Care (Older People)

Debate between Paul Burstow and Emily Thornberry

Tuesday 6th September 2011 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing the debate. The speeches and interventions have demonstrated why we need Back Benchers such as my hon. Friend to raise such subjects, which Parliament has not debated enough over the past 10 or 15 years. That may be one reason why, as several hon. Members have said, social care has historically been the poor relation of the NHS and inadequately funded relative to the NHS.

We should not delude ourselves that many of the problems and pressures that have been amply and passionately described in our debate have emerged in the last 12 months. Indeed, if one takes a run through Hansard reports of the past 30 or 40 years, one sees that they have been raised previously. I do not say that to excuse the obligation that rests with the present Government to address the issues, but I ask hon. Members to bear in mind the fact that we should come to the debate with humility and recognition that past responsibilities were perhaps not fully met.

Attention was drawn to the fact that by 2033 almost a quarter of the population will be over 65. Indeed, some parts of the country have already reached that proportion—my hon. Friend the Member for Newton Abbot (Anne Marie Morris) referred to the situation in Devon. I agree entirely with the point made by my hon. Friend the Member for Dartford (Gareth Johnson) that all too often in these debates we use the language of time bombs and consternation instead of celebrating not just the successes of our health and social care system in supporting vulnerable and frail people, but the contribution that, in turn, older people make in our society, often to their fellow citizens. We should do more of that and I want to make sure that we do.

It is worth saying that if the NHS and social care are to cope, some systems and processes need to change; I will say more about that shortly, but it is also necessary for older people themselves and their families and carers to call the shots about the decisions that affect their lives, so that the system can provide the care that people want, need and feel comfortable with. The whole agenda of personalising services so that people have the resources to be able to make choices and to be in control of those services is important, and the Government are determined to turn that ambition into reality.

Let me say something about the coalition’s commitment to see health and social care provided in ways that achieve better outcomes and deliver more personalised services. A thread running through the comments from hon. Members during the debate is the role of integration, which is a key element in realising better outcomes and better quality in the system. Integration is about care services working together in the interests of people and the local populations they serve, and about learning from one another’s experience and ending up with care and support that is of higher quality, safer, and more comforting than ever before.

We also need a sea change in the nature of the working relationships at local level, so that closer working relationships between local authorities and the NHS become the norm rather than the exception. That is one reason why we have made extra funding available. We can debate and will continue to debate in the House whether that funding is adequate, and I have no illusions about the challenges facing local authorities, but the Government have done much to ensure that local authorities have the resources to address them.

NHS funding that goes directly to local authorities for measures that support social care and benefit health will rise to £1 billion per year by 2014-2015. It is the first time that any Government have made such a significant transfer of resources. This year, £650 million has been allocated to PCTs and transferred to local authorities to invest in social care services. That will benefit health and have an overall impact on well-being. I am under no illusions about the interdependencies between health and social care services to which many hon. Members have alluded during the debate. One must look at both parts of the system to understand and mitigate the impact.

I look forward, as ever, to the next chapter of the report on social care by the hon. Member for Islington South and Finsbury (Emily Thornberry). From what I see, however, and from discussions I have had, I know that the picture is far from clear; it is mixed and different authorities are adopting different approaches to the challenges they face in meeting the Government’s deficit reduction targets. Some local authorities are being smart in the ways they confront those challenges and are looking at using telecare and telemedicine, investing in relevant services, and redirecting resources into earlier interventions that can make a big difference up stream. Other authorities—the ones we tend to hear about in debates such as this—are adopting more of a slash and burn approach and tightening eligibility without thinking through the consequences of such decisions and the impact on services. We need to challenge such actions not only in the Chamber but in our constituencies as constituency MPs. These pressures on the system are not new and we have seen such features for many years. Indeed, the vast majority of local authorities already used substantial need as a basis for eligibility and access to services before this Government came into office.

The £650 million that is being transferred to local authorities from the NHS is on top of the £530 million from the Department for Communities and Local Government that will go directly to social service departments.

[Emily Thornberry]

rose—

[Paul Burstow]

If the hon. Lady will forgive me, I want to ensure that I answer two or three of the key points raised by my hon. Friend the Member for Chatham and Aylesford. One key issue concerned the role of a Minister for older people. I certainly share my hon. Friend’s view that we must ensure cross-governmental dialogue and gain a much clearer understanding of the interdependencies between different policies and actions across the Government as they affect older people. The Government are not currently minded to appoint a Minister with specific responsibility for older people, but my hon. Friend has made a number of suggestions that could be a way to look at the issue. I undertake to take the point away and discuss with colleagues how we might join up services in a better way. A number of colleagues across Government have various responsibilities and we must find ways to ensure a clear articulation of the Government’s approach to ageing and an ageing society. We must ensure that that happens not only nationally but locally.

It would be remiss of me not to pick up on the comments about Southern Cross. I did not quite catch the second question, so the hon. Member for Islington South and Finsbury may wish to remind me of it so that I can answer. She asked about landlords, and the answer is that work to ensure that the transfers could take place required that measure to be concluded. As I understand, all landlords involved have now been identified, but if I am misinformed I will write to the hon. Lady and give her the details.

The hon. Lady also asked about home closures. In the past, I have said that when Southern Cross first made its proposals for restructuring the organisation, it suggested that the medium-term future—the next three or four years—would involve a limited closure programme. It did not specify a number and has not done so since. In some ways that programme is no longer the programme being followed; Southern Cross is effectively managing its own demise and passing homes on to new operators, which will have to make judgments about the economic efficiency of those businesses and the welfare of the people living in the homes, and decide whether they can carry on. We must have good advice and support to manage any closures that take place, which is why I have said on a number of occasions that I welcome the work done by the Association of Directors of Adult Social Services.

The hon. Member for Dartford raised an important point about tenure to which we must give serious consideration. I do not want to make a policy announcement about that today because the issue is complicated. We do, however, need to look at how we can give people a greater sense of confidence in the place they consider their home, and ensure that in the future they cannot be lightly tipped out to find a new care home. I will write to the hon. Member for Islington South and Finsbury about the second question to ensure that she gets an answer.

