Care Bill [Lords]

Sharon Hodgson Excerpts

Monday 16th December 2013 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I am grateful for the opportunity to speak in this debate, not least because this Bill, particularly part 1, is being followed very closely in my constituency. I am pleased to follow my hon. Friend the Member for Easington (Grahame M. Morris), who spoke very well about the issues at hand. Given the high level of interest in my constituency, I recently held a listening event that was kindly supported by Age UK Sunderland and Sunderland Carers. I wanted to find out what the people who would be affected by the Government’s planned reforms thought of them. In the time available, I will give a potted account of that discussion.

Before I do so, I want to say a few words about young carers. After concerted lobbying by Members on both sides of the House, particularly my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), we now have clauses in the Children and Families Bill providing for young carers’ needs assessments and there are clauses in this Bill covering a young carer’s transition to adulthood—a very welcome step forward. I pay tribute to the Minister and to his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), who are both in the Chamber today, and to the children’s Minister, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), for listening to Members and campaigners on this very important matter. However, I would like the Bill also to include a duty on medical professionals to identify and refer young carers so that they can benefit from those needs assessments. Family doctors are by far the best placed professionals to be able to identify where a child or young person is probably providing support to their parents, and it is not unreasonable to expect them to make sure that that child or young person has their needs assessed by the local authority. I very much hope that we will see more progress on this issue as the Bill continues its passage through the House.

Turning to the main provisions of the Bill on social care, if the Minister thinks that my constituents are happy with the package we have before us at present, he is very much mistaken. People’s first question is understandably, “Will this benefit me or my family members?”, and many of them, when they look beyond the press releases at what the Bill actually says, are finding out that it does not. They know that only people who are eligible for care will be covered by the headline-grabbing £72,000 cap on care costs. Therefore, if the Government say—as looks likely—that only those with the most severe needs are deserving of help, very few will be covered by the cap at all. Even if they are covered, £72,000 will not be the maximum amount they will have to pay; they will also have to pay hotel and accommodation costs of £230 a week, as well as any difference between the rate the local authority is able to pay and the actual care costs. All in all, they could be looking at an extra £300 a week that does not count towards the cap. That means that, over five years, a pensioner would have to find an additional £78,000.

The situation may be different for the Secretary of State’s constituents, but I cannot think of many pensioners in my constituency who would be able to afford that kind of bill without selling their home. Of course, there will be a deferred payment option, but that is just a more expensive version of what 95% of councils do already and it will not be available until a pensioner has run down all their other assets. Assuming they do qualify and they defer five years of care home charges, they could end up clocking up an extra debt of £13,800 in interest, on top of the £78,000 charge and the £72,000 cap.

[Norman Lamb]

I am grateful to the hon. Lady for acknowledging the change we made in the Children and Families Bill with regard to young carers. Does she welcome the fact that we are massively extending the means-tested support by increasing the threshold from £23,250 to £118,000, which means that people with assets right up to that level will get some contribution to their care costs for the first time ever?

[Mrs Hodgson]

But that is only if they and their needs are eligible. In all the cases I have looked at, no one has been able to convince me otherwise.

The average price of a home in my constituency is £150,000, so someone needing care for five years could see the entire value of their home gobbled up. Whether the home is sold before or after they die is academic, because it will still need to be sold and all but £23,000 will be called on to pay for care bills and the interest on them. The only real difference I can see between that and the current system is that people will pay interest for the privilege of deferring their home sale, and that is why the Opposition say that this is nothing more than a care con. Ministers have been keen to gloss over those facts, but they cannot con my constituents, who are wordly wise and have seen straight through all the spin.

The next thing my constituents asked me at the listening event was whether the Bill will improve the quality of care that they or their loved ones can expect to receive. The issue of quality of care quite rightly hits the headlines every now and again when particularly shameful examples of the treatment of the elderly or vulnerable are exposed. Those peaks in interest only reinforce the worries people already have about either moving into residential care or becoming dependent on strangers who come into their homes on a daily basis.

