Social Care
Toby Perkins Excerpts(4 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Barbara Keeley
I thank the hon. Gentleman for making that point; he does make it on every occasion that we debate this subject, so I congratulate him on doing so again. However, the person he needs to be directing his comments about cross-party talks to is sitting on the Government Front Bench. I am hopeful that the Secretary of State is going to tell us what he is going to do about cross-party talks, because those 15-minute visits are really not good enough.
Mr Toby Perkins (Chesterfield) (Lab)
I agree entirely about the need for cross-party consensus on this issue, but there can be no consensus until there is an acknowledgement of what has caused the care crisis—the underfunding of the health service and cuts to local government budgets, which have had an impact on A&Es, GPs and other services. Until there is an acknowledgement of what caused the situation, there can be no consensus towards a solution.
Barbara Keeley
My hon. Friend is right. I will come to the causes, because it is important to mention them.
The 15-minute care visit reduces the giving of care by care staff to a series of physical tasks, rather than the staff being able to see a person with their own interests, desires and opinions. It really strips them of the time to do the job they want to do. I pay tribute to all care staff, who go above and beyond in their jobs to improve the lives of the people they support. Without them, our social care system would not work, but they do not get the pay and recognition that they deserve.
Care staff, who provide essential practical and emotional support to some of the most vulnerable people in society, are among the most poorly paid workers. The average hourly pay for care staff is below the rate paid in most UK supermarkets. On average, care staff are paid less than cleaners and healthcare assistants in the NHS, and this has led to a vacancy rate of 122,000 care jobs and a turnover rate of 33%. Now the Government are planning to make the situation worse by turning away people who want to come to this country to work in social care. One in seven care workers is from outside the UK, but the average care worker earns £10,000 a year less than the Government’s immigration salary threshold, so will the Secretary of State tell us just how he thinks he is going to be able to fill the large number of vacancies in the social care workforce?
Mr Toby Perkins (Chesterfield) (Lab)
It is a great pleasure to follow the right hon. Member for Ashford (Damian Green). I found myself agreeing with many of the priorities that he set out; that gives us some hope about cross-party consensus.
I wish to talk about three things: first, the proposal by Derbyshire County Council to close the Spinney care home in Brimington in my constituency and six other homes throughout Derbyshire; secondly, the wider implications of Government funding decisions over the past 10 years; and finally, the role of carers and the impact of councils’ use of private sector agencies to reduce council budgets on the quality of care provided.
First, the Spinney is a care home built in 1974 and run by Derbyshire County Council. Up until the Conservatives took over in 2017, it had been rated good by the CQC and was full; since 2017, the council has stopped taking new residents, and gradually numbers have fallen as residents have passed away. All the residents and their families to whom I have spoken speak warmly of the quality and culture of care provided by the Spinney and oppose the council’s call for closure. In the past two years, five of the rooms in the Spinney have been fitted with en suite bathrooms—the lack of en suite facilities being one of the reasons given for the closure—but none of those rooms has been used. Now, Derbyshire County Council says it will close the home and allow the residents to live more independently.
The comments from residents make it clear what they feel. One said:
“I have no relations, no family, the carers and staff are my family…I want to live the rest of my days here it has all come crashing down around me”.
Another said:
“People will not get more than 10 minutes three times a day”
if they leave and go independent. They went on to say that
“this doesn’t stop people roaming the streets and the police having to bring them back.”
A family member said:
“My mum lived independently till she was 96 years of age. We all rallied round to look after her, but she was only safe once she was here at the Spinney.”
There are many, many more stories.
I note that the county council had a £5.7 million underspend last year in its social care budget, so I roundly condemn it for its decision, and I hope that it listens to reason when the consultation finishes and that it agrees to improve the Spinney rather than to let it close.
More broadly, we all know that the money available to councils for social care has been savagely cut during the nine years of austerity. Indeed, at the very time when our ageing population were demanding an increase in care spending, the Government were cutting £5 billion from council budgets for care. The money that the Prime Minister has promised, welcome as it is, is simply one step back up the mountain.
The failure to provide care for some of our most vulnerable citizens is not just morally repugnant and does not just shame us as a society, it is also economically illiterate. Failure to care for people in residential or domestic settings and leaving them to fend for themselves means that they end up in A&E. It means that they end up being treated more expensively in our hospital system. The 148 people who were left in hospital beds in Derbyshire because there was no care package available for them were costing us more than they should have done as a result of cost savings. Cuts in care are not only barbaric, but economically crazy too.
