Health and Social Care (Re-committed) Bill

Kate Green Excerpts

Wednesday 7th September 2011 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

rose—

[Kate Green (Stretford and Urmston) (Lab)]

rose—

[Nadine Dorries]

I want to finish this point, and then I will give way.

The counsellor would be completely impartial, give no advice or direction and be entirely independent, so if the woman had been through the process and then continued to abortion, she would do so knowing that she had talked through her options with somebody.

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[Gavin Shuker]

rose—

[Kate Green]

rose—

[Nadine Dorries]

I want to finish this point, and then I will give way. I know that the hon. Member for Stretford and Urmston (Kate Green) wants to intervene, and I will take an intervention from the hon. Member for Luton South (Gavin Shuker) first, in a moment.

There is a huge disparity in the figures, and the freedom of information request shows an even bigger disparity. Marie Stopes had told me—I hope I get this right—that the proportion of women who go to the organisation and do not proceed to termination is about 15%, although I do not know what freedom of information requests would show about those figures. The fact is that abortion providers are saying that 20% or 15% of women do not proceed to abortion, although freedom of information requests show that the figure is 8%, as was shown in the press this week. I have no idea why there is that disparity, or why they would say that the figure is 20% when it is not.

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[Nadine Dorries]

No, I will not give way again.

Those members of staff are themselves not necessarily happy with the guidelines and the way in which they are forced to operate. I speak to people at abortion clinics across the UK who would like the guidelines to change because they do not necessarily feel that women receive the counselling that they should receive because it is not offered but has to be asked for.

[Kate Green]

rose—

[Nadine Dorries]

I give way to the hon. Lady, who has tried to intervene several times.

[Kate Green]

Where in the hon. Lady’s amendment is there a guarantee of the quality of counselling that women would receive from such organisations?

[Nadine Dorries]

I hope that the quality of counselling is determined by the professional bodies by which the counsellor is accredited—they determine the standard of counselling. It does not matter whether counselling is for an abortion, for cosmetic surgery, or for anything else—it has a defined manner in which it is delivered, which is that advice is not given, that influence is not asserted, and that it is totally impartial. Any counsellor who is trained as such and accredited by a professional body delivers counselling in that manner.

Let me return to the mental health issue and the e-mails that I receive on a daily basis. One of the problems—

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[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I feel that I need to start by saying that this debate is about women; it is not about hon. Members. It is about ensuring that women get the very best possible services that they not only need but deserve.

There was much comment and speculation ahead of the debate, not all of it accurate or helpful. It might therefore be useful if I explain the Government’s approach to meeting the spirit of the amendments without primary legislation. I associate myself with my hon. Friend the Member for Bracknell (Dr Lee), who urged calm and balance. Today’s debate has not necessarily reflected either of those things.

How do the Government intend to meet the spirit of the amendments?

[Kate Green]

Will the Minister give way?

[Anne Milton]

I need to make a little progress.

The Bill gives new public health functions to local government. In some cases, the steps that local authorities must take will be prescribed in regulations, which include the provision of sexual health services and abortion services. That will be a duty of local authorities and not of clinical commissioning groups—some of the amendments in the group have caused confusion about that. We intend to specify in regulations that local authorities must ensure that part of what they commission is a choice of independent counselling.

Amendments 1 and 2 would fragment the service by splitting responsibility for the commissioning of counselling and for the commissioning of the rest of the service. If they and amendment 1221 were to be made, clinical commissioning groups and local authorities would have different but overlapping duties in relation to independent counselling, and the definition of “independent” would be different for each. We would have a fragmented service, which none of us wants. Most women go to their GP, which is not the same as a clinical commissioning group, or they self-refer to an abortion provider, so amendment 1221 would not work.

NHS Future Forum

Kate Green Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I can give my hon. Friend that assurance. Indeed, I can go further and say that one of the reasons the Future Forum has made no recommendations on the outcomes framework is that it found enthusiasm across the NHS for focusing on quality and outcomes and nothing but approval for the framework. Of course, the Labour party ignores the fact that, as stated in the White Paper we published last year, that is one of the central aspects of what we are setting out to do. He is right that the focus on outcomes, which enables people to see how this country performs in health, relative to other countries, and continuous improvement in health outcomes, rather than just a small number of focused targets, is instrumental in continuous improvement.

