Palliative Care

Sarah Champion Excerpts

Wednesday 4th November 2015 Commons Chamber

[Maria Caulfield]

I thank the hon. Gentleman. I absolutely agree. That point is picked up in the Bill.

The most shocking statistic concerns the diseases that people are suffering from. The London School of Economics says that 92,000 people a year miss out on palliative care help. At the moment, 88% of our palliative care provision goes to people with cancer. As a cancer nurse, I am certainly not saying that that needs to be reduced, but the majority of deaths are due to other diseases. Only 29% of people die of cancer, with 28% of deaths due to heart disease, 15% due to respiratory illnesses, 10% due to stroke, not to mention Alzheimer’s disease, motor neurone disease and multiple sclerosis. Until we ensure that palliative care provision is mainstream, and not just for patients with cancer, the majority of people will be denied access to a good death.

The Bill introduced in the other place comes up with solutions to resolve this situation and place the responsibility firmly in the hands of local clinical commissioning groups to ensure that all patients, no matter where they want to die or what disease they have, will get access to palliative care services. That will take the pressure off existing acute facilities that are currently having to provide them. The Bill makes some key practical proposals. The first is about the ability to admit people directly to palliative care facilities. This happens really well in a lot of places, but it does not happen everywhere. That goes back to the point made by the hon. Member for Strangford (Jim Shannon) about investing in our hospices to ensure that it can happen more widely. The Bill talks about support for healthcare professionals in all settings, so that whether they are an intensive care unit nurse or someone who works with motor neurone disease, they have a signposted facility to access specialist palliative care that helps them to help patients manage their symptoms.

The Bill fits very firmly into the Government’s seven-days-a-week NHS in calling for the availability of seven-days-a-week palliative care services. As I know only too well, it is at 4.30 pm on a Friday that a patient will phone up in pain and say they cannot cope, when pharmacies are closed and it is possible to get a prescription but not a drug. Someone who is breathless and needs a chest drain often has to wait until the Monday morning, in the meantime being admitted to A&E or a medical assessment unit and then finding it very difficult to be discharged to go home. This is why we need a seven-days-a-week palliative care service.

The Bill calls for some really basic things that should exist now but do not, such as sufficient equipment for our community services. It is unbelievable that a ward nurse who wants to discharge someone with a morphine pump cannot do so because the pump belongs to the hospital. Unless the community has a spare pump, that patient will not go home. That is why only 30% of people are dying at home—they are stuck in hospital because communities do not have the necessary equipment to look after patients. There are shortages of mattresses and feeding pumps, which would make a crucial difference if they were available.

[Sarah Champion (Rotherham) (Lab)]

I congratulate the hon. Lady on calling this debate on such an important and often overlooked issue. I support what she is saying 100%, but does she agree that it is not just the NHS, the community and the charitable sector that need to join up? Joining up health and social care would enable the seamless transition she is talking about.

[Maria Caulfield]

Absolutely. I am touching on some of the Bill’s highlights, but we also need to incorporate social care, because that is often the kind of support that carers need in order to be able to look after relatives.

The Bill also highlights the fact that medication is not available at all times. I know only too well that if a patient’s pain needs to be better controlled, they can get a prescription but they cannot get the drugs on a Saturday or Sunday or during the night. Once again, they are admitted to A&E for help in managing their pain. That is not acceptable.

Practical solutions are available to enable people to choose where they want to die. I was disappointed by the response of Lord Prior of Brampton in the other place when he dismissed the Bill so easily by saying that we did not need to legislate for good palliative care. I strongly disagree. If we can legislate for a charter of budget responsibility, which I strongly supported because it is important for this country to run a surplus, and if we can legislate to freeze VAT and national insurance because that is also vital to this country, and to charge 5p for every carrier bag, why can we not legislate to provide good palliative care for every person who needs it?

I urge the Minister to consider the Access to Palliative Care Bill, which is currently going through the other place, as a way to improve access to palliative services and to support patients, families and NHS staff.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank my hon. Friend the Member for Lewes (Maria Caulfield) for bringing this very important subject to the attention of the House and for doing so with her characteristic passion and verve. It has been a pleasure to answer her points in several previous debates. She has made her points with great clarity and it is with great pleasure that I will respond to every single one.

I will start where I finished on Monday night. This debate is timely, because it follows closely on that evening’s Adjournment debate, which was brought to the House by my hon. Friend the Member for Colchester (Will Quince) and to which other Members contributed with such great passion, interest and detailed knowledge. I firmly believe that, unless the NHS understands that the basis of care is not the end point of healthcare but a good in and of itself, we will not build a satisfactory foundation for the medical care that we hope is the experience of the majority in the NHS. For people for whom the end point is not recovery, but good and decent care, we must ensure that such care is embedded in the foundations of the NHS. If we do not, we will not provide a suitable foundation for good care throughout the system. That is why I see palliative care not as something that is nice to have—an added extra or a bonus within the NHS—but as something that is crucial to the delivery of good care throughout the system, whether or not people are likely to survive at the end of their care in hospital, in the community or at home.

I share my hon. Friend’s judgment of the debate on the Assisted Dying Bill, which I found fascinating. No matter where Members came from in that debate, what was clear was their wish to cherish, support and improve the palliative care services in our country and to ensure that people had access to the very best services not only in the UK, but in the world. That is where I will start my general remarks.

My hon. Friend is right to point out that the provision of palliative care is variable across the country, and I will turn to that in a second, but it is one of the areas that we should be very proud of, not least because of the dedicated work that people like her provide across the system in specialist settings and because of the unique gift that we have in this country of the hospice movement.

That is why the Economist Intelligence Unit, only a few weeks ago, judged that this country had the finest palliative care in the world in terms of access to services and the quality of those services. I do not say that in order to say that there is nothing to do—quite the opposite. The Economist Intelligence Unit pointed out that there are examples of extraordinarily good care across the country. I want to ensure that the experience is not variable, and that no matter where one is in the country, one receives the finest care.

Where should one look? I will point to a few examples of where exceptional care is being provided. In Bedfordshire, Sue Ryder has brought together palliative care services across the county. There is a brilliant linking up of services, whether they be in the community, in hospital or at home. As my hon. Friend knows well, home can encompass care home settings and private homes. That is a beacon of good practice that has been brought together by an expert charitable institution.

