National Health Service (Amended Duties and Powers) Bill

Sheila Gilmore Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

My hon. Friend is absolutely right; TTIP is a UK treaty, negotiated by the UK Government, and it will affect England, Scotland, Wales and Northern Ireland.

[Sheila Gilmore (Edinburgh East) (Lab)]

My hon. Friend may be aware that in response to a question I asked him this Monday, the Prime Minister indicated that he thought the health service would not be affected. He seemed to be suggesting that he did not want it to be affected. If that is the case, surely his Government should be supporting this provision to ensure that does not happen.

[Clive Efford]

My hon. Friend is absolutely right. We know that the Prime Minister has accepted it was a mistake, so the Government’s position on the Bill is a bit curious.

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[John Healey]

It comes as no surprise, and I am grateful to my hon. Friend for underlining that point. I was not planning to make that point, but I am glad that it has been made so clearly.

My argument is with the Prime Minister. So much for what he said, and so much for his word when he said back in 2011 that

“we will not be selling off the NHS”.

Perhaps the most serious consequence of this fragmentation, this privatisation and this contractualisation is the fact that the most important and fundamental value at the heart of the NHS—an imperative at its heart—is the ability properly to plan, co-ordinate and deliver services. That is being made much harder, as the Health Select Committee has said, and sometimes impossible by the operation of the Health and Social Care Act and competition law. If anybody doubts it, they should look at the case of the two NHS trusts—the Royal Bournemouth and the Poole NHS Trusts—whose merger made great sense to patients, but was prevented by this Government’s legislation.

Let me say a few words about the transatlantic trade and investment partnership. I have chaired the all-party group that has followed these negotiations for the last 18 months in order to try to encourage a better and more balanced public and parliamentary understanding and debate, as well as to put the Government on the spot and hold them to account for what they are doing. We are trying to ensure that if we get a deal, it will bring real benefits not just to British business, but to British workers and British consumers.

Two things have become clear. First, the NHS can be fully protected in TTIP. I am convinced of this, not just because other EU trade agreements have protected public services, but because if the Government want them, there are specific member state reservations to cover public services and because we have heard the confirmation, directly from the chief negotiator whom I have met twice about this, that even with ISDS—investor-state dispute settlement—provisions, which I do not support, nothing could prevent a future Labour Government from bringing parts of the NHS now in private hands back into public hands.

The second thing that has become clear is that these commitments have been secured despite, not because of, Government Ministers. It is clear that Ministers have done next to nothing to try to influence the negotiations and secure the full exclusion and protection we require for our NHS and wider public services. Indeed, rather as the right hon. Member for Banbury (Sir Tony Baldry) observed, the Minister for Trade and Investment, Lord Livingston, who is responsible in government for leading the British position, has said that he would welcome the inclusion of health services in any deal. When the Minister gets up to speak, perhaps he will—formally, in this House—make the Government’s position clear. What is clear is that if we are properly to protect our NHS in any future TTIP, we must have a strong British voice in Brussels, which we do not have at the moment.

[Sheila Gilmore]

I gave the Prime Minister an opportunity on Monday to say that he would take specific action to ensure that the NHS would be protected if TTIP were successfully negotiated. He did not do so, but does my right hon. Friend feel that this debate provides an opportunity for that to be done in his name?

[John Healey]

I would expect these trade negotiations to stretch into at least the end of next year, so I hope and expect that the responsibility for making sure that this deal is good for Britain will become that of a Labour, not a Tory, Government and of Labour Ministers, not Tory Ministers.

Five Year Forward View

Sheila Gilmore Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

Of course I would be delighted to visit my hon. Friend’s constituency. Morecambe Bay hospital is one of the hospitals whose problems we are looking at in a way that should have happened before but did not. We are turning round that hospital. We are determined to do it and we want his constituents to have absolute confidence in the quality of hospital care they receive.

[Sheila Gilmore (Edinburgh East) (Lab)]

The Secretary of State told us that a strong NHS needs a strong economy, so I presume he is extremely worried about the fact that reduced tax revenues have led, on this Government’s watch, to higher borrowing this year.

[Mr Hunt]

That is why we continue to take the tough and difficult decisions—[Interruption] that keep this country on the right economic path and which are opposed at every turn by Labour. They told us that our economic plans would lead to a million jobs being lost—[Interruption.]

Oral Answers to Questions

Sheila Gilmore Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Jeremy Hunt]

I can confirm that there are no such plans and it will remain free at the point of delivery. Nor do we have any plans to pay private providers 11% more than NHS providers, as happened under the previous Labour Government.

[Sheila Gilmore (Edinburgh East) (Lab)]

In response to my amendment to the Care Bill earlier this year about the portability of care packages to the countries of the UK, the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), promised that a voluntary framework would be in place by November. It is 10 days until November, so how is progress going?

[Norman Lamb]

I thank the hon. Lady for that question. We have drawn up a statement of principles, we have been discussing them with the devolved Administrations and we hope very much that we will be able to achieve an agreed statement of principles in November. I cannot guarantee it, but that is absolutely our objective.

