Winterbourne View
Tony Baldry Excerpts(11 years, 9 months ago)
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Norman Lamb
I thank the hon. Gentleman for that question and completely agree that we have to address the issue of skills. It is worth pointing out that there are some fantastic providers in the voluntary sector, and in the private sector as well. We should applaud that and recognise that there are many well trained people on low wages providing a fantastic quality of care, but there are also places where that is not the case. That needs to be addressed.
I absolutely agree with the hon. Gentleman that we should look closely at the voluntary or not-for-profit sector. I had a meeting recently with the head of Shared Lives, an organisation that places people with learning disabilities into people’s homes. Surprise, surprise—when people are treated with dignity and treated as human beings, their behaviour improves and sometimes all the complex problems subside. There is an awful lot we can do. In the new year I will bring together the providers of the best care available so that we can learn the lessons from them.
Sir Tony Baldry (Banbury) (Con)
As patients had come from different parts of the country to Winterbourne, there was a sense that they had got lost in that locality. Whatever happens, it is a tragedy that it took a television programme to discover all this. We are now going to have health and wellbeing boards and HealthWatch. Can my hon. Friend tell the House how, between them, they can ensure that they inspect and have a grip to ensure that something like this never happens in my county of Oxfordshire? It has never happened there because the structures of local government and health and social services are constantly monitoring and inspecting whatever is happening in our areas, irrespective of whether they are delivering health or social care.
Norman Lamb
I thank my hon. Friend for his question. He is absolutely right. The new structure provides far greater local accountability than we have ever had. One of my great criticisms of the old primary care trusts is that they are, in effect, completely unaccountable to their local communities. Health and wellbeing boards scrutinising what clinical commissioning groups and the local authority are doing can be very powerful. He also mentioned HealthWatch. Like its predecessor organisations, the local involvement networks or LINks, it will have the power to go into all care and health settings and inspect what is going on, often behind closed doors. We encourage HealthWatch to use those powers to shine a light on what is happening in some of those places.
Oral Answers to Questions
Tony Baldry Excerpts(11 years, 10 months ago)
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Sir Tony Baldry (Banbury) (Con)
T2. The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so?
The Minister of State, Department of Health (Norman Lamb)
I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.
Oral Answers to Questions
Tony Baldry Excerpts(11 years, 11 months ago)
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Dr Poulter
Let me bring the hon. Gentleman back to planet earth for a while—[Interruption.] He should have listened to the answer I gave a little earlier about allowing for flexibility in pay frameworks. Some degree of regional pay was introduced by the previous Government in “Agenda for Change”. On principle, then, the previous Government, the hon. Gentleman and his colleagues, including the former Secretary of State, were supportive of regional pay. However, on the current negotiations and discussions, we would like to see a collaborative relationship between employers, unions and employees in the NHS at the NHS Staff Council to make sure that we maintain national pay frameworks as long as they remain fit for purpose.
Sir Tony Baldry (Banbury) (Con)
Why should there be an assumption that local pay will lead to lower pay in the public sector? In a constituency such as mine, where the unemployment rate is below 2%, local pay could quite possibly lead to higher pay in the public sector so that people are attracted to it.
Dr Poulter
My hon. Friend makes an excellent point. It was the previous Government who, through the “Agenda for Change”, gave flexibility to NHS trusts to allow some employers to pay a 30% premium in areas with workplace shortages.
Social Care (Local Sufficiency) and Identification of Carers Bill
Tony Baldry Excerpts(12 years ago)
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Sir Tony Baldry (Banbury) (Con)
The Government published their White Paper, “Caring for our future: reforming care and support”, just before the summer recess, and I think we would all agree with its statement:
“Carers make a vital contribution to promoting the wellbeing and independence of the people they care for…The support provided by millions of carers is testament to the strength of our society and our communities. However, we also recognise that caring brings challenges. Providing better support to carers is therefore crucial to ensure that they can maintain their own health and wellbeing, care effectively and have a life of their own alongside caring.”
Earlier this year, various all-party groups, including the all-party group on social care, which is chaired by the hon. Member for Worsley and Eccles South (Barbara Keeley), who has so ably introduced this Bill, and the all-party group for carers, which I co-chair, met to consider the measures needed to do exactly what the Government say they want to do in their White Paper, namely provide better support for carers, so that they can
“care effectively and have a life of their own alongside caring.”
The hon. Lady was fortunate enough to come reasonably high in the ballot for private Members’ Bills and, with the help of a number of carer organisations, such as Carers UK, drafted a Bill that addresses the challenge of how we can give effective support to carers.
The Government then published their much-awaited White Paper on social care, which was widely welcomed. I am delighted to say that, for the first time, it makes substantial commitments to carers, which I will come to in a moment. Unfortunately, but perhaps understandably, most of the press commentary on the White Paper centred on what the cost of residential social care would be. The new policy and the contribution to the support of carers were not necessarily highlighted sufficiently, but they are included in the White Paper.