The Airedale, Wharfedale and Craven clinical commissioning group has blazed a trail with its expertise in palliative care, particularly through its adoption of the gold line telephone number, which is used not just by clinicians, but by families. People are lucky if they need palliative care and live in the Airedale clinical commissioning group area, because they are likely to receive the very finest palliative care available anywhere in the world.

I know that my hon. Friend has experience of hospital palliative care as a cancer nurse at the Royal Marsden, where exceptional care is provided that is comparable to the best care anywhere in the world. She will also be familiar with the work that is done at Frimley Park, where there is a comprehensive palliative care programme that goes across the hospital and is not seen as a bolt-on extra. The John Radcliffe hospital in Oxford has a similar approach with similar ends.

[Sarah Champion]

The Minister is citing excellent examples, but does he agree with me—I think that this is the intention behind the debate—that we should not just have exceptional examples, but 24/7 care wherever people are and whatever their condition is?

[Ben Gummer]

I agree completely with the hon. Lady. I was just about to turn to the very useful intervention that she made earlier, in which she said that palliative care is a mark of the integration of the health and social care sectors. It is no coincidence that one often sees good palliative care where there is good integration of health and social care. In a sense, the state of palliative care is a proxy for where care is well integrated and where it is not. That is why it should be seen as part of the larger challenge of achieving successful integration, on which there is a good deal of cross-party agreement.

My hon. Friend the Member for Lewes mentioned the fact that many people do not die where they would choose. She will be aware of the Choices survey, which was launched by my predecessor in the coalition Government, the right hon. Member for North Norfolk (Norman Lamb). It has reported, and the Government have committed to replying to it. She can take that as an indication that there is policy to come, and that we will study carefully the things we have set up. We intend to ensure that people have greater access to the services they require to ensure that they can die where they wish. We made that commitment in our manifesto—we were very clear about it—and we intend to deliver on it, as we intend to deliver on the rest of our manifesto.

My hon. Friend was entirely right to point out that that will require changes in services where they are not good. That will require commitments on palliative care nurses and the spreading of training. They have been achieved in Airedale, but have not been achieved in other clinical commissioning groups, where care is sometimes significantly lacking. There is much to do in some areas of the country. If I may use Bevan’s words, it is about universalising the best. We know what the best looks like. We now need to ensure that we spread it across the rest of the country.

My hon. Friend was right that palliative care has, unfortunately, in some cases been associated with cancer care. That is not how it should be seen. She will be aware in great detail of the European Partnership for Action Against Cancer system, which is being used to ensure that cancer patients can indicate their wishes for the end of life. It can also help clinicians to manage that end-of-life period. The EPAAC system was originated and developed specifically for cancer patients, but we intend to roll it out for patients no matter what the cause of their death.

My hon. Friend mentioned the need to provide services 24 hours a day, seven days a week. Without wanting to state the obvious, that is one reason why we want to get a seven-day NHS working. When people need the NHS—whether they need medical attention that will save their life or pain relief that will mean that the end of their life is bearable—it cannot be right if treatment is deferred to a Monday because we do not have services available on Saturday and Sunday. That is the crux of what the Government are trying to achieve across our NHS reforms: we want to achieve a truly seven-day NHS.

Briefly, on the Bill introduced by Baroness Finlay in another place, I cannot disagree with the general sentiments of the proposal. The degree of variability that we have is obviously wrong and we must put it right. It should be right, in a sense, to say, “Let us legislate in order to make it so.” I have reservations about the Bill—I have made them clear to Baroness Finlay—but I should like to outline them to explain why I believe it may not achieve what it wants to achieve, and why, on a wider point, it might be counterproductive.

If enacted, the Bill would be the first instance in the history of the NHS that means we would make specific clinical demands on clinical commissioning groups about a specific clinical area. To take an analogy, we have not had a cancer services Bill that demands things of CCGs on cancer services. The Bill would therefore set a precedent, which requires very careful consideration. My current judgment, and that of the Secretary of State, is that we do not want to determine that demand from the centre in the manner in which Baroness Finlay wishes.

There are other instruments for achieving what Baroness Finlay wishes to do, such as the mandates to CCGs and to Health Education England. There are ways to achieve by similar means the same ends that she wishes to achieve, which is putting certain obligations on CCGs to ensure that they commission care in a way that we expect. We need to be careful about how we do it. Airedale is so good because it has come to that point by itself and developed its approach organically. Other CCGs around the country have come to equally good solutions in a different way.

I would not want to impose a solution from the centre that squashes the local innovation of good leaders. I think we can all agree that the NHS in the past has not been good at allowing staff locally to celebrate leadership and innovation. There are lots of brilliant people in the NHS who have great ideas, but they do not feel empowered to bring them forward. We need to be careful, therefore, about imposing solutions from the centre, either from the Department, NHS England or this place, that do not recognise the ability of local people to come up with local solutions. I have told Baroness Finlay that I want to develop policies that do what she wants to do but not by the means she proposes. I hope to empower local people to get to where she wishes to go, and I hope to do so in a manner that celebrates success and exposes failure, so that we can put it right, and universalises the best as quickly as possible, without taking a top-down approach, which might have the contrary effect.

We are in a better position than other countries because of the remarkable work of charities and voluntary bodies over the last few years, and we have now accumulated a mountain of evidence from charitable groups and Government. My hon. Friend pointed to the 2011 NICE guidelines, but there were also the five priorities outlined last year in “Priorities of Care for the Dying Person”, and we now have the NHS Choices review, to which the Government will respond. We have enough paper evidence. We know what looks good, how to make it happen and that it needs to happen, and we know that many people die in circumstances that leave much to be desired. I point in particular to those who die in hospital. It is clear from the VOICES survey, which tracks the experience of families and individuals at the end of life, that people’s experience of dying at home and in community settings, especially in hospices, is generally much higher than in hospitals. Broadly—I generalise—half of people in hospital do not have an optimum experience of death.

We can change some things quite quickly, but we have got to this point because of the sustained effort over many years and the accumulation of evidence in a clinical area where Britain leads the world. I pay tribute to my hon. Friend and other colleagues with expertise in this area, to the many academics who have worked hard on this, and to the hard work of NHS England and its director of palliative care, Professor Bee Wee, who is a remarkable clinician. Over the next few years, as we fulfil our manifesto pledge, I hope that all parties can work together on this, calling on the experience of people from every part of the country—it was great to hear from the hon. Members for Torfaen (Nick Thomas-Symonds) and for Strangford (Jim Shannon), who shared their experience from other parts of the UK. If we can bring all this together, I think we can do something rather remarkable for people with no medical hope at the end of their life but to whom we should give the absolute guarantee that their care will be exceptional and will make what is never going to be a happy moment at least bearable and full of meaning for them, their families and their loved ones.