Care Bill [Lords]

Sheila Gilmore Excerpts

Monday 10th March 2014 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

I will speak to the amendments in my name. I share the view of the right hon. Member for Banbury (Sir Tony Baldry) that we should not have nodded the programme motion through blithely. Many of my constituents have contacted me about the Bill, because care in my area is on the edge of crisis, with the new threshold rolling it back for many people. That is why I support new clause 11; people need their human rights to be ensured in the Bill. New clause 2 is important, because we have a Children’s Commissioner and we need a commissioner for the elderly and other care services, so that there is someone to speak out for people. I support new clauses 7 and 9, because I agree that introducing legislation without funding is meaningless. We place local authorities in an impossible position, as they struggle to provide the services.

With regard to the work force, we need to ensure pay and adequate training, so that we fully professionalise the work force. In my area, we have a high turnover of care workers, which leads to distressing results. In one case, an elderly lady was burgled and on the next day a new carer came in, but she thought that she was being burgled all over again, because she did not recognise the person. That is the instability in the industry at the moment. That is why I support new clauses 17 and 18.

On the amendments in my name, new clause 31 is generated by one of my constituents called Jonathan Kay, who asked me to get the matter dealt with in the Bill. For many years, Jonathan has been funded by the local authority to employ a personal assistant to enable him to carry out his day-to-day tasks—he is a disabled person—but he has experienced serious problems with personal assistants in the past, even suffering abuse on more than one occasion. When employing personal assistants, Jonathan has found assessing the suitability of candidates extremely difficult, and he has not been able to obtain reliable recommendations from any public body, despite using public funds to employ them.

Part 3 of the Bill provides that the training and education —but no qualifications—of carers will be undertaken by Health Education England. The purpose of my new clause is for Health Education England to allow scope for the local education and training boards to do such work and to compile, publish and maintain a register of all persons who provide regulated social care for individuals under arrangements made by or paid for by a public authority. That would allow people such as Jonathan to access a list of trained professionals whom they can employ with confidence, we hope, in future.

With amendment 26, I am simply seeking to install into the Bill a provision on the right to live independently, as recommended by the Joint Committee on Human Rights, but dismissed by the Government. The Government might well have been concerned about the legal actions that were taking place with regard to the independent living fund, but the Committee’s report made its disappointment very clear that the Government had not taken the opportunity of the Bill to be explicit about their support for the convention on the rights of people with disabilities and article 19—“Living independently and being included in the community”—being a human right. It should therefore be included in the Bill. The Government have given assurances that the general direction of the Bill might achieve the same ends, but that is not good enough in that it does not enforce the rights in law.

My amendment 21 covers the same ground as new clause 15, so I will not dwell on it in any depth, but I will give an example. Whether with our parents or in our community, we all know about the uncertainty of charges for residential care. They cause real concern and anxiety among families. Yes, the ability of local authorities to negotiate rates influences the overall market, but that is why there is a need for some form of indicative price. A care funding calculator is used to set the care of people with learning difficulties, and that model has worked and saved public funds. We should at least be considering in the Bill that sort of process for care overall.

My proposals in amendment 20 would

“require the local authority, when carrying out the assessment, to capture an individual’s main and other disabling conditions”.

A whole group of organisations, including the Parkinson’s Disease Society, Sue Ryder, the Motor Neurone Disease Association, the Multiple Sclerosis Society, the Epilepsy Society, the Neurological Alliance and the Alzheimer’s Society, have all campaigned for this simple change in the assessment process, which merely requires local authorities to collect and record information about an individual’s main and other disabling conditions when they are conducting their social care assessments and arranging care packages. Why is that important? It is important for local authorities to be aware of the different conditions in their community, so that they can plan long-term services, but it is also important for us to be aware of the information nationally, so that care services and our investment can be planned in the long term. Taking that into account seems to be a minor amendment.

Amendment 22, which I also tabled, was proposed by the Royal National Institute of Blind People and lobbied for by a number of my constituents. In clause 76, the duty is placed on the local authority to establish

“a register of sight-impaired and severely sight-impaired adults who are ordinarily resident in its area.”

The existing provision relates only to adults and does not include children. My amendment simply ensures that the local authority is required to collect information on both adults and children. The reason for this is that, under the Children Act 1989, there is a requirement on local authorities to collect information with regard to blind and partially sighted children, but 20% of local authorities admitted failing to meet that legal requirement. Furthermore, 20% of local authorities have no register; three councils include just 1% of disabled children known to the authority on the registers; one in four authorities have whole registers with fewer than 2% of disabled children known to the council; and almost six in 10 councils include 10% or fewer of the disabled children. The RNIB therefore emphasises that in clause 76 we should place on local authorities a duty, when collecting information, to include children ordinarily resident in their area. Again it is the same mechanism; it is about the planning of services to ensure that they are properly invested in over the long term.

Overall, I welcome the Bill, but I fear that it will disappoint many as a result of the failure to address some of the considerable issues with regard to funding, rewards to the work force and professional training, and the appropriateness of the cap on costs.