The hon. Lady and those involved in promoting the Bill examined the measures in the White Paper and considered what other measures would be of further benefit to carers. A number of the Bill’s provisions are, therefore, not included in the White Paper, but I acknowledge that there is some overlap. For example, clause 1, which would introduce a duty to ensure sufficient social care support, is probably covered by the provisions in the draft Care and Support Bill.
I am anxious to find a way forward whereby we do not wake up tomorrow morning to headlines stating that the Government have killed off a Bill that would give more support to carers. We need to find a grown-up way to do this. My hon. Friends the Members for Shipley (Philip Davies) and for Bury North (Mr Nuttall) are present, and I suspect that these sextons on duty—these pallbearers of private Members’ Bills—will make lengthy contributions that may well not enhance the nation’s understanding of the problems faced by carers.
Before we make any further progress, I therefore want to make a request to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), who I am delighted to see taking responsibility for this issue at the Dispatch Box for the first time. The White Paper contains a welcome chunk of policy on carers, but people involved with carers feel that some areas could be further enhanced. All I want my hon. Friend to do is give a clear undertaking that, between now and the eventual Second Reading and debate of the Government’s Bill on social care, he would be willing to have meetings with the relevant all-party groups to discuss how provisions relating to carers could be further enhanced.
I fully accept—the interventions on the hon. Member for Worsley and Eccles South demonstrated this—that there are tensions in relation to how one balances duties on various organisations and partners in ways that are reasonable to their costs, and to some of the changing patterns resulting from the fact that local governments are now seen more as enablers than deliverers. I want my hon. Friend to give an undertaking that he would be willing to have discussions with those of us who are concerned about carers policy, to try to ensure that, when the Government’s Bill on social care is presented to the House, those parts relating to carers are as robust and as resilient as possible.
I hope that my hon. Friend is willing to give that undertaking. Given that he has only taken up his brief this week and has probably yet to read the briefing for incoming Ministers in his red box, I would fully understand it if he felt unable to respond in detail today and say, “Well, I can accept those bits of the Bill, but not those bits.” That would be difficult. It would be disappointing, however, if there were any scintilla of a suggestion that the Government want to “kill off” this Bill because they do not want it to pass. I hope that my hon. Friend will see this as an opportunity to have a constructive debate on policy on carers and their needs, and trumpet his willingness to engage with us to make sure that those parts of the Government’s new Bill relating to carers are as good as possible.
The Minister of State, Department of Health (Norman Lamb)
I am grateful to my hon. Friend for his comments, and I am happy to give, straight away, the undertaking that he seeks. I will engage fully with the hon. Member for Worsley and Eccles South (Barbara Keeley), who is the Bill’s promoter, and with the relevant all-party groups. It is important that we get this right and that we do not let down those people with caring responsibilities. I am very happy to give a firm commitment to engage fully between now and when the Government’s Bill is presented to this place.
Sir Tony Baldry
I am grateful to my hon. Friend for that undertaking. I would understand if the Government did not want the Bill under discussion to progress, but that must be balanced against his undertaking.
Dr Francis
I welcome the new Minister’s statement. Does the hon. Member for Banbury (Sir Tony Baldry) agree that the Minister should also be invited to engage with the national carer organisations and with the Health Ministers of the devolved Administrations, particularly because, as a good Liberal, he is an enthusiastic supporter of democratic devolution?
Sir Tony Baldry
We all know the organisations and bodies that are concerned about carers policy. I heard my hon. Friend the Minister say clearly that he was willing to engage with us and others to make sure that, when the Bill on social care is presented to the House, those parts of it that deal with carers are as robust as possible. For the first time, we are at last acknowledging that a large number of people in this country are carers and that there need to be robust policies in relation to them.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Will the hon. Gentleman give way?
Sir Tony Baldry
Before I give way to the right hon. Lady, I want to say that I hope that the Government’s Bill will codify all the existing legislation relating to carers. Over the years, a whole number of private Members’ Bills, one of which was introduced by the hon. Member for Aberavon (Dr Francis), have enhanced the role of carers. It is confusing and difficult for people to find their way around different bits of legislation, so it would be good if all of the legislation relating to carers were collected in one piece of legislation.
Norman Lamb
I am grateful to my hon. Friend for allowing me to intervene again.
It is the Government’s ambition to codify all the provisions relating to carers and care and support in one Act of Parliament. A big problem, as he rightly identifies, is that the law has developed in a haphazard way. Getting it all into one Act of Parliament, written in plain English, would be of real benefit to carers and others in the sector.
Sir Tony Baldry
I am genuinely delighted to hear my hon. Friend say that. It is really good news. If we continue on that basis, we will make substantial progress.
Dame Joan Ruddock
I wanted to intervene to say that I was surprised that the hon. Gentleman was satisfied with the Minister. I say to the Minister that it would be a miracle if one could get every piece of legislation into one consolidated Act; it just does not work in that way.
I say to the hon. Gentleman that it would be a great shame if the Bill were talked out today, after all the work, all the effort, all the support in the country and all the Members who have come here today to support it. The place to deal with the issues that the Government may or may not want is in Committee. A vote in favour of Second Reading today would send an important message on all the matters that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has spoken about so ably this morning.