[Kate Green (Stretford and Urmston) (Lab)]

The Secretary of State is aware of the situation faced by Trafford acute trust. Will he reassure my constituents that there is no prospect of Trafford General hospital being either broken up or taken over by a private company?

[Mr Lansley]

The hon. Lady will have a further opportunity to discuss that shortly. She will know that the NHS trust in Trafford is examining whether it might merge with one of two possible foundation trusts and whether it might change its corporate configuration, as it were, but entirely within the NHS.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 7th June 2011 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

I was interested to hear the Minister’s earlier answer to my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) about the situation in Trafford. Will he confirm that he will encourage a collaborative approach, involving the strategic health authority, the primary care trust, the existing foundation trust and the potential bidding foundation trust, to secure the best possible clinical and financial outcome for patients?

[Mr Burns]

Yes, I can tell the hon. Lady that it will be up to the SHA, the trust and officials at the Department—[Interruption.] The SHA is the strategic health authority in the north-west. It is for them to work together to produce a tripartite formal agreement—when agreed, it will be published for the local community to see—as the best way forward to seek solutions and to help trusts achieve foundation trust status. It is in their interest and the interest of patients to bring about improved, high-quality patient care.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 26th April 2011 Commons Chamber

[Anne Milton]

The hon. Gentleman specifically mentions a constituent of his, and I have every sympathy with people coping with muscle-wasting diseases, and indeed with their families. The burden can be quite considerable. The multidisciplinary group that examined services throughout the north-west deserves our thanks for its work, but the fact is that it is for NHS commissioners, PCTs and the emerging GP-led consortia to consider the evidence that they have. Indeed, if money can be saved by commissioning services in a different way, so they should be, but that decision should be taken locally.

[Kate Green (Stretford and Urmston) (Lab)]

2. What steps he is taking to ensure the provision of acute services in Trafford district.

[The Minister of State, Department of Health (Mr Simon Burns)]

This is a matter for the local NHS. Every NHS trust has a duty to provide the best quality care for its patients. The Government believe that the delivery of health services should be led locally, with clinicians working with GPs and patients to ensure that their needs are met.

[Kate Green]

I am grateful for that answer and for the Minister’s letter to me last week, but, having already lost paediatric and maternity services recently, and with the decision not to provide trauma services in Trafford, local people are understandably anxious about further services being lost. Is the Minister confident that sufficient independent oversight is in place to ensure that the needs and wishes of local people are adequately met?

[Mr Burns]

I hope that I can reassure the hon. Lady, because if there were to be any reconfigurations in the future—I put that in the conditional tense because the relevant trust is confident that there will not need to be any—quite clearly the four tests that my right hon. Friend the Secretary of State introduced last May would have to apply. There would have to be full consultation with local people and with clinicians, GPs and others in the health economy.

NHS Reform

Kate Green Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. My objective is to ensure that the statutory structure for the NHS moves on from one that had virtually no serious accountability. As Secretary of State, I could have done most of this without the legislation: I could have just abolished most of the primary care trusts and strategic health authorities. Previous Secretaries of State behaved in that cavalier fashion, but we are not doing that; we are giving Parliament the opportunity—a once-in-a-generation opportunity—to give the NHS greater autonomy and, in the process, to be transparent about the structure of accountability.

[Kate Green (Stretford and Urmston) (Lab)]

Is the Secretary of State aware of the instability that we are experiencing in the management of NHS services in Trafford, with provider services off at Ashton-under-Lyne, Wigan and Leigh on a temporary basis, with Trafford Healthcare NHS Trust forced to find a new partner for its management, and the primary care trust forced, first, to combine with other Greater Manchester care trusts for one year, before splitting into GP consortia next year? In view of all that instability and the uncertainty that it is causing to staff in the NHS and at Trafford, will the Secretary of State ensure that he has the adequate support in terms of project and change management that appears to be so lacking at present?