There is no way that a Government who have reduced council spending by 50% in real terms over 10 years can be anything but complicit in the care crisis that faces us, but providing ring-fenced money for care alone will not be the step required to make this right. There must be a whole-system approach that addresses the many causes of the crisis in care. Those causes include the inadequate number of GP appointments available, particularly in more deprived areas; the crisis in the recruitment of GPs, nurses and carers; and the casual and unprofessional way that carers are recruited, trained and employed, which means that workers at McDonald’s are given greater job security and better rates of pay than someone who plays a crucial role in the health of the most vulnerable citizens in our society. There is also the crisis in A&E, which sweeps up the greater share of the NHS budget. That crisis is then exacerbated by people taking up hospital beds when they could be at home receiving care, and so the vicious cycle continues.
Finally, I would like to touch on the issue of how carers are employed. Council budgets are a part of this equation, but, in truth, councils were outsourcing these services long before council budgets were shrunk. It should never be said that people who provide care on behalf of private companies—or, in many cases, those companies themselves—have any less capacity to care or any less empathy for their customers than people who do it in the public sector. However, many councils are signing tenders that can only lead to the provision of inadequate care.
Hillcare Group, a nursing care home provider in my constituency, wrote to me recently to say that the funding provided by Derbyshire County Council was £150 per resident per week less than in other local authority areas, and that ends up having an impact on the care that is provided. I have an idea: when councils set tenders, they should be setting a rate of pay at the time they use private companies. The reason for using private companies is not just about saving budget, but about that company providing care in a better way. It is not just a way of undercutting the wages of unionised council staff. If rates of pay across the sector were set by the councils, we would not find council contracts being provided by private companies in such an inadequate way.
This is a multifaceted and real problem. Residents and families of the Spinney are just the latest victims of our failure to take this matter seriously. I hope that it will be solved, because our older people desperately need it to be.
Helen Whately
I have already visited two care homes since becoming Minister for Care, and I want to visit many more. I hope I will be able to take up my hon. Friend’s invitation and see that good work for myself.
I pay tribute to my predecessor as Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage). I hear that she was visiting a hospice on reshuffle day—her actions illustrate the enormous commitment and compassion she brought to this role. I sincerely hope to follow in her footsteps.
I also thank all the hon. Members who have spoken today. Social care is important to many thousands of our constituents, and their interest and input are incredibly valuable.
Mr Perkins
I welcome the Minister to her post, and I welcome what she says about carers. Would it not be wonderful if, rather than just giving them her warm words, support and admiration, she were able to join a cross-party campaign to see that carers get paid more than burger flippers in McDonald’s so that we actually start recognising them with the same prestige as nurses and the same earnings as people in our health service?
Helen Whately
I thank the hon. Gentleman for his suggestion. It is almost as if he has seen my notes.
One thing I particularly welcome is the number of hon. Members on both sides of the House who spoke about the importance of careworkers, who provide such important care.
My hon. Friend the Member for Peterborough (Paul Bristow) mentioned that both his parents were nurses in the care sector. He drew on his knowledge of care and rightly said that the profession should be held in higher esteem and that, just as we hugely value NHS staff, we should hugely value careworkers. The hon. Members for Warrington North (Charlotte Nichols), for Blaydon (Liz Twist), for Dulwich and West Norwood (Helen Hayes), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker) and my hon. Friend the Member for Bury North (James Daly) spoke along the same lines, and I could not agree more.
Not long after I became the Member of Parliament for Faversham and Mid Kent, I joined a careworker, Kim, on her daily round. By the time I met her at 7.30 am, she had already started washing her first client. By lunch time, she had washed, dressed, fed, medicated and chatted with six or seven men and women. Some of them were grateful and some of them, quite honestly, were not grateful, but they were all utterly reliant on her care. That experience really brought home to me the skill, knowledge and compassion of our social care workers. For those who need help, there are amazing carers with hearts of gold, like Kim.
Our care system depends on an extraordinary workforce of capable and compassionate carers, but we need more people to choose care as a career. That means changing the perception of being a care worker. As a society, we must truly recognise the importance of the work. We must make sure that more people realise the range of jobs in care and the opportunities for progression. The Government are currently investing in an adult social care recruitment campaign with the strapline “When you care, every day makes a difference”. We are working with Skills for Care to support workforce development and there is funding for a workforce development fund. That is really important, but we know that we must go further in making sure that we truly value the important work that the care sector does and to make sure that the care profession attracts the workforce that we need and gives them the opportunities to lead a truly fulfilling career.