Question put and agreed to.

Francis Report: Update and Response

Sarah Champion Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I do agree, and I have had many discussions with my hon. Friend about how local health care services can be improved. It shows real courage to raise a concern about patient care at one’s own local hospital. Basildon is a fantastic hospital—it is very well run, and it has really turned a corner—but that does not mean it is perfect, as I am sure its chief executive would be the first to accept. It is possible to have a sensible debate about improving care while being honest about the problems. That is the big change we need to make, and my hon. Friend has given us an example.

[Sarah Champion (Rotherham) (Lab)]

I welcome the focus on whistleblowers and the support package, but the Francis report also said that patients’ complaints should be viewed as the canary for failing hospitals. What support is the Secretary of State giving to patients who make complaints, and can he reassure us that the hospitals and the Care Quality Commission will take the issue very seriously?

[Mr Hunt]

Yes. We have set out new guidelines. The right hon. Member for Cynon Valley (Ann Clwyd) helped us a great deal when we were looking into how to improve the NHS complaints procedure, in particular advising people about how to complain and ensuring they knew that they could talk to someone independent if they needed to. I try to look at a letter of complaint about something that has gone wrong in the NHS every day before I start my work, and I make sure that the trusts are aware of that.

Francis Report

Sarah Champion Excerpts

Wednesday 5th March 2014 Commons Chamber

[Sarah Champion (Rotherham) (Lab)]

I welcome this debate because it has given us an opportunity to reflect, to learn and, hopefully, to not make some of the same mistakes again. I pay tribute to hon. Members who were directly involved with the events surrounding Mid Staffs. Their persistence in protecting their constituents and changing the culture has been remarkable and something we should all learn from. I particularly pay tribute to the hon. Member for Stafford (Jeremy Lefroy) for telling us how the staff at Stafford hospital have learned and are working as hard as they can to make changes, so that they can deliver an excellent service to all their patients.

The Francis report, published a year ago, made stark reading. It exposed the dreadful practices that no one should ever have to endure, with shocking stories of patients left in their own excrement, unfed, and pleading for water. My heart genuinely goes out to patients and their families who suffered such poor treatment at the hands of an NHS that was seemingly driven by apathy, not by quality of care.

One year on, have we learned the lessons that were so hard won? Robert Francis made many recommendations about how the NHS should put patients at the centre of care. He spoke of a structure of fundamental standards and measures of compliance. He discussed openness, transparency and candour throughout the system, all underpinned by statute. He also raised the need to improve support for compassionate, caring and committed nursing. A recent report by the Nuffield Trust reviewed the progress made, and there is some good news. Nursing is receiving a significant degree of attention, especially in ensuring fundamental standards of care, and the handling of patient complaints locally has been given renewed attention by the chairs of local clinical commissioning groups.

I think that complaints and compliments are key to improving practice, and like many Members, I use the Sheffield-based social enterprise website, Patient Opinion, which to date has shared 65,000 patient experiences of care and received millions of hits from the NHS, MPs, commissioners and the general public. There is clearly a desire for patients to share their experiences, and an NHS that wants to listen and learn. Is it not worrying, however, that an independent organisation is fulfilling that role? Although I am a huge advocate of Patient Opinion and fully support its work, the voice of patients and accountability should also come from within the NHS, not just outside it. In practice, under this Government patients still have little say in how their health care is commissioned or provided. As my right hon. Friend the Member for Leigh (Andy Burnham) stated, more than £10 million of the £43.5 million allocated to Healthwatch branches is still unaccounted for, so how can Healthwatch fulfil its role?

The Nuffield Trust also identified bad practice. I am saddened to hear that some national bodies have persisted in the behaviours towards hospitals that contributed to the problems identified by the Francis report. That suggests that there is still a fundamental lack of co-ordination between different NHS bodies, and elements of the system-based culture that led to the failings in the Mid Staffordshire trust, but while this is saddening, perhaps it should not be surprising.

For the changes Francis recommended to be implemented, they need to be fully adopted by the Government. Instead, the Government have spent £3 billion on a top-down reorganisation that nobody wanted and nobody voted for. Almost 1 million patients have waited more than four hours in A and E in the last 12 months and, as has already been pointed out, hundreds of mental health beds have been lost in the last two years. Last year, a third of people referred for counselling gave up because the waits were too long. Patients are still suffering at the hands of the Government.

If we do not urgently change the culture of the NHS to become more patient-centric, patients will continue to suffer. There needs to be a fundamental culture shift in the NHS that has not yet been achieved, and will not be achieved while the Prime Minister continues to put profits ahead of patients. The recent proposals to sell off our medical records are a perfect example of how “supposedly” patient-centred the Government are. Data collection and monitoring are essential, so it is a shame that the Government are stopping the collection of some datasets, such as health inequalities.

Staffing cuts are preventing patients from being at the centre of care. How can we provide patient-centred care when the Government are side-stepping the need for adequate levels of staffing, in terms of both volume and skills mix? How can we expect nurses to put into place systems, such as having a named nurse, when their numbers have been cut by around 7,000 since 2010? The Royal College of Nursing has said that it wants to deliver patient-centred care, but without the right skills mix in place, it is difficult for it to do so.

Continued “efficiency savings”, driven by a Prime Minister who promised not to cut the NHS, make it virtually impossible for patients to receive a service suited to their needs. A continual focus on savings suggests to me that the Government have not learned from the Francis report. Patients are not always seen as individuals with individual needs and wishes. Our changing society means changing patients, and changing patients have changing needs. Today, nearly two thirds of people admitted to hospital are over 65, and an increasing number are frail or have dementia. Too often, hospital buildings and staff are not equipped to deal with people who have multiple complex needs.

One of my concerns is that patient experience is still variable. We need to understand why experience differs and how we can make it consistently excellent for all. Will the Government commit to identifying and tackling the causes of inequalities in patient experience? Do they have the conviction to look at the needs of the patient and how they can be best met, rather than looking at existing provision and how patients can be shoehorned into it?