There are tens, or even hundreds, of thousands of very capable and dedicated care workers out there who do what they can in an extremely challenging job and often on terrible terms and conditions, examples of which we have heard today. The Bill does very little to tackle the problems of long hours—or even zero hours—and those of low pay, no training and low staffing ratios that can lead to demotivation and desensitisation with regard to the dignity of the people being cared for. Ultimately, that is what brings down the standard of care that everyone who needs it should have a right to expect.

On the quality of care that people receive and the impact is has on their quality of life, I received an e-mail today from my constituent, Steve Hudson, regarding clause 48, which has been inserted in the Bill thanks to my noble colleague, Lord Low of Dalston. Clause 48 extends the protection of the human rights framework to everyone receiving regulated social care, whether they are in residential care or their own home and whether they are self-funding or in receipt of local authority support. Frankly, I was surprised that that was not the case already. As the Equality and Human Rights Commission said in its briefing, closing that loophole would be extremely beneficial in ensuring that the dignity and basic human needs of every person receiving care are at the forefront of every manager and business owner’s mind. I therefore hope that if the Bill progresses tonight, the Government will not seek to remove that provision in Committee.

The final big concern that my constituents shared with me at my listening event relates to funding constraints. It is clear to everybody that cuts to local authority budgets have a knock-on effect in the NHS, with beds, clinical staff and other resources unnecessarily tied up while care packages are put in place or even just reasonable adjustments to accommodation are made. It is no coincidence that delayed discharging is at an all-time high and costing the NHS some £20 million a month at a time when many local authorities are at financial breaking point and struggling to see how they can provide even the services they are legally obliged to provide over the coming years, let alone the kind of preventive services that they provided until recently.

Of course money is tight, but because it is tight, we should use the money we have in a smarter, more innovative way, as my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said so eloquently. That means pursuing the ideas put forward by my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Leicester West (Liz Kendall) for a whole-person care approach and the full integration of health and social care.

My constituents do not hate this Bill—they are pleased that there is a Care Bill—but they are frustrated by its lack of ambition and disappointed that the Government have watered down and cherry-picked the Dilnot recommendations so much that very few people will actually be any better off in the long run than they would be under the current system.

The Bill is inadequate and the House should decline to give it a Second Reading today, so that the Government can go away, have one of their famous pauses and come back with a version that meets the challenges that our health and social care systems will face over the coming years. Most importantly, the Government need to come back with a Bill that lives up to the hype that Ministers have tried to generate, and which does what all our constituents want and need it to do.

Gay-to-straight Conversion Therapy

Sharon Hodgson Excerpts

Wednesday 20th November 2013 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I congratulate my hon. Friend the Member for Ayr, Carrick and Cumnock (Sandra Osborne) on securing the debate, and on her powerful speech setting out the problem that we are hoping the Government can solve. I thank her, the Chair and the Minister for allowing me and other hon. Members to make small contributions to the debate.

I should also pay tribute to the many Members on both sides who have campaigned on the issue, particularly my hon. Friend the Member for Swansea West (Geraint Davies) for his excellent private Member’s Bill, and my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who did a national petition on the matter.

This debate comes during an important week for the LGBT community. On Monday, we celebrated the 10th anniversary of the abolition of the wretched section 28, and today is the annual transgender day of remembrance, when we remember the thousands of transgender people across the world who have paid the ultimate price, simply for seeking to be themselves. Those men and women have lost their lives at the hands of hate-filled zealots, because they had the courage to be who they wanted to be.

Pushing conversion therapy on people who are homosexual might not be on the same level as physical attacks on a member of the LGBT community, but it is certainly part of the wider problem of discrimination against them. That said, the psychological harm that medical professionals have recognised as a side effect of such attempts to change or tone down sexuality could well lead to the same end result.

Let us be absolutely clear: allowing the continuation of so-called therapists offering gay cures is, first, saying that being gay is problem that needs to be cured, and secondly, that it can be cured. Being gay is not an affliction. The only higher power that I defer to on the matter is the World Health Organisation, which has categorically confirmed that fact. Being gay cannot be cured any more than any other aspect of someone’s personality can be changed without doing that person serious damage.