Several Members rightly talked about unpaid carers, who also provide so much vital care. We fully recognise the value of that work and know the importance of support for those people who do so much caring. That is one reason why the Government will introduce a statutory right to leave from work for one week a year for the 5 million people who juggle work alongside being an unpaid carer.
My hon. Friend the Member for Bury North talked about quality of care, and it was really important to hear that mentioned as part of the debate. He spoke about how good care is in his constituency, and he is absolutely right that we should talk about how good care is throughout England. Some 84% of adult social care providers are currently rated good or outstanding by the CQC. Let us recognise the high quality of care.
My hon. Friend also spoke about the importance of integration—of the NHS, local authorities and care providers working together—as did my right hon. Friend the Member for Ashford (Damian Green), who is knowledgeable on this subject. The interplay between the NHS and social care is critical. The better care fund and the improved better care fund are a success story in respect of enabling more co-operation between the systems. It is crucial that we continue to build on that success so that our care system meets the needs of the individual, not just of the system.
My hon. Friend the Member for Watford (Dean Russell) made some excellent points about how, paradoxically, we can use technology to help to achieve more human and more personal care for a more cohesive and effective care system.
Both my hon. Friend the Member for Thurrock (Jackie Doyle-Price) and the shadow Minister for Care, the hon. Member for Worsley and Eccles South (Barbara Keeley), mentioned those with learning disabilities and autism who are being cared for in in-patient settings. I am new to this job, but I absolutely appreciate the importance of making sure that we do better in this regard. People should be cared for in the best place for their needs. At the end of last month, the number of those in in-patient settings had been reduced by 24% compared with 2015—
Health and Social Care
Toby Perkins Excerpts(5 years ago)
Ministerial CorrectionsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Perkins
I do not know whether the Minister is aware, but we have a winter every year. We have had one for the past 71 years, and yet these are the worst A&E waiting times in history, and they are the culmination of the policies that his party has followed for the past nine years: the cuts in social care, the number of GPs driven out of practices, and this Government’s failure on prevention. All of that has led us to the worst A&E waiting times in history, and the Minister’s answer does not start to look at the failure that he has delivered.
Edward Argar
Well, as I pointed out to the hon. Gentleman—he may not have heard this—demand in A&E has significantly increased this winter. He asks about GPs. I am sure he fully supports our clear commitment to 50 million more GP appointments and 6,000 more GPs. I am sure he also welcomes, in his own constituency, the £19 million investment by this Government in 2017 in a new urgent treatment centre, which will serve his constituents and is due to start work this summer.
[Official Report, 28 January 2020, Vol. 670, c. 664.]
Letter of correction from the Minister for Health, the hon. Member for Charnwood (Edward Argar):
An error has been identified in the response I gave to the hon. Member for Chesterfield (Mr Perkins).
The correct response should have been:
Oral Answers to Questions
Toby Perkins Excerpts(5 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Ms Dorries
Baroness Cumberlege’s review is examining what happened in the case of Primodos and will determine what further action is required. Ministers will consider any recommendations very carefully. We do not have a date for the publication of the review, but it will be very soon. Perhaps we can continue the conversation then.
Mr Toby Perkins (Chesterfield) (Lab)
Imran Hussain (Bradford East) (Lab)
The Minister for Health (Edward Argar)
Winter is the most challenging time of year for our NHS, when cold weather and an increase in flu cases place additional pressures on the service. As ever, the NHS staff have done an amazing job this winter, and the NHS has seen a significant increase in demand, with 1 million more patients attending A&E in 2019. The December figures, when compared with those in 2018, show a 6.5% increase on attendance at A&E.
Mr Perkins
I do not know whether the Minister is aware, but we have a winter every year. We have had one for the past 71 years, and yet these are the worst A&E waiting times in history, and they are the culmination of the policies that his party has followed for the past nine years: the cuts in social care, the number of GPs driven out of practices, and this Government’s failure on prevention. All of that has led us to the worst A&E waiting times in history, and the Minister’s answer does not start to look at the failure that he has delivered.
