Breast Implants

Sheila Gilmore Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend for her welcome for the statement. Those seeking cosmetic interventions must ask serious questions about not only the nature of the procedure but the quality and reputation of the provider organisation, and ask it how it would protect their interests if things went wrong.

[Sheila Gilmore (Edinburgh East) (Lab)]

The Secretary of State referred in his statement to the possibility that an organisation that had carried out operations had gone out of business. As there are long-term implications from such surgical interventions, has the Secretary of State considered instituting some form of levy or fund that would have to be paid into—nor do I want to let the private sector off the hook—so that if organisations go out business there would be a sum of money from which people could claim?

[Mr Lansley]

As I hope the hon. Lady will appreciate from what I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill introduces for the first time a comprehensive continuity of service regime for the NHS, and it also creates, through the health sector regulator, the potential for us to consider whether such continuity of service needs to be extended beyond the NHS.

Caring Responsibilities

Sheila Gilmore Excerpts

Wednesday 15th June 2011 Westminster Hall

[Sheila Gilmore (Edinburgh East) (Lab)]

I am pleased to have the opportunity to debate this subject under your chairmanship, Mr Streeter.

This is carers week. It is a time for us to praise carers, to have our photographs taken and to issue press releases to our local newspapers to show how much we care for the carers. In fact, however, it is a worrying time for carers, and the first aspect of that is the budget cuts.

The Government have made a great deal of their injection of £2 billion a year of extra money by 2014-15 to support social care. The Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), said that this

“means councils can meet cost pressures and maintain services”

However, an Association of Directors of Adult Social Services survey found that 98% of English councils showed overall budget reductions, even when taking account of the additional £1 billion for 2011-12.

Age UK says that spending cuts are projected to reduce spending on older people’s care by £300 million over four years, and that real spending on their care will be £250 million less in 2014 than it was in 2004. That is despite the fact that, during that time, we will have seen a rise of two thirds in the number of people over 85, one of the biggest groups that need care.

In 2005, half of our councils provided support to people who were assessed as having moderate needs. In 2011, however, that figure had fallen to 18%. To qualify for adaptations that could help them to manage better without care, people are assessed largely on the same basis. One example is showers that enable people to bathe without assistance. In the overwhelming majority of council areas, people now have to demonstrate critical or substantial need. Many constituents have asked for help with such things as shower adaptations but have been refused because they do not meet that need. One constituent has told me that, as a result, she can take a bath only if her daughter is there to help, yet she lives some miles away. If she had a shower, she feels that she could use it on her own, without having to call on her daughter for assistance. Not only would that improve her well-being and self-esteem, but it would clearly reduce the need for care. Use of these levels of eligibility for the person who needs the care places a greater burden on friend and family carers, who have to fill the gaps.

I argue that the cuts are short-sighted and could end up being more expensive. For example, if the carers’ help is compromised by having to take on an extra burden of care, or if the ill or disabled suffer accidents—perhaps because they do not have adequate adaptations—it will cost us a great deal more. We know that an older person having a fall is more likely to require expensive hospital care, or that a fall can act as a trigger for needing long-term residential care. Such accidents can often precipitate events that might not have happened for a long time, if at all. It is in that context that I argue that the cuts could be short-sighted.

In April, my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) carried out a survey of 61 councils; 27 were Conservative, 29 were Labour, four were Lib Dem. It showed that 88% of councils were increasing charges for social care services; that 16% were raising eligibility criteria, which as I said had already been increased; that 54% were making cuts in the voluntary service; and that almost two thirds were closing care homes or day centres. The Government’s response is often to say that it is primarily for local authorities, under the localism agenda, to decide how to spend the money. I bring to this debate a cautionary tale from north of the border.

Four years ago, the Scottish Government discovered localism, although they did not call it that. In 2007, they entered into a concordat with local government that included the removal of most ring-fenced funds and what I would describe as the velvet embrace of a four-year council tax freeze. Adult social care is not statutory. As a result, it often suffers in budgetary crises. Supporting People funding, which is primarily low level and preventive in scope, has been used since its introduction in 2003 for such things as supporting people in sheltered housing, and helping to meet part of the cost of care packages for people with learning and physical disabilities who have been moved out of institutional care—something that we all agree with—into their own homes.