NHS Reorganisation

Kate Green Excerpts

Wednesday 16th March 2011 Commons Chamber

[Mr Lansley]

I remember that if we ask the public whom they trust in public service, we find that general practitioners are at the top of the list. Members of Parliament and politicians are pretty near to the bottom of the list, so the public might take it pretty amiss that Labour politicians are insulting general practitioners by thinking that they are in it for the money. They are not; they are in it for the patients.

[Kate Green (Stretford and Urmston) (Lab)]

Will the right hon. Gentleman give way?

[Mr Lansley]

No.

Public Health White Paper

Kate Green Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

Through our tobacco control strategy, I am looking to achieve, as we will set out, a continuing reduction in smoking prevalence. In particular, I want to identify how we can substantially reduce the initiation into smoking among young people.

[Kate Green (Stretford and Urmston) (Lab)]

I genuinely welcome the Secretary of State’s recognition of the importance of a cross-Government approach to tackling health inequalities. He will be aware that Sir Michael Marmot identified income as one of the most important determinants of health. Will the Secretary of State make representations to his colleagues the Chancellor and the Secretary of State for Work and Pensions to ensure that everyone can have an adequate income, from those reliant on out-of-work benefits to those who are in employment?

[Mr Lansley]

I understand the hon. Lady’s point. Sir Michael Marmot has generously welcomed the White Paper’s proposals and its thrust. He made a specific proposal about a specific standard of living related to health—effectively a basic income proposal. That is not the Government’s proposal, but we intend to act on the other five domains in his report, the effect of which, among other things, will be to ensure that the welfare to work programme—the most ambitious and comprehensive programme ever initiated by any Government in this country to take people off benefits into work—will support people not only through better disability benefit assessments, which will help in health assessments, but by ensuring that people in work are healthier because they are less likely to be poverty and more likely to be free of the distress associated with unemployment.

NHS Reorganisation

Kate Green Excerpts

Wednesday 17th November 2010 Commons Chamber

[Diana Johnson]

Absolutely. Although not all PCTs have operated as we would like, there is good practice throughout the country. We should focus on that and see what we can learn.

I am concerned about the coalition Government’s approach to public health, because the junk food industry seems to be helping them to make policy, as some of our national media have reported in the past few days.

[Kate Green (Stretford and Urmston) (Lab)]

Is my hon. Friend aware that the Government have decided to abolish the health in pregnancy grant, which would further assist pregnant mothers with healthy eating and preparing for the birth of a healthy baby?

[Diana Johnson]

Absolutely. My hon. Friend campaigned long and hard for families, especially low-income families, in a previous occupation. The health in pregnancy grant is going and the Sure Start grant will now be paid only for the first pregnancy, so we are starting to see what the Government really think about improving people’s health, especially that of women.

Of course, we must not forget that during the election campaign in May the Liberal Democrats made it very clear that they thought NHS funding should not be ring-fenced. The right hon. Member for Twickenham (Vince Cable) said that the NHS should not be treated as a sacred cow. Again, we see the Liberal Democrats being the more regressive part of the coalition.

I wish now to concentrate on GP commissioning, because there are major issues on which we need to focus. Many specialist groups, particularly the muscular dystrophy group in Yorkshire, have been in touch with me to say that they are concerned that local GPs will not understand their health needs. I have talked to patients in the local hospital and other people receiving health care locally, who are anxious about their particular needs being met.

For me, a bigger issue is the performance of GPs. PCTs have been particularly successful in holding to account GPs who do not perform as well as they should, and I am particularly concerned about who is going to hold the ring. Who will deal with GPs who do not meet the needs of their communities?

A number of hon. Members have mentioned the bureaucracy in the new system of GP consortiums. I believe that there will be more administrators, and I say to the Secretary of State that, if we are to focus on health outcomes, bureaucrats will be needed to put together information and statistics and we will not, therefore, see the massive reduction in backroom staff that the Secretary of State expects.

A lack of accountability at local and national level is a major problem. The new national board—the largest quango that we have ever seen—is being created, but to whom will it be accountable? It is not acceptable for the Secretary of State and his Ministers to come to the House and say, “That is for the national board”, or “That is for local decision making.” We need control over what happens to our NHS. As I asked in my intervention on the right hon. Member for Charnwood (Mr Dorrell), why cannot we have some pilot projects? If the change is to be so great, let us pilot it, see what happens and take a considered approach. Let us have some evidence to back up the White Paper.