[Sheila Gilmore (Edinburgh East) (Lab)]

I am pleased to have the opportunity to speak to new clause 5, which is in my name. I thank the many Members who have supported the clause.

I have been pursuing the issue since 2011, initially on behalf of a constituent, a Mr Kenny, who suffered an injury when he was serving in the Army and is paralysed from the waist down. He originally lived in the London area, but his family is from Edinburgh and he wanted to move back to his family. For four years, he got absolutely nowhere, because neither authority would take responsibility for him being able to move. They argued backwards and forwards. Eventually, his family helped him to move physically, but for a period none of his care costs was being met, until Edinburgh relented and began to meet those costs. By that time, he had incurred quite a lot of debt.

I first raised the issue in 2011. The right hon. Member for Sutton and Cheam (Paul Burstow), who was then the Minister, said that it should be covered in the White Paper, but when that came out it only related to portability of care within England and not to the devolved authorities. I kept raising the matter and I was assured that something would be in the Bill, but when it was published the measures related to the portability of residential care packages but not home care packages.

Oral Answers to Questions

Sheila Gilmore Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

I have spoken to my hon. Friend about the scheme, which sounds excellent. Obviously we want to encourage it, while working within the correct processes. The Under-Secretary of State for Health, my hon. Friend for Central Suffolk and North Ipswich (Dr Poulter), has agreed to meet him to do all we can to speed it along.

[Sheila Gilmore (Edinburgh East) (Lab)]

One of the things that some older people would like is to move closer to their families. Will the Secretary of State update me on what discussions he is having with the Scottish Government on the portability of home care packages across the border?

[Mr Hunt]

We are very keen to make home care packages much more portable. There are problems with home care packages across the board, particularly the 15-minute slots that, frankly, are completely unacceptable. We are definitely looking at that issue and I encourage the hon. Lady to talk to the Minister responsible for care services, my hon. Friend the Member for North Norfolk (Norman Lamb), to get more details on the progress we are making.

Care Bill [Lords]

Sheila Gilmore Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right. This Bill promises far-off help for people while services are getting worse right now, because the Government have failed to address the crisis in local government’s ability to fund social care.

[Sheila Gilmore (Edinburgh East) (Lab)]

Will my right hon. Friend give way?

[Andy Burnham]

I shall in a moment.

What are the direct and practical effects of those cuts to council budgets? First, councils have cut eligibility criteria, so more people are exposed to care charges in a way that they were not before. Secondly, those care charges are now rising above inflation year on year, so more people are exposed to higher charges. This means that they are now more likely to pay right up to the new cap that the Government are introducing. That will not feel like progress to the public, and that is why we are making our reasoned objection to the Bill.

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[Mrs Anne McGuire (Stirling) (Lab)]

For reasons that might become clear later, I am pleased to follow the hon. Member for Bradford East (Mr Ward). Before the hon. Member for Pudsey (Stuart Andrew) drifts away, let me say that his contribution helped to address some of the issues of transition, which can sometimes get lost in this debate.

We should recognise that this issue is not unique to the United Kingdom; it is a challenge that many countries face, and the hon. Member for Arfon (Hywel Williams) recognised that, even within the United Kingdom, the devolved Administrations are looking at how to develop their own social care policies in the context of their own nations.

I want to recognise, as some of my hon. Friends have done, that the Bill makes some progress, but I also want to assert our right to highlight the areas where we think it is failing. That is the justification for the reasoned amendment. We could get bogged down in parliamentary procedure here, but I think it is the right of the Opposition to highlight major issues that we think should have been addressed without undermining our support for the principle of the Bill. I hope that those who think that we are being churlish will think again. It is the right route for an Opposition. Talking about being churlish, let me put it on the record that I have rarely heard an opening statement from a Secretary of State, moving the Second Reading of one of his flagship Bills, that was so churlish, so partisan and, frankly, so disagreeable.

For understandable reasons, the debate on social care often focuses on older people, yet as we have heard—from the right hon. Member for Sutton and Cheam (Paul Burstow) as well as from the hon. Member for Bradford East—a third of those who receive social care are actually working age disabled people. We sometimes overlook their needs, rights and aspirations within the wider debate. Too often “social care” and “elderly” go together, and we need to get ourselves out of that mindset, because although they look the same, I think we would all agree that a younger person’s need for support can be quite different from the support needs of those who are older. The emphasis on older people means that the terms of the debate are often not as relevant as they might be to younger people who require social care. They often want to combine that social care with a life that includes work, education and so forth, and they potentially have a different pace and pattern of life from that of older people.

It was to highlight these issues that the all-party groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler) as chair of the all-party group on local government, and Baroness Campbell of Surbiton and myself as joint chairs of the all-party group on disability, were delighted when 10 parliamentarians of all parties from both Houses agreed to undertake an independent inquiry. The hon. Member for Bradford East was involved in that.