Edward Argar
Well, as I pointed out to the hon. Gentleman—he may not have heard this—demand in A&E has significantly increased this winter. He asks about GPs. I am sure he fully supports our clear commitment to 50 million more GP appointments and 6,000 more GPs. I am sure he also welcomes, in his own constituency, the £19 million investment by this Government in 2017 in a new urgent treatment centre, which will serve his constituents and is due to start work this summer.[Official Report, 29 January 2020, Vol. 670, c. 6MC.]
NHS Long-Term Plan: Implementation
Toby Perkins Excerpts(5 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Matt Hancock
Yes, it will in all circumstances. This is a firm commitment, supported right across this House and right across our party, and it will be delivered. There is absolutely no question about that.
Toby Perkins (Chesterfield) (Lab)
We know that areas of greater deprivation have greater health needs than other areas. Will the Secretary of State tell us what more there is in the long-term plan specifically about increasing the resources for GP practices that serve areas of greater deprivation? They have longer waiting times and greater vacancy lists and we need specific action to support those practices.
Matt Hancock
Making sure that we have the right allocations for CCGs across the country that reflect the needs of the local population is a very important responsibility for NHS England—as the commissioner of those services—to make sure that the money follows need. After all, the principle of the NHS is that it is available to everybody according to need, not ability to pay.
Oral Answers to Questions
Toby Perkins Excerpts(5 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Matt Hancock
My hon. Friend is absolutely right: the £20,000 bonus is an important part of the solution, but so is having more GPs, and the fact that we have a record number of people going into GP training at the moment is great news that Members in all parts of this House should welcome.
Toby Perkins (Chesterfield) (Lab)
Matt Hancock
Of course the nature of being in a GP practice is changing. For a long time practices, which are essentially private businesses, also had the benefit of rising property prices that brought additional income on top of their income from the NHS. That is no longer the case because property is so expensive, so many people are changing the way that GPs are employed, so they are directly employed rather than through practices. That move is happening, but it is just one of the many changes we are seeing to try to make sure that being a GP is sustainable, and clearly things are starting to improve because a record number of people are choosing to become GPs.
Oral Answers to Questions
Toby Perkins Excerpts(6 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Toby Perkins (Chesterfield) (Lab)
The Minister for Care (Caroline Dinenage)
Diagnosing fibromyalgia can be difficult because there is no specific diagnostic test and symptoms can vary. A range of support exists to help GPs, including an e-learning course developed by the Royal College of General Practitioners and Versus Arthritis, and a medical guide on diagnosis and treatment developed by Fibromyalgia Action UK.
Toby Perkins
I am grateful to the Minister for that answer. I just hot-footed it here from Westminster Hall, where an excellent debate on fibromyalgia took place this morning. We heard a huge amount of evidence about people who suffer with fibromyalgia having waited more than a year to be diagnosed and having received treatments irrelevant to their condition. Clearly, diagnosis is not working at the moment. What more can the Minister tell us about investment in research to improve diagnosis and to try to get better outcomes for fibromyalgia sufferers?
Caroline Dinenage
I feel that my colleague the Secretary of State has set the bar for compliments to Members this morning. On that basis, I congratulate the hon. Gentleman on his Westminster Hall debate, which raised a key issue. The Department’s National Institute for Health Research welcomes funding applications for research into any aspect of human health, including fibromyalgia. Its support for that research over the past five years includes £1.8 million funding for research projects and £0.6 million funding for clinical trials through the clinical research network.
Oral Answers to Questions
Toby Perkins Excerpts(6 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Steve Brine
We are continuing to review the advice from our expert advisory groups on safe levels of folate intake, but, continuing our tradition of announcing things to the House first, I want to inform the House today that we are going to issue a public consultation, as of now, on adding folic acid to flour.
Toby Perkins (Chesterfield) (Lab)
The service from the East Midlands Ambulance Service NHS Trust has been a considerable disappointment for many of my constituents in recent months. When I met them about the service, they told me that on a huge number of occasions they have ambulances sat waiting outside accident and emergency departments, rather than getting to the next call. What more can the Government do to make sure we get these A&Es cleared?
Stephen Barclay
The hon. Gentleman is right to say that we need to improve those handovers. We have improvement programmes in place at 11 hospital sites in the east midlands, alongside which we are making a £4.9 million investment in 37 new ambulances. Part of this is also about the length of stay and addressing the pathway.
