Agenda for Change: NHS Pay Restraint

Debate between Philippa Whitford and Mark Durkan

Monday 30th January 2017 Westminster Hall

[Mr Dunne]

Once again, the hon. Lady is speculating about what might happen in future, and I am afraid that not only can I not comment on that, but I am not sure whether she is correct or not. There are some assumptions in what she said about what will happen to the national living wage. The Government are making some assumptions, but what the Government choose to do about the matter we will have to see. At present, the policy is certainly that nobody will be paid less than the national living wage. I can reassure her about that.

[Mark Durkan]

Just to clarify, like the hon. Member for Central Ayrshire (Dr Whitford), I was referring to the living wage and not to the national living wage, which is a figment of Government policy.

[Dr Whitford]

rose—

Carers

Debate between Philippa Whitford and Mark Durkan

Thursday 9th June 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I pay tribute to the hon. Member for Eastleigh (Mims Davies) for securing this debate in carers week. Frankly, one week in the year is not enough; carers care for more than just one week in the year. I will talk predominantly about informal carers—the people who are looking after family—but we should also remember the people who work in the care industry, because they support the carers and the people who need caring for. We have problems getting high-quality care because we do not value those people. We pay them very poorly. They work for companies that often treat them badly. Pay for travel time may not be included, and they may be doing 15-minute visits. These jobs are therefore short term and temporary, and people get out of them as soon as they have the opportunity. Unless we turn this into a profession that is valued and respected and includes development—as we have done with nursing, over the years—our relatives and loved ones will not be cared for by people who actually want to do the job. I would just like to open with that.

We have heard a lot of detailed statistics about informal carers. Across the UK, 10% of people—6.5 million—are involved in caring. In Scotland, the proportion is higher, at 17%. People often do not identify themselves. Those carers are not always the same people, because there is a turnover—a change—every year of one third, or 2.1 million people. Some of them, as the hon. Member for Strangford (Jim Shannon) mentioned, will be people caring for loved ones at the end of their life. When we lose that loved one, although we may face other challenges, we leave the informal care group, but other people take up that role. The same number of people—more than 2 million—enter and leave the role of informal carer each year.

We have heard about the cost that informal carers save the state. If we were to replace them with professional staff, the cost would be almost greater than that of the NHS, but how do we treat the people who deliver that care? A third of them live in poverty. That is because we have tangled things up so much around carer’s allowance, and we never seem to have a “health in all policies” view, so on different days of the week we make decisions that absolutely counteract each other.

My hon. Friend the Member for Ayr, Carrick and Cumnock (Corri Wilson)—I hope I got that right—mentioned some of the changes that have been made, including to the personal independence payment and the employment and support allowance work-related activity group. Perhaps the Government think that those changes send people back to work, but the reality is that many of the people affected, particularly where mental health or waxing and waning illnesses are involved, will not get back to work. That household will simply become more impoverished. We need to realise that that has an impact. If someone cannot afford to do things, their quality of life goes down. People who are caring— 1.3 million of them for more than 50 hours a week—already have a pretty tough life without having to deal with poverty on top of everything else.

We have heard that carer’s allowance is some £62 a week; it is pretty insulting that that is less than jobseeker’s allowance. People tend to spend six or nine months on jobseeker’s allowance, but they may depend on carer’s allowance, along with other benefits, for much longer than that. To pay someone, in essence, £62 a week for the hours that they put in is derisory. In Scotland, if I may correct the hon. Member for Strangford, we are not just considering raising carer’s allowance to £72 a week; that is a commitment. It will become the same as jobseeker’s allowance. Even that is very much a baseline. It does not recognise what those people need.

Of course, there are people in caring situations for whom money is not an issue, because they have a pension or large amounts of savings, but they are not the generality of cases, if a third of carers are in poverty. Half of them have used up all their savings and have had to borrow. A quarter of them have had to re-mortgage their home. That all adds stress to people who contribute massively to society.

We have well over a million older carers, as the hon. Member for Bexhill and Battle (Huw Merriman) mentioned. What has not been mentioned in this debate is that people on retirement pension do not qualify for carer’s allowance. That seems bizarre, because one of the biggest groups of carers is people who are retired. In the past, people would have been caring for a partner as they became more frail, but as people are living longer, we are retiring people who are caring for a parent, or for a parent and a partner. The hon. Member for Eastleigh spoke of caring for little ones and older ones, but we actually have people who are caring for older ones and much older ones. That is massively challenging.

At the other end, we have heard mention of young carers, who are defined as those under the age of 16. They are completely excluded from carer’s allowance as it starts only at the age of 16, yet those children again play a major role and suffer major detriment. They will often be in a poor household, because the parent—as it usually is—for whom they are caring will have suffered from the various cuts to support. Their parent may have a physical or mental illness, may suffer from addiction, or may in other ways not be the parent in the family. If 12 and 13-year-olds are carrying that burden, and cannot afford to go on a school trip, and do not have time to do the little Saturday job or paper round that allowed the rest of us to invest in the height of fashion, we are allowing their quality of life to be lowered still further.