The end of ring-fencing has led to a reduction in low-level support, the money being used to meet more immediately urgent needs. However, it has proved extremely difficult to track exactly where the funding is being used. The removal of the ring fence has made it hard to be absolutely certain that the money is not being used as it once was, other than through some of the outcomes.

Home care hours have been cut substantially in my city over the last four years. Many people now receive short visits—perhaps 15 minutes at the beginning and end of the day. However, the beginning and end of that day will be whenever the care services deem them to be, and people may be put to bed at 8 pm because it suits the care service. As a result, many families are having to plug the gap. That takes no account of considering such things as paying for care services. Visits can be very brief indeed.

A further difficulty in tracking what is happening is the increasing individualisation of decisions on care. A professional decision that someone needs fewer care hours can be hard to monitor, as individuals do not know what is happening to others and do not necessarily know that there is anything to challenge.

A family who I visited at the weekend have had their care hours cut from 50 to 42 a week. The husband, who is 74, has suffered severe strokes and needs constant care. His family have seen no change in circumstances other than their observation that they are worse, not better. His main carer is his 71-year-old wife; but having been fit and healthy and having worked to age 65, she is now beginning to suffer health problems, and recently suffered a slight stroke from which she has now recovered. No overnight care is provided outwith the family, and the wife often gets little sleep, with other family members regularly having to stay the night to give her an overnight break. The payments that the family receive to pay for care have reduced from £560 per week to £475 per week, based on the argument that their need was less. The family suspect that it is do with funding cuts. It would be more straightforward if local authorities were to say so, rather than suggesting that a professional decision had been made.

Others might touch on this later, but concern has been expressed about what has happened to the money for respite care that was made available by the previous Government. Many of the organisations involved have complained that it was not clear where the money had gone or whether it had been used for the purposes for which it had been granted. Further money has been given. The Prime Minister spoke about it again today. However, the main question is whether the money is being used for the purposes for which it was given. Although a hands-off localist policy makes it possible for Governments, devolved or not, to disclaim responsibility for what is happening, they remain, none the less, the largest funder of local services. A policy of successive council tax freezes tips the financial balance further towards central Government.

[Jack Dromey (Birmingham, Erdington) (Lab)]

Cutting support for the elderly and disabled is described as the cruellest cut of all. Is my hon. Friend concerned that the Prime Minister described Birmingham city council as “excellent” when it had been branded in the High Court as acting unlawfully in taking away care from 4,100 people in substantial need? Does she not agree that the council should continue to support organisations such as Elders with Attitude because they bring people out of their homes and stimulate them mentally and physically so that they lead a good life and do not become dependent on the national health service or have to go into a care home?

[Sheila Gilmore]

That is clear example of what is happening up and down the country not only for older people who need care but for older carers themselves, who have very specific needs. Half of the 6 million people who are providing unpaid care in the UK are aged over 50. In England in 2010, nearly 1 million people aged 65 and over were providing unpaid care to a partner, a family member, who might be younger than them, or some other person. The largest number were aged between 65 and 74, but there were nearly 50,000 people over the age of 85 who were giving substantial amounts of care. A quarter of all carers aged 75 and over provided 50 or more hours of unpaid care per week. Carers over retirement age are a particularly vulnerable group because they tend to have health issues themselves. Such people say that they really have no retirement or that they have not been able to enjoy the retirement that they had expected.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Lady on securing this debate. She refers to the age of carers. The survey to which she alluded earlier indicated that about half of all carers are in poor health. We often use the expression “a time bomb”, and it can be a cliché, but here we have a living example of a literal time bomb. If 50% of carers are in poor health themselves, we will, within a few short years, have a double whammy of a problem to deal with—the people who are being cared for and the carers themselves.