Derbyshire CCGs’ Finances
Toby Perkins Excerpts(6 years, 4 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Ruth George (High Peak) (Lab)
I beg to move,
That this House has considered Derbyshire clinical commissioning groups’ finances.
It does not give me great pleasure to raise this matter of great importance: the finances of our local health services and the clinical commissioning groups in Derbyshire. Two months ago—ironically on the 70th anniversary of the NHS—all the voluntary sector organisations in Derbyshire were shocked to receive letters stating that their funding from the clinical commissioning groups was to be cut. Our voluntary services provide much-needed support to thousands of frail, elderly and disabled people across Derbyshire, including support when they come home from hospital, befriending services, respite care, overnight stays and community transport.
Thousands of volunteers give their time to help vulnerable people, often in very rural areas where no other services are available, to live independently and stay well. They provide a constant check on those people’s physical and mental wellbeing. I thank all the volunteers across Derbyshire and the services that support them in helping people. They help older people to manage on their own, reducing the calls on GPs, visits to accident and emergency, and stays in hospitals or care homes for a fraction of the cost of those services. For example, the night-sitting service in High Peak provides emergency and respite care overnight—for example, when a carer is ill or to prevent a patient who would otherwise have to go into hospital from being admitted.
Toby Perkins (Chesterfield) (Lab)
I congratulate my hon. Friend on securing this important debate. Does she agree that, alongside the financial consequences of their cheaper cost, many voluntary organisations, such as Age Concern, which I saw last week, keep old people well and prevent them from having to use health services by providing services such as the befriending service in Chesterfield?
Ruth George
Absolutely. Age Concern and other voluntary services work fantastically well with thousands of older people.
Last year, the night-sitting service supported 93 people with more than 2,000 hours of care at a cost of just £34,000. That works out at just £369 per person for an average of three nights’ support each. Just one of those nights in a hospital would have cost the CCG more than that.
The CCG says that the county council provides an alternative service, and it may do on paper, but as we have a drastic shortage of social carers, like so many other places, no other help is available. The voluntary sector provides friendly, personalised, local care for far less than any other service could. For example, New Mills and District Volunteer Centre told me that it supports 550 mostly elderly, widowed and disabled clients for an average cost, between the staff and the volunteers, of just £2.26 an hour. If just two of those 550 clients have to go into a care home as a result of losing the volunteer services—in practice, it is likely to be many times that—the cut will cost more than has been saved.
Stephen Barclay
I was just about to come on to the voluntary sector, because that is where the hon. Lady’s speech started, but in her remarks she talked about the four CCGs coming together as part of the “efficiencies of scale”—her precise phrase—so I shall come back to the voluntary sector later.
Toby Perkins
I am probably in the position of largely agreeing with the Minister. I remember that, back in 2010, we had the Derbyshire primary care trust, but then the Lansley reforms came in, broke up the PCT and turned it into five different organisations in North Derbyshire. Can he imagine how galling it is for us to hear that those organisations, which went from a very strong financial position back in 2010, are now in utter financial chaos, so the Government are going to undo the Lansley reforms and to get those economies of scale that we were telling them about back in 2010?
Stephen Barclay
There seems to be a slight contradiction in the hon. Gentleman’s argument. He is arguing that, on the one hand, the financial position was strong in 2016—I remind him simply that the Lansley reforms were in 2012—and, on the other hand, that the issue is with the Lansley reforms.
Toby Perkins
May I make a point of clarification, because the Minister is misquoting me? I said that the financial position was strong in 2010, not in 2016.
NHS Outsourcing and Privatisation
Toby Perkins Excerpts(6 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jonathan Ashworth
I will take an intervention from Chesterfield and then I will make some progress.
Toby Perkins (Chesterfield) (Lab)
Chesterfield Royal Hospital is consulting on setting up a subsidiary company. Does it not seem madness that, to save £3 million that the hospital is paying the Government, it is creating this new organisation, which is being funded by the Government anyway? It is the emperor’s new clothes. The money is going round in circles without doing any good.
Jonathan Ashworth
In addition, hospitals have wasted millions in consultancy fees in setting up these organisations. They create a two-tier workforce because new joiners will not necessarily be on “Agenda for Change” terms and conditions, and they could at some point be completely sold off to the private sector. It is a back-door privatisation.
