North West Ambulance Service

Rosie Cooper Excerpts

Monday 22nd January 2018 Commons Chamber

[Tony Lloyd]

The right hon. Gentleman is of course absolutely right on both counts. First and foremost, we must value the paramedics and the technicians who make our ambulance service work, and nothing whatever of what I am saying is critical of them. They joined the service to help save lives and to get people into our national health service, but this is of course the reality, and I am grateful to people who have spoken privately about what is going on. Whistleblowers are really important.

To make another point briefly, I wrote to the North West Ambulance Service about its failings—I will come on to the particular failing later—in the middle of August, but I had to raise the issue on the Floor of the House to get an answer two and a half months later. Quite frankly, the answer is almost not worth the paper on which it is written because the climate of secrecy—the climate of “Mind your own business,” which is said even to Members of Parliament—is very unhealthy. I hope that the Minister will take that on board.

[Rosie Cooper (West Lancashire) (Lab)]

I agree very strongly with my hon. Friend’s comments. I recently wanted to get a transcript of some calls—harrowing calls—in cases where people had died because of the inefficiency of the ambulance service. Last year, for example, my office got a call about a family waiting 90 minutes for an ambulance to arrive for somebody who had had a heart attack. The management of the organisation several times missed an opportunity to send an ambulance, and there is no excuse for this. People are depending on this service. We need whistleblowers and we need people telling the truth, but for such an organisation not to make transcripts readily available is a disgrace.

[Tony Lloyd]

Absolutely. My hon. Friend’s point speaks for itself. We need a climate of openness and one in which people who work in the service and care about it can feel emboldened to speak out. The law actually protects them, so it is outrageous that a public service should put people under such pressure, and it is outrageous that a Member of Parliament should struggle to get transcripts relating to her own constituents. There is a lot going wrong.

The reality—the Minister may want to reflect on this—is that over the past six years, the demands in the highest category in the north-west have gone up by some 50%. We can discuss what that means, but at the same time the number of paramedics has increased by only 16% and the number of those in technician grades by some 28%, so the staffing simply is not keeping pace with the change in demand.

There is something worse. I have already mentioned the fact that we have seen the closure of A&Es and the increased pressure that those closures inevitably bring, but on top of that we face the daily reality—again, this is not part of the winter crisis—that our ambulances and our skilled paramedics are having to wait outside our hospitals in some cases for hours on end. Let me give the House a few illustrations. At one of our local hospitals, Royal Oldham—an important hospital for my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and me—an ambulance had to wait for three hours and 46 minutes before it could discharge one of its patients on 7 January. At North Manchester—again, one of the hospitals that Rochdale borough depends on—an ambulance took eight hours and 50 minutes to do so on 3 January: somebody waited in the back of an ambulance for eight, or nearly nine, hours. At Fairfield, which is also one of our local hospitals, a figure of over 10 hours was recorded in December.

Something is going fundamentally wrong when people are waiting in the back of an ambulance for the care that they ought to be getting inside our hospitals. However, something else is going wrong, because such cases mean that the skilled staff in those ambulances cannot be out on the road going to the next job where they are needed and to the one after that. One of the paramedics—a whistleblower, as it were—with over two decades of service in our ambulance service told me that when he started, he typically went to nine different jobs during a working shift. It is now sometimes as few as three or four jobs a night, because he and his colleagues spend their time waiting outside hospitals, for reasons that have already been identified.

I know from the different roles I have had that things have been going wrong for years with the quality of our ambulance services. When I was a police and crime commissioner, the police would complain to me that, when attending a situation, they would often be forced to wait because there was a clear need for an ambulance, and sometimes they would have to deliver people to hospital because the ambulance could not arrive in time. The police certainly do not say that critically of their colleagues in the ambulance service, but they know that they are not the right people to be charged with carrying sick people to hospital.

The Minister has probably been told that one of the palliatives in the system is the series of green cars staffed by paramedics who are first on the scene. If we had a properly funded, properly staffed system of ambulance provision across the north-west, that might be a very intelligent design, but it is a very stupid design when paramedics are in short supply, because if the job the paramedic attends turns out to be really serious, they cannot operate as a paramedic, because the green cars are not ambulances; they are simply a means of transit. The paramedic then has to ring for an emergency ambulance. A paramedic told me that he attended a cardiac arrest where the patient was in a serious condition, but he had to wait with them for 45 minutes, without being able to give more than basic attention, before the ambulance arrived. Such situations should not be routine, but paramedics tell me that they happen regularly, so we know that things are going wrong.

I want the Minister to consider one issue particularly seriously. When Rochdale A&E was closed, a commitment was made to the people of my constituency that there would be a paramedic on every ambulance coming from Rochdale. We have found out that that is simply an illusion. My constituents were lied to—I think I can use that term, Madam Deputy Speaker—because there was no circumstance under which that promise could ever have been delivered. We were told at the time, “Don’t worry. You’ll have to travel a little bit further, but you’ll be travelling with highly skilled paramedics.” One in four of the most serious category calls across the north-west do not have a paramedic in attendance, because we do not have enough paramedics in the service.

The story I am telling is a seriously unhappy one. It would be unhappy if this were some kind of intellectual game, but as the experience of Ron and Pat Gerner shows, this is about people’s lives. It is about people, sometimes at the most difficult point in their lives, who are anxious and concerned about what will happen next at a time of individual and family crisis. This does matter and it matters enormously that something is done about it.

I say to the Minister that certain things that need to be done almost leap off the page. First and most obvious, we need a better handover system from ambulances to A&E units. It is not beyond the wit of health professionals to come up with something better. If we are saying that one of the skills shortages in the health services is that of paramedics, we must use them intensively. That is what the paramedics want. They do not want to be sat in stressful conditions outside a hospital. We need to better deliver the service. Ministers have to drive that through. They have to seize this important opportunity.