The problem is not necessarily what has been addressed by the Government, but what has not. The blame culture fostered by the Government leads to fear and finger pointing, rather than improved patient care. The Government need to commit to re-introduce a culture of learning, support, and quality patient care in the NHS. A blame culture will not get us anywhere: listening to patients, and taking their needs seriously, will.

Oral Answers to Questions

Sarah Champion Excerpts

Tuesday 25th February 2014 Commons Chamber

[Norman Lamb]

As far as possible, we should be trying to ensure that children with mental health crises can remain at home; it does not make sense, in very many cases, to put them into in-patient care. However, we have made it clear, as has NHS England and as was confirmed in the crisis care concordat last week, that beds should be locally available whenever they are needed.

[Sarah Champion (Rotherham) (Lab)]

19. Will the Minister indicate when a clear strategy for the commissioning of tier 4 mental health beds will be determined and what additional resources will be made available to support the mental health needs of children and young people? The current situation is intolerable.

[Norman Lamb]

I mentioned earlier that the rapid review that is being undertaken by NHS England will report in March. It is essential that we have sufficient beds available, as close to home as possible, for children and young people. As I also said earlier, as far as possible children should be cared for at home, and only as a last resort should they go into in-patient care.

Early Childhood Development

Sarah Champion Excerpts

Thursday 30th January 2014 Westminster Hall

[Andrea Leadsom]

Yes. I am grateful to my hon. Friend for making that point. Benchill has that amazing ability to reach new families by offering birth registration. As hon. Members will know, if a man is not married to the mother of the child, the only way to have his name on the certificate is to be present physically at the registration as the father. Therefore, the advantage of offering registration in children’s centres to families is that it offers the opportunity for the children’s centre to look at the parents together. Benchill certainly encourages its staff to chat to dad. It encourages them not to focus just on mum or baby, but to talk to dad and the other children if they are there—to engage with them, try to give them support and let them see what services are offered to dads and babies and not just mums and babies. That is a perfect example of how to support the entire family. In one fell swoop, Benchill deals with the problem of stigma—everyone goes to the children’s centre, so clearly there is no stigma—and those families who are deemed hard to reach and who so often need services but do not get them are automatically engaged.

The fifth proposal in our manifesto is that there needs to be a presumption of data sharing among perinatal health professionals. The incorrect perception remains that sharing concerns about a mum, a family or children is against the law. In fact, professionals talking to one another and sharing their concerns and the information that they have on different families could very often save lives by allowing earlier interventions to be made.

[Sarah Champion (Rotherham) (Lab)]

The hon. Lady is making a very interesting point. I am doing an inquiry into child sexual abuse, and one of the key blocks to getting prosecutions is the lack of information sharing among health bodies, education bodies, local authorities and the police, so I fully support the recommendation on that, because it seems to me the only way in which we can prevent abuse and other forms of neglect.

[Andrea Leadsom]

The hon. Lady is absolutely right. Sadly, in serious case reviews there is very often an element of failure on the part of health professionals—a failure to talk to one another. Very often, that is a contributing factor to the disastrous outcomes that we sometimes see for families and children.

[Andrea Leadsom]

Yes. Even my hon. Friend’s harder line is absolutely right: there should be a presumption in favour of data sharing. It should not be a case of people saying, “Oh, I didn’t know,” or, “I didn’t think it was allowed.” It should be a case of people being told, “If you didn’t share information, you should have done.” At the moment, that is not understood strongly enough.

Of course, data sharing is relevant not only in child neglect or child abuse cases. Let us say that a midwife meets a mother antenatally and is aware that that mother is terrified at the prospect of giving birth because of the physical implications, because she is afraid that her partner might leave her or because she is afraid that she will lose her job as a new mum. Often, when such issues are picked up antenatally, there is, first, a lack of places to refer that mum on to and, secondly, a lack of a communication path to enable the midwife to think about whom they should be talking to.

There is, therefore, a very strong argument for creating formal links between midwives, health visitors and children’s centres to ensure not only that they can talk to someone else, but that they must talk to someone else. The relevance of that to the mum’s experience is that if a midwife is concerned about a mum, they can perhaps refer her on to a mental health specialist midwife and a mental health-focused health visitor. That could all take place under the auspices of a sensitively attuned children’s centre, so that the mum’s needs can be met throughout the perinatal period, giving her the best chance of forming the vital secure bond with her baby. Data sharing is relevant not only to cases involving severe child protection issues; it is also about supporting mums who are just struggling. As we know, the statistics suggest that as many as 100,000 mums a year may be just generally struggling. It is not that there are severe physical or neglect threats to their babies; it is just that those mums need a bit of support, and at the moment we are not giving them that.

That takes me on to our sixth proposal. There is a huge need to provide proper training for front-line health and social care professionals in the importance of attachment and early brain development. I have been involved for about 15 years with parent-infant partnership charities that provide psychotherapeutic support to families. We also provide training to front-line professionals. It is astonishing how many post-training evaluation forms we get from midwives, health visitors, GPs and social workers that say, “Wow! I wish I had known before how important the earliest relationship is.” That is not as much about the physical health as about the emotional health and the attachment.

Our seventh proposal is that local commissioning groups and health and wellbeing boards should specifically consider the social and emotional needs of babies in their local strategies.

The eighth proposal is that childminders and nurseries should consider how they can better meet the attachment needs of babies in their care, and that Ofsted inspections should specifically provide guidance and assess their performance. As a member of the Committee considering the Children and Families Bill, which passed through the House of Commons recently, I was pretty shocked, when we had Ofsted in to give pre-Committee evidence, to be told that Ofsted inspectors do not routinely assess those looking after the very youngest—potentially babies from the age of three months to two years old—on how well the care setting is meeting their attachment needs. There is this sense of schoolifying in the inspection regime. It forgets about how well the key worker is playing with the baby, responding to the baby, smiling at and cuddling the baby and being the key person who changes the nappy, does the feeds and so on. All those things are absolutely crucial for secondary attachment if mum or dad is out at work.

[Sarah Champion]

I know that the debate is about early years, but I was also surprised to find that in schools, there is no requirement for Ofsted to measure safeguarding; they deal only with educational attainment. We must look more holistically at a child from birth onwards.

[Andrea Leadsom]

As the hon. Lady said, the debate is about the earliest years. If we can get those right, there will be many fewer problems later in a child’s development. We can close down the pipeline of later problems by intervening and supporting families far earlier.