Sir Tony Baldry
Having been a Minister in the last Government and as a grown-up and senior Member of this House, the right hon. Lady has a clear understanding of how legislation works and evolves. A large number of private Members’ Bills during the 13 years of the last Government did not make progress in the form in which they were drafted. The point is not that the Bill must pass today in this form, but that it contains a number of provisions, some of which are not in the White Paper.
The grown-up and responsible undertaking that I have received from the Minister is that he will have intelligent discussions with all of us who are concerned about carers policy over the next few months to see whether we can get some of these provisions into the Government Bill when it is brought forward. If not, all of us will want to hear good reasons why, given that some of the work in the private Member’s Bill builds on previous legislation, for example on child care, where there are clear precedents for what we are seeking to achieve.
Barbara Keeley
It is not without precedent for Conservative or Labour Governments to accept private Members’ Bills relating to carers. I think that I am right in saying that of the three pieces of legislation brought forward by Labour MPs, one was brought forward with the agreement of a Conservative Government and the other two with the agreement of a Labour Government. For all the pious aspirations in the carers strategy documents that are rolled out by Governments, it is the concrete rights and measures in those private Members’ Bills that have made the difference, as I said in my speech. It is important to recognise that sometimes a specific measure is needed, rather than a lot of consolidation and aspiration, which make no difference to carers on the ground.
Sir Tony Baldry
The hon. Lady has raised two important points and I will deal with them both, because I do not want there to be a scintilla of misunderstanding.
The private Members’ Bills brought forward by the right hon. Member for Torfaen (Paul Murphy), the hon. Member for Aberavon, Lord Pendry and others were valuable contributions. The difference with this private Member’s Bill is that since the hon. Lady and those who are proud to sponsor it brought it forward, the Government have published a substantial White Paper covering this policy area. We are dealing with a policy that the Government are still consulting on and thinking about across Whitehall and with other organisations.
It is in all our interests that effective carers legislation is, as far as is possible, contained in one piece of legislation, namely the Government Bill. I am not for one minute suggesting that codifying existing carers’ rights is sufficient. I am saying that if and when the Government bring forward the Bill on social care, I hope that a large part of it will deal specifically with carers, and that within that part there will be a codification of existing carers legislation, which the Minister has acknowledged there will be.
Dr Francis
May I clarify what happened with my Bill? It was part of the wider strategy of the Labour Government to advance equalities legislation. It is therefore slightly disingenuous of the hon. Gentleman to suggest that my Bill was somehow separate from the wider advances that were made. Similarly, he should be saying, as the joint chair of the all-party parliamentary group on carers, that he supports this Bill, irrespective of the wider advance in social care legislation under this Government, whenever it comes.
Sir Tony Baldry
I am clearly being uncharacteristically incapable of communicating what I am seeking to achieve. I do not in any way resile from the provisions in the Bill. The provisions that the hon. Member for Worsley and Eccles South has put forward are necessary and valuable. I am simply trying to find a constructive way to ensure that as many of those provisions as possible eventually arrive on the statute book.
The hon. Member for Aberavon has to recognise that the Government have a strategy for carers, which is set out very clearly on pages 34 and 35 of the White Paper on reforming care and support. It states:
“From April 2013 the NHS Commissioning Board and clinical commissioning groups will be responsible for working with local partners to ensure that carers are identified and supported.”
That existing strategy has a number of parts that we would all want to discuss with the Ministers and officials who have responsibility for this policy. For example, much of the hon. Lady’s Bill is rightly about how we help and support carers in the world of work. The White Paper states,
“we will produce and publish a road map setting out action to support carers to remain in the workforce.”
I am always a bit suspicious of phrases such as “road map”, because I am never sure what legislative force a road map has. We will want to discuss with Ministers, in fairly robust terms, how we can ensure that the Bill that the Government bring forward in due course meets the aspirations and needs of the millions of carers in this country, for whom all of us present in the Chamber are concerned.
Mr Nuttall
I am most grateful to my hon. Friend for giving way. I hope to be helpful to him. Does he agree that rolling up the thrust of the private Member’s Bill into the Government Bill, which I think is the line that he is going down, would be entirely in line with the first recommendation of the Law Commission’s “Adult Social Care” report, which states that there should be a single statute in this area?
Sir Tony Baldry
Absolutely; having a robust single statute is in everybody’s interest. We need to understand that we are not abandoning, resiling from or giving up any of the provisions in the Bill, but saying, to use a rather boring lawyers’ term, that they are adjourned generally with liberty to restore. In other words, we want to make quite sure that we have the opportunity to have a series of meetings with the Minister and his officials, so that we can go through the details of what is proposed for the Government’s Bill and how many of the private Member’s Bill’s provisions we can incorporate in it. The Minister has given his undertaking that we will have those meetings, and I know it was given in good faith.
It is the Government’s clear intention and policy to support as many people as possible to be in work, and one challenge for carers is the difficulty of retaining employment. The Government, hon. Members and everyone else have common cause on that, so it is just a question of how to make effective policy.