Deafness and Hearing Loss

Rosie Cooper Excerpts

Thursday 30th November 2017 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship today, Ms Buck. I thank my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this debate. This is one of those occasions when the only suitable ministerial and departmental response to the words spoken in the debate is urgent action to review, reconsider and change course. That means helping deaf people, working across Government instead of in silos, and putting deaf people at the centre of the decision-making process. I include an important area that people have talked about quite a lot today: the Department for Work and Pensions, where Access to Work needs to be promoted, not capped. Unfortunately, that cap will affect so many of our deaf and hard of hearing constituents when we come to the end of the grace period in April 2018.

I am the eldest child of deaf parents, and I was their voice and ears from a very young age. That was invaluable to them, enabling them to be easily heard and understood in a hearing world. My dad was born deaf and my mum became deaf at four years of age. I say that I was kidnapped by the deaf community at birth, because my culture, language and community are theirs. That poses me some difficulties on occasion, because I can be very straightforward in the way I deal with matters. My first language is BSL, not Sign Supported English—most people think that is BSL, but it is not.

I was tempted to sign my whole speech. I was going to do that and have the interpreters voice over my comments for my colleagues, to give everybody a feel for how it is not to be able to communicate directly—not for a minute, not for a sentence, but for five minutes or however long it takes me to finish this speech. Not to be able to communicate directly with the person we are talking to is really, really strange and difficult. Deaf people feel and experience that every single minute of their lives.

My experiences and the communication difficulties I saw led me, when I was Lord Mayor, to provide every deaf person in Liverpool with a minicom. We paid for them by getting children in schools to learn the deaf alphabet. They saw it as a secret language and really enjoyed it, and I got minicoms for everybody who was deaf in Liverpool. Some might ask why that was so important. We talk about isolation, but even though I thought, as a product of that environment, that I understood it, I came home with a minicom for my dad and gave it to him. He looked at it and was so happy, and then he took it and pressed “Nine… nine…” I said, “Whoa!” and he said, “Who else can I call? Nobody else has got one, only the emergency services and the doctor.” I thought, “Right, I get the message: every deaf person in Liverpool needs one.” That made me realise that I needed to get on with it and get everybody a minicom.

Mobile phones have improved the situation, but as the hon. Member for Milton Keynes South (Iain Stewart) has outlined, we are not progressing with transmission services as we should. I have known Chris Jones for many years, and it is a really important thing, but the agenda is so large that we need Ministers across Government to start tackling it quickly. Being able to communicate is fundamental to someone doing their job and doing a good job. The evidence is clear that Access to Work is a system that enables deaf people, particularly those who use BSL, to use their own voices in the workplace, with the communication support they need.

When I think about it, I am probably one of the first examples. My dad was a plasterer and he was so good—I genuinely mean that—that directors of building companies, since they could not phone him, used to come to my house and sit down around the table. As a child, from the age of eight or nine onwards, I used to sit on a Friday night and instead of all the millions of bits of paper going back and forth, I was drafted in to be the person from Access to Work. My dad did really well. He kept getting more and more money. They wanted him, the prices went up, and I did that every few months.

To me, the evidence is clear: the cap does not simply hinder deaf people’s ability to do their jobs, but will cause them to turn down employment offers and promotions. It might have meant that my dad did not get such a good deal on his next contract. It leaves self-employed people in a precarious position, where the small profits they have worked hard to earn go toward expensive interpretation costs. That is absolutely not a cost-effective way to work. The UK Council on Deafness found that nearly half of those whose income will be capped in April said that they would not even apply for promotion in future because they worried that they would not receive enough communication support. That presents barriers to those aspiring to careers in professional, managerial and senior roles. I have a friend who was the headteacher of a deaf school. Without support, how will that happen in the future?

We need to allow deaf people to progress as far as their talent allows. I have spoken to many other deaf people in lower roles but who aspire to do better. They have stopped looking forward and now live every day in fear that they may lose the job they have. Every day is a challenge, especially if they lose that support for two days a week. We must all be clear that deafness is not a limiting learning disability. There is no reason why deaf people cannot secure employment in senior roles, so long as Government decisions do not dampen down the support that they require.

Central Government just cannot sit back in the hope that employers and the self-employed will simply make up that two-day deficit in support costs that the cap is estimated to impose, especially when employers are already saying that they are not confident about their businesses employing a person with a hearing loss. We simply cannot waste huge swathes of talent. I know that, because my dad, who was born deaf, was probably one of the greatest men I have ever known. He was fantastically clever, and he was deaf, but that did not prevent him from doing anything—and we should not allow it to.

Does the Minister accept that the cap reimposes limits on the ambitions and financial security of deaf people, and leaves the next generation without the belief or ability to succeed in a 21st century workplace? They can. My dad has died now—he was 91—but he did it before; he was a trailblazer. Do not stop the new trailblazers. Help them to forge ahead.

It is also vital that the Minister recognises that, outside this place, the majority of British citizens and employers lack awareness of Access to Work. That really helps to explain why a recent labour force survey found that 30% of working-age people who identify themselves as having a hearing loss are not employed; I actually believe the proportion is higher than that. Does he recognise the need for a single gateway that would provide assistance and advice for employers seeking Access to Work support for their employees who are deaf or have a hearing loss?

I have listened to people refer to deafness as an invisible handicap, and it absolutely is; it is an invisible disability. However, that also means it is an easy target for cuts, especially in the NHS, Education and the DWP. We must guard against taking that easy, quick solution in the hope that deaf people and the hard of hearing will not be able to articulate the anger they feel at their treatment. I have two hearing aids, and I ask the Minister: if my hearing deteriorated to such an extent that I needed communication support to do my job as an MP, would these rules enable me to do the job effectively? If not, how is everybody else supposed to do their jobs under these rules? Do the rules not jeopardise employment, rather than helping to increase it within the deaf and hard of hearing community?

On a slightly different subject, as I said before, my first language was sign language, and I was delighted that the Labour party general election manifesto earlier this year committed to giving BSL full legal recognition. That would improve the structures and the expectation of full language access, through fully qualified interpreters, in all aspects of public life. However, that leads to a question: if the Government do not value interpreters, how will that encourage people to take up those roles?