I appreciate the warm words of support—broadly speaking—that have come from all parties about the Dilnot inquiry and the appetite to get on with action. I will ensure that that appetite is well understood across Government. We are clear that the report submitted by Dilnot in July makes an excellent contribution to providing a framework or scaffold around which we can take forward a wider reform of social care for the future. We will soon set out a further process of consultation not only about the details of implementing the Dilnot inquiry—he sets out a number of parameters in his report that are up for further discussion, not least the one mentioned earlier in an intervention—but about the wider issues of quality in social care that were referred to by the hon. Members for Wirral South (Alison McGovern) and for Newton Abbot. We will approach all those issues in a combined way that will lead to a White Paper next April—that answers the question raised by the hon. Member for Chatham and Aylesford.

It is above my pay grade to announce what is in the Queen’s Speech; that has to be someone else’s job—probably Her Majesty, when she sets it out in detail, and the Prime Minister and the Cabinet who make those decisions. The Government remain committed to legislating at the earliest opportunity to bring in the Law Commission’s reforms and address the question of funding reform. I hope that answers the points of concern that have been raised.

The hon. Member for Chatham and Aylesford also mentioned housing, and she was right to talk about choice. That underscores the need for a cross-departmental approach to ageing and an ageing society, and I will raise her comments with my right hon. Friend the Minister for Housing and Local Government. Given his responsibilities for supporting people, it is important that I do that.

Prevention underlies many points that have been raised today and there is much we can do both to prevent admissions into hospital appropriately and to manage hospital discharges better. The increased roll-out and use of personal budgets will play a part in that, and will provide people with more control over the packages and nature of the care they receive.

The contribution made by the voluntary sector and charities has rightly been highlighted in this debate, in particular the role that such organisations can and do play in tackling social isolation. They also provide practical, low-level help—for example, helping to change a light bulb, which sometimes seems to take for ever. We must ensure that communities feel confident to give that help and are given support to provide mutual aid. Through our work on the big society we are determined to see that through. Local councils have an important role in improving health and well-being through commissioning those low-level services, and that has been well described in the debate.

The hon. Member for Newton Abbot expressed some concern about the role of the CQC. Like her, I met representatives from the care sector to discuss their views about what will soon be the first full year of operation for the CQC. The CQC was established in 2009 but has been fully operational only since October last year. Not all of what it does and will do has been explained to care providers as clearly as it should have been, but some of those defects are now being remedied. Just last week I had the opportunity to visit the CQC and see the work it is doing to establish a new, much simpler website. That website will provide a lot more information to providers about how issues of compliance with essential standards are being addressed.

Southern Cross Care Homes

Debate between Paul Burstow and Emily Thornberry

Tuesday 12th July 2011 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the future of Southern Cross Care Homes.

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

As the House will be aware, Southern Cross has been working with its landlords and lenders to agree a restructuring process to secure a viable way forward for the future. As I set out to the House on 16 June, the Government have made it clear that our overriding concern is the welfare and safety of the 31,000 residents in Southern Cross’s care, and that we expect all parties to work together to secure a consensual, solvent restructuring of the business that meets their collective responsibility to secure the welfare and care of residents.

When I last updated the House on 16 June, Southern Cross, its landlords and lenders had the previous day announced an agreement to work through, over a period of four months, arrangements for a consensual, solvent restructuring. Yesterday’s announcement was one step in that ongoing process, and discussions to resolve the remaining steps continue.

I know that there is concern about what yesterday’s statement might mean, and that residents, families and staff are anxious to know what will happen next. Let me repeat the assurance I have given to House before: whatever the outcome, no one will find themselves homeless or without care. We will not stand by and let that happen. We will continue to work with the Association of Directors of Adult Social Services, the Local Government Association, the Care Quality Commission and others to ensure that there is an effective response to any potential disruption to the continuity of care and to ensure that all residents are indeed protected. A consensual restructuring that assures a smooth transition to new arrangements will mean that those contingency arrangements will not be needed. We all want that to happen.

Let me reassure hon. Members about some of the questions that I know they will have. First, yesterday’s announcement stated that at the end of the restructuring process the Southern Cross corporate entity will cease to exist. That has no effect on the provision of care or the operation of care homes. Southern Cross remains in operation, and will continue to operate all its care homes until any transfer to new operators takes place.

Secondly, the transfer of care homes to alternative operators will be a managed process that ensures continuity of services. Yesterday’s statement makes it clear that care home staff will transfer on their current terms, and that the service that residents receive should be unaffected by the transfer. All parties involved in the negotiations have given a clear commitment that the continuity of care will be paramount in that process. Local authorities are already working to ensure that they can assist in the smooth transfer of arrangements in respect of homes in their areas. The Department has been working with ADASS and the LGA to support that.

Thirdly, no transfer will take place without new operators being approved and registered by the CQC. There has been speculation that companies with no experience in the care sector will take over the running of homes, but that will not happen. Alternative operators will need to be reputable and experienced companies that can satisfy the CQC that they are capable of delivering high-quality care and of meeting all regulatory standards. The CQC will not drop its standards in ensuring that requirements are met. I understand that each of Southern Cross’s landlords is settling its arrangements regarding which care home operators to work with, which is an essential part of the ongoing discussions. That will cover all landlords, so that there is a clear way forward for all homes.

Finally, I assure the House that the CQC has been working with Southern Cross landlords and other stakeholders for several months to ensure the smooth transition of services, and that it has processes to deal with re-registration, and to undertake the essential checks that are needed as a priority. It is having ongoing conversations with Southern Cross, landlords and other providers on the timing of applications.

The Government’s priority is to ensure that the current problems with Southern Cross are resolved and that a sustainable way forward can be secured, but, as the Prime Minister has previously stated to the House, we must all be clear on what future action is taken and draw lessons from what has happened.

I said earlier that yesterday’s statement from Southern Cross was one step in a process that will be ongoing in the coming weeks and months. Until all future arrangements are settled, Southern Cross will continue to operate and to provide care in all its homes. Only at the end of the process, when all transfer arrangements have been completed, will Southern Cross as an entity cease to exist. By then, all homes will have a clear plan for future operation, and the continuity of care will have been secured. That is the approach that the Department of Health has taken. Officials are in daily contact with all relevant parties. This Government are not sitting back; we are fully engaged.