Likewise, it is clearly crucial that carers are identified, that they know themselves to be carers and that the supporting machinery identifies them as such. The provision of respite care has helped. In the past, I have asked GPs, “Why don’t you identify patients in your practice who have carers?” They have said, “Well look, Tony, there’s not really much point, because there’s not much that we can do to help them. We can identify them, but how much further does that get us?” At least now, with the NHS being able to provide respite care, there is a real purpose to GPs’ doing that. We need to ensure that the system sends the right signals and provides the right support.
Diana Johnson
I listened carefully to what the hon. Gentleman said about employment. The Bill contains provisions to do with young carers’ education and colleges of further education. I am concerned that the Department for Education’s direction of travel is not towards providing regulation on those matters to schools, colleges and universities. The Department for Business, Innovation and Skills, which holds the universities portfolio, should also be involved in that. The Minister has given an undertaking from the Department of Health’s side, but other Departments are also involved. I am not convinced at the moment that the Bill’s provisions will find their way into the Care and Support Bill. I would like this private Member’s Bill to go forward, because it contains additional measures that we want in place.
Sir Tony Baldry
It is very rare that an area of public policy, particularly on something as important as carers, can be dealt with by just one Department. I have absolutely no doubt that the Government’s White Paper on social care is the subject of an enormous amount of interdepartmental discussion. One task of the various all-party groups is to highlight to the Department of Health the issues that relate to other Departments, so that it can negotiate with those Departments before bringing forward its Bill. There will be cost implications in different areas, and I am sure there will be a robust debate about money on Second Reading of the Care and Support Bill. We have not yet come to that.
I say to the hon. Lady that the White Paper was published only shortly before the summer Adjournment. There has been little opportunity for any of us to interrogate Ministers in other Departments about policy areas such as those that she rightly identifies. Of course, a number of Ministers, like the one who is here today, have only just taken on new ministerial briefs. I believe that at Minister of State and Parliamentary Under-Secretary of State level, only 11 Ministers will be opening the same red boxes this weekend as they did last weekend. Those of us who have been Ministers know that it takes two or three weeks just to absorb the briefing for incoming Ministers, so we should not be impatient. What is important is to ensure that those of us who are in all-party groups relating to carers, or who are concerned about carers policy, can support the Government’s social care Bill on Second Reading.
Philip Davies
I am grateful. I have been trying to decode what my hon. Friend said about me and my hon. Friend the Member for Bury North (Mr Nuttall). I do not know whether he was trying to be insulting, but in his characteristically charming way, or whether he was merely saying that we take a close interest in each private Member’s Bill, which I would say was a compliment, even though perhaps a rather ham-fisted one.
Is my hon. Friend trying to say that if we get the undertakings that I am sure we would all like from the Minister today—he has already made some—it would be helpful if the hon. Member for Worsley and Eccles South (Barbara Keeley) were to withdraw her Bill?
Sir Tony Baldry
We all have to be grown-up about this. The hon. Member for Worsley and Eccles South has come up in the ballot, and it is a matter for her how she deals with the Bill. She is perfectly entitled to take it forward. I am just concerned to ensure that there is no scintilla of a suggestion that we will get ourselves into a hole. I was in the House when Nick Scott was the Minister responsible for the disabled. We got ourselves into a terrible hole over a private Member’s Bill by giving the impression that we were not interested in policy relating to the disabled, which of course was totally untrue. I do not want there to be any suggestion of that happening in relation to carers. I hope that we have now found a constructive way forward.
Sir Tony Baldry
I had not intended to take so much time, so I will conclude after giving way to the hon. Lady.
Roberta Blackman-Woods
I am grateful to the hon. Gentleman for giving way when he was about to conclude. I am having some trouble following Government Members’ logic. Surely it would help if we could get into legislation the measures to support carers that we all want to see. We should give a strong message that the House supports the Bill.
Sir Tony Baldry
Let me have one last crack at this; then I will sit down. I believe everyone in the Chamber agrees that supporting carers is incredibly important. One privilege of being an MP is that people invite us into their homes and open up to us about their problems. I suspect that we have all been to many a house where an elderly wife looks after an elderly husband, or the other way around, who has early or age-related dementia. Given our tendency to live longer, the costs of nursing home care and sometimes the difficulties of local authority budgets, the reality is that more and more people with Alzheimer’s or other age-related dementias are having to stay at home longer and be cared for by loved ones.
We also go into homes like the one that I visited recently, where I found a mother looking after her daughter who had severe learning difficulties and was effectively bedridden. That mother has looked after her daughter lovingly for much of her life. As we know, the challenges and strains of such a situation often lead to the break-up of other relationships, with all the consequences that brings.
There are also many young carers, who are often the hardest group to reach and the most overlooked. People are not always conscious that there are young carers. When we go into their homes, it is sometimes unclear who is the parent and who is the carer, and how the parent can take parental responsibilities for the child while the child takes caring responsibilities for the adult. The swings in that situation can be extraordinarily difficult.