NHS and Social Care Funding
Toby Perkins Excerpts(8 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jonathan Ashworth
My hon. Friend makes his point extremely well, although I would not want to be so mean about the Secretary of State—[Hon. Members: “Go on!”] No, I am not going to be mean about the Secretary of State.
Toby Perkins (Chesterfield) (Lab)
In the past few moments, we have heard the ludicrous suggestion that Labour did not deliver on either spending or performance, but in fact our track record was excellent. That is not just my opinion; the former Prime Minister, David Cameron, said in 2011:
“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E, or months and months to have surgery done. So let me be absolutely clear: we won’t.”
He knew that Labour had a good record and that the NHS used to be good; why will these Tories not admit it?
Jonathan Ashworth
My hon. Friend makes a powerful point. Indeed, I remember, when we were in government, shadow Health Secretaries standing at this Dispatch Box opposing every penny piece of money that Labour was putting into the NHS. I remember a shadow Health Secretary, who now sits in the Cabinet as the Secretary of State for International Trade, standing at this Dispatch Box and saying that the A&E target was “indecent.” That was the Tories’ attitude when we were in government, so it is no wonder that we are sceptical about the Government’s intentions for the A&E target when we look at their history.
Mr Hunt
I have already given way to the hon. Gentleman. There are many other Members who want to intervene.
That is why we have a new inspection regime that makes it harder to cut corners in the way that used to happen when beds were not being washed, there was poor infection control and ambulances were being used as waiting rooms.
Toby Perkins
I am grateful to the Health Secretary for outlining some of the steps that he is taking in the face of this immediate emergency. Does he also recognise that the major cause of the problems in A&E is simply a lack of staff? Consequently, does he regret the huge cuts to training budgets in 2010, 2011 and 2012, which are having a real impact now on the number of nurses and doctors in our NHS?
Mr Hunt
I agree that staff numbers are critical, but we have, since 2010, 1,500 more doctors in our A&E departments and 600 more consultants. Across the NHS, we have more than 11,000 additional doctors, so we do recognise the pressures that the NHS faces. Indeed, we have 1,600 more doctors than this time last year, so we are doing a great deal to solve the problem.
Toby Perkins
The hon. Lady is right to say that we have an ageing population but that is predictable. Does she think it is also significant that in 2008 the UK was spending about the same as all the major EU nations, whereas the OECD now says that we are spending considerably less than most of the other major nations? Is that not actually causing this problem?
Dr Whitford
Money is not the only problem. I accept that part of it is about how things are done. The Secretary of State talks about variations and many hospitals performing well, but, as I said, only one trust is meeting the target and only nine are at over 90%, so it is not that the majority are doing well and a few are failing.
The ability to look at how we deliver the NHS is crucial, but change costs money. We must therefore invest in our alternatives so that our community services and primary care services can step up and step down to take the pressure off. One of the concerns about the STPs is that because people do not have enough money, a lot of them start by thinking that they will shut an A&E, shut a couple of wards, or shut community beds—even though those are what we need more of—to fund change in primary and social care. Then the system will fall over. We need to have double running and develop our alternatives and then we will gradually be able to send the patients there.
Mr Mark Harper (Forest of Dean) (Con)
I am very pleased to follow the hon. Member for Liverpool, Riverside (Mrs Ellman). I am sorry that the hon. Member for Central Ayrshire (Dr Whitford) is no longer in her place. I particularly enjoyed her remarks, in which she set out a number of constructive policy suggestions, drawing on experience in Scotland, and suggested that we could reflect on them and improve the situation here.
It was disappointing to hear not a single policy suggestion in the shadow Secretary of State’s 33-minute contribution. He might reflect on that because the debate will not move forward otherwise.
The hon. Member for Central Ayrshire drew upon her clinical experience, but I also enjoyed the contribution of the right hon. Member for Doncaster Central (Dame Rosie Winterton) who, after a period of enforced silence as Opposition Chief Whip, drew upon her ministerial experience, demonstrating the value of ex-Ministers contributing from the Back Benches and bringing something to the debate.
I have reflected on the Labour motion before us today, which specifically talks about the four-hour target and funding issues, which I will touch on in my inevitably brief speech. As I said in an earlier intervention, I was in the House on Monday when the Secretary of State was clear in what he said and I do not understand why Labour Members fail to see that. He did not in any way water down the target. The right hon. Member for Exeter (Mr Bradshaw) challenged him and the Secretary of State specifically “recommitted the Government” to the target. He was actually generous in paying tribute to the Labour Government for having introduced it, saying that it was
“one of the best things about the NHS”—[Official Report, 9 January 2017; Vol. 619, c. 46.]—
and in no way resiled from it.