What will we do if people do not learn BSL and are not there as interpreters? We already have cases of unqualified people interpreting in courts. That is wrong. They have no idea about deaf culture or the nuances and what people really mean. There is a difference between somebody who is just learning sign language and somebody who is really fluent or speaks it as a first language and understands what a deaf person is really saying. We need to value those interpreters.

My final question to the Minister is: does he agree that legal recognition will provide another means of improving awareness of deafness and of the barriers that deaf people and those with hearing loss deal with in the workplace? We need to ensure that Access to Work is extended to many more employers than the current minuscule few who actually use it. I look forward to hearing the Minister’s reply. Ultimately, he will be judged on the ability of the deaf community and those with hearing loss to succeed and to realise their potentials. That means in every part of their lives—particularly in the workplace, education and health, because without those things, what are we to do? Please give them the same chances that we get.

NHS Continuing Care

Rosie Cooper Excerpts

Monday 27th November 2017 Commons Chamber

[Norman Lamb]

I will come on to that point in a moment. We are seeing more and more cases of couples being forcibly separated, which is really shocking and a denial of their human rights, so I agree with the hon. Gentleman.

At the end of March 2017, 57,000 patients were eligible for continuing healthcare in England, which was down 1.6% on the previous quarter and 2.7% on the previous year. What possible explanation for that can there be? Demand is rising significantly every year across the country, yet the number of people entitled is going down. That must be due to decision makers imposing tougher eligibility criteria.

[Rosie Cooper (West Lancashire) (Lab)]

Is the right hon. Gentleman aware of the trend in my constituency of people who are already in receipt of continuing care being reviewed and deemed no longer eligible? As a result, the cost of their care is pushed on to local government, instead of continuing to be met from within the health service?

[Norman Lamb]

I am aware of that. Often there is no change in such people’s condition, but sometimes their condition deteriorates. Sometimes the cost is pushed on to the local authority, but sometimes it is pushed on to the family, which is another very serious concern.

There are also a great many complaints about the process that is used. There are complaints about evidence being ignored, which can result in a judgment that someone is ineligible for NHS continuing care, and about professionals lacking an understanding of the condition that they are supposed to be considering. A survey conducted by the Continuing Healthcare Alliance found that 66% of people felt that professionals knew little about the condition that was under consideration. More seriously, there were allegations that medical opinions were being ignored. The BBC heard from three health workers who revealed, effectively as whistleblowers, that medical opinions were actively ignored as part of the process.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank the right hon. Member for North Norfolk (Norman Lamb) for securing the debate and giving the House a chance to discuss NHS continuing healthcare. He has achieved a pretty good attendance here tonight, given that it is a Monday on a one-line Whip, which is symptomatic of the interest in the subject. I find that heartening, and he spoke with great sincerity and passion about his concerns. We are grateful to him for that; I know that he thinks very deeply about this subject.

This subject provides challenges, as the right hon. Gentleman pointed out, and he made some valid points about the problems facing the continuing healthcare system. In particular, the Government are aware of issues around variation and the complexity in the system. He highlighted some important examples of that. He also highlighted discrepancies, which he was right to raise. We all recognise the frustration that many members of the public sometimes have with the current system. For those with complex needs, and their families, the process can be very difficult to understand, which can lead to stress and confusion at an already difficult time in their lives. He will know that variation in the system has been a concern for some time. First, I will set out what the Government are doing to address those things and to try to achieve consistency, before I turn to some of the other concerns.

Decisions about NHS continuing healthcare are important and have a big impact on people’s lives, which is why it is right that there is a careful and considered decision-making process in place, which must take into account each individual’s care and support needs. My officials are currently working on updating the NHS continuing healthcare national framework, which is the national guidance that underpins the system. That will help health and social care professionals across the country to apply the framework more consistently and effectively, and improve the experience for individuals. We are working with NHS England, local authorities and key stakeholder organisations such as the Continuing Healthcare Alliance and other charities on this update, to ensure that we draw on the full range of experience and knowledge. Members of the public with experience of NHS continuing healthcare have also made a valuable contribution to this process.

I would like to reassure the House that this update to the national framework will not affect eligibility for NHS continuing healthcare, or the extent of the service provided by the NHS. Instead, the update aims to clarify the process and improve outcomes for patients, carers and their families, and those working in the health and care system. The Department will publish this update to the national framework in the new year. However, we understand that these changes alone are not enough to deliver all the necessary improvements, particularly on issues such as the variation in eligibility decisions that the right hon. Gentleman highlighted. That is why we are working closely to support NHS England with its NHS continuing healthcare improvement programme.

The aim of the improvement programme is to consider how NHS continuing healthcare services can be improved by addressing key areas of concern—namely, variation in patient and carer experiences, and ensuring that assessments occur in the right place and at right time. That issue has also been raised in the debate tonight. The programme will set national standards of practice and strengthen links between other NHS England work programmes that promote the personalisation of care.

To some extent, there will always be some variation in NHS continuing healthcare eligibility rates, and that can be due to wide range of reasons, such as the age dispersion within a local population, variation in levels of health need between geographical areas and the availability of community services, including step-down beds, intermediate care, rehabilitation services and end-of-life services. However, NHS England analysis shows that variation in NHS continuing healthcare eligibility is reducing over time. Work to address variation has already seen improvements, with an approximate 7% reduction in the distribution of variation across standard NHS continuing healthcare eligibility decisions since 2013-14, but the National Audit Office report shows that we obviously have some way to go.

The NHS continuing healthcare assessment process has also been mentioned tonight, and NHS England has introduced a quality premium for 2017 to 2019 to incentivise clinical commissioning groups to carry out more than 80% of assessments within 28 days. Clinical commissioning groups with the highest number of delayed cases are required to establish improvement plans setting out key milestones and planned improvement measures.