--- Later in debate ---

[Emily Thornberry]

I thank the Minister for his response to my urgent question. Yesterday’s Southern Cross announcement that responsibility for managing 752 homes will pass back to the 80 landlords who own them has created a vacuum. I was interested to hear him say that that was part of a managed process, because it does not look like that—it has been a source of terrible uncertainty and great anxiety among residents and families. We have had so little information.

I am grateful for the information that the Minister has given today, but we need much more. Can the Government publish a list of all 80 landlords, or are the rumours correct that some of them have yet to be identified? Yesterday it was further announced that control of 250 of the homes would be handed back to the landlords immediately. We need to know which homes they are so that people living in them know who is running their home. Many of these landlords have little or no experience of running care homes. Does he have any information on the intentions of property companies such as London and Regional homes, which owns 90 former Southern Cross homes, or Prestbury, which owns 21?

I understand that the Association of Directors of Adult Social Services is doing its best to support its members, who will have a key role in ensuring that the operating companies can provide good quality care, and also that local authorities know how to perform financial stress tests to ensure that the new businesses have sound financial models, but what assistance is the Minister giving? Does he intend to provide additional resources to hard-pressed local authorities in order to help them? What advice can he give to local authorities if, for example, the new company is an offshore company? If the Department of Health does not have the expertise to assist ADASS, will he give that organisation access to officials from the Department for Business, Innovation and Skills, who might be able to provide that assistance?

Presumably, the new operators taking control of the homes will need to be registered with the Care Quality Commission—the Minister has assured us that that will happen—but given the staff shortages at the CQC will he assure us that the registrations will be completed quickly? The House has heard him guarantee that the new operators will honour the previous terms and conditions of the 44,000 employees, but how does that square with the announcement of 3,000 job losses? Does he know how many homes are likely to close and what the timetable is for such closures? What will happen to the 50 former Southern Cross homes owned by Lloyds properties, which is in administration? What about NHP, which owns 250 former Southern Cross homes and which is at a standstill with its bondholders? These problems must be addressed. We need a home-by-home plan from the landlords, and he must give us that plan. The buck stops with him. Will he now accept his responsibilities?

[Paul Burstow]

My slightly-longer-than-it-should-have-been answer to the hon. Lady’s question was an attempt to set out as much detail as was possible about the steps being taken to achieve a consensual, solvent restructuring of the business so that the homes can continue to operate. That is what my answer was all about. She asked about the role of the CQC, which, as I said to her, has been working for some months with the landlords to ensure a smooth process of re-registration as new operators are identified to take on the running of individual homes. I also said in response to her initial question that every home will be transferred. There is a plan in place that will lead to all homes being transferred over the next four months. She asked about engagement with BIS. Of course, as part of the ongoing work, the Department of Health is engaging with BIS to ensure that we have the very best advice in dealing with these issues. The Government have been—and remain—fully engaged with the process.

Oral Answers to Questions

Debate between Paul Burstow and Emily Thornberry

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I shall certainly elaborate on how we are doing that in greater detail later. For some months we have been working with the landlords, the lenders and Southern Cross, and making sure that local authorities are fully prepared for any likely contingency and the CQC is ready to deal with re-registrations, should that become necessary.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

The Minister of State has told us that one of the reasons why the publication of the White Paper has been delayed is to allow cross-party talks, so I wonder whether he can help us: when will the meeting between the Prime Minister, the Deputy Prime Minister and the Leader of the Opposition take place?

[Paul Burstow]

I am surprised that the hon. Lady does not know. As I understand it, there is a date in all three people’s diaries, but it is not for me to share that date. Although we do need to have cross-party talks between the leaders and the health spokespeople involved, we should also look back and draw some lessons from the royal commission on long-term care. What surprises me is that when that report was published by the right hon. Member for Holborn and St Pancras (Frank Dobson), all that was offered was a debate—not a debate that the Government would lead, but a debate that would take place across the country. We are still waiting for the end of that debate. This Government have a timetable and a commitment to engage.

Southern Cross Healthcare

Debate between Paul Burstow and Emily Thornberry

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

The right hon. Gentleman is absolutely right. The Government’s paramount interest—it is the interest that all of us in this House should have—is to ensure the welfare of residents. That has been the message that I, as a Minister, and officials have been giving, and will continue to give, to Southern Cross and to the landlords, and the CQC will have the responsibility of ensuring that that is carried out. It is absolutely clear that we all have to ensure that the restructuring succeeds, because that is in the best long-term interests of the residents.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I thank the Minister for his statement, limited though it is. I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on being granted this urgent question on an issue of great importance to Members of the House.

This is not the first time that Members have tried to bring the Minister with responsibility for care services before them to respond to their concerns. The lack of leadership and information from him during this period of uncertainty and anxiety for Southern Cross residents and their families, as well as its employees, has been notable. As a result of the agreement reached yesterday, we now appear to have a period of relative stability. However, great uncertainty remains for residents and employees at Southern Cross homes. We have heard that Southern Cross will now begin a period of restructuring, with reports of around 300 homes changing management, but contracts have been ripped up and it seems that 3,000 jobs are being lost. What assurances can the Minister give on security of employment for those working in Southern Cross?

On safety, last week we heard that Southern Cross is making 3,000 people redundant. We have also heard from the Care Quality Commission that Southern Cross has breached standards at 164 care homes—the equivalent of 28% of its English estate. Can the Minister guarantee the safety of and standard of care for residents, and how will he do this? Will the CQC carry out more frequent inspections?

There has been widespread condemnation of the business practices that led to Southern Cross’s financial problems. It is all very well for the Minister to point fingers at what might have happened many years ago, but this problem exists now, and the Minister is in government now. When people are treated as commodities with no thought to the consequences for them of this risky business model it is important that Government step up to the plate and do something about it. Southern Cross is not the only company in this industry to have financial difficulties. We have heard from the Business Secretary that the business model of Southern Cross and others in the residential care industry will be looked at by his Department. Will the Minister provide more details on the timing of this review and how Members will be told about its findings?