That report was lodged earlier this year and I trust that the Minister and my own Front-Bench colleagues have had the opportunity to consider its recommendations. What came out from all the evidence from disabled people, organisations and professionals was that the current system is not delivering on basic things such as washing, dressing and getting out of the house for many younger disabled people. If social care is to mean anything to the lives of the disabled working adult, it should be underpinned by a real recognition of the importance of an independent life. So the criteria of what is important should also include how the care dovetails into other important elements of daily life such as participation in work or education.

I acknowledge that in clause 1 the Government have recognised that promoting individual well-being is not just about care. They also recognise that it is about

“participation in work, education, training or recreation”

and

“social and economic well-being”

and

“domestic, family and personal relationships”.

However, those ambitions will not be realised unless the issue of eligibility is properly recognised and the substantial anticipated savings highlighted in clause 2 creating a preventive care system will not happen either. I fear that the national eligibility threshold in the Bill is currently set too high. In Committee in the other place, that was recognised by peers from all parties and none. It will shut out 105,000 disabled people from social care and prevent them from living independent lives with dignity.

Councils are now moving at a rate of knots towards providing social care only to those with critical or substantial needs. We cannot divorce what is happening in social care from some of the other changes the Government are introducing. We are moving towards substantial care in terms of social needs and we are withdrawing disability living allowance from people with less complex needs. We are perhaps moving to a situation where those with severe and complex needs will be taken care of and supported while those with fewer needs will not be, so there will be a double-whammy in terms of social care and the DLA transfer.

I recognise that the Government have transferred some £2 billion from the NHS into social care and into making the transition easier, but this cannot be seen outwith the context of a 33% cut in local councils’ budgets by 2014 and the chronic long-term underfunding of the social care system. Over the past three years, £2.68 billion has been cut from adult social care budgets, which is 20% of net spending, but the number of working-age disabled people needing care is projected to rise by 9.2% and the number of older people needing care will rise by 21% between 2010 and 2020.

[Sheila Gilmore]

On my right hon. Friend’s list of changes affecting people needing care, does she agree there is also the issue of the independent living fund which has helped working-age people? The Government have lost a court case in respect of their failure to consult properly on that. Does my hon. Friend agree that that should be looked at carefully?

[Mrs McGuire]

I agree with my hon. Friend and I raised that with the Minister in a Westminster Hall debate. The Care Bill does not address the role that the Department for Work and Pensions plays in supporting social care through the benefit system and the independent living fund is a classic example of that. At present, people who can pay for social care through access to the ILF do not know quite what is happening, because the Minister—as I think he said last week at the all-party group—is still considering his options.

I want to echo a comment by the hon. Member for Bradford East—I can assure him that he will not get so many mentions in any of my speeches again. He pointed to something that I think is often missed, which is that the debate often crystallises around the spend, which is not seen as an investment. I acknowledge the work done by Scope, and carried out by Deloitte, highlighting that for every £1 invested in care for disabled people with moderate needs a saving of £1.30 is generated. The figures are pretty staggering. There would be a £700 million saving to central Government through an increase in tax revenue and a reduction in welfare spending. This Government always tell us that they want to reduce welfare spending; well, there are opportunities to do so without doing some of the things that they are doing. There would be a £570 million saving to the NHS and local government, and £480 million would be saved by local government by avoiding the need for disabled people to enter expensive residential and crisis care.

The Minister knows that there is considerable political and organisational support for a lower eligibility threshold. The draft Care and Support Bill pre-legislative scrutiny Committee recommended that, when setting the national eligibility threshold, the Secretary of State should have regard to the duty of local authorities to promote individual well-being. The report of the joint inquiry I have mentioned also highlighted the issue of eligibility.

We in this House often talk as though we are somehow divorced from the beneficiaries of the legislation we pass, but I say to Members that we are talking about ourselves here. Any one of us could walk out of this Chamber tonight and be in need of social care tomorrow. If we want a good social care system, we should ask ourselves this question: what would we want for ourselves if we had a stroke or a car accident or fell down those marvellous marble stairs outside and cracked our head? That is the criteria that we should be using. This Bill makes small progress, but there is a lot more to be done.

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[Grahame M. Morris (Easington) (Lab)]

I am pleased to have the opportunity to speak in this debate. Like several colleagues who have spoken, including the hon. Member for Totnes (Dr Wollaston), I served on the Joint Committee on the draft Care and Support Bill, under the chairmanship of the right hon. Member for Sutton and Cheam (Paul Burstow), and I also serve on the Health Committee, so I have a particular interest in this Bill. I had originally intended to make a more wide-ranging contribution, but I will confine my remarks to part 1, which deals with care and support.

I had hoped that the Secretary of State would conduct a hearts and minds exercise in trying to selling the Bill, so I was rather disappointed that he turned it into a political knockabout, jumping straight into the most contentious elements, and clause 118 in particular, which sets out the trust special administration arrangements.

I do not think that we can consider the Bill without giving some thought to the background. Let us not forget that over this Government’s tenure, £2.68 billion— at 20% of the net adult social care spend, that is not an inconsiderable sum of money—has been cut from council budgets. Although we were talking about the principle of well-being in relation to clause 1, which I think all Members support, in practice cuts of that level mean that fewer people are getting help with paying for their care and more people are being charged for vital services, such as help with getting washed and dressed and with eating—the basic things that most of us take for granted.