What we want from the Government is similarly clear. The action taken last year by the British Association for Counselling and Psychotherapy, and in 2010 by the UK Council for Psychotherapy, is welcome. However, they cannot solve the problems themselves if the people they strike off their registers can still legally continue to call themselves therapists.

We need a system to ensure that counsellors and therapists are properly accountable. A statutory register has been put forward in the past as a solution to the problem, and in the absence of any better ideas, I still think that that is the way to go. However, I would be grateful for any other solution that the Minister can put forward that would have the same effect.

While such a system is set up, no doctor practising in this country—and certainly no doctor paid by our NHS—should be sending any of their patients to conversion therapy. Even if that patient begs to be referred, doctors swear an oath to do no harm, not to do whatever their patient asks them to do. We know that conversion therapy is harmful and doctors should know that too. We also know that the majority of people who request conversion therapy do so because of pressure or abuse from family or peers—

[Mr Jim Hood (in the Chair)]

Order. I now call the Minister.

Social Care (Local Sufficiency) and Identification of Carers Bill

Sharon Hodgson Excerpts

Friday 7th September 2012 Commons Chamber

[Barbara Keeley]

My hon. Friend is absolutely right. Indeed, the carers centre in Salford has a young carers project that has developed to the point of having a presence in all but one of the secondary schools in Salford. It has also started a more limited level of work in primary schools. It is vital, because it is identifying young carers and spreading awareness among teachers and pupils about the role of young carers. It is only that work with other pupils that will stop them bullying and picking on young carers.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Further to that point, does my hon. Friend agree that it is vital that all professionals who come into contact with young carers get together and communicate more, especially with regard to young people who are trying to stay under the radar and doing everything possible not to be identified as carers? The one person in their lives who could probably identify them as carers is the GP, because the GP would know the needs of the parent they are no doubt caring for.

[Barbara Keeley]

Very much so. It sometimes involves social workers and very often teachers. Teachers need this awareness because young carers may fail to turn up at school, not do their work on time, and not be there for exams. It is often said by young carers’ organisations and projects that GPs and health professionals ignore young carers. A 10 or 11-year-old is expected to care for someone with perhaps an alcohol problem or a mental health problem, and yet the GP or doctor involved in that situation simply ignores them, treating them as if they were not there.

--- Later in debate ---

[Barbara Keeley]

The problem we are trying to address is that the people who are responsible for the welfare of these students and their progress through their courses do not recognise that caring will get in the way of what they can achieve at university, given all the potential difficulties—for example, a sudden deterioration of the cared-for person’s condition. Policies are often in place for parent carers with children and mature students, but there is a complete gap in what universities have considered for other carers.

[Mrs Hodgson]

I hope that the Bill will deal with a situation that I fear my daughter’s best friend will otherwise fall foul of. They have both just done their GCSEs, they are both as able and bright as each other, and they both want to go on to university. My daughter plans to go away to university while her friend is considering staying in the local area, for the reasons my hon. Friend has highlighted. I worry that without the Bill her aspirations may never be fulfilled, because if she does not get the support it suggests she might start at university but then find that she is unable to continue. That would be so sad, because at 16 the two friends are as bright as each other.

[Barbara Keeley]

I agree; that is a very good point.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I am pleased to have to opportunity to speak in the debate and proud to be a co-sponsor of the excellent Bill introduced by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). Quite simply, regardless of whether it proceeds today—it was sad to hear from the Minister that it will not—the Bill is about recognising the huge contribution that carers make to our society, the billions of pounds they save the Exchequer and, most importantly, the human cost that incurs: poverty, isolation, mental and physical exhaustion—the list is endless.

Provision for carers is patchy, but the most frustrating thing for me is the fact that, where there is support out there, in many cases carers are unable to access it. Perhaps they do not know about it, or perhaps they fear reaching out for help in case they are taken away from the person they are caring for. For far too many carers help comes only when they reach a crisis point, which can ultimately end in tragedy, as we know. That is what the Bill seeks to address and why it is so important.