Young adult carers are defined as being 16 to 25. If they are students, they are automatically excluded from carer’s allowance, regardless of the fact that a quarter of them work more than 20 hours a week. If they work less than 35 hours a week, they do not qualify for anything. If they are official students, they qualify for nothing.

We have all these pockets of people who are working really hard, yet we as a state are offering no support to them. That is the minimum that we should be doing. They will still be doing a hard job and putting in long hours that save the country masses of money. We should all feel ashamed that they can have to choose between eating and heating, and that there are young people who have no opportunities and know that their job opportunities will be limited by going through that. Obviously, given my health background, I have looked at the health of these people, and they are twice as likely to be ill. Indeed, 8% of them are on disability living allowance as was, so we have someone who has frailty caring for someone else who has frailty.

One fifth of the people who are putting in more than 50 hours a week are not getting any services because, as has been mentioned, they do not identify themselves as carers, no one else identifies them as carers, and they have no idea where they should go to get help. I back the call that this should be part of the health service’s duty. If a doctor diagnoses someone with advanced cancer or dementia, or a child with disability, they should ask, “Who are the carers here?”. That is part of the primary care role in Scotland, but I am not sure what the roles are in England. Certainly, as part of the quality framework in Scotland, there must be that discussion. There is still room for improvement in our communities on that. People simply see themselves as looking after their family, but actually, they are looking after all of us.

We know that the ageing population will increase. We already have 800,000 people with dementia, who are being looked after by 670,000 carers. At the moment, 60% of us will be carers at some point. As the numbers increase, all of us must expect to spend a portion of our lives as a carer. If that always causes massive detriment to our work, our ability to do anything and our quality of life, we will have allowed the quality of life of everyone to deteriorate.

For women, there is a disproportionate hit, because 60% of carers are women, and one in four of those women will end up giving up work. As was mentioned, they end up in part-time, low-quality, low-paid jobs, and they do not get promotion. Right at the end, they get a rubbish pension, which, as we have heard in many debates in this Chamber, may be plucked out from underneath them. That is the last slap in the face. With modern technology, we should be able to have more home working and flexible working to allow people with talent and skill to remain active and have a career, even if they face a few years of having to commit to caring for someone. As we go into the future, whether we are carers or not, as politicians we need to make sure that we provide the basic funding and services to support carers as they support those who need help.

As individuals, we need to do more in our communities. We have heard mention of carer-friendly communities. I was honoured last Saturday to be part of the launch of one of my local towns, Prestwick, as a dementia-friendly community. It was a fantastic event, and the turnout of the community at the market cross for music, food, cupcakes, fiddling and singing by the wonderful Musical Minds choir, which is made up of people with dementia, was fantastic. The community is already coming forward, and local businesses have undergone training.

Within that, we have a group called Crossroads, which supports carers and allows them little informal breaks, so that they can try to keep some of themselves. Women are used to being recognised as somebody or other’s wife and somebody or other’s mother once they have got past being so-and-so’s daughter. The problem for somebody facing this intensity of care is that they can feel like they disappear altogether—that they as a person have no outside view at all. Their hobbies are gone and, as was mentioned earlier, their friends are gone.

It is important, not just as politicians and people in families, but as members of our communities, that we value and recognise carers if they are out and about, and accept the person they are caring for, no matter if they are a bit loud, if their wheelchair gets in the way, or if they need time to get on the bus. If we accept the person they are caring for, the carer will also feel more accepted in our communities. Basically, I call on everybody, because we all have a role to play.

[Mark Durkan (Foyle) (SDLP)]

Just as we must not lose our recognition of people, or identify them just by their disability, the fact that they need care or the fact that they are carers, it is important that we recruit carers to contribute to thinking on public policy—and not just when it relates to care issues; often, carers are disfranchised and disconnected from society because of their caring commitments. All of us at all political levels need to do more to engage carers, so that they contribute to a range of public policies.

[Dr Whitford]

I thank the hon. Gentleman for his contribution. I refer him back to the comments of my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) about the Carers Parliament in Scotland, which looks at young carers, young adult carers and older carers. When they consult, the Scottish Government make great efforts to pluck people out of the voluntary world to come and tell them how it really is, because unless we hear how it really is, we are not going to fix it.

We all have a duty, including the Government, to look more at health in all policies. We cannot fix everything, but we should not be adding poverty on top of all carers’ other challenges.

Violence against Women and Girls (Sustainable Development Goals)

Debate between Philippa Whitford and Mark Durkan

Wednesday 27th April 2016 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

I beg to move,

That this House has considered violence against women and girls and the Sustainable Development Goals.