On cuts, the Minister says that there will be robust local arrangements, and I am sure that local authorities will step up to the plate if asked to do so. He must recognise, however, that local authorities are already under enormous strain as a result of the cuts imposed on them by his Government, including the cuts that they are already having to make to adult social care. How can they be expected to pick up the pieces of this national problem without assistance nationally from Government? In other words, are they to be given more resources to deal with the problem of Southern Cross if they are expected to be involved in plan B?

[Paul Burstow]

The hon. Lady is long on critique but very shallow when it comes to how she would approach this differently. Last week, I set out in a written ministerial statement the approach that the Government were taking. We also dealt with this extensively at last week’s Health questions.

The hon. Lady asked about the 3,000 job losses that are being proposed as part of redundancy measures by Southern Cross. Let us be clear: it has a statutory obligation to declare a ceiling for the number of job losses that may—I repeat, may—take place in the business. I have asked the CQC to undertake additional inspections to address concerns arising from the proposed job losses, and that has already been put in place.

The hon. Lady talks about cuts in social care spending but glosses over the fact that this Government, through the spending review, agreed to an unprecedented transfer of resources from the national health service to support social care, with £2 billion extra going into social care by 2014.

We might agree that we need to learn lessons from what is happening to Southern Cross, in respect of regulation and how we ensure a stable and successful social care sector for the future. That is why the Government are committed to an overhaul of social care and to bringing forward a White Paper to set out the plans in due course.

Winterbourne View Care Home

Debate between Paul Burstow and Emily Thornberry

Tuesday 7th June 2011 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

(Urgent Question): To ask the Secretary of State for Health to make a statement on the Government’s decision not to hold an external independent inquiry into the abuse of vulnerable adults at Winterbourne View.

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

Nobody watching the BBC’s “Panorama” programme last week could have been anything but shocked and appalled by the systematic abuse of residents at Winterbourne View. May I, first, extend my deepest sympathies, and those of all of my colleagues in the Government, to those so horribly mistreated and abused, and to their families and loved ones? For the avoidance of doubt, I should say that we have not ruled out an independent inquiry. A criminal investigation is under way and it is important that we do nothing that could prejudice it.

In the coming weeks, the Care Quality Commission will inspect the other 22 hospitals run by Castlebeck and the reports will then be publicly available on CQC’s website. The CQC is also starting a three-month inspection of the 150 hospitals that care for people with learning disabilities, and this will include unannounced inspections. Where it identifies inadequate care, the CQC will require the necessary improvements to be made immediately. South Gloucestershire council will also lead an independently chaired serious case review. I have asked the Department of Health to draw together the findings of these various investigations and ensure that they are completed in a thorough and timely manner. I can also report that Mark Goldring, the chief executive of Mencap, will bring an independent voice and a depth and breadth of knowledge of the needs of people with learning disabilities to the task of drawing conclusions and learning lessons. Once in possession of the full facts, and once the police investigation has concluded, we will be in a position to decide what further action is required.

Since being made aware of the abuse, our priority has been ensuring the safety of patients at Winterbourne View. Fifteen staff have been suspended by Castlebeck and no further patients will be accepted at Winterbourne View. All residents now have a personal advocate and the CQC is working with all the agencies involved to find suitable alternative placements for them, taking into account their specialist needs and the wishes of their families. I issued a full written ministerial statement on these matters at 9.30 this morning.

It is the right of every individual being cared for by others to be treated with dignity and respect and it is the responsibility of those trusted with their care to provide it: a responsibility that weighs most heavily on those who care for the most vulnerable, including those with learning disabilities. This responsibility rests in four places: with the providers themselves, in this case Castlebeck; with commissioners, both primary care trusts and local authorities; with the regulators, including both the Care Quality Commission and the professional regulators, and the CQC has acknowledged it should have acted sooner and issued an unreserved apology; and, of course, with individuals. No training, guidance or management should be needed to tell people that the behaviour experienced by the residents of Winterbourne View was nothing other than obscene and unacceptable.

In future, our proposed HealthWatch organisations will provide a valuable early warning and will be able to ask the CQC to investigate where concerns exist. We intend to put safeguarding adults boards on a statutory footing, helping local authorities, the NHS and the police to work together to safeguard vulnerable adults. We will do everything in our power to prevent incidents such as those at Winterbourne View from happening again and to ensure that, if they do, the system responds quickly and decisively to protect those at risk.

[Emily Thornberry]

The Opposition agree entirely with the sentiments expressed by the hon. Gentleman. It was with great shock and sadness that we saw the terrible events happening, before our eyes, on the television screens. To see the abuse of the most vulnerable by those entrusted with their care was truly shocking and sickening. In the wake of this tragedy, however, vital questions must, in our view, be answered fully and impartially.

Although internal investigations conducted by the CQC and South Gloucestershire council, both of which are directly connected with this failure, will be of some value, they are nevertheless insufficient. We are asking for an independent inquiry similar in nature to the well-respected “Healthcare for all” inquiry, which Sir Jonathan Michael carried out in May 2007. The Government could include in that inquiry experts to work alongside Mark Goldring, such as Professor Jim Mansell, who has already conducted two reviews for the Department of Health into the structure of homes for those with learning disabilities, because the issues raised in his reports are still to be resolved, as this tragic case suggests.

We need full and frank answers. Was the CQC’s failure to monitor the treatment of residents due to the lack of resources? Was it due to the shortage of 300 staff, as reported in the Financial Times last week? Does the CQC have adequate powers to act in cases such as that of Winterbourne View and, if so, is it using its powers appropriately? If not, how must the CQC be strengthened to prevent a repeat of this failure and what actions will the Government take to ensure that staff working in social care are better trained and regulated so that events such as those at Winterbourne View can never be repeated?

