Health and Social Care

Steve McCabe Excerpts

Monday 13th May 2013 Commons Chamber

[Andy Burnham]

That is what happens when a market is set up in the NHS, pitting one hospital against another in open competition. That is what is beginning to take hold in the NHS, where the Government waste money on consultants and all the other things that come from bidding for contracts. That is a direct effect of the legislation they pushed through. This reorganisation and the budget cuts I mentioned a few moments ago are providing a toxic mix. This is why for 32 weeks running, the NHS in England has missed the Government’s own lowered A and E target for major units. It really is time that the Health Secretary got a grip on the issue. We hear that last week he was trying to hatch a panic plan to deal with the A and E crisis. That is the reality of what was going on behind this threadbare Queen’s Speech: the Health Secretary was trying to cobble together a plan to deal with the A and E problems, weeks after we had first raised the issue in the House.

We hear of an e-mail leaked by an NHS finance officer which said:

“The SoS would like to announce tomorrow that £300m-400m is being invested to solve the A&E problem. We have spent most of the day trying to hold him off doing this.”

The Health Secretary seems to have forgotten that his powers to intervene were given away by his predecessor. He no longer has the power to mandate the NHS to do what he wants; the NHS can now “hold him off”. I am afraid that he looks weak. He has no response to what is happening to A and E departments. And where is the “£300 to £400 million” plan? It has not materialised. That is proof that when the Government surrendered their powers of control over the NHS, the Health Secretary surrendered his ability to do anything about the problems that we now face.

It is just as bad when it comes to staffing. We hear that nurses’ posts continue to be lost. Nearly 5,000 have been lost since the Government came to power, and according to the findings of a survey published yesterday, nurses fear that further tragedies could happen as a result of staff losses. That should set alarm bells ringing throughout the Department of Health. The Care Quality Commission has said that one in 10 hospitals in England does not have adequate staffing levels. The Health Secretary nods. I am glad that he accepts that, but, again, what is he going to do about it?

I welcome the fact that the Care Bill will contain measures relating to the Francis report, and I will work with the Health Secretary on that, but let us get to the crux of the issue of safe staffing levels, because that is the most urgent problem facing the NHS. The Health Secretary nods again. Let me make him an offer. If he introduces a benchmark—if he specifies minimum staff to patient ratios—we will support him, and the measure will go straight through the House. I shall wait for him to respond to that offer, and to ensure that the recommendations of the Francis report are properly implemented.

I give a cautious welcome to some of the Health Secretary’s measures to deal with health tourism, but let me issue two caveats. First, it is important not to overstate the nature of the problem, and secondly, it is essential for health practitioners not to be turned into immigration officers. In March, when asked how much health tourism was costing the NHS, the Health Secretary said:

“I don’t want to speculate… but… we have heard… it’s £200 million.”

On the same day, the Prime Minister’s spokesman said he believed that the figure was more like £20 million. Perhaps the Health Secretary could account for the difference—or did he just add a zero?

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Would it not be helpful if the Health Secretary could tell us exactly how much he thinks is being lost and what it will cost to try to recover the money? At present the only figure that he has is the one on the invoices, rather than one relating to the money that is actually recovered.

[Andy Burnham]

We must wait to see what the Government produce, but we need to be sure that they are attacking the real problem rather than playing politics with an issue and creating the impression that all the A and E problems are caused by immigration. If that is their real intention, they will have no support from the Opposition.

--- Later in debate ---

[Steve McCabe]

If the coalition survives longer than the hon. Gentleman suggests, does he think that next time round it might be an idea for the Government to have a debate and then produce a Queen’s Speech, rather than producing a Queen’s Speech and then having a debate about what should not be in it?

[Mr Leigh]

That is an interesting argument. I have appended my name to the important amendment to the Queen’s Speech, and we should have a serious debate on the issue. This is not Conservative Members of Parliament obsessing about Europe; this is a real issue for people. It is no longer a dry as dust issue.

In Boston, a seat with a 12,000 Conservative majority, UKIP won nearly every council seat two weeks ago. Unlike my hon. Friend the Member for Stone (Mr Cash), the people there are not particularly worried about all the details of European legislation, but they are worried about immigration. I echo what my hon. Friend the Member for Broxbourne (Mr Walker) said in his very measured speech: people in Lincolnshire are not closet racists. They welcome Polish, Lithuanian and Latvian people, but they want their public services to be supported, when, on the coast of Lincolnshire, public services are overwhelmed. Since 2004, 1.1 million have arrived in this country from eastern Europe, and we have to address that issue.

--- Later in debate ---

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

It is a pleasure to follow the thoughtful speech of the hon. Member for Mid Derbyshire (Pauline Latham).

I congratulate the Government on their fine display of unity on the Queen’s Speech. In all my years in the Whips Office, I cannot recall seeing anything quite like it. In the early days of the Government, the ambition was simple: wipe out the deficit in a single Parliament, set debt on a downward path and restore health to the economy. Hon. Members were to judge success by how the credit ratings agencies maintained the triple A rating. Simple! The Government now claim that their ambition is to cut the deficit by a third, but almost everyone else believes it is more likely to be cut by only a quarter. That is our lot for the rest of the Parliament. Debt is rising, not falling, and triple A credit ratings are but a distant memory.