The final proposal in our manifesto “The 1001 Critical Days” is that although children’s centres should continue to provide a universal service, they should prioritise specialist services for families with the highest level of need regardless of their social and economic circumstances. Service provision must be needs-based and universal, but focused on specialist services for those who really need them.

As I have said, since 2001 I have been closely involved with parent-infant charities that provide psychotherapeutic support to families who are struggling to form a secure early bond with their baby. I am delighted to say that a year ago I set up a charity called Parent Infant Partnership UK, which has set out with philanthropic donations to establish specialist parent-infant psychotherapy services based in children’s centres around England and Wales. The first brand-new Parent Infant Partnership, LIVPIP, will launch this month in the constituency of the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger). It will provide psychotherapeutic services for families who need them in the Liverpool area. I am absolutely delighted about that, and I hope that other local authorities will want to establish similar specialist services themselves.

[Sarah Champion]

I am very supportive of the scheme that the hon. Lady is describing, and I hope that it can be rolled out more widely. In Rotherham, we have some fantastic Sure Start centres that offer great parenting classes. Does the hon. Lady share my concern that because our early intervention grant has been reduced, we are having to look at cutting the number of Sure Starts from 22 to nine? I am concerned that the vital parenting support given by the Sure Starts will be lost.

[Andrea Leadsom]

The hon. Lady will know that there is a presumption against closure, and several local authorities have considered closing Sure Starts but have chosen not to. I once took my hat off in the Chamber to the Labour party for creating Sure Start—I was subsequently told that props were not allowed in the Chamber—but the problem is that they are not universally understood. If we ask the proverbial man on the Clapham omnibus what a school is for, we will get the same answer from every man on that omnibus. If we ask what a children’s centre is for, however, we will get all sorts of different answers. The fundamental problem with the Sure Start children’s centre system is that there is no common understanding of what they are for and the extent to which they should be provided.

My opinion—this is not part of our manifesto—is that children’s centres should have a statutory footing like schools do. If a school year 4 is failing, we do not say, “Well, shut it then, and those children can just go without learning to read and write.” The profound implications of children’s centre services on a child’s development may be far greater than whether they learn to read and write at the age of four, and far more fundamental for their life chances, but we are willing to shut children’s centres. I appreciate what the hon. Lady has said about cuts, but we need to improve understanding of children’s centres and spread the good practice that undeniably exists in some. We must persuade local authorities that children’s centres are not for cutting; they are profoundly important—at least as important as schools and hospitals. That is my opinion, but I hope that answers the hon. Lady’s good point.

Psychotherapeutic interventions from parent-infant partnerships have changed lives for the better for thousands of families. For those families whose babies now have the best start in life, rather than a disastrous one, politicians can count the savings to the public purse. Early years intervention has the potential to save billions of pounds from the cost of dealing with poor mental health, antisocial behaviour, crime and violence. My hope is that all political parties will adopt the achievable and sensible recommendations of our manifesto “The 1001 Critical Days”, and that we will together strive for the real prize, which is, surely, to change our society for the better.

[Fiona O'Donnell (East Lothian) (Lab)]

I apologise for my late arrival. I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing, with her friends and colleagues, such an important debate. It is excellent to have the opportunity to debate these important matters at length under your chairmanship, Mr Weir.

Hon. Members might be surprised to see a Scottish MP contributing to the debate, because Scotland and England have such separate and distinct approaches to child care, maternal care and paternal care, but there are lessons that we can learn from each other, and that is why I was keen to make a contribution today. In addition, I have been working closely with two third-sector organisations, the National Childbirth Trust and Bliss, on problems that arise when babies are born prematurely, and I want to focus on the needs of children, parents and the wider family when babies are born prematurely.

I have personal experience of the strain that that causes, having given birth to twin boys eight weeks prematurely when I also had a two-year-old and a four-year-old. When anyone asks me how I do the difficult job of Member of Parliament, I assure them that it is a piece of cake compared with being a mother of four children under four. My first-born—my daughter—has cerebral palsy, and when my twins were born I was living in rural Oxfordshire and not driving, so I faced multiple barriers to making that important bond with my premature babies. It is an awful experience for a mother to arrive home when it is more or less obvious that she has given birth—it is especially evident when twins have left the uterus—but because the babies are not with her, no one comes up to ask what happened. The mother is deprived of the opportunity to celebrate the birth of her children.

There is constant worry and strain over whether those children will grow up healthy and well, or even make it through that dangerous period in their lives, and parents have to take each day at a time. I pay tribute to the staff in the special care baby unit in Banbury who brought my babies—who are now 6 feet 2 inches and feet 3 inches and making a useful contribution to society—through that time. The right hon. Member for Banbury (Sir Tony Baldry) had newly been elected, and while my twins were still in the womb, I marched in protest to keep the special care baby unit open, not realising that they would soon be using the unit’s services.

There are particular strains for working parents. I was not a working parent at the time, so I did not have to make choices about maternity pay. People frequently do not understand that a baby who is born significantly prematurely often does not catch up, in terms of age and stage development, until they are at least two years old—I believe that it can take longer than that, and it certainly did in the case of my boys—and maternity pay does not allow for that. A mother is faced with the difficult choice of whether to take paid maternity leave while her baby is in hospital and possibly critically ill, or wait until the baby returns home. I would like the Government to look at that, because it puts such a strain on parents.

The hon. Member for Congleton (Fiona Bruce) spoke about the need for other Departments to be involved. Given its responsibility for maternity and paternity leave, the Department for Business, Innovation and Skills should be part of a joined-up approach. The Department for Work and Pensions must also be part of that, because although poverty and deprivation are certainly not the only factors that contribute to a lack of secure attachment or the health and well-being of parents and children, they can make a huge difference. In my case, we suffered from the combination of four children under five and huge financial pressure on our family, and we were at risk of losing our home. I started childminding the children of wealthy parents, so that they could have piano lessons and beauty spa treatments, to try to make ends meet. That puts a huge strain on a family, and for a mother or father at home, the child is often the only outlet for that frustration.