Last week, the Minister created confusion with his response. On Tuesday, he seemed to imply that there would be an independent review of the case but by Wednesday he seemed to have changed his mind. Does he now think that internal reviews will be sufficient to answer the questions? I hear what he says about sub judice and the police inquiry, but we are not asking for an inquiry into individual culpability. We are asking for an independent inquiry into the failure of the system, for that inquiry to begin immediately and for there to be no delays. We need assurances that there will be a wide-ranging review, held in public, that will shine a light on the terrible events at Winterbourne View. Only an independent inquiry will do.

[Paul Burstow]

Of course, we need to ensure a full and thorough inquiry into all these matters, which is being undertaken in the serious case review, which will be chaired independently, and in the work of the CQC. That will go on as the Department brings together all the different reviews and that is why we are very pleased that Mark Goldring will take part in the process.

The hon. Lady suggests that there was confusion last week, but the confusion was only that which she sought to spread. We were very clear from the outset that we wanted to examine all the results from all the different inquiries, and that is what we are doing. We are not ruling out any further inquiries, but we want to ensure that the processes that are in hand are concluded and that we make judgments with the full facts available.

Oral Answers to Questions

Debate between Paul Burstow and Emily Thornberry

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

The hon. Gentleman makes a fair point that relates to the earlier question where I indicated that we are in constant contact with the devolved Administrations and will continue to have that dialogue—if necessary, at ministerial level.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Although we welcome the Government’s statement today that whatever the outcome of the restructuring of Southern Cross, they will not allow anyone to find themselves homeless, may I cast the Minister’s mind back to a week ago? Where was he? Why was he not visiting Southern Cross homes and speaking to residents, families and carers, as I was? Does he not now regret hiding in his bunker and allowing No. 10 to attempt to answer the questions that were put to the Government on behalf of these very vulnerable people?

[Paul Burstow]

I was about to say that I was grateful to the hon. Lady for the question, but clearly I am not. I have been following this as a Minister throughout, and I continue to follow it closely and to give the necessary instructions to officials to secure the future and the fate of the residents in these care homes. We have to be cautious and careful about the language we use on this particular endeavour. That is what I am doing, and I would urge the hon. Lady to do the same.

[Emily Thornberry]

The Minister can be assured that I am careful in the language that I use, and the words that I wish to use are these: does he agree that it is simply wrong that financiers and some of Southern Cross’s previous directors have creamed off millions of pounds while putting at risk the care of 31,000 elderly people who seem to have been used merely as commodities? Now that this has come to light, will the Government look urgently at whether regulation should be extended to ensure the financial stability of organisations that we entrust with the care of our most vulnerable?

[Paul Burstow]

That question has already been asked, and I have already indicated the approach that we intend to take with regard to the White Paper. I also point out that the establishment of the business model that Southern Cross operates of separating out provision from the ownership of the homes took place not under this Government’s watch but under her Government’s watch.

Social Care Services

Debate between Paul Burstow and Emily Thornberry

Tuesday 17th May 2011 Westminster Hall

[Paul Burstow]

Yes; we can build on that point. The Government recognise the importance of social care and the fact that it lets people live independently, which is what it should be about. It should be about enabling people to live well, to be safe, to continue to do things that we take for granted and to be active participants in civic life.

As has been rehearsed in this debate, there are big challenges. There are demographic challenges and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) has outlined some of those facts. The hon. Member for Wolverhampton North East (Emma Reynolds) has rightly said that, while we should be concerned about the challenge, we should not be so concerned as to forget to celebrate the fact that we have an ageing population—a population that is living for longer and, in many cases, living healthily for longer as well. We also have changing societal expectations and a greater expectation of being able to make choices for oneself, to be in control of one’s own life and to be able to have high standards of support to facilitate that. We have financial challenges. We have a structural deficit. For every £4 that this Government spend today, £1 is borrowed, and we are spending £120 million every day on interest charges.

Reference has been made to the survey by the Chartered Institute of Public Finance and Accountancy for the BBC. I have to say that, of the many surveys that have been produced, including that of the hon. Member for Islington South and Finsbury, it is probably the least robust of the lot. There we go—I give the hon. Lady credit that her survey must be more robust than that of CIPFA, which did not provide a great deal of detail and did not ask the right questions. Indeed, those who answered the questions were not all social services authorities, and they included things in their figures that are not part of social care. Even the Association of Directors of Adult Social Services has criticised that piece of work.

On attempting to address and mitigate the impact of the reductions that the Government have had to make in formula grant over the past year, we have strived to mitigate it in those areas with the greatest needs to make sure that we have increased the support in those areas, relative to others.

The hon. Member for Stockton North talked about high mortality figures in constituencies such as his own. Again, we have to dwell on why that is still the case after so many years, why we still have that legacy, why we have to continue to address those challenges, and why this Government, through their commitments in public health and elsewhere, are determined to make progress.

Despite the deficit legacy, we have taken some decisions. Members have forecast that I would refer to them, and I make no apology for that. We set out in the spending review in October how we would ensure sufficient resource in the system to allow decision makers at a local authority level to protect social care, if they decide that that is their priority. We have a good settlement in that context. An additional £2 billion will come to social care by 2014-15, and that money is getting through. In January, £162 million was put into social care via the national health service, which is something that we were asked to do and which we have done to ensure that social care gets additional support. Moreover, there is £648 million of additional funding from April this year. That money is going to social services departments and is being transferred by the NHS for that very purpose. A further £1.3 billion is supporting the transfer of funding for the commissioning of learning disabilities.

Those sums constitute the biggest transfer of hard cash from the NHS to social care ever. It is not only about supporting social care, but about breaking out of silos. It is about using cash to get people to start having those dialogues that are so important to achieve the collaborative behaviour and integration that are essential to delivering better services for our citizens.

On top of that is the £530 million that will come through the formula grant. I will not micro-manage, from this Chamber or my desk in Whitehall, every single social services authority and tell them how to use that money. It must be their decision, based on need, and they are accountable for such decisions.

[Emily Thornberry]

The Minister has anticipated what I am about to say. First, if money is being transferred from the health service to social care, I presume that it is being done by primary care trusts, which are at the same time being abolished. Is he confident, therefore, that that money is properly accounted for by the Department of Health, given the current chaos reigning within the health service? Secondly, will he tell us how much of the money given to local authorities is actually being spent on social care in the way in which it is supposed to be?

