NHS Provision (Brighton and Hove)

Debate between Peter Kyle and Caroline Lucas

Monday 24th October 2016 Commons Chamber

[Caroline Lucas (Brighton, Pavilion) (Green)]

This debate is intended to highlight the ongoing NHS crisis affecting my constituency and the city of Brighton and Hove and to outline solutions to what is far more than a purely local problem. The concept of a publicly funded national health service is at risk, and the situation in Brighton and Hove reveals a whole host of systemic problems that stem in large part from the Health and Social Care Act 2012. Patients and staff are being let down in my constituency and elsewhere, and it is more than likely that the additional strain of the winter months will further exacerbate the crisis.

The picture I will paint of the situation in Brighton and Hove is deeply worrying. It encompasses our hospital, our GP provision, our ambulance services and our community care. Those services are held together by incredibly dedicated staff, who often work well beyond the hours for which they are paid to keep things going. I want to thank and pay tribute to each and every one of them. Despite their tireless efforts, however, the overall picture of health and social care in Brighton and Hove is chaotic, not because of a lack of hard-working staff, but mainly as a result of two things: harsh funding cuts and an increasingly fragmented structure based on marketisation and the increasing commercialisation and privatisation of our NHS.

I will provide a quick overview. Our local hospital, the Royal Sussex, is in special measures for both quality and finance. As of July, over 9,000 people had been waiting for more than 18 weeks to start treatment—the worst recorded among 185 providers and the 208 clinical commissioning groups that submit data nationally. Over 200 people have been on a waiting list for more than a year.

While I am talking about the hospital, let me quickly put on the record the fact that I am very grateful that we are soon to have a brand new building—we certainly need it. The hard-working staff in that hospital are operating in a building that stems from before Florence Nightingale; it is the oldest estate in the whole NHS. At the same time, it is undertaking increasingly complex work for the whole of Sussex as a major trauma centre for the wider region.

[Peter Kyle (Hove) (Lab)]

My neighbour mentions that we are constructing a new wing to the hospital and a bunch of other services locally. Does she agree that the fact that this is going to create an additional administrative burden and challenges for staff, including clinical staff, means we have to get this situation in Brighton and Hove right now, otherwise the additional burden could just be too much for the system locally?

[Caroline Lucas]

I am grateful to the hon. Gentleman, as he anticipates exactly what I am going to say. Of course we need new bricks and mortar, but we also need finances for the services inside them. We desperately need a central funding settlement that recognises the unique pressures on our hospital, so that the systems can be updated. For example, we need a computerised records system—this is not rocket science but we desperately need it. We need increased capacity, particularly for accident and emergency, because we are now serving a much wider region, as a result of being a central trauma centre. With debts currently of about £45 million, Brighton and Sussex University Hospitals NHS Trust is facing a situation that is simply unsustainable.

That is just one example, but there are plenty of other examples of what is going wrong in the health service in Brighton and Hove. Patients in the city have seen six GP practices close so far this year alone. When The Practice Group announced that it was walking away from its contract to run five surgeries in the city, the decision was largely a financial one. With almost 11,500 patients registered, the disruption and uncertainty was widely felt, and other nearby surgeries were simply expected somehow to manage increased patient numbers. NHS England was not required to step in to help because of the terms agreed with The Practice Group. The fact that this type of contract is no longer permissible was of little comfort to the patients forced to find a new GP with whom to register. I particularly recall the constituent who contacted me after a sixth surgery, Goodwood Court, was closed and who was unable to visit the emergency drop-in clinic at Brighton station for an urgent inhaler prescription because of a disability. That is just one individual, among many, who has experienced unnecessary, unhelpful anxiety and distress as a result of the Government’s NHS policies.

Our emergency ambulance service was placed in special measures on 29 September following a Care Quality Commission report that rated it as “inadequate”. The inspectors praised front-line staff, but identified unsafe levels of staffing, as well as poor procedures and leadership. The city’s mental health services, especially those serving children and young people, are overstretched and underfunded. Adult social care services in Brighton and Hove face ongoing cuts, despite the cost to individuals and the NHS. That means that over the next four years the city council is looking at potential cuts of £24 million and the complete privatisation of the remaining council adult social care, day centres, carers and so on.

I have lost track of the number of times that Ministers assert they are investing record amounts in the NHS, yet conveniently fail to mention the record amounts they are simultaneously cutting from local authority budgets that are supposed to cover essential care services for vulnerable people.

--- Later in debate ---

[Caroline Lucas]

I am sure that The Argus will be sad to see itself relegated to the seat behind me.

The subcontractor is a company called Docklands Medical Services Ltd. This is apparently a phoenix company for the aforementioned Docklands. As I understand it, the new company seems to be suggesting that it was acceptable for it to operate under the Care Quality Commission licence that was issued to its predecessor, the bankrupt Docklands. The application process for a licence is carefully designed to ensure that standards for vehicles and other safety checks and safeguards have been met. Just allowing a new successor or phoenix company to inherit a licence is setting the bar dangerously low, exposing patients and staff to unacceptable risks.