[Sheila Gilmore]

I thank the hon. Gentleman for that contribution. That is exactly the point that I was trying to make. The carers face not only health problems, but financial difficulties. Carers over retirement age do not receive a carer’s allowance even though they incur additional costs. They could use additional funds to buy some respite time that they might not otherwise get. They often become cut-off and isolated because they are not able to get out of the house to enjoy the sorts of social activities that enable people to live healthier and more fruitful lives.

Furthermore, there is an anomaly that needs to be resolved. Those on a low income who are over retirement age claim carer’s allowance, but they do not get paid it. Instead, they get access to a carer’s premium in pension credit. We have about 250,000 carers in that category. It is very confusing because they are claiming a benefit that they do not receive in order to get access to a completely different benefit. Hopefully, that is something that the current Government, with their zeal for simplifying the benefit system, will move very quickly to address.

As we debate this subject in Westminster Hall, the main Chamber is considering the Welfare Reform Bill on Report. Many colleagues who would have liked to be here are taking part in that debate. They know how important the Bill is to carers as well as to other people. The proposed changes to benefits are a big worry for carers. At present, carer’s allowance can be claimed if the person being cared for qualifies for either the middle or higher rate component of the disability living allowance. The successor benefit, the personal independence payment, will only have two bands of the daily living component, which is the equivalent of the care component. What is still not clear is how eligibility will work under the new benefit. Will it apply only if the cared-for person receives the new higher rate? How many people will lose eligibility for carer’s allowance as a result of these changes? In the Bill Committee, the Minister was unable to give us an answer to that question. However, Disability Alliance has calculated that to achieve even £1 billion of cuts to DLA—the Government’s forward projections expect there to be a £2 billion saving overall—there could be a risk to 643,000 people who currently receive the lowest rate and to a further 100,000 people on the middle or higher rate.

We are told by the Government that we cannot assume that everyone who currently gets the lower rate of DLA will lose out in the benefit changes because the new test will be very different to the old one, which leaves a question mark over an undetermined number of people. We cannot assume that all the losers in the new personal independence payment regime will be people who do not have a corresponding link to the carer’s allowance.

[Anas Sarwar (Glasgow Central) (Lab)]

I congratulate my hon. Friend on securing this timely and important debate. There is no doubt that the proposed cuts to the employment and support allowance and the DLA will have a devastating impact on thousands of families right across the country. One such couple, Mr and Mrs McCann, wrote to me expressing their own concerns. They both had to take part-time jobs because of caring responsibilities for their daughter, resulting in a 50% reduction in their combined salaries. They do not qualify for carer’s allowance because they have an income of more than £100 a week. They rely on their top-up element for their child tax credit and the DLA that their daughter receives. Does my hon. Friend think that it is fair that this family should have to face the brunt of the cuts and even further hardship?

--- Later in debate ---

[Sheila Gilmore]

I certainly do not think that that is fair. I also fear that for some families, not necessarily for my hon. Friend’s constituents, it can be the crisis point that makes it impossible for them to continue with their caring responsibilities. If the family cannot continue to care, the cost to society of institutional care will be very much higher than that of properly supported family care.

There is also a small group of carers who currently receive income support. They are not necessarily in the same household as the person for whom they care, but their caring responsibilities mean that they are unable to be in work—or at least to be in very much work. Around 250,000 people are in that category. They will transfer from income support to universal credit, and, as currently drafted, there is no earnings disregard on that for carers. At the moment, a carer in receipt of income support has a £20 a week earnings disregard, which enables them to do some part-time work as well as their caring responsibilities and still have some financial benefit. An amendment to the Bill on Report was not accepted by the Government, but I hope that they will think again on that point.

There could also be people with caring responsibilities who would fall foul of the proposed benefits cap. A single parent with three or more children living in a relatively high-rent area who also cares for a parent living somewhere else could be affected. The Government have made much of the fact that people receiving DLA will not be affected by a benefits cap, which is good. However, there are people who are carrying out an important caring function who might, in certain circumstances, be covered by the cap. I ask the Government to consider exempting them.

