Health and Social Care

Debate between Sarah Wollaston and Helen Goodman

Monday 27th February 2017 Commons Chamber

[Dr Wollaston]

My right hon. Friend makes an extremely important point: it is about not only the overall budget but the distribution. I think we would all agree, on both sides of the House, that deprivation must be properly weighted, but he is absolutely right that age and the resulting need for services is one of the key drivers of need. That is probably not adequately reflected in the way resources are currently distributed.

There is undoubted evidence of the impact of the financial position on patient care. Unfortunately, this whirl of hospitals having to cancel routine procedures has a further impact on their ability to meet their financial targets, because of the reduction in their income. I hope Ministers will not simply consider this as a short-term issue; more importantly, they must look at how we can fund these things sustainably in future. They must not look at health and social care in their separate siloes but see them as a single system and genuinely look at how we are going to take things forward.

If we do not address this problem, we need to be honest with our constituents about the consequences. People talk about a collapse in the NHS. I do not believe that that will happen, but what we will see is a continuing deterioration in performance, with a real impact on the quality of care, which will put lives at risk. The safety, which is essential to our patients and which the Department of Health has prioritised, is increasingly in danger of slipping.

A number of Members have commented on sustainability and transformation plans. In principle, they are extremely important as a way not only of acting as a road map for the Five Year Forward View, but of enabling us to return to a much more logical way of planning for integrated health and care. Hopefully, they will enable us to get away from endless contracting rounds in the NHS and move towards genuine planning. I am afraid that what has undermined them has been inadequate local consultation, inadequate working with local authorities, and, crucially, inadequate funding. If we do not have the funding to put in place the transformation of services, we will see these plans fail. Increasingly, those plans are being seen as a vehicle for cuts—

[Helen Goodman (Bishop Auckland) (Lab)]

They are.

[Dr Wollaston]

I say to the hon. Lady that, genuinely, these plans offer us an opportunity to produce a transformative process, but they are being undermined by a number of critical points, and we should address them.

National Health Service Funding

Debate between Sarah Wollaston and Helen Goodman

Tuesday 22nd November 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow my hon. Friend the Member for Central Ayrshire (Dr Whitford).

I want to touch briefly on the importance of clear data, the current financial position, and the need to agree on a settlement for the future in this House rather than continuing to have such confrontational debates.

I can see how the £10 billion figure has been arrived at: by adding an extra year, starting from 2014-15, and by transferring budgets to NHS England. When the Secretary of State refers to the NHS, he is actually referring to NHS England. He is not including public health. He is not, for example, including Health Education England. However, it is crucial that they are considered. As my hon. Friend the Member for Central Ayrshire said, when we talk about transferring money from public health to the NHS England budget, we are cutting off our ability to control the increase in future demand. We face significant challenges, which we will not address unless we invest in those future services.

We sometimes talk about public health as if it were not frontline care, but it is. We are talking about, for instance, services to help people with addictions and sexual health services—really important costs for the NHS. There is also the challenge of the reduction in Health Education England’s £5 billion budget, £3.5 billion of which is spent directly on the wages of health service doctors who are undergoing training, but also delivering frontline services. Cuts to Health Education England cut us off from future sustainability, because that is the budget that trains, retains and sustains our existing workforce. This is all crucial to frontline services.

The other way in which the £10 billion figure has been arrived at is by changing the baseline from which we calculate real-terms increases. I would say that it has never been more important than it is now for the public to have confidence in the data that we use. Trying to return us to talking about total health spending is not trying to be awkward; it is trying to be honest with the public. It is difficult to argue that more funding for health and social care is necessary if a £10 billion increase has been claimed. It is important that we continue to use the same consistent baselines that have been used in the past, so that the public can see what has happened to total health spending.

I welcome the front-loading of the settlement, and I welcome the fact that the NHS has been relatively protected in comparison with other departments, but the scale of the increase in demand is extraordinary. When Simon Stevens talked about welcoming the increase that had been granted, he made it clear that it was dependent on a fair settlement for social care and a radical upgrade in public health, and those two aspects are lacking.

I think that both sides are correct. I can see how the Secretary of State has arrived at the £10 billion figure, but whenever that figure is used we should also present a figure that refers to total health spending in the way in which it has always been referred to in the past. I think that that would help to build the Secretary of State’s case for an increase in funding as we go forward.