In my constituency there is a fantastic organisation called Sunderland Carers, which provides the kind of support that all carers need, and I have met the group on a number of occasions to discuss what needs to be done to support the hidden army of carers. They completely support the Bill, and I am grateful to them, and in particular to Kevin Devine, for providing me with two case studies that I will use to illustrate the impact that the Bill could have.

[Roberta Blackman-Woods]

I, too, do a lot of work with a carers’ support group in my constituency, Durham and Chester-le-Street Carers Support. Does my hon. Friend agree that such organisations would be greatly assisted by the measures set out in the Bill, because they would help them develop the range of support services that they and we want to see provided in their communities, and they really need additional help to give the support they want to give?

[Mrs Hodgson]

I totally agree. Those organisations are out there doing good work, but often they still need guidance, and legislation can often be at the root of that and can really help to ensure that they are funded, rather than having to scrabble around for money left, right and centre.

[Diana Johnson]

I would like to draw my hon. Friend’s attention to the carers’ centre in Hull, which is led by Greg Harman. Unfortunately, it recently lost its funding, so it will now become part of the NHS and carers’ services will be provided through the local social community organisation we have set up. The organisation did a huge amount to support carers in Hull, and I know that over many years they saved lives, because people were desperate when they got to the carers’ centre and the support they were given was incredible.

[Mrs Hodgson]

That is exactly the point. We know that provision is patchy across the country. Where it is good, it is very good; but where there are gaps, that can lead to tragedy, which none of us wants to see ever again.

The first of the two cases I want to highlight is that of a middle-aged male carer who gave up his full-time job to look after his wife, who has multiple sclerosis. He encountered many health professionals because of his wife’s illness, but his caring role was never acknowledged; it was always about her needs, and rightly so. Because of the lack of recognition from professionals, he struggled on his own for three years without any real support, never realising that he should have had it. By chance he saw an advert inviting people to take part in Sunderland Carers’ “Caring with Confidence” programme, which was a major turning point in his life. He was able to access practical support such as getting adaptations for his home to make the physical aspect of caring for his wife easier. Lifting and carrying someone can have serious implications for a carer’s own health. People have to be trained in how to lift people in a caring environment; it cannot be done automatically without potentially causing injuries. He could access short break services that gave him brief respite from his 24/7 caring role. This allowed him to take a holiday with his wife, with the extra support regarding the physical aspect of caring for her that made it a genuine holiday for both of them as a couple. He also gained a lot of support from meeting other carers, combating the isolation that he was feeling.

Finding Sunderland Carers changed that man’s life in almost as dramatic a way as becoming a carer had in the first place. However, we should be concerned about the fact that he could still be struggling out there on his own had he not seen the advert. All the professionals he saw could have signposted him towards that support but, for whatever reason, they did not. Whether it was because they did not know about the support available or did not think it was their job to tell him about it, I do not know. They could have helped him before he was forced to quit his job, which as well as cutting his social ties meant that the couple were in effect living on the breadline. That is why this Bill is so important.

A vital part of the Bill is about the identification of school-age and young adult carers. Caring can be tough at any stage of life, but for a child or a young person it not only impacts on their ability to enjoy the same kind of childhood as their peers but can define how the rest of their life will pan out. The figures are stark. Research by the BBC in 2010 suggested that there were as many as 700,000 young carers in the UK—about one in 12 of secondary school pupils. Further research says that there are almost 300,000 aged between 16 and 24, more than 61,000 of whom are 16 or 17, with one in five providing more than 20 hours a week of care. As I mentioned earlier, one of those 16-year-olds is my daughter’s best friend, so I have first-hand knowledge of the impact that this can have on a young person’s life. There are more than 220,000 young people aged between 18 and 24, and carers make up more than one in 20 people in that age group. That means that one in 20 of the 18 to 24-year-olds we come across is a young carer.