What is almost unique about this Bill is that since the hon. Member for Worsley and Eccles South came high in the ballot and brought forward her Bill on carers, which was fantastic, the Government have produced a substantial White Paper covering exactly that policy area. Part of the Bill overlaps with the White Paper and part does not, but the Minister has given the undertaking that he is willing to engage with us on the bits that are not yet established as Government policy in the White Paper, to see whether it is possible for them to become Government policy before the Care and Support Bill receives its Second Reading. I would rather have an undertaking to engage in constructive debate and discussion about trying to get those provisions into the Bill, than run the vagaries of whether the Bill gets a Second Reading today—of course, how we proceed is entirely a matter for the hon. Lady—and whether, when we get to the rather boring part, Report and Third Reading, the Bill fails to make sufficient progress because the Government do not want it to proceed.
I hope that all sides of the House will recognise the importance of supporting carers and getting the policy right. The Government have acknowledged the importance of carers in the White Paper, and we must all engage in further work. We would have had to do that anyway in Committee, but instead we will work with the Minister and his officials. We must ensure that all hon. Members can support the Bill, so that when it is published it does justice to the need to support millions of carers throughout the country about whom we are concerned.
Norman Lamb
I am grateful to my hon. Friend for raising that point. Yes, absolutely, there is and I will come back to that. One concern I have is the focus in the Bill on social care, whereas the thrust of Government policy is the importance of integrated care. My hon. Friend and the shadow Minister referred to Torbay. I am passionate about that approach. We can do an awful lot more. The whole approach should be to integrate health and social care in our planning and our execution, rather than, as the Bills risks, silo-ing social care and assessments of social care and carers’ needs separately.
The shadow Minister commented on budgets. I absolutely understand that budgets are tight and that local authorities are in difficult times, but the new budget survey from the Association of Directors of Adult Social Services shows not huge cuts but that councils have risen rather impressively to the challenge and identified savings of £1.89 billion since 2010-11 by using resources more efficiently. Surveys show that councils’ spending on adult social care is due to fall by only £200 million or so. If the money can be used much more effectively, we can ensure that services are protected.
One thing I am interested in pursuing in my new role is how well we commission care. There is disturbing evidence of a race to the bottom, with care being commissioned on the basis of an hourly rate and the cheapest getting the contract. We need to do everything we can to ensure that commissioning provides incentives to improve health and well-being, prolong independence and improve mobility, thereby saving money and improving care, which is what we need to achieve. There is probably a widespread view that we do not commission care nearly effectively enough. There must be a substantial improvement in our expenditure on social care.
We agree with much of the intention of the Bill, but for a number of reasons we cannot support it. First, it would perpetuate the fragmentation of carers legislation, which we are seeking to end. My hon. Friend the Member for Bury North made the point that the Law Commission argued for a single statute. It seems irrational, at the very moment that the whole sector is celebrating the fact that we are seeking to bring everything together, to have a separate Bill introducing new duties. The debate about getting the framework right—putting everything together in one clear framework, written in plain English—needs to be part of the Government’s Bill.
Sir Tony Baldry
I urge my hon. Friend to be as conciliatory as possible. In fairness, when the hon. Member for Worsley and Eccles South (Barbara Keeley) started with her Bill, the Government had not published their social care White Paper, so she had no idea what it would contain. The important thing is to focus not on the Bill’s potential failings but on a process that enables us to look at its ideas and concepts and decide which will fit into the social care Bill that my hon. Friend will bring forward for Second Reading in due course.
Business of the House
Tony Baldry Excerpts(12 years ago)
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Mr Lansley
When the Opposition have wished to present an issue for debate and have chosen the issue of tuition fees, I have announced it as a consequence.
I am grateful to the right hon. Gentleman for his reference to legislation. I wonder whether he meant by it the piece of legislation which, shortly after its introduction, he described as “consistent, coherent and comprehensive”.
Sir Tony Baldry (Banbury) (Con)
It is clear from what the Prime Minister said yesterday at Prime Minister’s Question Time, and will be clear from the statement that we shall hear shortly, that a considerable number of initiatives are being taken throughout Whitehall to promote growth and jobs. Indeed, it is sometimes quite difficult to keep up with what is being done. Could the Leader of the House arrange for a quarterly statement to be deposited in the Vote Office, in which every Whitehall Department reports to the House on the initiatives that it is taking to promote growth and the progress of those initiatives?
Mr Lansley
I will of course reflect on my hon. Friend’s suggestion. However, although he says that it is difficult to keep up, the connection between the things that are being done is often very straightforward. For example, our announcement in July of funding for lending that would allow increased access to mortgages at more affordable rates will be followed up by my right hon. Friend the Secretary of State for Communities and Local Government in his statement shortly. While we wish to create more demand for new housing, we also wish to ensure that some sites that have not been developed can be developed in future.