Like others, I hope that we shall see an uplift for social care in the autumn statement, because the impact of social care on the NHS is now profound. There cannot be a Member in the House to whom it has not been made clear by people who come to his or her surgery that the state of the care system is in collapse and providers are in retreat. Even those who can afford to pay are finding it difficult to gain access to care.

[Helen Goodman (Bishop Auckland) (Lab)]

In my constituency there are some villages where no social care is available because none of the private providers can afford to deliver it. Does the hon. Lady, in her role as Select Committee Chair, know whether that applies in other parts of the country as well?

Legal Aid, Sentencing and Punishment of Offenders Bill

Debate between Sarah Wollaston and Helen Goodman

Tuesday 17th April 2012 Commons Chamber

[Dr Wollaston]

I welcome the significant improvements that have been made in respect of domestic violence, so I shall concentrate on Lords amendment 168.

The Secretary of State says that because welfare appeals often involve arguments about points of fact rather than points of law, welfare appellants should not qualify for legal aid. However, justice is about facts. Many of the people whom we meet in our surgeries have fallen through the gaps in Atos assessments. They may not have ticked the right boxes, but within five minutes it is abundantly clear that the wrong decision has been made. In my experience, the expert and professional advice marshalled by the citizens advice bureaux makes all the difference to whether our constituents receive justice. Cost-shifting might be reasonable, but only if the £20 million per year went far enough to fill the gap that has been created.

Historically, South Hams CAB in my area has received 60% of its funding through legal aid. It was not a question of local authority cuts; the authority had not funded the CAB in the first place. Although some of that £20 million has gone to my local CAB and will make a significant difference, the CAB has nevertheless had to cut staff, and has lost 45 hours per week of high-quality professional time. Of course we all pay tribute to the volunteers, but it is mostly the detailed and specific marshalling of facts by specialists that determines whether the right decision is made at a tribunal.

I believe that the employment of more decision-makers would make a big difference, but I also believe that the work done by CABs saves us a great deal of money in the long term. I ask the Secretary of State to think again about how much more we can do to fill the gap so that our CABs can maintain the incredibly high-quality professional service that they provide for all our constituents.

[Helen Goodman]

Once upon a time the Tory party was the party of liberty, and was particularly energetic in defending the liberties of the individual against the power of the state, but such activity has been completely abandoned this evening, particularly in the Secretary of State’s approach to welfare benefits. It is wholly objectionable for the welfare system to operate without a proper right of redress and recourse unless there is a disagreement about a point of law. That opens the gate to maladministration and low standards, and to a continual lack of proper administration of people’s benefit entitlements.

Not for the first time, the Secretary of State has revealed a perspective that is complacent, out of touch and gender-related. The absence of a woman in the justice team has been highlighted again today. As I have said to the Secretary of State before, I wish that he would telephone the Prime Minister and ask him to replace the hon. Member for Huntingdon (Mr Djanogly) with the hon. Member for Maidstone and The Weald (Mrs Grant), because she would make an excellent Under-Secretary of State. She would do a great job, and above all she would improve the policy. That is what interests us.

I intend to focus on two issues. The first is domestic violence. The hon. Member for Maidstone and The Weald drew attention to the problem of the time limits in the Government’s definition. Taking such a strongly legalistic approach to the evidence base and refusing to accept Lords amendment 194 removes the context of the pattern of domestic abuse. We know that by the time women go to the police they have experienced an average of 35 instances of domestic violence, which is why we want the Bill to provide for a different evidence gateway.

The second issue involves children. I find it incredible that although the Secretary of State expresses concern about child abduction and people seeing their children taken into care and says that in those instances legal aid should be available, when it comes to the needs of the children themselves he is prepared to abandon the 6,000 who will lose their entitlement if the amendment is not retained. It is clear that vulnerable children who are leaving care or estranged from their families may experience significant legal problems involving such complex issues as debt, housing, education, law and benefits. It is impractical to expect young people who already face significant difficulties to bear the additional burden of dealing with the justice system.

It is not clear that what the Government are doing is in accordance with the UN convention on the rights of the child. In another place, Lady Walmsley warned that if children’s access to legal aid is not protected, the Government

“will be taken to the international court. It is as simple as that.” —[Official Report, House of Lords, 16 January 2012; Vol. 734, c. 443.]

I ask Ministers whether they have taken into account the extra costs that will be associated with further appeals to the international courts. We need a proper system that is sensitive to the most needy children in our country.