I have no doubt that councils, particularly those in the north that I am familiar with, are doing their best to save money and provide services efficiently by changing the way care is provided and, where they can, working more closely with the NHS. However, the scale of the cuts means that they are being forced dramatically to reduce services and increase charges to balance the books. All the evidence that has come to the Select Committee and the anecdotal evidence that Members receive indicates that is the case.

The Secretary of State got into a little argument in his opening statement with regard to eligibility thresholds, which is a really important point. In 2010-11, 38 councils provided free care to people with “low” or “moderate” needs, and 114 provided free care only to those whose needs were considered “substantial” or “critical.” Those needs really are substantial and critical, as we can see if we look at the definitions, which are set out in the guidance. Now, however, only 15 councils continue to provide care and support to people with “low” and “moderate” needs and 137 provide care only to those assessed as having “substantial” or “critical” needs. That means that in many areas preventive services have all put disappeared. Setting the threshold at such a high level is therefore a false economy.

According to Age UK, as a result of tightening eligibility criteria, 800,000 people in the UK have a care need but are not getting any support. As my right hon. Friend the Member for Stirling (Mrs McGuire) mentioned, there is another care crisis, because a third of the total of those requiring care are working-age adults. Indeed, four in 10 working-age disabled people who receive social care say that it does not meet their basic needs, including eating, washing, dressing and getting out of the house. One in three says that cuts in social care have prevented them from working or volunteering.

Charges for vital care services, such as home help and meals on wheels, are increasing fast. In effect, that is a tax on some of the most vulnerable people in our society, people who have already been hit the hardest by benefit changes. Some Government Back Benchers talked about the need to cut the deficit. There is a need to address the economic situation, but not on the backs of the poorest and most vulnerable. To my mind, it is a question of political priorities. I am proud that my party has pledged to scrap the bedroom tax, which I think brings great shame on the coalition Government because of its impact on disabled people.

Other Members have mentioned the consequences of price variation. I do not want to repeat those arguments, but it certainly is a factor when calculating the care costs for the cap. For example, in Tower Hamlets home care is free, but in Cheshire East—I am not sure which hon. Member represents it—it costs £20 an hour. In east Durham, the area I represent, it is about £10, so there is wide variation in costs.

We cannot improve the quality of care for older and disabled people without improving the working conditions of the 1.5 million people employed in adult social care, many of whom are on low pay and lack job satisfaction. In many cases that can lead to poor care for some of the most vulnerable people in society. Care workers do an incredibly valuable and important job, yet the TUC has estimated that between 150,000 and 220,000 of them are not even paid the legal minimum wage, and over 300,000 are employed on zero-hours contracts.

[Sheila Gilmore]

Does my hon. Friend agree that the problem of low pay and poor conditions, which he is outlining so well, is a concern for not only the workers, but ultimately the people receiving the care, for example because of the lack of continuity of care?

[Grahame M. Morris]

My hon. Friend makes an excellent point. That ties in with home care visits. The United Kingdom Homecare Association has indicated in a briefing that three quarters of home care visits now last 30 minutes or less and that one in 10 last only 15 minutes. There must be deterioration in care if carers are there for only 15 minutes. Care rationed in 15-minute slots is simply unacceptable, and I think that the House should reflect on what is happening. This is important because older people end up in hospital unnecessarily and stay longer than is necessary. There has been a 42% increase in delayed discharges from hospitals since figures were first collected in August 2012. Indeed, last month saw the largest number of delayed days in hospital ever recorded, and there were 78,400 such days in October alone. These delayed discharges now cost our NHS £20 million each month. That money could be used to fund about 1.5 million hours of home care for vulnerable older people and help to keep them out of hospital when they can be supported in their own homes.

Ministers claim that they want joined-up services, but through the Health and Social Care Act 2012 they legislated for fragmentation. Their integrated transformation fund contains no new money but is made up of £3.8 billion that is coming out of existing NHS and social care budgets. I accept that the Bill provides a framework and establishes important principles, and there are things that we can agree with. However, fine words are all very well, but we need immediate action such as the measure proposed by my right hon. Friend the Member for Leigh (Andy Burnham) to use £700 million from this year’s NHS underspend to help tackle this crisis now. We need some vision from all parties but especially from the Government parties.

I looked at some old early-day motions to see how some of these proposals were tackled in the past. My hon. Friend the Member for Sefton Central (Bill Esterson) suggested that this should be paid for through general taxation, and I agree. In one old EDM, a number of Members from all parties agreed with that principle; I see some of them nodding now. It is not such a radical or revolutionary step.

We clearly need a wholesale change in how we deliver health and social care. We need a whole-person approach and a national care service. We need the same ethos that applied during the establishment of the NHS, which brought together disparate entities and groups into one body. We need to bring health and social care together into a single service that provides all the care an individual will need throughout their life.