My hon. Friend the Member for Rotherham (Sarah Champion) rightly raised the issue of Sure Start centres. We do not have them in Scotland, but like many Members, I have watched at least two episodes of “Benefits Street.” When a Sure Start worker worked alongside some parents, it was incredibly inspiring to see how empowered the mother was. She was talking about the need to create a calm atmosphere and be consistent. It was the most inspiring and optimistic thing to see a parent given such skills. The way to do that is not by punishing them or withdrawing benefits, but by getting alongside people, showing them that we are on their side and understand, and giving them the necessary skills. I very much hope that the children from that family will grow up happier, healthier and able to contribute to society, and that they will not need that kind of support when they are parents. Investment in the early days is so important and can make such a difference to children’s outcomes.

[Sarah Champion]

I was surprised, and quite shocked, that 26% of babies in the UK—that is 198,000—are estimated to live in a traumatic family environment, and the effect on their well-being is considerable.

[Fiona O'Donnell]

I thank my hon. Friend for her intervention. It is so distressing—no child chooses where it is born. No child is born bad; bad things happen to children. It is really depressing to face the idea that a child’s outcomes should be determined by the streets they were born between. At NCH, which is now called Action for Children, I worked with children who were at risk of being removed from their family. I always felt that that was an ironic term, because the best thing for some children was to be removed from their family, as it was for the parents, too. For those children, there was really no opportunity. Many had suffered emotional and, at times, physical and sexual abuse.

I urge the Minister to look at the excellent children’s panel hearing system that we have in Scotland, because it works well. It is great, because the child is absolutely at the centre of the process. This is not about what happens in the first 1,001 days, but seeing a child finally disclosing the abuse they have suffered, with us all having to leave the room until they felt able to tell their story, was the most remarkable thing, as was knowing that, hopefully, it was the beginning of a process of survival and recovery from that abuse. It was desperately sad to hear a 10-year-old boy say to me, “I know I can never be a parent, Fiona, because I couldn’t be trusted.” It is unthinkable that children should have to face such choices. As the hon. Member for South Northamptonshire said, we must educate health workers, teachers, nursery workers—everyone involved in a child’s care—to spot the early signs of abuse and not be frightened to raise concerns.

I look forward to hearing the Minister’s response, as well as that of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), particularly on the issue of parents of premature babies. We know that breastfeeding brings huge benefits to babies. I am a mother of premature twins.

Hospices (Children and Young People)

Sarah Champion Excerpts

Wednesday 18th December 2013 Westminster Hall

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I do join him in commending them, as does everyone inside and outside the House. We recognise the tremendous work they do—they are on call at all times. I sometimes wonder how they handle the sadness and emotion they have to confront each and every day as part of their vocation.

Northern Ireland Hospice is committed to fostering, encouraging and supporting a quality research culture internally, regionally, nationally and internationally, and it is known for the high level and quality of care it gives. My right hon. Friend the Member for Belfast North (Mr Dodds), who has just left, referred to the Northern Ireland Assembly Health Minister’s commitment to contribute £2.3 million to hospices, and that commitment by elected representatives shows the appreciation of what hospices do.

It is essential that those receiving end-of-life care have the best care available and are made as comfortable as they can be in their last days. It is also essential, as the hon. Member for Pudsey said, that the family have all the information they need, whether that is in a hospice setting, the patient’s home or through a palliative care package—those are the three areas that have to be looked at.

Some 49,000 young children in the United Kingdom of Great Britain and Northern Ireland live with a life-limiting or life-threatening condition and need palliative care. There are inspirational professionals working alongside them in their family homes, hospitals, community settings and hospices across the United Kingdom.

It is horrifying to think that if we had more children’s hospices, they would be filled, because the need continues to grow. Every time we find a drug that works against a strain of cancer, for example, a resistant strain appears. For that reason, it is essential we put money into not simply hospices and nurses, but research, and I am convinced the Minister will take the issue of research on board in her response.

I recently read a report stating there is a real danger that palliative care and palliative medicine will be the least evidence-based subjects in medicine in a few years’ time unless vastly more research is done. While palliative care is vital, research is equally important, so perhaps the Minister can give us some thoughts on that.

I hope we are all blessed with young children and grandchildren who are bubbly and full of life, but some families are not. Those families have to live with a child who is ill, and it is tremendously heartbreaking to acknowledge that. Before yesterday’s debate on rare diseases, the Teenage Cancer Trust sent us some information saying that 30% of children with life-threatening diseases will die before they reach the age of five. Again, that puts things in perspective.

Macmillan nurses told me that the sufferer’s mood is affected by their family. If the parents are content and relaxed, the child is likely to reflect that. This is about the family and everyone involved. It is also about the day trips and the residentials, which the hon. Member for Pudsey referred to.

We have fantastic charities, such as the Make-A-Wish Foundation, that help children with terminal illnesses live a dream. However, that in no way absolves us, as MPs, from our responsibilities to the families, and nor does it absolve the Government or the regional Assemblies from theirs.

Together for Short Lives has also highlighted an issue to me. Will short breaks for children who need palliative care be fairly and sustainably funded from ring-fenced funding allocated to local authorities for short breaks? We look forward to the Minister’s answer, and I trust it will be yes.

Another issue highlighted to me was benefits for families. As soon as the child is taken to the next scene of life—as soon as they leave this life—the parents are left to deal with their grief and their debt. Sometimes, handling the first overrides handling the second. There must be some leeway over cutting off benefits, so that the family has time to realise their financial situation and handle it accordingly. The Minister does not have direct responsibility for the benefits system, but will she say how we can help families get through the switchover at a time when grief is the ultimate driver of where they are? What can we do to ensure that they are entitled to time off and that their benefits are reduced gradually?

[Sarah Champion (Rotherham) (Lab)]

On the point about families, no parents separated as a result of the death of their child in the four years I was at Bluebell Wood, whereas the average in the country is 50%. Hospices are also very good at helping families to secure benefits and housing and to deal with their grief. The hospices therefore give holistic care.

[Jim Shannon]

I thank the hon. Lady for contributing her personal knowledge on that matter. I ask the Minister to tell us how the Government will improve support for the families of children with life-threatening or life-limiting diseases who die, to ensure that family members are entitled to time off and to have their benefits reduced gradually.

To conclude, a child’s illness is the most stressful thing a parent can face. We are failing the family and, by extension, the child if there is a lack of support. That can and, indeed, must change. I ask the Minister to outline what will be done to bring about the changes the hon. Member for Pudsey and others have outlined. We cannot heal these children—I wish we had that talent, but we do not, as much as we might want it—but we can make the journey easier. When will we start to deliver the extra, full care that is so needed?