Care and Support
Tony Baldry Excerpts(12 years, 2 months ago)
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Mr Lansley
I know that the hon. Gentleman will not have had a chance to look in detail at the White Paper, but it makes it clear that the costs in the spending review period are more than adequately met by the additional resources. [Interruption.] The hon. Gentleman and his colleagues are confusing two different things. The White Paper looks at specific additional tasks—for example, in the provision of independent information and advice, including local information about access to care services. That is more than fully funded. The figure he mentioned referred not to the number of care workers but to the number of care apprenticeships that are being developed with the sector.
Sir Tony Baldry (Banbury) (Con)
As co-chair of the all-party parliamentary group on carers, I welcome the new rights for carers that are proposed in the White Paper. However, a couple of things follow from that. First, GPs, social workers and others have a responsibility to do everything possible to identify carers, because unless people identify themselves as carers, they will not be able to access those rights. Secondly, we should support carers by developing training programmes for them, so that those who find themselves in that position are empowered to undertake their caring role.
Mr Lansley
I am grateful for the work of my hon. Friend and the all-party group. This is an important moment. If the House approves the draft Bill, the rights and entitlements of carers to assessment and support will be set out in law for the first time, in the same way as we have done for those for whom they care. He makes an important point. The draft mandate for the NHS that I published last week gives specific attention to the need to identify and support carers. I hope that these proposals will also enable the NHS and social care to join together in support of carers.
Oral Answers to Questions
Tony Baldry Excerpts(12 years, 6 months ago)
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Paul Burstow
I know that the hon. Gentleman takes a close interest in this matter. He is a member of the all-party group on tuberculosis, and I believe he is meeting the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) to discuss these matters further. He is right that this is a big issue in London as well as a global issue. The Department is working closely with TB Alert, the tuberculosis charity, which is running a series of programmes to raise awareness. It is working with the NHS and the voluntary sector, particularly in communities with higher risk populations, and we are working with the Royal College of General Practitioners to develop an online resource to promote the better detection and treatment of TB in primary care. I hope that he can explore these issues further, but the Government take them very seriously and are working with other agencies to make progress.
Tony Baldry (Banbury) (Con)
It was 50 years ago that my dad moved on from being research secretary at the British Tuberculosis Association at Harefield because, in the 1950s, TB had ceased to be a killer in the UK. It is a tragedy that it has now come back, largely as a consequence of people with infectivity from overseas bringing TB into the country. What more can be done to enhance the screening of travellers from high-infection areas entering the UK so that those infected with TB can be identified and treated before they infect others in the population here?
Paul Burstow
My hon. Friend makes an important point about one aspect of the better control of TB and its spread. The Home Office has been running a pilot programme for some years. It continues to evaluate the effectiveness of that programme with a view to establishing whether it is more widely applicable. We know that this disease has moved from the general population to specific high-risk groups, which is why the targeted approach I mentioned in my initial answer is the key to controlling it.
Health and Social Care Bill
Tony Baldry Excerpts(12 years, 6 months ago)
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Tony Baldry (Banbury) (Con)
I start by apologising to the House for making what I suspect may sound like a slightly portentous speech. It is not meant to sound portentous, but if it does I apologise.
Because of the effluxion of time, there are not many former Ministers on the Government Benches are, but there is, irrespective of the topic, an important point that needs to be made in the context of today’s debate. I urge every right hon. and hon. Member, before they vote at the end of this debate, to get a copy of House of Lords Hansard for yesterday’s debate, where this matter was debated. There are, in that Lords Hansard, two speeches that hon. Members would do well to read: those of Lord Wilson of Dinton and Lord Armstrong of Ilminster, both former heads of the civil service.
Lord Wilson was head of the civil service during the time of a Labour Government, and both he and Lord Armstrong made it very clear in their speeches yesterday that to release the risk register would be extremely bad news for the relationship between the civil service and Ministers generally. Irrespective of this issue, irrespective of the topic, if risk registers were to be released, officials would needlessly be politicised and thus be concerned about the advice that they gave to Ministers. Ministers would then find themselves being given verbal advice, fewer people would be involved and that would not help the machinery of government.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Will the hon. Gentleman give way?
Tony Baldry
I will give way to the right hon. Lady in a moment.
Lord Wilson made it clear in his comments:
“Every day in government, Ministers consider policy issues and depend on the Civil Service for advice. Anyone who has been a Minister understands the private space in which civil servants give their best advice.” —[Official Report, House of Lords, 19 March 2012; Vol. 736, c. 643.]
It seems to me that this debate is really very much about a matter of principle: the relationship between civil servants and Ministers.
I understand the Opposition wishing to make some political points, but many of them, including the right hon. Lady to whom I am about to give way, have recently been Ministers, so I am sure they understand that point, and it does not behove the House, in its desire to make a political point, to seek to undermine a long-standing relationship between Ministers and officials.
Dame Joan Ruddock
Why therefore has the strategic health authority in London felt able to publish its risk register? There are 18 areas of risk, and those that were red are, after mitigation factors, still red, so we learn something very important. That is why we should have the risk register under discussion published.
Tony Baldry
I understand that point, but they are very different registers. The register to which the right hon. Lady refers is meant to be publicised. The two are of an entirely different nature, and that point has been explained to the House by my right hon. and hon. Friends on the Treasury Bench on a number of occasions.