[Paul Burstow]

The answer to the first question is yes. The answer to the second question is that I will write to the hon. Lady with further detail. However, it is certainly the case that money is being agreed between the NHS and social services for the provision of social care services that support health and underpin prevention.

I would also like to refer to the work of the King’s Fund, which is reputable body that is often cited by Opposition Members. It has confirmed that, if we take into account efficiency savings, there is no funding gap for social care during the spending review period. Of course, the grounds on which some councils have made their budget judgments mean that some have acted to protect social care through innovation and the redesign of services. Other councils have decided to change their eligibility or charging policies.

Reference has been made to the ADASS survey, which shows that social care spending as a share of council spending has increased. The hon. Member for Islington South and Finsbury has referred to savings that local authorities are making. For every pound of savings that will be made from social care this year, 70p is a result of efficiency and doing things differently and only 20p—this is still something that I regret—is a result of actual reductions in service.

Yes, eligibility has been tightened, but that is not new. As I have mentioned, a survey carried out by the Learning Disability Coalition shows that those tightenings in eligibility criteria have been part and parcel of local government decisions for many years. Indeed, the ADASS survey shows that, when this Government came into office last year, 101 local authorities were already limiting eligibility to services to those with “substantial” need. Twelve months later, 116 local authorities are using “substantial” need and just six are using “critical” need. It is worth looking behind those headlines, because some councils are changing the eligibility criteria, but they are reinvesting the savings they make from that decision into preventive services, such as telecare and giving people personal budgets. For example, Southwark council has reviewed the needs of people with learning disabilities and is changing its services through the introduction of personal budgets, supported living and providing more control and dignity. It is saving resources, but it is also giving people a better quality of life.

The hon. Member for Newcastle upon Tyne North described the unacceptable quality of care in some care homes and the inquiry that was carried out by a local broadcaster. She is right to describe some of the shocking stories that she has heard and to decry how older people all too often get relegated in the headlines compared with scandals over the care of children. She talked about the Care Quality Commission and the fact that it has changed its inspection model. I respectfully suggest that the basis for the legislation that introduced essential standards and has led to a more risk-based model for inspection was debated in the House not under this Administration, but under the previous one. We have not abandoned the changes the previous Government started or thrown the whole regulatory framework up in the air yet again and caused chaos, as often happened in the past 13 years. We are trying to ensure that that model delivers.

The hon. Member for Newcastle upon Tyne North asked about skills and training. Those issues were also touched on by the hon. Member for Blaydon (Mr Anderson). The Government are working with Skills for Care, which will produce work force, retention and personal assistance strategies to address the sorts of concerns that the hon. Lady and others have mentioned. I will publish those shortly.

--- Later in debate ---

[Emily Thornberry]

On the issue of confusion, the Minister spoke earlier about the King’s Fund and said that its view is that cuts will not be made to social care. I have just checked that, and I believe that the King’s Fund has said that there will be a shortfall of £1.2 billion by 2014-15.

[Paul Burstow]

The King’s Fund has stated that but, if one reads on, the document concerned states that if efficiencies of 3.5% are made, there is no need for a funding gap to open up.

On social care law reform, our current legislation is the product of 60 years of piecemeal legislation that looks back to 19th-century poor law principles. A Law Commission report makes 76 recommendations and provides a firm foundation on which we can build. The Government intend to publish a White Paper later this year and to introduce a Bill in the second parliamentary Session.

Our intentions are clear. During the life of this Parliament, we want both the law on social care and its funding to be reformed. We want that reform to be based on a vision in which there is a greater personalisation of social services, a more preventive focus on how those services are provided and a real attempt to deliver around outcomes. We want services that are more innovative and that are based around growth, telecare and involving other providers. There also needs to be a partnership between the individual, the state and health and social care providers. That is how we can secure the future of social care and make a real difference for every one of our constituents. I thank the hon. Member for Stockton North for initiating the debate, and I hope that we will have more debates about social care than have taken place during the past 13 years.

Oral Answers to Questions

Debate between Paul Burstow and Emily Thornberry

Tuesday 26th April 2011 Commons Chamber

[Paul Burstow]

My hon. Friend makes an important point about ensuring that competition is always based on quality, not just price. If she would like to write to me with more details about the matter, I would certainly be happy to follow it up with her.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Since the Government are no longer doing an assessment of the provision of social care by local authorities, I have done it for the Minister. My survey has found that not only have eligibility criteria been tightened, but 88% of councils are increasing their charges, 63% are closing care homes and day centres and 54% are cutting funding to the voluntary sector. Now that I have told the Minister the facts, will he take back his comment that

“no councils need to reduce access to social care”?

Would he like to start being straight with the public?

[Paul Burstow]

I will take Labour facts with a pinch of salt. Under Labour, social care was always very much the poor relation. Under this coalition, social care has received a £2 billion spending boost and an unprecedented transfer of resources from the NHS—something that the hon. Lady’s party, if it had been in power, would not have been able to do, because it would have been busy cutting the NHS.

Oral Answers to Questions

Debate between Paul Burstow and Emily Thornberry

Tuesday 25th January 2011 Commons Chamber

[Paul Burstow]

The NHS has real-terms increases in its resources, and those resources are going into the programme that we outlined in our outcome strategy. Three quarters of a billion pounds will be going into that programme to deliver improvements in cancer services and the £200 million, being extra, will go into improving cancer services. That is the commitment that the Government have made and that is the investment that we will make.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Is the Minister listening when Macmillan warns that the proposed changes to the NHS risk us losing expertise in the cancer networks? If that happens, Macmillan says that

“cancer treatment will get worse…some treatments could even collapse in parts of the country…more patients could die earlier”.

As the Minister in charge of cancer services, should not he be on the side of cancer patients, not backing his boss’s reckless reforms?

[Paul Burstow]

The last comment was pretty cheap, and no Government Member has suggested that the future of the cancer networks is in doubt. Indeed, in the coming financial year, the funding is secure. As we move to the new arrangements, it will be for the NHS commissioning board to decide the appropriate arrangements for commissioning in the future. We are clear that the expertise of those groups could, should and will continue to be used to support commissioning in the future.