The Bill has many positives, but it is fundamentally important to deal with the eligibility threshold. If it is set above “moderate”, it will do little to help working-age disabled people.

If the Minister does not mind, I would like him to clarify whether the duties of openness and transparency in the Bill will apply equally to all organisations that provide NHS services, including private contractors who provide outsourced services; he will be aware of my ten-minute rule Bill. I urge people to consider the Bill and to support Labour’s amendment.

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[Sheila Gilmore (Edinburgh East) (Lab)]

Health and social care are devolved to the Scottish Parliament, so I rarely contribute to debates on those issues in the House, but one aspect of the Bill is very relevant to my constituents—the portability of care packages between England, Scotland, Wales and Northern Ireland.

My argument is best explained by reference to the case of my constituent, Neil Kenny, who raised his concerns about the lack of portability of care packages back in 2010, when I was first elected. Mr Kenny suffered a broken neck while serving in the Army. He is paralysed from the chest down and uses a wheelchair. Although he is originally from Edinburgh, he lived in London in the early 1990s, during which time he received funding for his care package from Greenwich council. In 1996, he decided he wanted to move back to Edinburgh to receive additional support from his family, but when he informed Greenwich council of his intentions it indicated that it would be unwilling to continue to contribute to his care package and that if he wanted to move he would have to contact Edinburgh council, which he did but which also said it was unwilling to support him.

The disagreement revolved around the two councils’ conflicting interpretation of the social work group Act 1968, particularly two clauses, one relating to the “authority of the moment” and the other to “ordinary residence”. This impasse continued from 1996 to 2000. In October 2000, Mr Kenny resorted simply to moving to Edinburgh, with help from his family physically to do so, and paying for his own care, which put him into a lot of debt. Although Edinburgh eventually agreed to pay for his care, he should never have had to experience such difficulties. Disabled people should be as free as anyone else to move from one local authority to another—something that simply is not possible at present, it would appear, owing to the ambiguity of the law governing this area.

When I took up the case with the Department of Health in 2011, the former Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), indicated that it would be addressed in the Government’s care and support White Paper. This was published in July 2012, but although it contained a short section on portability between local authorities in England, it made no mention of transfers between England, Scotland, Wales and Northern Ireland. When I raised the matter again in September 2012, I was told that a clause to facilitate cross-border placements would be put in the Care Bill.

Schedule 1 to the Bill makes provision for cross- border placements across England and the devolved Administrations, but this is limited to residential care and does not include community-based packages. As many people have eloquently said today, Government policy has long encouraged people with disabilities and health conditions to live in the community, integrated into society rather than segregated in residential accommodation, so the decision to facilitate the portability of residential packages and not community-based care packages is very disappointing. I wrote again to the Minister expressing my disappointment, and the response emphasised the differences in the care systems and the difficulties of applying rules across borders and suggested that officials were still working with the devolved Administrations to develop principles for how transferring community care packages might work in future.

Given that both the UK and Scottish Governments have known about this issue for a considerable number of years, it is deeply frustrating that it has not moved further forward. The difficulty of applying rules across borders appears to have been resolved within the Bill in respect of residential care, so it is unclear why it is impossible to do the same with community-based packages. I have been in communication with the Scottish Government as well, and they have given largely identical responses to those of the Department of Health. Clearly, both recognise the problem, but have yet to give it sufficient priority to find a resolution.

I hope that I can persuade the Government to recognise the issue fully, and they have the opportunity to do so with this Bill. I shall table an amendment either in Committee or on Report to facilitate the portability of community-based care packages. Today, however, I would be grateful if the Minister provided a more comprehensive explanation of why this has not been provided for in the Bill. That is the specific individual issue that I am particularly keen to see addressed, but let me also offer a few comments and observations from the perspective of north of the border.

In today’s debate and others I have heard during my time at Westminster, a great deal of discussion on the cost of care is about the “who pays?” element. Does the state pay? Does the individual pay? At what point do we take a decision? They are all important questions, but if we spent all our time looking at the cost of care only from that perspective, what would get forgotten is the need to put additional funding into care to make more care possible.

I can look at that from a Scottish perspective because we have been part-way down this route already, albeit only a very small part, with the introduction of free personal care in Scotland nearly 10 years ago. I emphasise that the Scottish provisions apply only to a relatively small part of personal care. After people have heard all the hype about free personal care in Scotland, they tend to assume that everything about it is free, but then discover that it clearly is not. Creating even this relatively small part of care and making it “free” meant that the financing was transferred to the Government, to the taxpayer, to all of us.

At the same time, however, not an extra penny was put into the care system at a time when, as much discussed today, demand was steadily rising. If we add to the mix the difficulties of local government in Scotland—we have had six years of council tax freeze and the reduction of councils’ overall budgets—the result is that my Scottish constituency is affected by exactly the same issues as people have raised here: rising thresholds for care, for example, which mean that only those with substantial and critical needs get any care at all.

