a victory for public health, for common sense and for future generations”.

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

Smoking is a childhood addiction, not an adult choice. The announcement is welcome, in that it moves us in the right direction, but if the review should recommend what is, in my judgment, a much-needed change when it is published in March, just how quickly would the Government be able to bring in the necessary regulations?

[Jane Ellison]

My right hon. Friend is right that we would need to be able to act quickly if, following the recommendation, we decided to proceed. The power to make regulations is being proposed in the other place exactly so that we may move quickly at the point we receive Sir Cyril’s review. I have looked at the draft schedule, and if the Government were minded to go forward with this policy, I see no reason why it could not be put through before the end of this Parliament.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 26th November 2013 Commons Chamber

[Jane Ellison]

We know that NHS England has welcomed Professor Briggs’ recommendations. They are contributing to a substantial body of work on orthopaedics, with the sole objective of improving outcomes for patients. I am sure that my hon. Friend will welcome the fact that this year for the first time data about surgical outcomes have been published at both hospital and consultant level, with the objective of driving up quality and supporting patient choice.

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

14. What steps he has taken in response to the findings of the report by the Chief Medical Officer, “Our Children Deserve Better: Prevention Pays”, published in October 2013.

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

The chief medical officer’s report warmly welcomes the Government’s commitment to increasing health visitor numbers and support in the early years, and I shall be working with the children and young people’s outcomes forum to inform future improvements in children’s health.

[Paul Burstow]

My hon. Friend the Minister will know that about half the burden of mental health disease can first be identified during the teenage years. In her report, the CMO says that our information about the prevalence of childhood mental health problems and the level of under-diagnosis of mental health problems among that population is out of date. When will the Government commission the next survey? The last one was done in 2004. Is it not time to do another?

[Dr Poulter]

My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

Mid Staffordshire NHS Foundation Trust

Paul Burstow Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

I do not have the results in front of me, but I am happy to supply them. I want to take up the right hon. Gentleman’s point about avoidable deaths, because one of the changes we want to make today is to avoid the temptation, when there is an avoidable death, for people on the front line to say that it was unavoidable. We are trying to create the structures that make it easy for people to speak out if they think that a death was avoidable and to ensure that they are encouraged to do so.

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

I very much welcome the introduction of a statutory duty of candour, which the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), wrote into our 2010 manifesto. May I ask the Secretary of State about his plans to prosecute if the fundamental standards are breached, which is an important step with regard to corporate criminal accountability? In drafting those standards, will he ensure that advice is sought from the Director of Public Prosecutions, the Health and Safety Executive and others to ensure that the wording is clear and fit for purpose so that when a prosecution takes place there is no hiding behind the language in those fundamental standards?

[Mr Hunt]

We will absolutely do that. We are in the process of a very big consultation to ensure that we get the definitions of the fundamental standards absolutely right, but we also want to try to create a culture that means we do not get to that point in the first place. One of the problems we had with the current system is that the definition of success for a hospital tended to be about meeting waiting time targets and financial balance, rather than caring for patients properly. We want to re-engineer the system through the new inspection regime so that a hospital cannot be good or outstanding unless it is delivering good or outstanding care.

Urgent and Emergency Care Review

Paul Burstow Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

Perhaps the right hon. Gentleman might like to hear what the British Medical Association said yesterday about walk-in centres. The BMA is not known for its support of Government policies, but it said that urgent care centres

“were often opened in places with little patient demand…The result has been a lot of money being spent on these facilities with some now closing because commissioners have found there is not sufficient demand”.

That is the problem we are sorting out.

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

One long-term cause of pressures in our A and E departments is the lack of parity of esteem between physical and mental health. Does the Secretary of State agree that it is unacceptable that two thirds of people experiencing a mental health crisis do not get access within four hours to a psychiatric assessment? Was it not a failure of the previous Government not to set access standards for people with mental health problems? Is it not time, as the mandate does today, to deliver just that?

[Mr Hunt]

My right hon. Friend is absolutely right about that. We do need parity of esteem between mental and physical health. The situation puts particular pressure on A and E departments, including the one closest to this House, at St Thomas’s hospital, where people said that the biggest single worry they have and the biggest single thing that makes it difficult for them to meet their targets is the lack of quick access to psychiatric services. We are looking at this matter and he is right to highlight it.