--- Later in debate ---

[Mr Simon Burns (Chelmsford) (Con)]

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this important debate. It was refreshing to listen to such a fluent and interesting speech by someone who has done so much work in the hospice movement before entering this House three and a half years ago.

As many hon. Members have said, and others will know from constituency experience, the hospice movement is fantastic. The dedication of those who work in it, whether providing the care or, equally importantly, raising the finances in their community, is vital. We cannot thank them enough for their dedication and hard work.

We have concentrated in the debate, as people often do when talking about the hospice movement, on children’s and adult hospices, which are vital. However, there is an area in between that is all too often overlooked: the need for more palliative care, and hospice care and treatment, for young people aged between 18 and 40. The needs of someone in their late teens or 20s are completely different from the needs of children, or of aged adults, who make up a large proportion of the people cared for in adult hospices. Things have been improving in recent years, with greater recognition of the situation, but I do not think enough account was taken in the past of the age group in question.

I will be honest: 10 years ago it would never have occurred to me that there was a problem. I assumed that someone who was not a child would go to an adult hospice, where the care would be wonderful—as it is—and that would meet the needs of even a young adult. However, when I met my constituent Denise Whiffin, and the friends around her, it was brought home to me how much extra attention and concentration is needed to meet the special requirements of that age group. Denise Whiffin’s son Jonathan was diagnosed, aged three, with Duchenne muscular dystrophy. Of course he was cared for through the children’s hospice movement. However, when he was in his late teens that was of course no longer the most appropriate form of care. He moved to an adult hospice, with people who were much older, and whose needs, outlook, attitudes and requirements were totally different.

Denise Whiffin and others in my constituency looked around and came across a role model. I believe that it was the first hospice to be created in this country—in Oxfordshire—specifically for those aged 18 to 40. The group was inspired to try to replicate that in Chelmsford, to provide the same sort of help for mid-Essex. Those involved have done sterling work in the past decade, raising money from scratch. For some years they have been able to provide a wide range of badly needed services for young adults, in the patient’s home setting. Those things include specialist advice and support; unique care packages for each patient, drawn up by the clinical nurse specialist; expert advice on transition from children’s to adult services; practical nursing care; respite care in the home; counselling—which is vital for many families and young people; and a chaplaincy service and music therapy. They have expanded because of demand for specialist care for the age group, and their hope and ambition now is that in due time they will acquire premises in which to provide health care and palliative care.

[Sarah Champion]

My colleague has hit the nail on the head, and his example of a hospice is exemplary. However, aside from the social aspect, one of the most shocking things for a child is that on their 18th birthday the support of the paediatric consultant who has been with them all the way through is taken away. They are given an adult consultant who might not be able to see them for three or four months.

[Mr Burns]

The hon. Lady makes a valid and important point, which comes as no surprise, given her distinguished professional work before coming to this House after the Rotherham by-election. It is about continuity of care. Just because someone reaches a cut-off point in their age and lifespan, they should not necessarily—automatically—have to change from those who have been providing their health care up until that point. The individual’s needs and requirements might progress or change so that their consultant or other health care practitioner needs to change because of the skills that they have, but that is a totally different argument. I hope that my hon. Friend the Minister and the Department of Health as a whole will look at the matter to see how we can provide greater continuity of care from health care professionals where that is appropriate, so that there is not an arbitrary cut-off point.

I do not want to detain hon. Members much longer, because I know that others want to contribute, but I do think that we must bear this in mind. Fantastic work is going on, as has been shown by a number of interventions and speeches during the debate, in children’s hospices and, equally, in adult hospice care, but let us concentrate more on developing for the young people in the 18-to-40 age group provision that meets their specialist requirements, so that they, too, can have provision and quality of care that is tailored to their requirements and demands.

Hospital Mortality Rates

Sarah Champion Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

We will quite simply do what it takes to ensure that we implement the recommendations of the Keogh review for north Lincolnshire hospitals. We owe my hon. Friend’s constituents nothing less. The first step is to be honest about the problems. The big difference between the two sides of the House is illustrated by the fact that we will restore morale not by pretending that the problems do not exist but by being honest about them and confronting them. That is what we will do in my hon. Friend’s constituency.

[Sarah Champion (Rotherham) (Lab)]

I should like to start by offering my deepest sympathy to the patients and families. We are talking about mortality statistics, but these are actually loved ones who have been lost. For the second time today, I ask the Secretary of State whether he will accept, adopt and implement the recommendations in the Francis report.

[Mr Hunt]

And for the second time, I say yes.

Oral Answers to Questions

Sarah Champion Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Jeremy Hunt]

We will, of course, give every support to the management at Basildon to turn around their hospitals. The wonders of modern technology have informed us that the shadow Health Secretary was wrong to say that there has been a decline in nursing numbers in Basildon: they have actually gone up by nearly 100 since the last election.

[Sarah Champion (Rotherham) (Lab)]

T3. The Francis report recommended that the National Institute for Health and Care Excellence draw up minimum safe staffing levels that would be policed by the Care Quality Commission. It stated that NICE should develop“evidence-based tools for establishing”the staffing needs of each service in the NHS which is likely to be required“as a minimum in terms of staff numbers and skill mix.”Will the Minister tell us when the Government will act on this and all the recommendations in the report?

[Mr Hunt]

If the hon. Lady heard the exchange earlier, she will know that what Robert Francis was recommending was evidence-based tools, not a national minimum staffing level. The reason for that is that the number of nurses needed varies from hospital to hospital and ward to ward. We need to make sure that that happens. In the best hospitals it already does. The system that we have—this was supported by the shadow Health Secretary in his evidence to the Francis review—is not one where the Secretary of State sits behind his desk and dictates the number of nurses required in every hospital. If we did that, we would not be able to run the NHS properly, but we need to make sure that there are proper standards in place, which is why we have a chief inspector of hospitals to make sure that that happens.

Health and Social Care

Sarah Champion Excerpts

Monday 13th May 2013 Commons Chamber

[Sarah Champion (Rotherham) (Lab)]

I would like focus on two groups of people who are not adequately covered in the Care Bill: young carers and the disabled.