The right hon. Gentleman mentioned the claim that budgets are effectively being capped, but I want to emphasise that the national framework for NHS continuing healthcare makes it clear that the starting point for agreeing an NHS continuing healthcare package and the setting where NHS continuing healthcare services are to be provided should be based on the individual’s preferences. However, in some situations, a model of support preferred by the individual will be more expensive than other options and clinical commissioning groups can take comparative costs and value for money into account when determining the model of support to be provided. None the less, the principle that healthcare is free at the point of delivery should and does stand.

Right hon. and hon. Members also raised the breach of human rights and the challenges made to some CCGs. We are interested in the thinking behind that and will explore such issues further.

The right hon. Gentleman discussed the wide variation in the conversion rate of assessments. In his constituency, the conversion rate of 24% appears low when compared with the national average of 31%, but that has to be set against the fact that standard NHS continuing healthcare is currently available for 68.13 per 50,000 people compared with a national average of 43.04 per 50,000 people. I make that point because meaningful comparisons are difficult, but he is right to highlight such issues so that we can satisfy ourselves that we are delivering the commitments in the Care Act 2014, which states that no one should be deprived of care if it is based on their need.

The right hon. Gentleman suggested that some clinical opinions were being questioned, so I want to make the Government’s position clear. CCGs must have regard to the guidance, which states:

“Financial issues should not be considered as part of the decision on an individual’s eligibility for NHS continuing healthcare, and it is important that the process of considering and deciding eligibility does not result in any delay to treatment or to appropriate care being put in place.”

All hon. Members should ensure that that is being adhered to and make appropriate challenges where we believe it is not. The Government and NHS England are looking at strengthening our assurance processes to ensure that those standards are met and that CCGs comply with the national framework. Since April this year, that now includes extended quarterly reporting of NHS continuing healthcare data metrics and robust improvement monitoring, including on eligibility and assessment conversion rates.

I know that the right hon. Gentleman wrote to NHS England about the performance of North Norfolk CCG. I am sure that he is waiting for the outcome of the review with some interest, and I will not be surprised if I hear from him again on this. I am grateful for his interest in this subject and for the spirit in which he made his comments.

As we are all living longer, the challenges to the health service and the care system are becoming ever greater, and he is absolutely right to highlight the need for cross-party co-operation as we address these issues and set the long-term future of care and health on a more sustainable footing.

[Rosie Cooper]

I understand how the system should be and how the Minister wishes it to be, but our comments tonight have been about how the system is. We can make information available to the Minister about instances that show the system is not working as she describes. I have a constituent with a severe spinal injury who was getting continuing healthcare. There was a tick-box exercise that she thought was just a review, but, nine or 12 months later, the care has been taken away.

[Jackie Doyle-Price]

I would be happy to look into that case. I have received advice that continuing healthcare packages for lifestyle or physical conditions are often altered depending on progress. The guidance under the framework is quite clear on what is applicable, who is eligible and what conditions are not eligible. Where there is a question on whether obligations are being met under the law—the obligations are enshrined in the Care Act and under the NHS principle that all treatment should be free at the point of delivery—the hon. Lady is right to make that challenge. I am more than happy to investigate that case.

I am running out of time, and I am sure this will not be the last time we address this issue, so I conclude by thanking the right hon. Member for North Norfolk for securing the debate and thanking all hon. Members who have shown an interest. This debate bodes well for our discussions over the coming months on these vital subjects.

It is vital that we continue to work closely with NHS England, local authorities and key stakeholders to improve the system for everyone. There is a lot of work to do and, although the direction of travel in some respects is positive, as with all these things, we are all less patient than we would like to be.

I hope the right hon. Gentleman can appreciate that the Government and NHS England are very much aware of the challenges in this area, both in his constituency and in the constituencies of other hon. Members. I am confident that the steps we are all taking to improve the system are the right ones and will deliver an improved experience for patients, families and carers based on a more consistent application of eligibility and variation.

Question put and agreed to.

NHS Pay

Rosie Cooper Excerpts

Wednesday 13th September 2017 Commons Chamber

[Jonathan Ashworth]

My hon. Friend is right to raise that point. I shall go on to explain that the pay cap is at the heart of the recruitment and retention crisis that is now facing the national health service.

[Rosie Cooper (West Lancashire) (Lab)]

Does my hon. Friend share the shock of GPs and NHS staff when they learned that, while frontline staff were limited to a 1% pay rise, the governing body of the Liverpool clinical commissioning group gave themselves rises of between 15% and 81%? None of the regulators noticed this, including NHS England and NHS Improvement, and it all took place under the nose of the Government. This shows that there is one rule for the bosses and another for the workers.

[Jonathan Ashworth]

My hon. Friend is absolutely right. She has been determined in her pursuit of this issue and I know that that will continue.

Incontinence

Rosie Cooper Excerpts

Tuesday 5th September 2017 Commons Chamber

[Mrs Moon]

I thank my hon. Friend for that intervention. In particular, we should look at the need for teachers to understand the issue of incontinence. They need to understand that a child who constantly puts their hand up and says that they need to go to the toilet is not trying to get out of the lesson, and that it is perhaps an indication of a deep-seated problem that needs to be tackled. There is certainly a need to educate and to build awareness of continence problems in schools. This relates to the little ones coming into the reception class—some of whom, increasingly and shockingly, have not been potty-trained and have not learned to control their bowels and bladder—and the problem continues throughout the school. Schools need to step in and ensure that parents and children have access to the help and advice that they need.

People should have the confidence to talk about the problem to GPs and to seek an early diagnosis and intervention. People should not have to assume that it is something they have to live with. It is estimated that people manage the problem themselves for an average of five years before seeking help. We also need to highlight the detrimental impact that incontinence can have on an individual, and the fact that existing policy responses exacerbate the situation. This is a quality-of-life issue. It affects sleep and mental wellbeing, and it can cause isolation. For a child, it can have a long-term impact on their self-esteem and on family relationships, and it often makes them vulnerable to bullying.