Oral Answers to Questions

Debate between Paul Burstow and Emily Thornberry

Tuesday 7th December 2010 Commons Chamber

[Paul Burstow]

I am grateful to the hon. Lady for her question and I know that she has campaigned on that issue. She will know that on 25 October, the Secretary of State asked the independent reconfiguration panel to consider the issue that was raised by the Portsmouth health overview and scrutiny committee regarding a referral of ward G5. The advice has now been tendered, and the Secretary of State has asked the panel to undertake a full review of the case. He expects that report by March of next year and I am sure that during that period, conversations at ministerial level will be helpful.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Most people want to die at home, but they are prevented from doing so by the lack of out-of-hours support. Also, 24/7 community nursing is popular with the National Audit Office because it saves money. Even the Government say it is crucial, so why do they not use some of the £3 billion they are wasting on top-down reorganisation to ensure that everybody gets a community nurse at the end of their life, if they want one? How can the Government guarantee care for the dying if they abolish primary care trusts?

[Paul Burstow]

Perhaps a little humility might have been a necessary preface to that question, including, not least, an acknowledgment that the hon. Lady’s question is based on the failings of the previous Administration to deliver the necessary improvements in end-of-life care. On GP commissioning, there is undoubtedly an opportunity to integrate health and social care to deliver more timely and appropriate community-based end-of-life care, and we intend to deliver it.

Rarer Cancers

Debate between Paul Burstow and Emily Thornberry

Wednesday 27th October 2010 Westminster Hall

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

I am grateful for the opportunity to respond to the debate. I congratulate my hon. Friend the Member for Manchester, Withington (Mr Leech) on securing it and I particularly thank him for giving me notice of the focus of the debate, because, as he rightly says, the range of issues that could be covered in a debate on rare cancers is very wide. I hope that my remarks will therefore address his particular concerns.

The argument that my hon. Friend makes about the iniquities facing people with rare cancers is a clear riposte to the challenge posed by those who say that the NHS needs no reform because it works perfectly. That is often said to me, but my hon. Friend has set out a compelling case why there are areas in which scrutiny, change and reform are undoubtedly necessary. In fact, there are significant failings in the current system of drug pricing and access. The Government are determined to put them right so that we can help more people to get fair access to drugs and treatments that will help them.

In that regard, my hon. Friend rightly draws attention to today’s launch of the cancer drugs fund consultation. It is an important moment for the 27,000 people diagnosed with rarer cancers each year. The £200 million a year investment that we shall be making from 1 April 2011, on top of the £50 million that started to go into the system from 1 October this year, means that the NHS will be in a position to provide more support than it has been able to in the past. We will ensure that more patients get drugs and treatments not otherwise available on the NHS.

The Rarer Cancers Foundation has said that our interim funding for the cancer drugs fund will benefit more than 2,000 cancer patients this year alone. Clearly, the £200 million investment that we are making from next April will benefit thousands more. My hon. Friend—

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Will the hon. Gentleman give way?

[Paul Burstow]

I am afraid not, because in these debates one has to have obtained the permission of the hon. Member who secured the debate and then the Minister. For that reason, I cannot give way.

[Emily Thornberry]

Please excuse my inexperience. I have just one question—

Finsbury Health Centre

Debate between Paul Burstow and Emily Thornberry

Wednesday 23rd June 2010 Commons Chamber

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

I congratulate the hon. Member for Islington South and Finsbury (Emily Thornberry) on securing this debate on an issue that is clearly very important to her and many of her constituents, who have campaigned for many years. I thank her for taking the time for this debate, not least because it has educated me about some initiatives that were taken prior to the foundation of the NHS. Some of those were clearly inspirational and influential in shaping the ideas that informed the foundation of the NHS.

Earlier today, I had a look at the plans, so I saw for myself just what a huge beacon of hope a building of that sort would have been in the 1930s in the area that the hon. Lady describes. I understand the strong feelings that she has expressed and the powerful case she makes.

The hon. Lady asks for an assurance on the building. I will amplify the reasons for this in a moment, but such an assurance would prejudge the process, which I am sure she would not expect me to do in the House tonight. However, I want to be as helpful as possible. In setting out the case tonight, she rehearsed some of the important history—it goes back more than 70 years. Having seen the pictures and the plans, I share her view of the significance of the building, which clearly goes beyond the boundaries of the London borough of Islington.

The building’s design was ahead of its time. I am told that the centre was the first of its kind, and the hon. Lady outlined the many services that the centre has provided over the years. It was indeed a visionary endeavour.

[Emily Thornberry]

The point is that it was the first publicly funded health centre in the country. Although it was primarily funded by a local authority, that local authority showed the way to a future national Government.

[Mr Burstow]

Such initiative on the part of local authorities is perhaps something that we should applaud and learn more from for the future even today.

When I was preparing for the debate, it was drawn to my attention that the architect of the centre, Lubetkin, was involved in the design of the penguin pool at London zoo. I have had the pleasure of visiting London zoo with my children, so I recognise the range and scope of his designs. As the hon. Lady said, when the Finsbury health centre was opened in 1938, Lubetkin remarked:

“Nothing is too good for ordinary people”.

He was quite right too. The notion of the health centre as a palace of the people is important.

Lubetkin was ahead of his time, but that motto resonates today, because all NHS staff, not just those at the Finsbury health centre, take it to heart and practise it every day. They have played, and continue to play, an essential role in improving health within the London borough of Islington and elsewhere, and I can understand why the centre is viewed with such affection and passion by local residents, and why this matter has aroused such strong feeling.

I need, however, to rehearse some pros and cons. I understand that the future of the Finsbury health centre has been under discussion and debate for at least 20 years, and that more recently Councillor Martin Clute, the chair of the Islington overview and scrutiny committee, has played an important role in leading the debate about the relevant priorities. I am also told that the primary care trust and Islington council’s health and well-being review committee are continuing to find ways forward and to discuss this matter.