As a result of this debacle, our struggling hospital trust—yes, the one in financial special measures—has incurred £171,000 of private ambulance costs so far this year to plug the gap left by Coperforma and its subcontractors. To recoup this cost, the trust has, quite rightly, invoiced the clinical commissioning group, which appointed Coperforma. No doubt other trusts similarly affected will have done the same, with serious consequences for the CCGs’ budgets and, therefore, for the money available for other services. Whichever part of the Department of Health ends up footing the Coperforma bill, it represents an unforgivable waste of money and resources, and their diversion away from patient treatment and care.

I trust that the Minister will agree that patients in Brighton, Pavilion or anywhere else should not be paying the price for the failure of private companies that are profiting from NHS contracts. Will he therefore ensure that the CCG is not out of pocket in turn as a result of Coperforma’s mismanagement? I would also like his Department to stop passing the buck when it was his Government who passed the legislation that required services such as non-emergency patient transport to be put out to tender. It is unacceptable for no one in the Department of Health to know whether a fleet of 30 ambulances were properly licensed to transport Sussex patients for three months over the summer. When the Minister responds, will he tell us whether he agrees?

[Peter Kyle]

Is it not extraordinary that the contract was awarded in the first place? Coperforma and the whole underlying supply chain have underperformed and failed patients from the very first day that they took over the contract, and they continue to do so today. The service cannot be returned to where it was before, because the ambulance trust that it was taken from is also in special measures and now no longer has the capacity to take it over. Is not the lesson from this experience that if such a contract is outsourced, the Government must make sure that due diligence is done correctly so that patients do not suffer in this way?

[Caroline Lucas]

I am grateful to the hon. Gentleman for his contribution and I entirely agree. When I have talked to staff of the CCG, they have acknowledged that they are using an off-the-peg contract that is not suitable for such a service, and that there have therefore been problems in the system as well as with the company, which is not providing the service that people in our city deserve.

Small Businesses: Tax Reporting

Debate between Peter Kyle and Caroline Lucas

Monday 25th January 2016 Westminster Hall

[Peter Kyle (Hove) (Lab)]

May I thank the hon. Member for Hertsmere (Oliver Dowden) for securing the debate? I share his condolences for the family of his predecessor, who passed away today. Even though his predecessor was not a Labour Member, he certainly made a big impact on politics in his day, and that legacy will be remembered for a great deal of time.

I am the Member of Parliament for Hove, in the city of Brighton and Hove, which is one of the most entrepreneurial cities in the whole country. It also has one of the highest rates of self-employment in the country. The self-employment rate for 16 to 64-year-olds in work is 13.5%, against a national average of 10%, with 55% of those people working in construction and 36% in professional, scientific or technical trades. That shows the nature of self-employment in the south, and self-employment is often a gateway to entrepreneurialism. Many of those self-employed people will go on to set up limited companies and become creators of wealth and employment, which drives the economy in Brighton and Hove.

Statistics, however, do not cover the nature and challenges of making the move to self-employment or setting up a microbusiness. I became self-employed early in my career and then moved on to set up a limited company and a microbusiness. I co-founded a local business, which, looking back, was the most educative experience of my life. We learn a huge amount when we decide to jump in with both feet and set up a business, as an enormous breadth of understanding and skills goes into setting up an enterprise and becoming an entrepreneur.

One key thing I learned from that experience was the nature of the risk involved in becoming self-employed or running a microbusiness. When we talk about people who are self-employed or run small businesses—sometimes as their friends, but particularly as policy makers—there is often an assumption that growth is linear, and that money increases and risk diminishes each year, as they get used to growing business and to the sector they are involved in.

My experience was very different. Growth came on the back of extreme risk and extreme vulnerability, followed by a period of comfort. I then had to make a decision: should I stay in my comfort zone or take the decision to move out of it, back into extreme risk and vulnerability? The business jumped into periods of growth, with each jump and each improvement in annual figures coming on the back of a period of risk. As the business employed more people and its growth increased, the risk did not diminish; it got greater and greater, because more depended on the business’s success. I have a huge appreciation for entrepreneurs who are growing businesses, because there is no inevitability about the success of any business. It comes only on the back of extreme hard work and the ability to take risk on behalf of a business and the people who depend on it.

Few people enter self-employment or set up small businesses with all the skills they need to do so. They sometimes lack skills in sales, admin, accounting, marketing, social media and product development. No one inherently possesses all those skills—particularly accounting—when they go into business or become self-employed. It is very unlikely that all of the 55% of self-employed people in the city I live in who work in construction have all the administrative and accounting skills they need. Talk of changes to accounting and reporting can therefore be extremely intimidating to them.

Gaps in people’s skills can be not just intimidating but terrifying. While people are learning skills, or worrying about lacking them, they are not doing. They are not out there selling, building the relationships that every business and self-employed person needs or winning new business. We must be mindful of that when we heap new regulation, and changes in accounting and reporting, on people who are self-employed or run small businesses. Talk of regulatory change can be intensely worrying for those who lack accounting skills. People who are worried become risk-averse and do not have the boldness of character we need in our entrepreneurs, particularly in the small business sector.