Access to toilets can become a determining factor in every journey and activity away from the home. The condition can also lead to more complex health problems, which are inevitably more expensive to treat, and some people even choose residential care so that they can have management of their problem. One specialist in the field summed the situation up by saying:

“The reality is that bladder and bowel continence needs can affect anyone at any age. It can reduce a person’s enjoyment of life, ability to live an independent life, reduce education and work opportunities and lead to further medical complications.”

Patient surveys have highlighted the limitations imposed on people’s lives by their conditions. For sufferers who responded to a survey, those restrictions and sleep deprivation were the worst aspects, with 93% saying that it had affected their mood, 63% saying that it had affected their ability to work, and 39% saying that it had forced them to take time off work. Frustratingly, there are solutions for many, but people all too frequently struggle to cope on their own, using incontinence products available in local chemists rather than seeking the help that could be available from the NHS.

[Rosie Cooper (West Lancashire) (Lab)]

It is really important to note that people who rely on getting pads and looking after themselves are not getting the best service, and doctors and nurses are sadly not receiving training in this most important area. Shockingly, the pre-registration nurse curriculum does not include training for bladder or bowel incontinence, so it is all too easy not to address the real problem. We need that experience to help people; we should not just pad them up. People can be helped with exercise, for example, and there are many interventions that could help instead of them being told simply, “Go and buy a pad.”

[Mrs Moon]

I commend my hon. Friend’s work for the all-party parliamentary group on continence care, which does invaluable work in this area.

I am going to jump to another section of my speech. It is shocking how many people go into hospital with no continence problems but may be incontinent or doubly incontinent and have major problems by the time they leave. It is far too easy for nurses and doctors to see the use of pads as the only solution. At some point, I hope the Minister will look at how we can gather figures from hospitals on how many patients enter with continence problems and how many leave with continence problems to get some idea of how great the problem is.

I chair the all-party parliamentary group on Parkinson’s, and the Minister will be aware that Parkinson’s UK has campaigned for many years due to the problems that people with Parkinson’s have when they go into hospital and their carefully timed medication regime is changed to fit in with drugs rounds on the ward. A perfectly mobile and continent person can become immobile and incontinent due to NHS failure. That cannot be allowed to carry on. It is shameful that we are facing such problems in 2017.

Diagnoses are not made in a huge number of cases. Healthcare professionals do not provide consistent assessments, diagnosis and follow-through according to standard practice. Even basic things, such as an assessments of where the toilet is in relation to where someone sleeps, are not carried out by social workers. I cannot begin to tell the House how many times people are admitted to hospital as the result of a fall at night caused by them trying to negotiate the stairs to go up or down to a toilet that is on a different level from where they sleep. It is shocking that people face having to wear an incontinence pad because they cannot use the stairs or because there is a risk of them falling at night when accessing the toilet. We simply must get this sorted out.

Incontinence can cause additional problems. Urinary tract infections, pressure sores, anxiety, depression and falls cost the NHS a great deal of money, and we could save money by making relatively simple changes. I have not been able to find any comprehensive analysis of the cost to the NHS and other services that would demonstrate potential savings from early interventions. As far as I am aware, such an assessment has not been carried out. A series of parliamentary questions tabled last year revealed that data are not held by the Department of Health on the number of people admitted to hospital for catheter-associated urinary tract infections, for non-catheter-associated urinary tract infections or with urinary incontinence generally. If it existed, such information would help to clarify the extent of the problem. An estimate was offered in 2014-15, with NHS trusts reporting an annual cost of £27.6 million, which is almost certainly an underestimate.

Too many individuals are bearing the brunt of managing their condition. Buying a regular supply of pads costs anywhere between 10p a pad, for a child, and 60p a pad, depending on the type of pad required.

--- Later in debate ---

[Steve Brine]

Clearly, it is not my place to promise work tasks for Education Ministers, let alone other Health Ministers, but they will have heard what the hon. Gentleman said. I have a feeling that he will be following this matter up, no doubt through the all-party group. The chair of that group, the hon. Member for West Lancashire (Rosie Cooper), is sitting but two rows in front of him.

As well as outlining an individual’s pathway from assessment to treatment and recovery when possible, the guidance advocates integration across the different areas. Strengthening the workforce’s knowledge is absolutely key. In England, continence care and the importance of this issue to the comfort of patients is already an important part of the basic training offered to a wide range of clinicians and care workers and is part of the Nursing and Midwifery Council’s training curriculum.

The commissioning guidance builds on that by setting out the minimum standards required along with the specific roles and responsibilities for every member of a patient’s continence team including the individuals themselves, their family—very important—and carers. It is important to acknowledge that, following assessment and with the right advice, self-management of a condition can improve outcomes considerably.

There will always be people, including some in care homes, who have a need for aids. A group of specialist nurses for adults and another group for children are currently preparing some consensus guidelines on commissioning continence products, which in due course the Excellence in Continence Care board will consider for endorsement as a supplement to the framework. Of course we need to make sure that commissioners are following the framework, and NHS England is taking several approaches to tackle this. Let me touch on a few of them.

[Rosie Cooper]

The Minister’s comments are very welcome, but what pressure can he really apply to get clinical commissioning groups to implement NHSE’s guidance and to get the GMC, the Nursing and Midwifery Council and medical schools to include training in continence? If we can get that right, those facilities will be there when people say that they have the problem. Then we will get the clinical intervention, not just the costly pads in response.

[Steve Brine]

I thank the hon. Lady for her intervention. I will take that away with me, and I will come on to the point about the CCGs.

I was just about to outline the approaches that NHS England wants to take to ensure that commissioners are following the framework. They include arranging for CCGs to have access to teams of expert clinicians, commissioners from areas that have adopted the guidelines and are following best practice, and people with lived experience to review their existing service against the best practice and make appropriate improvements. NHS England is also exploring the potential for a mandatory data set to provide transparency about the continence services being commissioned and encouraging CCGs to develop integrated commissioning arrangements to improve co-ordination, experience and use of resources. That is all very positive.