We are discussing departmental risk registers and the advice that civil servants give to Ministers. All I am saying is that right hon. and hon. colleagues, before they vote, should at least take care to consider the advice of former heads of the civil service on the effect that publication would have on the relationship between civil servants and Ministers.
Tony Baldry
I can assure my hon. Friend that what I am saying is true. All he has to do is walk a few feet to the Vote Office and pick up a copy of Lords Hansard and read for himself the speeches of Lord Wilson of Dinton and Lord Armstrong of Ilminster. All I am saying to my hon. Friend—
Karl Turner (Kingston upon Hull East) (Lab)
Will the hon. Gentleman give way?
Tony Baldry
No.
All I am saying to my hon. Friend is that this is a debate about the relationship between civil servants and Ministers, a relationship that has worked very well and very effectively in this country.
Here we have heads of the civil service advising Parliament that this move, which the Opposition would seek to force upon us, is not in the best interests of the relationship between civil servants and Ministers and is not in the best interests of the good running of government.
Adult Social Care
Tony Baldry Excerpts(12 years, 6 months ago)
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Tony Baldry (Banbury) (Con)
I am grateful for the opportunity to contribute to this debate, not least as co-chair with Baroness Pitkeathley of the all-party group on carers. The first point I want to make is about the phrase “adult social care”. One of the difficulties in this area is that if we are not careful we develop a secret garden of policy and we all start to descend into shorthand—referring to Dilnot as though everyone understands the five paragraphs that follow from that. I thought that the shadow Secretary of State for Health made a good point when he said that, for many people, this is all about being afraid of getting old. I think that this should be about not adult social care but care of the elderly.
When the Law Commission was asked to define social care, the best that it could come up with was the phrase
“promote or contribute to the well-being of the individual.”
That was pretty otiose. We should focus on care for the elderly because we will need to enlist in our constituencies many more people to get involved in this, not least local councillors, with the introduction of health and wellbeing boards. I do not know about other hon. Members but, although I think that the provisions in the Health and Social Care Bill on integration are really good news—I will come on to that in a second—I do not sense that county councillors and others have yet woken up to the fact that shortly they will be part of the boards and will be involved in delivering integrated care. Part of the reason for that is that this has been a bit of a secret garden of policy. One of the things that Ministers will have to do in the near future is go out and talk to, in two-tier authorities such as mine, county councillors, but in others those councillors who are responsible for running social services, to get across the fact that the whole way in which services are delivered will fundamentally change.
About half the speeches this afternoon have been what I would describe as old-fashioned speeches to Ministers, saying, “Please can we have some more money?” The truth of the matter, as we all know, is that there is no more money. It is actually more challenging than that. We have the Nicholson challenge of 4% efficiency savings in the NHS over four years. We will make this work only if we completely rethink the way in which we deliver services. We all know of far too many people who are in hospital but could be moved elsewhere if intermediate beds were available. That would mean they could be moved out of acute beds, such as those at the John Radcliffe hospital or the Horton general hospital in Banbury, but that would require someone working out how to provide more community facilities and intermediate beds and how they would be paid for, and that will require a lot of rethinking by county councillors and GP commissioning bodies working together.
We have to start to put this in a language that everyone understands. When the White Paper is published in the “spring”—that leaves only April—there is a danger that we will all get fixated on Dilnot and the cap. It seems to me that that is just one part of the whole equation for improving care for the elderly and, increasingly, elderly people suffering from dementia. The figures on dementia are really pretty scary. Among the many organisations that produced briefings for today’s debate is the Alzheimer’s Society, which reports—I had forgotten this—that there are now nearly 750,000 people in the UK with dementia, and that figure is set to rise to over 1 million by 2021, when many of us expect still to be in the House.
Dementia costs the UK economy £20 billion a year. When I was first elected to the House, most Christmases I would visit the homes for the elderly in my constituency. The residents then were mostly spry widows in their 70s, but now all the homes are almost totally full of people suffering from dementia or age-related dementia. This is about how we care for the elderly and, increasingly, elderly people with dementia, many of whom are having to stay at home longer. Indeed, the Alzheimer’s Society says that more than half of the people suffering from dementia have not yet been diagnosed as such because their families or those are caring for them are probably disguising the fact.
Barbara Keeley
I do not know whether the hon. Gentleman thought that my speech was one of the old-fashioned ones asking for more resources, but he probably did. However, I gave three examples of cuts to services for people with long-term conditions: the support services for people with dementia that Age Concern was running; a community matron service; and active case management for people with long-term conditions. It is inexcusable for those to be cut. If the Nicholson efficiency reforms are causing those services to be cut there is no way forward, because those are the supports in the community that will keep people out of hospital. It seems crazy. I now have three examples, whereas at Christmas I had only one. I am distressed to think that those services are being cut, because they are the way to support those people in the community.