I have seen items that can be charged for going up in price. I have seen the outsourcing of many care contracts to save councils money, but at the expense of the care workers and, indeed, the care recipients. I have seen the poorer conditions that lead to the 15-minute care times that we have heard about. We see them in Scotland, which was brought home to me very clearly when my mother-in-law was terminally ill, having been a fit person up until then. The first time the care giver came I was in the house, and I thought I would go on the computer and do a little work. The computer had only just fired itself up when the carer popped her head around the door and said, “That’s it, I’m off now”. It was barely 10 minutes. That situation is very real.

We should talk about who pays and how we divide the payment up—I am not saying that there are easy solutions—but if we do not address the question of the quantum of resource being put into care, we will continue to have these problems. I can assure everyone that this is exactly the situation in which we find ourselves in Scotland.

Tobacco Packaging

Sheila Gilmore Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

One of the reasons we asked a distinguished paediatrician to conduct the review, rather than someone from a public health background, was that he would be able to bring a fresh mind to it. Sir Cyril will set his own terms, which he will announce in the next few weeks.

[Sheila Gilmore (Edinburgh East) (Lab)]

Does the Minister appreciate that one of the reasons for the scepticism among Opposition Members is that in the summer last year, either there was a U-turn or the policy was still under review. Why was an independent review not requested then? If that had happened, it would have been completed by now, and we could have gone ahead.

[Jane Ellison]

As Members on both sides of the House reminded me forcefully during the Back-Bench debate earlier this month, new evidence has recently emerged, and we are also coming up to the anniversary of the legislation being passed in Australia, so this is the right time to do this.

Health and Social Care

Sheila Gilmore Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress.

The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.

Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.

In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.

[Sheila Gilmore (Edinburgh East) (Lab)]

I respectfully suggest that the Secretary of State should look at the situation north of the border, where reform to change who pays has worsened the situation because no extra funding was put into care; all that happened was that we shuffled around who actually paid. Will he look carefully at that situation so that it is not repeated? How much extra funding is he going to put into the system?

[Mr Hunt]

I agree with the hon. Lady that the amount of financial support is important. I gently say to her that her party wants to cut the NHS budget, which would make the situation vastly worse.

The Bill is a vital element of our plans to improve the lives of the frail and elderly and of people with long-term conditions and disabilities, but it is only one element. Other areas that do not require legislation will come together in a plan for vulnerable older people. The plan will consider all aspects of how we look after older people most in need of support from the NHS and social care system. It will look at how our hospitals are set up to support frail and elderly patients, particularly those with dementia, in emergencies. Of course, we must continue to give people with serious needs immediate access to highly specialised skill, but in many cases we could offer better alternatives outside hospital. That would improve clinical outcomes and reduce pressure on A and E departments.

Secondly, the plan will look at primary care—in particular, the role of GPs in supporting vulnerable older people. Active case management of vulnerable people is making a huge difference in some parts of the country and we will look at whether the primary care sector as a whole has the incentives, investment and skills to deliver that. We will also consider the provision of out-of-hours services and how to restore public confidence in them following the disastrous changes to the GP contract in 2004.

Thirdly, the plan will look at the barriers and incentives that prevent joint commissioning and stop people from getting joined-up care. In particular, it will consider the operation of financial incentives in the system, which can act as an unnecessary and counter-productive barrier. The Minister responsible for care, my hon. Friend the Member for North Norfolk (Norman Lamb), who is leading on integration, will announce further practical steps forward later this week.

I intend to announce the plan in the autumn, with implementation from April 2014. It will require a great deal of careful work, ask difficult questions and make tough decisions, but if it leads to more personal, more integrated and more compassionate care, it will stand alongside the Care Bill as an important step forward in reforming the care received by millions of people.

Adult Social Care

Sheila Gilmore Excerpts

Monday 16th July 2012 Commons Chamber

[Paul Burstow]

Obviously, I will happily look at the report and I look forward to meeting the all-party group to discuss its findings and recommendations later.

I want to report to the House the findings of the ADASS survey, which was published recently. Last year’s survey found that for every pound saved by local authorities in social care, 69p came through greater efficiency. This year, it found that that had risen to 77p in every pound. Yes, some councils are cutting services, and last year 23p in every pound that councils saved came from service reductions, but this year that figure is just 13p in every pound. Local authorities are getting smarter in organising their services, so I want to pay tribute to those councils and councillors who have worked hard with service users, carers and providers to protect services to make the best possible use of the extra money the Government have provided. As a result, between last year and this year, council budget spend on social services has gone down by just 1%.

[Sheila Gilmore (Edinburgh East) (Lab)]

On the question of efficiencies, would the Minister include councils that tendered a service and made a saving, but to the detriment of the end user of the service? That is how we got to the 15-minute, short-term care options. Is that an efficiency or a cut in service?

[Paul Burstow]

When there is a crude race to the bottom and contracting is by the minute simply to ration access to the service, resulting in a care home provider or home care provider delivering care on a very time-and-task oriented basis, that is totally unacceptable. We know that in places such as Wiltshire, where home care services are organised on an outcomes basis, that is delivering better results for the service users and releasing resources to reinvest in services.