The situations that these young people are placed in and the demands that are made on them will vary greatly, but I want to give one example, again given to me by Sunderland Carers, to show the impact of caring on children’s lives and how much receiving the right support can help them. The example is that of two children who went to live with their grandparents at a young age because their mother was unable to care for them. The arrangement worked very well for a number of years. The children were thriving at school, had plenty of friends and took part in a number of other activities. But as time passed their grandparents grew older and their health and mobility suffered. They did not ask for help because they feared losing custody of their grandchildren. The children could not get out and about due to lack of transport, and this left the grandparents struggling to entertain them. As things progressed, the grandparents struggled to get the children to school, especially in poor winter weather conditions, because the grandfather relied on a mobility scooter, and occasionally he could not get them there at all. This affected their attendance, and even when they were at school they were often distracted because they were so worried about their grandparents’ health.

Thankfully, the school eventually recognised the children as being young carers and was able to get the family the support that they needed. A common assessment framework was put in place and a team was developed around the family. The children were then able to take part in activities that allowed them to get out and have a normal childhood and meet other young carers. Also, while they were out, the grandparents were able to get some much-needed rest, which meant they had more energy when the children were at home. The school transport problem was resolved, and now the children have a 100% attendance record. I have no doubt that they will still face challenges as they grow up, but now they have been identified as carers they should get the right support to help them to cope, and eventually to get qualifications and careers and to develop normal, fulfilling adult lives.

[Roberta Blackman-Woods]

In the case that my hon. Friend describes, it is good that the school managed to identify that there was a problem, but that does not always happen. What is so important about the Bill is that schools, colleges and universities will now have to proactively go out there to find the young carers and then think about how they are going to be supported. That is very much needed.

[Mrs Hodgson]

Exactly. Unfortunately, as my hon. Friend has said, many children are under the radar—some in even worse situations—and they will not be as lucky as those who have been identified. That is true of all school-age children, but it is arguably more true of young adults in further and higher education, who have less time with tutors or teachers who would be able to spot the obvious signs. That is what clauses 5 and 6 seek to address, which is why the Bill is so important and should be considered seriously. I hope the Minister will do that.

Teachers and educational institutions are not alone in their ability to identify young and young adult carers. I served on the Children, Schools and Families Committee in 2008 when we considered the issue of young carers, specifically children who are under the radar. I asked why GPs in particular were not more proactive in identifying such children, because it is a common-sense deduction that a parent with certain health conditions who is not receiving support from professionals or a spouse is probably relying on their children. The answer from Dr Jo Aldridge of Loughborough university was that GPs—and, for that matter, psychiatrists treating those with mental health issues—generally did not see such things as part of their job description. Clause 4 would take the long overdue step of making it part of their job description, which would be of particular benefit to young and young adult carers, as well as to all other unidentified carers. That is why the Bill is so important.

In conclusion, we want and need carers to provide care, because it saves the Government billions. Carers, by and large, want to continue to provide care, because they love the individual they are caring for, but the Government need to support them in doing so. Ignoring the needs of carers is simply not sustainable, because it leads inevitably to crisis; to a loss of expertise from the work force and of income tax for the Treasury; to, most importantly, children and young adults missing out on the opportunities available to them; and to poor educational outcomes, so it harms the life chances of those children who just want to look after their loved ones. That cannot be right, which is why the Bill is so important. I know that it will not progress today—the Minister has said as much—but I hope that he will pick up on the key measures that we have highlighted that are not in the draft Care and Support Bill and incorporate them into it, so that we can help carers of all ages with the best possible legislation.

[Diana Johnson]

I know that my hon. Friend is about to finish, but, given her experience in education, does she think that, considering the range of schools that are now available, such as free schools and academies, the Bill goes far enough? Should the duty be extended and placed on those new types of school as well?

[Mrs Hodgson]

Yes, and I hope the Minister will talk about this with his colleagues in other Departments. He said earlier that there is a lot of crossover with a couple of other Departments. He also gave a commitment to my hon. Friend the Member for Worsley and Eccles South to carry out a consultation and involve her in the next stages. I hope that he will look at all of the areas that need to be consulted and legislated on, and that require buy-in from other Departments, such as Education. I also hope that he will look at how academies and free schools, which are answerable totally to the Secretary of State, can be incorporated into the proposals, because they will not be answerable to their local authorities, which may lead on some of this work when it becomes a reality. I hope that this debate will not have been in vain and that some of the vital things that we have discussed will find their way into the Bill on care and support.