Important changes are also proposed in relation to the money that is given to families with disabled children. Disability additions under universal credit will continue to be given in similar ways to the additions and premiums that are given within the current benefit system. However, the current lower rate of benefit is being halved. We are told that the higher rate is being increased—by £1 a week—but many families who have children receiving the lower rate of payment will have their payment halved. The reason being given for that is that it brings the disability additions for children into line with the disability additions for adults. However, I have a question, one that I have asked previously in relation to these reforms. Why do such alignments always have to be downward? Why is it only deemed to be fair if we equalise downwards—not even meeting in the middle, but equalising downwards—in this way? Given the considerable additional costs that we know families with disabled children have, this change seems to be another particularly harsh one and it will worsen the position of many families.

There is a cumulative effect to all of these changes. There are benefit changes of several kinds that might kick in for the same household, together with changes in the support provided by local authorities for services such as home care. The cumulative effect of all these changes will be very harmful indeed to families who have someone who needs a certain level of care. There will also be a particular effect on the carers themselves, those people who we are only too pleased to praise in this one week of the year. We have to put our money where our mouth is on this subject.

To conclude, I have a number of specific questions for the Minister. What assessment have the Government made of the impact on carers of the estimated £1 billion of cuts to social care services in the current financial year? What arrangements do the Government have in place to monitor what is happening at local level, so that they can fulfil their pledges to improve support for carers? The changes in benefits, such as the change from DLA to PIP and the move to universal credit, could lead to thousands of carers losing carer’s allowance, so is the Department of Health assessing the impact of those changes to families and indeed to services if families can no longer afford to provide care? Will the Minister seek to ensure that carers do not lose out in the welfare law reform proposals? At the moment, we are being told that some of these things will be ironed out, potentially in detailed regulations. So, whatever happens with the Welfare Reform Bill today, detailed regulations could still be needed and I want to know what the Minister will do to raise this issue with her colleagues in the Department for Work and Pensions. Also, do the Government intend to accept the Law Commission’s recommendations set out in its recent report on carers? Finally, how should the forthcoming reform of the funding of social care take account of carers’ contributions?

I thank everyone for their attention to this subject today and I look forward to hearing the Minister’s response in due course.

NHS Future Forum

Sheila Gilmore Excerpts

Tuesday 14th June 2011 Commons Chamber

[Sheila Gilmore (Edinburgh East) (Lab)]

Will the Secretary of State accept that he would not be in the position he is in today had there been proper pre-legislative scrutiny of this Bill? Will he recommend to his Cabinet colleagues that that process is used for all future legislation? It is a case of more haste, less speed.

[Mr Lansley]

We as a coalition Government are engaging in more pre-legislative scrutiny than any of our predecessors. In this instance, I do not accept the hon. Lady’s proposition. What has been done by the NHS Future Forum could not conceivably have been achieved in pre-legislative scrutiny, because it was essentially about engaging people across the service in how we will implement principles that are widely supported across the service. It is very much of the here and now, rather than something that could have been done in advance.

Oral Answers to Questions

Sheila Gilmore Excerpts

Tuesday 7th June 2011 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

5. What steps he is considering in relation to Southern Cross Healthcare; and if he will make a statement.

[Sheila Gilmore (Edinburgh East) (Lab)]

8. What steps he is considering in relation to Southern Cross Healthcare; and if he will make a statement.

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

Southern Cross has plans in place to restructure its business and is keeping the Government updated on progress. We will continue to keep in close touch with the situation and work with local authorities, the Care Quality Commission and others to ensure that there is an effective response which delivers to everyone the protection that we should want for all in those residential homes.

--- Later in debate ---

[Paul Burstow]

The Government continue to maintain very close contact with the devolved Administrations on those issues to ensure that we co-ordinate in that way, and the hon. Gentleman is right that we need to make sure that the standards of care provided in all those homes are maintained. That is a role that the CQC has been discharging and will continue to discharge.

[Sheila Gilmore]

Housing associations have regulatory control over financial management and viability in order to protect tenants’ homes. Will the Minister consider putting in place a similar regime to protect the homes of care home residents?

[Paul Burstow]

Within the current legal framework established in the Health and Social Care Act 2008, there are requirements on financial viability, but we will undoubtedly want to look at those issues when we come to publish a White Paper on social care reform later this year.