In addition, the National Institute for Health and Care Excellence—or should I say NICE as I am now getting to grips with all the acronyms—has produced a range of guidance for clinicians to support them in the diagnosis, treatment, care and support of people with continence problems, including the 2015 quality standards for urinary tract infection in adults, which sets out how treatment must be holistic.

I understand that the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), recently replied to the hon. Member for Bridgend on the issue of paediatric continence data and the risk of losing the National Child and Maternal Health Intelligence Network, which provides a valuable data resource. Let me take the opportunity to reassure the hon. Lady that the ChiMat legacy website can still be accessed. Paediatric continence is a very important issue. I understand that Public Health England is grateful to the Paediatric Continence Forum for its productive collaboration over the years and that it wishes this relationship to continue. It has agreed that if PHE’s infrastructure remains the best place within the health system to enable these reports and to make the data available at a local level, it will make every effort to recreate the paediatric continence needs assessments during its 2018-19 business planning process. I am the Minister responsible for Public Health England. I see its leaders regularly and I will raise it with them next time I see them.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

I am more than happy to meet my hon. Friend. The principle behind the capped expenditure process is that we should have fairness between patients in different parts of the country. We should not see patients in one part of the country disadvantaged because the NHS has overspent in their neighbouring area, but the way in which we implement the process must be sensitive and fair. We must ensure that we get it right.

[Rosie Cooper (West Lancashire) (Lab)]

What advice would the Secretary of State give to my constituents who receive their urgent care from Virgin Care, and are told that wounds should be dressed only once and that, in the event that they need to re-attend, they should purchase further dressings from the local chemist? Free at the point of delivery?

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Dunne]

The hon. Gentleman has been assiduous, as is his wont, in trying to get to the bottom of the costs of the PFI impact on the hospital in his area. If he has a discrepancy, it would be very helpful if he pointed it out to me in writing. I will then respond to him.

[Rosie Cooper (West Lancashire) (Lab)]

14. What plans his Department has to increase the provision of social care for people with unmet needs.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Social care continues to be a key priority for the Government. That is why local authorities in England will receive an uplift in the money available for social care over the next three years of 17% in cash terms. That significant uplift will allow councils to support more people and sustain a diverse care market.

[Rosie Cooper]

Does the Minister recognise that the figure he has just given—the additional £1 billion in the Budget—is just half of what is needed to fill the shortfall in social care? Will he tell the House what he is doing to ensure that the sector gets the additional money and to stop councils being bankrupted by their social care requirements?

[David Mowat]

The 17% cash uplift over the next three years exceeds what we have been asked for by a number of stakeholders in the sector. I have conceded at this Dispatch Box many times that the sector is under pressure. The additional moneys that we have come forward with will help to alleviate that and will make a big difference. In Lancashire, the figure is not 17% over three years; it is 18% over three years.

Health and Social Care

Rosie Cooper Excerpts

Monday 27th February 2017 Commons Chamber

[Rosie Cooper (West Lancashire) (Lab)]

The Department of Health explanatory memorandum on the supplementary estimates sadly has the feel of rearranging the deckchairs on the Titanic. The estimates and the reports highlight the extensive range of issues facing the NHS. My involvement in health issues in West Lancashire, from individual constituents’ cases to the commissioning of multimillion pound contracts, tells me that my constituency is a microcosm of the questions to which the multitude of bodies within the NHS need to find answers. My constituents can wait up to a week for a telephone conversation with a GP to assess whether they need an appointment—they then have a further wait for the appointment—so is it any wonder that people turn to A&E and minor injuries units?

Clinical experience at the top is laudable and to be welcomed, but there is a shortage of GPs and lost capacity because of the time GPs spend on clinical commissioning group governing bodies. In West Lancashire, CCGs have handed community health and urgent care services contracts to private providers, potentially threatening the future of Southport and Ormskirk Hospital NHS Trust by removing services and essential financial turnover. The chair of the CCG is a local GP who spends three days a week on CCG business. Five further GPs have executive lead responsibilities. Apart from the loss of capacity, there are the financial considerations of GP remuneration for their work on the governing body. One GP earns more than £100,000 a year for that three-day week, while the chief accounting officer is also on approximately £100,000.

There is a fundamental lack of direct accountability of CCGs, which I understand are the responsibility of NHS England. GPs hand out contracts to private providers in the face of significant and substantial local opposition in West Lancashire, and there is no mechanism for meaningful accountability for how those GPs spend taxpayers’ money. My constituents did not get to vote on who represents them on a CCG, and they have no means by which to replace them if they do not believe the GPs act in their best interests.

The question arises whether NHS England and NHS Improvement have enough resources to deal with the increasingly complex contracts and structures they are supposed to supervise within the NHS. Threats to the smaller acute trusts come both from local GPs and from the sustainability and transformation process, the name of which is increasingly a misnomer. The plans were quietly generated by small groups of people without the involvement of most of those who need those services or their public representatives both locally and nationally. Some of us miss strategic health authorities. I would be interested to hear from Ministers whether the STP process will provide capital resources to enable hospital trusts to develop transformational change projects.

Increasingly, NHS Improvement and NHS England cannot agree on the current state of NHS finances. NHS Improvement’s forecast for this financial year has worsened in each financial quarter. Currently in quarter three, it forecasts a deficit of £873 million, while NHS England appears confident that the final deficit figure will be no more than £580 million. I took a deeper look at the figures for quarter three. A huge question appears when we look at the sustainability and transformation fund moneys the Government have given to trusts. Admittedly, trusts retain the allocated funding only if they achieve certain financial targets at the end of the financial year. If they do not achieve those targets, the extra funding disappears like snow in July. The system deficit could therefore be much greater.