[Several hon. Members]

rose—

National Health Service

Sharon Hodgson Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

For staff who are trying to hold things together through the chaos the Government have brought about, what a kick in the teeth it must have been to read in the Sunday newspapers that unless they accept pay cuts, they will be made redundant. My right hon. Friend says the staff made those improvements, but so did he. As the incoming Secretary of State, he made improvements to waiting times for cataract surgery, which, if I remember rightly, were commonly about a year in the late-1990s. We brought those waiting times right down. Now what do we hear? We hear that under this crowd people with two cataracts are being told, “You can have one done, but not both.” That is what the NHS has been reduced to under this Government. The Secretary of State has promised action, and I have given him the evidence. He now must take action.

The second area on which the Government need to be challenged is privatisation. As the debate on the Bill drew to a close, the Secretary of State made this clear statement:

“The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS.”—[Official Report, 27 March 2012; Vol. 542, c. 1335.]

It is hard to know where to start, but how about the NHS walk-in centre in Sheffield, which is managed by a private company and has just started charging patients with whiplash injuries £25 for treatment, or the NHS hospitals now marketing private treatments for in vitro fertilisation, cancer screening or bone screening since the cap was lifted? How about the letter sent to all PCTs requiring them to identify three or more services for tendering under the “any qualified provider” measure in 2012-13? How about the 100 or so tenders for a range of services that have been offered to the private sector on this Secretary of State’s watch, with a total value of more than £4 billion? So let me ask the Minister and the Secretary of State today: will they now at least be honest about their true intentions for the level of private sector involvement in the NHS?

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Is my right hon. Friend as concerned as I am about the exponential rise in the number of private health care ads that we see on our television screens and in our newspapers every day? These ads had almost disappeared under the previous Government. Advertisers advertise only when they know that there is a market.

[Andy Burnham]

This is really important; it is where all of what the Government are doing comes together. They have put in place restrictions in treatments— 125 separate treatments, as I have just mentioned— and at the same time they have given a 49% cap to NHS hospitals to do more private work. So as the NHS decommissions services, hospitals are then free to start offering those services. That is why my hon. Friend is beginning to see the changes that she is noticing, and this is the clear agenda of the Conservative party.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Burns]

As the hon. Gentleman will appreciate, I do not want to be drawn into that too far because this is an independent assessment by the joint committee of primary care trusts and I do not want to be seen to be interfering, but I can say that neither we nor the JCPCT have ever said categorically exactly how many centres there should be. It will be up to the JCPCT, as it considers the representations it receives, to decide how many there should be. If it decides to have more than four, it would not need the processes that he is suggesting because it has the power within its remit to increase the number if it thinks circumstances warrant it.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

18. What steps he is taking to improve cancer care for older people.

[The Minister of State, Department of Health (Paul Burstow)]

We are working with Macmillan Cancer Support and Age UK on a £1 million programme to improve cancer care for older people. The programme consists of 13 pilot sites across the country to improve intervention rates for people over 70 who have a cancer diagnosis. Pilots will introduce new ways of assessing older people for cancer treatment, offer short-term, practical support for older people undergoing cancer treatment and will address any age discrimination in cancer services by identifying and addressing the training needs of all professionals working with older people.

[Mrs Hodgson]

I am sure that the Minister will have seen the report published today by the Roy Castle Lung Cancer Foundation, which reiterates the considerable research showing that older lung cancer patients do not receive the same level of treatment as younger lung cancer patients. In fact, it shows that a 60-year-old sufferer is six times more likely to be given surgery than an 80-year-old sufferer, which obviously means that their outcomes are considerably worse. How does the Minister explain that inequality and how can it be tackled?

[Paul Burstow]

I am grateful to the hon. Lady for highlighting that further piece of evidence that shows why the Government have already given a commitment to ensure that there are no exemptions for the NHS from the application of our duties in respect of age discrimination, as there should be no place for age discrimination in the NHS. In addition, the work we are doing with Macmillan Cancer Support and Age UK is the way forward to ensure that we learn the lessons and drive up standards for the care of older people.