It is a great pleasure to serve under your chairmanship, Mr Owen, on this fine crisp morning. I do not need to rehearse to many Members in the Chamber the importance of the sustainable development goals. Many Members and the Minister and his Department have worked hard on refining and developing the goals. Goal 5 is to

“Achieve gender equality and empower all women and girls”.

That is the most important goal in our efforts to combat violence against women and girls. A number of targets flow from it, directly addressing the issue. In particular, the second target under goal 5 is to

“Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation”.

The third target is to

“Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation”.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

May I suggest that we add breast ironing to that list of harmful practices? People do not know much about it, but it tries to damage the young breast to stop it developing because of a misconception that the child will then not go through puberty and develop. It is incredibly destructive. People do not know about it, in the same way that we did not know about FGM.

[Mark Durkan]

I thank the hon. Lady for that point. So much work has been done under the sustainable development goals. We have a target that gives examples, and we now have awareness of other things that might well have been included as examples, such as breast ironing. Her point proves that the sustainable development goals should not be seen as frozen in cold print on the page. They are meant to be an ongoing, changing, ever-improving and ever-strengthening commitment on all our parts. Remember, they are universal goals. That is one reason why we need to demarcate the sustainable development goals from the millennium development goals in terms of their universality. We want to see the infrastructure of commitment, investment and intervention underpinning the sustainable development goals.

The Minister will face many questions and hear many suggestions in this debate on assurances that he can give on behalf of the Department for International Development and the Government more widely. He is responding on behalf of DFID, but the universal goals are not just about what happens in other countries. We should be supporting and helping to foster those goals, but the goals also involve commitments and standards in our countries and jurisdictions. That is not just the responsibility of Ministers and all of us who serve in this House, but people at other levels, including devolved levels.

--- Later in debate ---

[Dr Philippa Whitford]

I thank the hon. Gentleman for giving way again. Does he agree that, from the developmental point of view, putting more of our effort and money into helping girls and women strengthens the whole community?

[Mark Durkan]

Yes, it is one of the best ways of fulfilling the “leave no one behind” principle. Investments and interventions to support women and girls would be one of the best multiplier contributions that could be made towards fulfilling not only those targets and objectives, but others as well. The enablement and empowerment that comes with advancing the position of women and girls, allowing them to counter the ravages of sexual and other violence, would be one of the most transformative things. So if we want a real change multiplier in any society, we must address the position of women and girls. Our own history and social experience demonstrate that.

Drugs: Ultra-rare Diseases

Debate between Philippa Whitford and Mark Durkan

Tuesday 16th June 2015 Westminster Hall

[Dr Whitford]

The important thing to remember is that if this is all done by individual requests, the NHS does not go to the companies. We need to realise that companies have often made investment over decades and that nine out of 10 drugs they research will go nowhere, but it is important to have a wider debate with companies to get the best price. Hon. Members mentioned that some companies are willing and able to reduce the price to get a drug in.

Drugs are licensed. We must not mix up licensing with funding. Licensing is about asking, “Is this drug safe and proven at a basic level?”, not anyone coming in and saying, “Rare plant juice will cure everything.” These are licensed drugs that we could prescribe—a doctor has the right to prescribe them—but the NHS has to make the decision about whether to fund them; those are funding decisions, not licensing decisions.

It is important that families know what the pathway is and how they move on when their clinician takes a case forward. It is important that they know they can respect decisions and how to lobby at the next step, and that they feel their voice is being listened to. We feel that PACE has, over more than a year, allowed us to do that. Clinicians in Scotland got frustrated about decisions going through without us informing that decision.

There could be a system that sits on the side of NICE, or a sub-group. One of NICE’s three assessments will never be given over to a drug intended for 88 patients when it is also assessing drugs that might be taken by 500,000 people. Rare diseases would always fall behind, and that is why those must have their own system and why the patient voice must be heard in these ways. Obviously, things have changed with the Health and Social Care Act 2012, but I commend such a structure to the Minister.

[Mark Durkan (Foyle) (SDLP)]

The hon. Lady is making a thoughtful contribution. Does she agree that it would be worth all Administrations in these islands, who together form the British-Irish Council, collaborating on these issues, particularly borrowing from the good example being developed in Scotland, and seeing whether there can be common achievement and common advances, and perhaps even creating some common funding stream, as well as the discrete funds that she has talked about?

[Dr Whitford]

Obviously, devolution gave us the power to do things differently, but I do not think that we should re-invent the wheel. Often, we will accept work done by NICE or re-evaluate it quickly, to see whether things should be applied differently, but we do not just go back to the beginning. However, I am sure that ideas can be shared in both directions.

It seems that certain drugs were left as orphans when the system changed. We know that patients with the brain tumour form of tuberous sclerosis, which the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) mentioned, can access the drug through the cancer drugs fund, but if they have a kidney tumour and are treated by urologists they are not part of that system and simply will not be aware of it. Such random unfairness exists.