--- Later in debate ---

[Julie Hilling]

Yes. The cuts faced by northern local authorities in particular are dire. Bolton will have to find £100 million worth of cuts during the current Parliament.

[Sheila Gilmore]

Does my hon. Friend agree that it simply is not good enough to express—as the White Paper does—concerns about matters such as short periods of care time, or the fact that some carers are not even earning the minimum wage, if there is no way of making things work financially? I do not believe that councils have chosen 15-minute slots deliberately; I believe that they have done it in order to save costs and make efficiencies. Similarly, there are carers who have to pay for their own travel.

[Julie Hilling]

We have to realise that we are facing a crisis now, not a crisis in the future. People in our constituencies are suffering daily. A young man in my constituency who has learning difficulties and has relied on carers to help him with his everyday life will now see his carer only once a week. Contact with a carer is the only contact that many such people ever have with another human being, and that contact is now going. It is truly a false economy. This low level of care for people with moderate needs is what keeps them in their homes, keeps them healthy, and stops them ending up in residential care prematurely. Bolton is managing to maintain substantial and critical care, but it will have to find £34 million in cuts over the next two years, and it is worried that it will have to join other councils in only providing critical care.

Paying for home care is a huge worry. The average cost is £13.61 an hour, but it can be a great deal more; in Brighton and Hove, carers cost £21.50. It is not unusual for people paying for care to have to find more than £10,000 a year to cover that cost. That spending needs to be taken into account if we are to have caps over the whole amount. Many Members will know that my mother has been in and out of care over the past 12 months. We have spent £20,000 since October on her care.

The cuts to local authority budgets are affecting other support services, and the consequent cuts to the voluntary sector are having dire consequences. The voluntary sector provides luncheon clubs, social activities and carers groups, all of which are under pressure or at risk.

Horwich visiting service in my constituency has lost funding and can no longer employ its part-time co-ordinator. That was the person who recruited volunteers, sorted out the police clearance, provided training, ascertained the needs of clients and supported the volunteers. The volunteers will continue to visit the elderly and disabled people with whom they are currently in contact, but it will not be possible to recruit new volunteers or take on new clients.

The fees local authorities pay to care homes is also an issue. There has been a significant real-terms cut over the last two years. That inevitably impacts on care. It also means self-funders are charged more in order to subsidise the costs of council-funded residents.

The choice of home is another huge concern. The other day, I was speaking to one of the police officers on the parliamentary estate. He told me his mother was in a care home. He and the family had chosen a home that suited her needs and they had sold her house to pay for the care, but now the money is running out and he does not know whether the local authority will pay the care home fees, whether his mum will have to move or whether the family will somehow have to pay the additional costs. If the cap is ever introduced, that will be too late for him, but he still needs to know that the care costs will be met in future.

The needs of the elderly and disabled do not move in a straight line. Some people may need to go into care for a period of time, such as when recovering from an illness or an accident, but, with support, they may be able to return home. However, we were told that after six months my mum would have to sell her flat to pay for her care. In fact, after eight months in a care home, she has returned to her own flat. That shows that people do not move in a straight line through the system. Decisions should not be taken on the basis of cost alone; they should be taken on the basis of needs, too.

Let me conclude by reading out a comment from a constituent of mine called Amy:

“Alongside the funding crisis there is also a huge injustice in the way we pay for care. This includes the dementia tax, where tens of thousands of families are left to pay all their care costs whilst other terminal conditions are paid for by the NHS.

The significant cost of care means many carers face financial hardship and are often forced to give up work.

We need reform to build a fair and sustainable care system which delivers dignity, independence and peace of mind.”

Amy is right. We need to get on with this. We need to find a solution where people’s needs are taken into account, and where people do not live in fear for both themselves and their families. We need to find a solution to this problem that all of us can live with, and that cares for people who are in need in our society.

Care and Support

Sheila Gilmore Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

I am sorry, but I simply do not recognise the figures that the hon. Gentleman is using. The Association of Directors of Adult Social Services has suggested—these are not my figures—that this year the service reduction in adult social care budgets on a monetary basis was £113 million and last year it was £226 million. The great majority of the figures he is quoting are actually not cuts at all; rather, they are service efficiencies, which are being reinvested for the benefit of maintaining eligibility.

[Sheila Gilmore (Edinburgh East) (Lab)]

My constituent who has been campaigning on portability of care packages outwith England will be extremely disappointed, because he was given to understand in correspondence from the Secretary of State that this would be covered in the White Paper and it clearly has not been. While we are thinking about Scotland, does the Secretary of State accept that the problem will not be solved even by shifting some of the costs of care from the individual to the state? We have had free personal care in Scotland for some years, but it has not resolved the problems because no additional money was put into the system.

[Mr Lansley]

I will not attempt—not least because of time—to give an analysis of the difficulties that have been experienced in Scotland. From my point of view, I had understood that what we have set out to do in the White Paper is very much to ensure continuity of care, so that when people move—certainly in England, for which I am responsible—local authorities have a duty to ensure continuity of support. If we can make it so that this happens across the United Kingdom, I am absolutely open to having the discussions necessary to do so.