Care Workers

Debate between Paul Burstow and Helen Jones

Wednesday 5th November 2014 Westminster Hall

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

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

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

The guidance states:

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

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

[Helen Jones (Warrington North) (Lab)]

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

[Paul Burstow]

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

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

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

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

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

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

Oral Answers to Questions

Debate between Paul Burstow and Helen Jones

Tuesday 18th October 2011 Commons Chamber

[Helen Jones (Warrington North) (Lab)]

6. What steps he is taking to ensure that patients receive accurate and unbiased information on treatment options.

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

The NHS constitution gives people a right to information about their treatment options. I want everyone to get timely, trustworthy information such as patient decision aids, so that they are involved in their care decisions. The Health and Social Care Bill will ensure that the commissioning board and clinical commissioning groups secure that.

[Helen Jones]

In the light of that answer, will the Minister condemn the decision by GPs in Haxby to use NHS data to tout the services of their own private company and give wrong information to patients? Or is that simply a foretaste of what will happen under the Health and Social Care Bill when clinical commissioning groups decide what services are necessary, leaving private companies in which they may have an interest to pick up the slack in a privatised, marketised NHS in which patients come last?

[Paul Burstow]

The hon. Lady is spreading yet more myths and misconceptions about the reforms that this Government are making. If she had researched the matter more thoroughly, she would know that there is a code of conduct for the promotion of NHS-funded services, which makes it clear that providers of primary medical services cannot directly or indirectly seek or accept from any of their patients payment or other remuneration for any treatment. As a result, the PCT is questioning that clinic about how it has used patient information and will continue to pursue the matter.

Health and Social Care (Re-committed) Bill

Debate between Paul Burstow and Helen Jones

Wednesday 7th September 2011 Commons Chamber

[Paul Burstow]

I rise to support the Government’s amendments and to explain the Government’s thinking on the amendments tabled by Opposition Members and other Members in the House. This large group of amendments covers a range of key clauses that enable us to deliver on a number of key tenets of the Bill: first, an NHS led by clinicians; secondly, an NHS with quality at its heart; thirdly, an NHS that is open and collaborative; and, fourthly, an NHS with clear, stronger political accountability. It is on the last point that I would like to start my remarks today.

The role of the Secretary of State has been the subject of great debate, especially in recent weeks. It is right that we should have this debate and it is a very important issue, especially given its particular complexity, but let us ensure that the debate is based on the facts. Too often, opinions have been offered and accusations made without full knowledge of what the Bill does and does not do.

Let me start by clearly setting out what the Bill does not do. First, it is absolutely not the Government’s intention in this Bill to allow the Secretary of State to wash his hands of the NHS. The Government believe in a comprehensive, tax-funded NHS that is free at the point of use, based on need and not ability to pay. Nothing in this Bill will change that. Secondly, I want to reassure hon. Members that there is no question but that the vast bulk of NHS-funded health care will continue to be delivered by NHS bodies that are bound by law and their constitutions to remain as public sector bodies and to fulfil a primary duty of providing services to the NHS. Indeed, the Bill contains a new provision—for the first time—specifically to prevent any future Secretary of State or NHS bodies from acting to promote the private sector over the public sector.

Let me turn to what the Bill does. It ensures not only that the Secretary of State will remain politically and legally accountable for a comprehensive health service but that he will retain the capacity to intervene where necessary to ensure that a service is provided.

Let me start with the accountability of the Secretary of State. Not only does the Secretary of State retain a raft of specific duties that mean he cannot wash his hands of the NHS but the Bill retains the legal requirements that services should be free of charge except where already specified. It now includes requirements, too, on securing continuous improvement in the quality of services, on promoting research and the use of evidence learned from research and, for the first time ever, on the need to have regard to the need to reduce health inequalities.

[Helen Jones (Warrington North) (Lab)]

Will the Minister explain to the House why, rather than providing a duty to act to reduce health inequalities, the Bill requires bodies only to have regard to health inequalities? It is quite possible to have regard to them and to do nothing to reduce them.

--- Later in debate ---

[Paul Burstow]

That anxiety was expressed in Committee by some Opposition Members. As a result of the NHS Future Forum’s recommendations, we have put in place further checks to ensure that those concerns are allayed. Not least of those—as well as our view that the health and wellbeing boards should have on them a majority of elected councillors—is that they will have clear rights of membership from the local healthwatch, which will be listening to the wider community and will represent those wider concerns. They will have the views and expertise of the director of public health, the director of adult social services and the director of children’s services. If they feel that the strategy that they have all agreed is not being honoured in the commissioning strategy, they can ultimately refer that matter to the NHS commissioning board, and that can lead to changes being made.

[Helen Jones]

Many of us are concerned that we will not know properly what is going on in CCGs, because there is no requirement for them to be subject to the Public Bodies (Admission to Meetings) Act 1960 and to meet in public. They can decide whether to meet in public. How on earth is accountability to be maintained if those bodies can decide in private—[Hon. Members: “No, they can’t.] Yes, they can. They can decide in private how they will consider input from the health and wellbeing boards, and what they will do about it. Where is the line of public accountability?

[Paul Burstow]

I fear that, unfortunately, the hon. Lady might well have dusted down an old copy of the Bill, before the Future Forum made its recommendations and we made amendments to make it absolutely clear that a CCG’s governing board must meet in public. That is the decision-making body. Moreover, we also require those boards to set out in detail and publish all their decision-making arrangements—unlike PCTs, whose decisions could be made in private and no one would know.

Let me move on to health and wellbeing boards influencing commissioning decisions. Other people have questioned why we should have a quality premium at all. Indeed, amendment 1199 would remove the NHS commissioning board’s ability to reward CCGs financially for the quality of services—I emphasise that—and the outcomes that they secure, or reductions in health inequalities, which is something that all hon. Members across the House want to be promoted. That is the basis on which we want things to move forward, and high-quality services should be recognised and rewarded.

With amendments made in the second Bill Committee, we made it absolutely clear that such payments will provide an incentive to CCGs to focus on improving quality and outcomes. We will work with patients and professional groups to draft the regulations to reinforce that clear undertaking, which was made as a result of listening.

Oral Answers to Questions

Debate between Paul Burstow and Helen Jones

Tuesday 29th June 2010 Commons Chamber

[Mr Burstow]

The hon. Lady makes an important point, but perhaps she will be a little cautious with her question, not least because the previous Government made a lot of promises to carers in respect of the amounts of money that were to be invested, only for carers to find that on the ground the money was not delivering changes in services. So this Government are determined to ensure that we not only make promises but deliver on them. That is the commitment that this Government have made.

[Helen Jones (Warrington North) (Lab)]

15. What percentage of patients at Warrington Hospital were treated within 18 weeks of referral in the last 12 months for which figures are available.