There are strong arguments on both sides, many of which the hon. Lady has rehearsed. For instance, we have to consider the view that what was state of the art 70 years ago may not be well suited to the demands and delivery of 21st-century health care. The PCT has told me, in briefings I have received, that there are real limitations to the centre in its current form. For instance, there are problems meeting statutory requirements on disabled access. In addition, reception and other patient areas are badly laid out and cramped, and the centre is in a poor state of general repair. Criticism could be levelled at the PCT for failing to make those investments, but nevertheless those problems remain. I am also told that it is proving difficult for the centre to provide patients with dignity and privacy, about which we should all be concerned. The hon. Lady has already told us about the status of the building. It is a grade I listed building, which inevitably places additional restrictions on what work can be done to rectify the problems I have identified.

On the other hand, the local health and well-being review committee has published a report questioning the PCT’s conclusions and has raised important concerns about access to health care for some of the most vulnerable groups in Islington.

[Emily Thornberry]

Lubetkin designed the building with the idea of flexibility in mind, as was highlighted to the PCT and Islington council when I was having discussions with English Heritage. Although it is a grade I listed building, there is a huge amount of good will in terms of what can be moved and how things can be changed within the building, because everyone wants, if possible, for the building not to be mothballed, but to continue to be a living, breathing building.

[Mr Burstow]

I hope we can find a way to preserve it as a living, breathing building and a testament to its history.

Finsbury health centre could be modernised, as the health and well-being review committee has said. The hon. Lady’s point about the co-location of services was made in the representations from the overview and scrutiny committee. However, the PCT would say that considerable financial costs are associated with that. It has estimated that the capital costs of £9.1 million to refurbish the health centre could translate into about £1 million a year over 25 years. By contrast, it says that the PCT could provide a new building somewhere else in the area and that the rent for that would be £600,000 per annum. On that basis, the NHS asserts that it would be paying a premium of £400,000 per year to keep the Finsbury health centre open.

I understand the trust has pursued various sources to fund the refurbishment, including the Heritage Lottery Fund, but these have not been available due to the eligibility criteria used. With this in mind, clearly there is an important issue that needs scrutinising about the costs and benefits of keeping the health centre open. Would that money be better spent on providing services to local people elsewhere rather than in the existing building? There is an opportunity cost here—contested perhaps, but a cost none the less.

On the Islington new deal committee, I understand that representations were made, about which the hon. Lady has talked, but I gather that they were rejected last December by the committee and the moneys not made available. However, I think that I can give her some hope in respect of announcements that the Government made a few weeks ago on the principles that we see being critical to how we reconfigure services in the future. That is clearly relevant to this controversial issue, because it is important that neither I nor the Secretary of State should be taking sides in the debate that is taking place locally. It is important that the matter is resolved locally and, only if it cannot be, that Ministers then become involved.

The issue should be resolved by the PCT and the local health and well-being review committee working with patient groups, clinicians and, more generally, the local authority to reach an acceptable solution. I recognise that change in the NHS has always been a problem, in terms of how it is handled locally. It has certainly been an issue in the past—I have seen that in my own constituency—and that is often why decisions have provoked the deep concerns and anxieties that the hon. Lady has described this evening. That is why the Government are determined to do things differently, in a way that gives MPs, the public and particularly clinicians the opportunity to shape the decision-making process. That is why the Government have already announced an immediate moratorium on all pending service changes. Indeed, we have required NHS London to look again at the entire Healthcare for London strategy.

The Secretary of State for Health has set out four crucial tests that all future service changes must now pass. First, they must have the support of GP commissioners. Secondly, arrangements for public and patient engagement, including local authorities, must be strengthened. Thirdly, there must be greater clarity about the clinical evidence used to underpin any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice. The whole point is to ensure that all decisions that affect local communities are taken by local communities, with particular reference to what clinicians think is the best solution, based on robust clinical evidence. The point that the hon. Lady made about co-location needs to be considered in that regard.

What does all that mean for Finsbury health centre? It means inviting patients, GPs, clinicians and the local council to play a fuller role in deciding what should happen next, sharing responsibility for deciding on the best way to secure those important services. I understand that further local discussions are taking place between the PCT and the health and well-being review committee about its report and how the PCT will respond to it, which it will within the next few weeks. I stress that it is vital that the PCT and the local health and well-being review committee continue to work together with local groups to find a resolution to the problem. However, the PCT tells me that it is in the process of reviewing its plans against the criteria that the Secretary of State has set out. I would urge the hon. Lady to engage with and challenge the PCT to ensure that it is doing just that.

It is particularly important that the PCT works with local GPs and commissioners. Furthermore, it is not just the overview and scrutiny committee that needs to take a view; the whole of the London borough of Islington council needs to form a view as well. I strongly believe that it is in everybody’s interest that the issue is resolved quickly. It has been going on for far too long, and I understand the hon. Lady’s frustrations. What we need is a resolution that addresses those concerns in the way suggested by the Secretary of State to look at reconfigurations.

I hope that a swift resolution is possible, but there is always the possibility that the local health and well-being review committee will still consider the outcome unacceptable and refer it to the Secretary of State. The hon. Lady asked me how that would be dealt with by the Department. The answer is that there will continue to be an independent process of reconfiguration review to offer the Secretary of State advice in undertaking his arbitration and decision-making responsibilities at that final stage.

I recognise that these are difficult decisions, and they quite rightly provoke debate and discussion—and, in this case, disagreement. I am afraid that not all decisions can be made here in Whitehall or Westminster by Ministers, and we certainly should not seek to dictate. However, what is important to me as a Minister is the integrity of the decision-making process. By seeking the support of GPs and local people, basing decisions on clear evidence, and ensuring that all changes improve patient choice, we believe that we can achieve a better health care system for the people of Islington—one that is affordable and cost-effective. That is what I now expect from NHS Islington.

The hon. Lady will continue to play an important part in that, ensuring that all the sources of funding are understood and can be brought to bear. I hope that she will engage with the PCT and the local authority to get the long-term solution that delivers health care that is fit for purpose and is what local people want.

Question put and agreed to.