Indeed, I think the shadow Secretary of State said in his remarks that the Secretary of State had somehow talked about ensuring that the target applied only to those with urgent health problems and that he had somehow said that secretly outside the House. However, I have looked carefully at the Secretary of State’s oral statement, given in the House just two days ago, and he was explicit about ensuring that the four-hour standard related to urgent health problems. He specifically referenced Professor Keith Willett, NHS England’s medical director for acute care, and said that
“no country in the world has a”—
four-hour—
“standard for all health problems”.—[Official Report, 9 January 2017; Vol. 619, c. 38.]
The target is for urgent health problems, and if we are to protect vulnerable patients, that is what we need to ensure—it is incredibly valuable.
The motion also relates to social care funding, so I want to talk about the charge that the Opposition keep making about local authority decisions. It is entirely true that the coalition Government had to make savings from local government budgets in the previous Parliament owing to the previous Labour Government’s lack of preparation following the dramatic financial crisis. We inherited a budget deficit of 11% and had to make such savings, but local councils had choices in the decisions they made about where the cuts fell. Gloucestershire County Council prioritised spending on adult social care, stating that it was the single most important service that it delivered. The budget related not only to older people; a third of it went on provision for adults with disabilities, including learning disabilities. The council protected that budget in cash terms, which is one reason why we are one of the best performers in the region and have low delayed patient discharge from the acute sector. While I do not pretend that there are no problems—of course there are challenges—the hard-working health and social care staff do an excellent job.
Toby Perkins
I am grateful to the right hon. Gentleman for giving way, but his comments about local government are ludicrous. The cuts that local government faced were far greater than those to any Department. The Government cannot introduce that level of cuts and then say to local government, “You have to decide what you cut.” Of course that was going to lead to social care cuts.
Mr Harper
The point that I was making is that my local authority also faced significant cuts and had to make choices. It chose to prioritise adult social care as the single most important service that it delivered, so it had to make difficult cuts in other areas. However, the choice to put adult social care at the top of the list of priorities was the right choice six years ago and remains the right choice today. If councils chose to put adult social care at the bottom of their list, that was not the right decision.
There is no acute A&E department in my constituency, but it is served by A&E departments in Gloucester and Cheltenham. I visited the new chief executive at Gloucestershire Hospitals NHS Foundation Trust and met some of the staff in the A&E department—the hospital has had its challenges—and she is working hard with her management team on turning around the performance of A&E, which has not been up to scratch. I talked to her about the processes they are putting in place, and I am confident that, with the hospital’s hard-working staff and improved leadership, they will be able to hit the targets that the Government have asked them to meet.
Toby Perkins (Chesterfield) (Lab)
This is a vital issue, and I congratulate my hon. Friend the Member for Leicester South (Jonathan Ashworth) on bringing it before the House. The pressures on our national health service have a multitude of causes. Many of them are societal: whoever was in power would be dealing with an ageing population, limited financial resources and global competition for skills. However, many aspects of the crisis have a political origin, and the Government cannot continue to avert their eyes from that.
In my contribution today, I want to talk about my own experience of the pressures that our NHS staff, and particularly those in A&E, are facing and ask Members to walk a mile in the shoes of those who are on the frontline, making life-and-death decisions every single day. My exposure to these pressures is both professional and personal. Professionally, in common with many other MPs, I have recently spent time in the A&E department of my local hospital, the Chesterfield royal, shadowing staff on the watch.
I have said that my exposure to these issues was also a personal one. Last year, on Friday 15 July, my father died of an aneurysm. Four days earlier, he had been sent home from the A&E department at Coventry and Warwickshire hospital with what a vascular surgeon described at my father’s inquest as “classical aneurysm symptoms”. With a history of vascular problems and a previous near-fatal aneurysm, he presented at the hospital’s A&E department, suffering extreme pain in his right groin, radiating to side and back. He was described as being confused and uncommunicative. Yet, after five hours in A&E, he was sent home in a taxi. Four days later, he died in my arms.