After the costs in administrative chaos caused by the top-down reorganisation of the health service, which the Prime Minister promised would not happen, the Government are turning their hand to social care. They are right to do so, at least in the sense that social care is a time bomb that desperately needs tackling. My most recent survey of constituents in Selly Oak shows that 73% of them consider care to be an issue of extreme importance, and only 42% think that the quality of care received by someone close to them is satisfactory.

People are struggling—people such as Mrs Hanslow, who cares for her 96-year-old father. She asks only for the odd break, and in the past she has arranged that by phoning a social worker. When she tried that this February, she discovered that the social worker had left. The office said that somebody would phone her back, but nobody did. She phoned again and was told that she needed to make a fresh application; apparently, files and arrangements leave with the social workers these days.

After several abortive attempts, Mrs Hanslow spoke to a nice lady called Wendy, who said that she would sort the situation out. Then a Mrs Collins rang saying that she was arranging for a social worker to come. But guess what? Mrs Hanslow waited in all day and no one came. Frustrated, she rang again and spoke to a Jackie, who could find no record of her application or complaint but said that someone would ring her back. No one rang, so Mrs Hanslow phoned again. This time, people at the office were not so nice. Mrs Hanslow was told that nothing had been reported because the social worker was out of the office.

[Pauline Latham]

What the hon. Gentleman is describing is the fault of the local authority, not the Government. The local authority is responsible for social workers, not the Government.

--- Later in debate ---

[Steve McCabe]

Bad practice is a problem everywhere, and everyone has to take responsibility for it—that is my point.

When Mrs Hanslow got upset and said she would have to cancel her break and lose her deposit, she was told, “That’s up to you.” She did not get her respite care. She is now under the care of the GP, and if she cannot carry on, we will need to find a bed for her dad. Perhaps he will become another bed blocker; there are so many in Birmingham that the brand new Queen Elizabeth hospital cannot cope and emergency wards in the old hospital, scheduled for closure, are reopening.

What about my constituent Margaret McGarry? She has cared for her elderly mother, who now has 9% kidney function and has had a dementia score of six, for about 10 years; if it was not for Ms McGarry’s love and care, her mum would probably be dead. In 2004, her mum received direct payments from Birmingham, which enabled Ms McGarry to hold down her job as well as look after her. The family then moved to Redbridge, but Redbridge decided that Ms McGarry’s mum was Birmingham’s responsibility. Ms McGarry pointed out that she was the carer and that her mum lived with her, but that was not the case as far as Redbridge was concerned. Eventually, the council offered the equivalent of six hours of support, as opposed to the 34 that Birmingham had provided.

Last year, after a hospital experience that almost killed her mum, the family moved back to Birmingham. Ms McGarry’s mum now needs almost constant care. That means another assessment, which takes weeks and weeks. As soon as they moved, Redbridge council terminated the payments. Birmingham’s assessment commenced in August. In November, it recommended fewer care hours than Redbridge and by December still had not paid a penny. As the old lady’s health deteriorates, so does the level of support.

I have had a letter from the man in charge assuring me that the case is complex. One of the complexities seems to be that Ms McGarry has exercised her rights and engaged a solicitor. Apparently, that is a very naughty thing to do if a person is caring for an elderly relative because Ms McGarry has now been advised that all direct payments are being stopped. That is the reality of social care in this country today, and it is against such nonsense that we are asked to have faith that the Government are going to give people more rights. We are asked to accept that £150 million and promises from the Secretary of State will fix the problem. It may have escaped the Government’s notice, but the most recent round of cuts took a further £800 million out of services for the elderly and disabled, on top of last year’s cuts. When will it dawn on the public relations boys in No. 10 that it is pointless pretending they are giving people more rights when they are cutting services to the bone?

Let us examine what the Government are actually doing. They say they are setting a cap at £75,000—£72,000 in the first instance—raising the savings limit to £123,000 and giving a guarantee that no one will have to sell their home. Of course, £75,000 covers only the costs of care, not what is called hotel costs, such as food and accommodation. The cap is not, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out, the amount the individual spends, but the amount a local authority can buy for £75,000. When we add the real costs of residential care, rather than the local authority rate, to the hotel charges, it is much more likely that an individual will spend at least double that amount before the cap kicks in.

The £123,000 savings threshold means that anyone who has capital, including an empty home, will have to pay all their care costs until the cap is reached. That only leaves the guarantee that no one will be forced to sell their home—except that since October 2001 no one has been forced to sell their home. The previous Government introduced the deferred payments scheme and, in 2009, advised local authorities that if they failed to recognise the scheme, the courts would almost certainly rule their actions illegal. No interest is charged on deferred payment arrangements while a person is in receipt of care, or for 56 days after their death. The Government intend to make the existing arrangements compulsory, but also apply interest charges from the moment the scheme is activated. While questions remain about who will qualify, it is estimated that most of the additional subsidy will go to the richest 40% of people in the care system. That is what is wrong with the Government. The Government are built on falsehoods: falsehoods about the unity and purpose of the coalition; denial about the real state of the economy; and policies that are more about UKIP than the UK. We need genuine reform. That is what a decent Government would put in the Queen’s Speech.