The self-employed have a lot to worry about. One third of them will earn less than the minimum wage for two or three periods in a year. They have no statutory holiday, and the working time directive does not cover their work. All of us will have heard stories from knocking on doors and talking to constituents at community events or reading their correspondence. I was struck by one particular story when I was campaigning during the general election. I knocked on the door of a tradesman who was self-employed and always worrying about the next contract. He told me, as he held his young baby in his arms, that he had never once been on a full week’s holiday with his wife and children. Instead, his wife takes the children away for a week once a year and he goes to meet them for the weekend, because he cannot take the risk of not completing a contract. That type of experience is repeated throughout the self-employed sector and the microbusiness sector. People in those sectors make a lot of personal sacrifices in order to drive the economy, particularly in the south of England.

[Caroline Lucas]

The hon. Gentleman is making a powerful speech, and he tells a strong story about the constituency of Hove, which is relevant to my constituency next door. Does he agree that the pressures on small businesses are made even worse by the fact that they often struggle to get hold of HMRC advice right now, whether on the phone or by other means, because tax offices are closing? As well as having a bigger consultation on the issue, the Government should look again at the resources going to HMRC.

[Peter Kyle]

The hon. Lady makes an incredibly important point. We have both been involved in local government issues and campaigned on national issues. Every moment that a self-employed person spends on the phone to the local council, HMRC or any other Government Department is a moment they are not spending getting new business, delivering new contracts and earning the money that will give them the security they need in the long term.

We know that HMRC has a lamentable record on customer service, which the Minister graciously acknowledged in answering questions in the main Chamber recently. I know that he will focus on that issue, and people such as myself and the hon. Member for Brighton, Pavilion (Caroline Lucas) will continue campaigning on it, because it is extremely important. In the interests of fairness, I will also carry on campaigning against my council in Brighton and Hove, which is a Labour-run council, to ensure that it offers better services for, and better contact with, its local businesses and self-employed people.

I am well aware that people who run big businesses in the city that I represent, whether American Express in Brighton, Kemptown or EDF in my constituency of Hove, have a named contact in the local authority. That contact is called the chief executive. If the chief executive of one of those big businesses wants to get the council on the phone, they call the council’s chief executive. However, the drivers of our local economy—people who run companies that employ fewer than eight people, which make up 90% of the businesses in our city—do not have a named contact in the local authority. There are no consequences if a phone is not picked up, or if a message is not returned. That symbolises how power is distributed in the wrong direction.

It would be wrong if we designed and implemented policies that put people off wanting to become self-employed. The calls that Members from all parties have made in this debate, imploring the Minister to ensure that there is a period of consultation, have been extremely well put.

Humanitarian Crisis in the Mediterranean and Europe

Debate between Peter Kyle and Caroline Lucas

Wednesday 9th September 2015 Commons Chamber

[Peter Kyle]

I thank my hon. Friend for that intervention, because it highlights just how much generosity there is within the British public at the moment, and that should be absolutely commended. At a time when anybody can get into their car to deliver aid to people in need, we must ensure that this is done in a structured way. I encourage people who are tempted to do this to co-ordinate with humanitarian organisations that have experience, because people who are fleeing war do not just need the clothing that is on offer. That is incredibly important, but many will need specialist emotional support, too. We need to make sure that they get access to both.

Brighton and Hove, the city I represent, has that generosity in abundance. The council is preparing to take five families, which is a modest contribution but it is what is being asked of it at the moment. It is also making contingency plans to take many more. We will rise to the challenge. The hon. Member for Brighton, Pavilion (Caroline Lucas) is in her place, and I am sure that she, like me, has been inundated with offers from the general public to take people into their homes. That is symptomatic of the huge generosity that exists in the population at the moment, and I pay tribute to their humanity and generosity. We must also accept that this situation could be here for the long term. Many people will have emotional damage and will need specialist care. People who are offering to take people into their homes need to be cognisant of that and make sure that they are equipped to give the care that is needed into the long term.

[Caroline Lucas]

The hon. Gentleman is making a powerful case. He referred to Brighton and Hove, the city we both represent, rightly saying that many people there want to help. Does he agree that we need to put more pressure on the Government for the funding, particularly for local authorities, and for them to guarantee that it will last beyond the one year? I am really concerned that one year is not enough.

[Peter Kyle]

I certainly share the hon. Lady’s concerns and she makes a pertinent point. It is incredibly important that when the Department for International Development funding runs out, councils get the commitment into the long term, in order to continue their efforts.

I have seen what it takes to make somebody leave their home, their community and the people they love—they do not do that lightly. The push of war is greater than the pull of Britain. This crisis involves hundreds of thousands of people—it is into the millions now. When there is a crisis involving that number of people, we can find in that population anything we like, because every ounce of human characteristics will be on display. People who look for criminality will find it, and people who look for economic migrants will find them. The job of this House is to take decisions in the round and see that, overall, this group of people need help, are fleeing their country because of war and are turning to us for help in all sincerity. We can argue about numbers but there is one basic question: are we doing all we can as a nation on our own soil, or is there more we can do? There are more people who need to come here, the British people are prepared to take more and it is the Government who are getting in the way. On that basis, I am happy to support today’s motion.