Although individual mistakes by an experienced and, I believe, respected A&E registrar were clearly made in this case, what was particularly haunting was his response to questions during the inquest about why my father was sent home. He recounted the pressures in the A&E department that day, and said that it was non-stop and particularly busy on that Friday afternoon, so that from one case to another, he was constantly having to decide, as he did most days, which sick patients, all of whom needed to be in a hospital bed, to send home this time. He said:
“There simply aren’t enough beds for those who need to be in them, so every day we have to make these choices. I probably sent home 5 people that day who should have been in a hospital bed, but those are the choices we are left with, when there aren’t enough beds”.
He asked if my father minded going home and when he did not object, he stuck him in a cab.
These pressures and these life-or-death decisions are not unique to that registrar or that hospital. Dr Stephen Hitchin, an out-of-hours doctor and an A&E doctor at Chesterfield royal said:
“Chesterfield Royal Hospital have confirmed to the CCG today that they are experiencing SEVERE pressure (RED STATUS) in A&E, Emergency Management Unit, Clinical Decision Unit and critical care beds…This has come from a toxic combination of underinvestment, social care cuts, staff cuts, poor planning and GP surgery shortages. This is a failure of policy from this Government plain & simple. They are to blame & must take responsibility & action to correct this crisis”.
Another consultant said:
“The only thing keeping the wheels even vaguely on is a grim determination and professionalism. Any good will to the system was eroded months ago. The government have thought that Emergency Departments can just soak up exploitation and abuse ad infinitum but we can’t. We have exceeded ‘acceptable tolerances’ long ago.”
If that is the experience of people working within the system, how can we be surprised when it leads to personal catastrophes? How can we be surprised when doctors on whom we have spent tens of thousands of pounds to train, take the expensive training and move to other countries where they feel they are better appreciated? The experiences of those consultants and registrars were echoed by those I met when shadowing the A&E department at Chesterfield royal. Other issues emerged. Certainly there were people in the A&E department who were not urgent cases and should have been at their GP. When I asked one of them why he had come to A&E, he said it was because he had been trying to get a doctor’s appointment for three days at his GP surgery and just could not get one.
The scale of the GP crisis is adding to our A&E crisis, not just because people present who should be seeing a GP, but because problems that could have been sorted out or identified if they were seen early enough escalate without access to primary care. The Government must take responsibility. The cuts in training budgets in 2010-11 and 2011-12 were catastrophic for the provision of the next generation of staff, and we are now reaping the full cost of that decision. Quite apart from the ethics of having to rely on overseas staff to keep our NHS sustainable and the impact that has on health services in developing countries, it is crazy that, at a time of a global shortage of trained medical staff, the Government deliberately cut off the flow of new home-grown recruits.
The story is similar in nursing. In 2010-11, 25,525 students enrolled on a nursing degree course, but owing to budget cuts, that number had been reduced by nearly 15% within two years of a Tory Government, and even now it is more than 10% down. The staff shortages have also led to a ballooning of agency costs: in the past two years, an additional £2 billion has been spent on agency staff. More and more money is being spent on extra staff and not, as it should be, on patient care.
We need to remind ourselves that things were different under a Labour Government. A Labour Government led to record NHS satisfaction levels, achievement of the 98% waiting target, a sustainable GP and A&E system, and, in the words of the King’s Fund, the most efficient health service in the world. The Labour Government led to much higher patient expectations, but under the present Government that progress is being eroded. By 2008, after 11 years of Labour investment, the UK’s health spending had finally caught up with that of leading EU nations, but OECD figures show that, once again, our spending is now “significantly below” theirs.
I am ashamed to say that I am grateful that my father experienced his first life-threatening aneurysm on holiday in Germany. The quality of the emergency care that he received in Munich saved his life and gave us, his family, three more years with him. I regret that the same could not be said of our NHS last year.
We have it in our hands to make our NHS once again a service admired around the world. Although the challenges that it faces are substantial, they are also predictable. If the Government had listened to those who questioned their cuts in training, the impact of pension reforms on GP retention, the impact of GP shortages on A&E departments and the impact of care cuts in the poorest areas on our health service, we would not be facing the crisis that we face today. The call for further action on A&E waiting times and investment in our care system cannot be ignored.
The Government seem to be presiding over the managed decline of our NHS, but the scale of this crisis will engulf them if action is not taken now. It means old people struggling to cope; it means the disabled being left in their homes rather than being able to take advantage of things that we all take for granted; and it means people being sent home from A&E departments to die. We must do better.