The Department of Health’s funding of the NHS has a consequential impact on services, but we are also witnessing savage cuts to local authority budgets. As the provider of social care, Lancashire County Council is perilously close to being bankrupt in the next five years based on current funding projections. We talk about health and social care as if they are absolutely intertwined, yet the Government allow the competitive existence between the two services to continue. As both systems seek to survive financially, each body makes decisions to seek to minimise their expenditure. The social care system is unable to get people out of hospital, while hospitals seek urgently to discharge medically fit patients. I have a great fear that, as each day passes, the struggle for survival owing to the ever-tightening financial strictures imposed by the Government, and their lack of solutions, means that patients are getting lost. Organisational form and financial considerations mean that patients are a distant third on the priority list.

I do not know whether creating chaos and turmoil within the system is part of a longer-term strategy to lead us to a new healthcare system of private providers and health insurance—the Secretary of State will have to answer that one. What I see from the estimates provided for the transfer of moneys between budgets is that we are just tinkering at the edges of a system that needs to be properly financed. We cannot just shove a few pennies into the left hand while taking pounds from the right. Our NHS and our constituents deserve so much better.

Accident and Emergency Services: Merseyside and Cheshire

Rosie Cooper Excerpts

Tuesday 22nd November 2016 Westminster Hall

[John Pugh]

Precisely. I am going on to some brief analysis of the problems of A&E, but it is certainly the line in the sand that we must defend.

Elderly people are obviously the major clients for A&E, and Southport by any analysis has an enormous number—a very high percentage—of people who will require A&E. Moreover, as the ambulance service says, and as the hospital will confirm, when people arrive at A&E these days they are iller than ever before. The reason for that is that access to GPs and to social care is worsening—social care has suffered extensive cuts, and has done so in my area, and is struggling.

To make matters worse, one reason for A&E throughput being a little slow is that, more than ever, people going to A&E are not being turned around and sent home, but need to be admitted, so beds are needed for them, although previous reports recommended ward closures in Southport hospital. Furthermore, discharging people from existing wards is a slower process, because social services are, frankly, struggling. The system is getting logjammed, with ambulances at one end and people not being discharged at the other.

To add to the problem is a matter that the hon. Member for West Lancashire (Rosie Cooper) will wish to bring up: the CCGs have taken the community care contract off Southport hospital, where I thought it was well placed, and given it to two organisations new to the field. How that is supposed to help integration, I do not know.

[Rosie Cooper (West Lancashire) (Lab)]

There is a serious problem in West Lancashire and the Southport conurbation. The local population has been excluded from all these decision-making processes. There is a serious need for the NHS bosses to explain what they mean by “downgrading”, as their perception of A&E can vary quite significantly from my community’s understanding. Simply sharing information without any explanation leads to anxiety and serious distress about the future of health services. I come back to the point that the hon. Gentleman has just been making: in the face of the fact that it will destabilise the hospital, the CCG—that is the local GPs—has just awarded the contract for urgent and community services to Virgin Care, which has no real track record. We do not have a real assessment of what is going on, and my constituents are being put at risk.

[John Pugh]

I thank the hon. Lady for that clarification and amplification. There really is a problem with integration, and I do not know how that will be better solved by bringing more organisations—particularly untried organisations—into the fray.

We are all exasperated by watching people make a hash of things and create rather than solve problems. CCGs are neither accountable nor always reasonable, and frankly sometimes have their own agendas. They are often tough on hospitals but less so on GPs. They are of course GP-led organisations, which is a weakness in how they are structured. I have a letter from the biggest surgery in my patch complaining about abuse received by receptionists. Hon. Members will be able to guess what that abuse is about. It is not excusable, but the rationale for that abuse is that people are having real difficulty making appointments in a timely and effective way, and as a result they are going to A&E, sometimes in desperation. Surveys that I have done over time have shown GP access to be as much of an issue in my constituency as A&E waiting times. As the hon. Lady just said, NHS bosses collectively are either deliberately or accidentally causing the destabilisation and unbalancing of provision in the area, and no one can stop them.

[John Pugh]

I am not sure whether that is the deliberate intent, but that is certainly a possible result.

[Rosie Cooper]

CCGs are nominally accountable to the Secretary of State or NHS England. Will the Minister address who actually guarantees that CCGs will provide really good service? The incompetent CCG in Liverpool that presided over the unholy mess at Liverpool Community Health NHS Trust has been allowed to preside over future services and new contracts in Liverpool. It is the same incompetent organisation. How is that okay?

[John Pugh]

The hon. Lady reinforces the point that I was going to make next. No one in the NHS locally is in a position to bang heads together and say, “Hang on, what do the public actually want or expect here?” The CCGs speak to NHS England and the Secretary of State. They are the decision makers. It seems to me that one of the coalition Government’s biggest mistakes was abolishing the regional strategic arms of the NHS—the bodies accountable for integrating and making things work together and making services across an area work effectively. Instead, we have groups of special interests—the big providers on one side and wholly unaccountable CCGs on the other—and, frankly, a recipe for chaos.

[John Pugh]

There was actually an attempt to make clear in that legislation where responsibility lay. I am very familiar with that debate and do not want to re-engage with it at the moment.

There is an absence of a genuine force for integration at a local level. We all know that there are institutions in any local environment that will be shored up at all costs, regardless of the clinical benefits to the population. Like the banks, a big private finance initiative such as the Royal Liverpool hospital will never be allowed to fail, because when PFIs fail, they revert to the Government’s books. Such services therefore tend to attract neighbouring services, whether or not it is a good idea for those neighbouring services to be attracted and regardless of the practicalities or the patients.

To come to some sort of conclusion, without a 24/7 A&E in Southport and all that follows from that—a great deal follows from that in terms of what other services may then go—people will suffer longer and more anxious journeys. I shudder to think what would happen if there were an incident at a big event in Southport, such as the flower show, the air show or the musical fireworks, and we did not have a 24/7 A&E. For better or worse, Southport is on the periphery of Merseyside and the hospital is also used by large parts of Lancashire. Southport straddles the boundary between Sefton and West Lancashire. The local hospital trust has to interact with two CCGs that face different ways. As it stands, the hospital is massively convenient for patients but inconvenient for those who like symmetry in the NHS. Precisely because of that, we are in constant danger of being overlooked and not championed, which is why Sefton Council recently passed a motion drawing attention to its concerns, particularly about the A&E.