Tony Baldry
One of the advantages of having been in the House for a little while is that one spends some time on the Government side, some time on the Opposition side and some time on the Government side again—I hope not to be on the other side again but am quite content wherever. One of the things I have learnt is that which side one sits on does not change reality. The reality is that this challenge is so enormous that it will not be solved simply by all of us telling the Treasury, “You’ve given us £2 billion. Please can we have another £4 billion, or another £8 billion.” It will only be changed if we fundamentally rethink how we deliver services for the elderly. If all Members asked how many delayed discharges there were in the general hospitals in each of our constituencies, I suspect that we would find that it is a huge number—I am afraid that Oxfordshire is currently one of the worse offenders. We have to do better. We have to fundamentally rethink the whole way we deliver these services.
Andy Burnham
I agree with the hon. Member for Kingswood (Chris Skidmore), who talked about the contributory principle, because there has to be a partnership between the individual and the state. If the hon. Member for Banbury (Tony Baldry) is ruling out general taxation, which I agree with him on because it would not be fair to make the younger population pay yet another cost, does he not accept that one ultimately comes to some difficult options in raising the extra money to build a fairer care system? We all have to start being honest about that and put some difficult options on the table, so that the public can have a debate about them.
Tony Baldry
Of course, general taxation will continue to play a part because it will fund the national health service, including the services delivered in acute general hospitals and so forth. However, far too many elderly ladies who go into a general hospital with a stroke or a broken hip stay there for longer than they need to for their treatment and could go home. We all need to engage in a debate in our constituencies that breaks out of the secret garden and involves far more people, including elected representatives, voluntary organisations and others.
Finally, I want to talk about carers, because I do not believe that any debate on care for the elderly should take place without a discussion about carers. I am the co-chair of the all-party parliamentary group on carers, so the House would be surprised if I did not mention them. There are two things that carers want. The first is recognition, which is now becoming slightly better. We need GPs and others to help people to understand that they are carers and to ensure, wherever possible, that they apply for a carers assessment, so that we can give support to carers. That will be particularly important if we are asking people to spend more time living at home when they are suffering from dementia and other conditions.
There are simple things that can be done. One of the worries of people who care for someone with dementia is that they will wander off and get lost. Age UK in Oxfordshire is starting a new initiative that encourages people to text a number if they see Mr Smith wandering down the street. Most of us are a bit embarrassed or shy if we see a neighbour wandering off and do not think that we should apprehend him, even if we think that he might not know where he is going or that it is not in his best interests to wander off. The question is how to deal with that as a community. There are lots of complexities in these matters. The whole community has to get involved if we are going to have more people living at home.
The second thing that carers want—I have said this on occasions too numerous to particularise—is breaks. We must ensure that there is a decent system of respite care. If there is not, carers sooner or later break, and when they break, they break for ever. That means that people whom it had been possible to care for at home go into a nursing or care home, never to emerge. With judicious and supportive carers’ breaks and respite care, many carers can be supported to carry on caring for a long time. Carers need to be valued and deserve to be valued. At every opportunity, the House should say an enormous thank you to the hundreds of thousands of carers in this country.
NHS Risk Register
Tony Baldry Excerpts(12 years, 7 months ago)
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Liz Kendall
I notice that the Secretary of State does not deny that members of his own Cabinet and Conservative and Liberal Democrat Back Benchers are concerned about the Bill.
Instead of fighting among themselves, the Government should be relentlessly focused on ensuring that the NHS meets the challenges of the future. Our ageing population, the increase in long-term conditions, and the huge medical and technical advances mean that the NHS must continue to change to improve patient care and deliver better value for taxpayers’ money. As my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) said, that means shifting the focus of services into the community and more towards prevention, so that people stay fit and healthy for longer. It means centralising some health services in specialist centres so that patients benefit from medical advances and get the best standards of care. It also means ensuring that local NHS and council services work together so that older and disabled people can stay living independently in their own home.
The NHS needs service reform, not structural reform. The Bill will make the changes impossibly hard to achieve. The recent Health Committee report on social care states that the best examples of integrated services have been achieved by care trusts, which were set up under the Labour Government, and yet those are being swept away by the Bill. In 2009, NHS London centralised stroke services into eight hyper-acute units. That decision was very controversial at the time, but within six months it had more than tripled the number of patients getting vital clot-busting drugs to the highest rate of any large city in the world. The Bill will put strategic service changes such as that at risk.
Liz Kendall
I have outlined what local NHS services have said about the risk register. If the hon. Gentleman had been in the debate earlier, he would have heard Government Members saying that we are not focusing on patient care or setting out how the NHS needs to change. The point that I am making is that the Bill will prevent the strategic changes that the NHS needs.
There is no evidence that smaller, GP-led commissioning groups can deliver major changes to hospital services. The organisations that have done so, such as NHS London, are being abolished. The real risk is that the full, free and unfettered market that will be introduced by part 3 of the Bill will stop the NHS from making the changes that patients desperately need. It risks preventing hospitals from working together to centralise stroke or trauma care; it risks preventing hospitals from running local community services or working with GPs and local councils to better integrate care, for fear that they will fall foul of UK and EU competition law; and it risks putting power into the hands not of patients and clinicians, but of lawyers and the courts.