I recently had the pleasure of spending time with a remarkable group of Rotherham young carers who are supported by Barnardo’s. Because of funding limitations, Barnardo’s is able only to work with young people between the ages of eight and 18, and only 100 in a year. Sadly and shockingly, Barnardo’s estimates that 3,000 young people are carers in Rotherham alone. It has on its waiting list children as young as six who are counting down the days until their eighth birthday when they can get some support.

The young carers asked me to make colleagues aware of their plight. Hannah told me that the main thing she wanted was recognition for the work she did. She understands her mum, who suffers from severe depression, better than anyone. Hannah wants her experience to be fed into her mum’s assessments. As she said,

“they trust me to look after her but they don’t trust my opinions.”

When Hannah calls the medics to say that her mum is deteriorating, she should be taken seriously. Instead, young carers have to contact their Barnardo’s worker to lobby on their behalf, because they are not recognised by the authorities.

I welcomed many of the measures in the draft Care and Support Bill, but they are limited to adults caring for adults. The Care Bill represents a missed opportunity to improve the rights of all carers, including adults caring for children and young carers. The young carers I met know that, because of them, their parents do not have to stay in hospital, a mental institution or a care home. They know how much their help saves the Government. On their behalf, I urge the Minister to make sure that the Care Bill gives young carers a little support in exchange.

Consolidating provisions relating to adult carers in previous Bills will create neat, codified legislation, with

“clear legal entitlements to care and support”

for adults, while young people will be left with piecemeal, leftover legislation that practitioners will struggle to navigate. This is highly problematic. As I have said, workers often need to act as advocates for young carers and protect their rights. This area has long faced the challenge of a confusing legal framework, and the Bill has the potential to make matters worse. It appears to provide a clear picture of carers’ rights, while in effect excluding some of the most vulnerable carers.

I recognise that the bulk of the changes needed to protect young carers need to be made in the Children and Families Bill, but changes could also be made in the Care Bill. In order to prevent inappropriate caring, it is important that measures are put in place to ensure that adults’ needs are met and that young people with potential caring roles are identified as part of an adult’s assessment. Not only would that recognise the important role that young carers play, but it would allow their needs to be acknowledged formally, forcing existing services to be more accommodating. For example, all of the young carers I met faced challenges at school, with inflexibility on late homework, missing school and the need to call home during the day. If young carers are formally recognised as part of the assessment process, that could be fed through to the school and teachers could be notified of the young person’s needs, allowing them to be better supported.

On the Bill’s implications for those with disabilities, my office has seen a marked increase in the number of cases of disabled people struggling to make ends meet. The introduction of the employment and support allowance has been confused and poorly administered. I have dealt with numerous cases of vulnerable people being placed in unnecessarily stressful situations and left financially worse off by this Government’s reforms. Such cases already make up 10% of my overall case load. The abolition of incapacity benefit will soon be followed by the abolition of the disability living allowance and the introduction of personal independence payments, meaning that disabled people are being squeezed at an unsustainable level.

[John Woodcock]

My hon. Friend is making an important speech. Does she share the concern of my local disability association that the problems with the ESA benefit and how it has been reassessed have led to grave worries about the introduction of personal independence payments?

[Sarah Champion]

I thank my hon. Friend for yet another example of the extreme stress that people are being put under and the mismanagement of this entire process. The pressure of the burden being placed on them is intolerable.

I am extremely concerned that the Government’s Care Bill will put further pressure on that vulnerable group. The key issue for social care reform is eligibility. A third of social care users are working-age disabled people. The Bill will not improve the social care system for them, and 105,000 disabled will be shut out from receiving the social care that enables them to live their lives.

My hon. Friend the Member for Easington (Grahame M. Morris) mentioned statistics from Scope that make depressing reading. Four in 10 disabled people who receive social care support say that it does not meet their basic needs, including eating, washing, dressing and just getting out of the house. A third of working-age disabled people say that cuts to their social care have prevented them from working or volunteering.

The Bill appears to focus on the elderly and does not address the care crisis facing disabled people. For those working-age disabled people who do not meet the eligibility threshold, the £72,000 cap on care costs will not apply. They will continue to need to meet the cost of their social care. If an individual’s care needs increase later in their working life to the point that they become eligible for social care, the cap will not take into account the contributions they have already made to meet their care needs.

I agree that the introduction of a national eligibility threshold is a step in the right direction. Alongside a new assessment system, I hope that it will end the postcode lottery in care provision. However, it is vital that the threshold is set at a level that ensures that working-age disabled people receive support to meet their basic needs.

The Government spend £14.5 billion a year, or 2% of public expenditure, on adult social care, which includes older people’s services. However, it was estimated by the Dilnot commission that social care services are under-resourced by £2 billion. Those services are being further squeezed by the pressure of an ageing population and a 33% reduction in local council budgets. Local authorities are therefore dramatically under-resourced for the demands that are placed on them. As a consequence, they have been raising the threshold at which disabled people become eligible for support. Recent surveys suggest that almost half of local authorities plan to reduce spending on care services for adults, which will hit those with learning difficulties and those with disabilities.

Unless there is sustainable funding for adult social care, the situation is likely to get worse. The upcoming spending review must be used to secure more long-term funding for social care services to underpin the Care Bill. The Government must not lose sight of disabled people and young people as the Bill progresses.

Oral Answers to Questions

Sarah Champion Excerpts

Tuesday 15th January 2013 Commons Chamber

[Norman Lamb]

I entirely share the hon. Gentleman’s concern. The Government have already taken action: we set out a strategy in March last year, and we are now consulting on the introduction of a minimum alcohol price. That could save up to 700 lives a year in 10 years’ time, which would make a dramatic difference. I am sure that the hon. Gentleman supports what the Government are doing.

[Sarah Champion (Rotherham) (Lab)]

Damage to health as a result of alcohol consumption often leads to wider social damage. I have seen that at first hand when visiting shelters for the homeless in Rotherham. Many homeless people cannot gain access to rehabilitation services because they do not have GPs to refer them. What steps is the Minister taking to ensure that those services are available to everyone, especially those who need them most?

[Norman Lamb]

The hon. Lady has raised a really important point. One of the consequences of the responsibility deal is that by 2015, 1 billion units of alcohol—about 2%—will be taken out of the market, and that will help some problem drinkers significantly. Moreover, the money that the Government are investing in public health gives local authorities an opportunity to invest in prevention services in order to deal specifically with the core group of people to whom the hon. Lady has referred.