Hon. Members will have gathered that I do not have entire confidence in the transformation process. None of us will say that we are not aware of the need to work more smartly and in a more integrated fashion to make the health pound work a lot harder, but the record will show that this is not the first time that I and the hon. Member for West Lancashire have brought the affairs of this hospital and this health service patch to the House’s attention. I fought off a previous attempt to get rid of our A&E when that was mooted by consultants on the usual ground that if the NHS ceases to do anything, it will cease to cost anything. The public have campaigned vigorously for an urgent care centre in Southport, and a succession of Ministers have been lobbied in this place about that plan, only for it to be scuppered by behind-the-scenes NHS politics. I have no reason to feel any confidence at all in this process—not when I see the hospital trust itself make a complete hash of whistleblowing charges against senior management and protract the process through its own simple incompetence.

[Rosie Cooper]

rose—

[John Pugh]

The hon. Member for West Lancashire is positively bursting to get in.

[Rosie Cooper]

Does the hon. Gentleman agree that STPs are in danger of becoming a managerial exercise in contingency and risk planning, where the NHS speaks to itself? Several years ago, in the Health Committee, I put to Bruce Keogh the charge that where we were going, there would be 30-plus trauma centres in this country and every A&E would be downgraded. With STPs, the NHS is talking to itself, not the communities it serves, and it will come up with that very same plan. I can see that happening in front of me right now.

[Sir Roger Gale (in the Chair)]

Order. I have to make the point that these half-hour debates are specifically the property of the Member in charge. Mr Pugh is entitled to give way to whomever he chooses, but interventions should be interventions, not speeches, and every moment that is taken curtails the opportunity for the Minister to respond.

--- Later in debate ---

[Mr Dunne]

I am not going to get into a prolonged debate about the CQC report, but it rates the entire trust as “requires improvement”. We have confidence in the overall reporting, and looking at A&E in that context reflects an accurate impression of the current status of the trust. For example, three of the trust’s seven A&E consultant posts are filled by locums or agency staff. That mix of staffing is not sustainable for any A&E department. I am aware that the trust and its commissioners are looking to address that.

Several hon. Members referred in interventions on the hon. Member for Southport to the NHS sustainability and transformation plans. I emphasise to the House that STPs are collaborative plans designed to help local organisations deliver on the “Five Year Forward View”. They are formed by CCGs, providers and local authorities working together in an area to develop a plan. Some have also involved other stakeholders who will be affected by changes in their area and can contribute to improvements. The true test will be whether a revised healthcare system really improves matters for patients.

We are still at an early stage in the process. The local NHS describes the plan for Cheshire and Merseyside as a plan for a plan at this stage. I will not therefore pass judgement today on the STP process or the content of the Cheshire and Merseyside STP. I am not in a position to do so. I do not know the local position as well as the local clinicians who have drawn up the plan; no one in Westminster or Whitehall does. Local clinicians must ensure that they involve the public and patients—and Members, as the hon. Gentleman called for in his closing remarks—and explain what they think is best for each local area. I reject the charge that the plan will not involve the local communities; it absolutely needs to involve local communities to be taken forward. It is a central tenet of the approval of the plans that there is public engagement.

[Rosie Cooper]

rose—

[Mr Dunne]

I am afraid I have very little time, and the hon. Lady will have an opportunity to pick my brains directly on anything I do not address in my remarks, because we are meeting next week. I am happy to talk to her. We have had a dialogue over some of the health issues that are of most concern to her, and I thank her for her efforts in bringing those to my attention.

The STP process is not run by or for the Department of Health. It is run by the NHS for patients of the NHS. Design of health services, including front-line health services and A&E, is a matter for the local NHS. The reforms that my noble Friend Lord Lansley made when he was in post have put clinicians in charge of the care people receive and how it is delivered to serve their populations best. Local authorities are vital in helping set the direction of health and social care development locally. Guidance on STPs from NHS England has been clear about the importance of local authorities in partnership arrangements and of the NHS working with local authorities to deliver prevention and public health improvements. It is crucial that the NHS and local authorities work closely to ensure the key aims of the STP process can be delivered: better health, better patient care and improved NHS efficiency.

The STP for Cheshire and Merseyside was published a week ago, on 15 November. As I said, the NHS described it as a plan for a plan. In the area represented by the hon. Member for Southport, it builds on the “Shaping Sefton” local delivery system, which I understand had considerable public engagement. It is disappointing that the leaking of an early and incomplete draft of the STP led to speculation and some concern. I hope that the publication of the formal document will dispel some of those fears. I assure the hon. Gentleman that no changes to the services people currently receive will be made without local engagement. When and if final plans propose service change, formal consultation will follow in due course.

Motion lapsed (Standing Order No. 10(6)).

National Health Service Funding

Rosie Cooper Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Michael Gove]

Answer the question.

[Rosie Cooper (West Lancashire) (Lab)]

rose—

[Jonathan Ashworth]

I give way to my hon. Friend. [Interruption.]

--- Later in debate ---

[Rosie Cooper]

Perhaps the right hon. Member for Surrey Heath (Michael Gove) would like to tell me how cutting the A&E at Southport and Ormskirk hospital and giving local community and acute services to Virgin Care can be a positive story for the NHS.

[Jonathan Ashworth]

This is exactly the sort of point that we are making; my hon. Friend is absolutely correct. That is why we need to look carefully at all these STPs. Of course, we do not know much about them at the moment, because all we see is glossy brochures that tell us that everything is going to be all right and not to worry. We want transparency. The Secretary of State should insist that every single STP is published and that we have the details of the cuts that will be made in our communities.