I do not believe that any of the Government’s proposals will improve the health care of the people I represent. Of course we believe that clinical involvement is important, and of course doctors and other health care professionals should be involved. My hon. Friend the Member for Rochdale (Simon Danczuk) made the point that we should use the PCT structure to provide more clinical information and advice—we can have that involvement without throwing out the whole structure.

The Government must also consider other health care professionals, such as pharmacists. There are pharmacists on the high street in my constituency who really contribute to the health care of my constituents. People such as Mr Hall on Beverley road and Cath Boury on Newland avenue do face-to-face work to encourage people to give up smoking or reduce their weight. If we want to get clinicians involved, let us get all the clinical practitioners involved.

I finish with the “any willing provider” model in the White Paper. The Labour Government made it clear that the NHS was the provider of choice. That was exactly the right thing to do, because it recognised the important role the NHS has played over the past 60 years. It has staff with specialism and dedication, but the idea of “any willing provider” is just code for the private sector, is it not? The attitude is, “Let’s just roll it out and have the private sector run our NHS.” Most people in this country, particularly those who vote for the Liberal Democrats—I point to their Benches in saying this—will be shocked to know that their MPs are standing up for the private sector. It is disgraceful, and I hope very much that the White Paper will be amended to state that the Government support the NHS as the main provider of choice, rather than going down the road of the private sector and the Americanisation of the NHS.

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[Mr Baron]

The answer to the hon. Lady’s question was supplied by my right hon. Friend the Secretary of State in answer to my question earlier. The one and five-year cancer survival rate figures will be published and presented, although how that will happen is in the melting pot. I very much welcome the work of the Office for National Statistics, the National Cancer Intelligence Network and the London School of Hygiene and Tropical Medicine. Whatever form the figures take, they will be in a performance table, not a league table, to ensure that all PCTs and then GP consortiums are tasked with improving performance, irrespective of how they compare with others. That will obviously include PCTs in deprived areas across the country.

I suggest to my right hon. Friend the Secretary of State that the focus on outcomes must include patient experience measures and longer-term quality of life measures, such as whether patients are able to return to work. That, too, is very important from the point of view of cancer patients.

As an aside, I suggest that there is a question mark about process-based targets such as waiting times in general. To return to the point made by the hon. Member for West Ham (Lyn Brown), the real problem when it comes to late diagnosis is not whether it takes one, two or four weeks for a patient to see a cancer specialist. It is how long it takes for the suspicion to be raised that cancer exists in that patient in the first place. Perhaps we should incentivise GPs to detect cancer earlier.

[Kate Green]

I absolutely appreciate the expertise that the hon. Gentleman brings to the debate, but I should like to ask his views on the issue of anxiety while waiting for an appointment. Whatever the physical outcomes of early treatment, there is a peace of mind issue for patients who are anxious to see their doctor as quickly as possible.

[Mr Baron]

I accept what the hon. Lady says, and I hope that the focus on outcomes will include matters such as patient experience surveys, which will incorporate that very point. It is an integral part of a patient’s experience, and it should be picked up when we start focusing on outcomes.

I return to GPs being incentivised to detect cancers earlier. In that vein, I very much support Cancer Research UK’s campaign to encourage greater access for GPs to diagnostic testing. That will be terribly important when it comes to detecting cancers earlier.

Moving on to GP commissioning of cancer services, there is no doubt in my mind that there is room for improvement in this area, and it would be naïve of Members to believe otherwise. There is often frequent confusion between the roles of strategic health authorities, cancer networks, PCTs and hospital trusts. The priorities of the cancer reform strategy are often not aligned with those of the PCTs.

I should like to play devil’s advocate and suggest to the Secretary of State that we need to tread carefully in dealing with the challenges ahead. The Secretary of State will be aware that GPs see only about eight new cancer cases a year, and that cancer is a set of 200-plus diseases with often complex care pathways. The GPs are often involved in the early and late stages of that care pathway, but the complex bit in the middle is often conducted by clinicians in hospitals.

Challenges lie ahead. We need to ensure that the responsibilities of the NHS commissioning board, the PCTs and the GP consortiums are clearly defined to avoid fragmentation of treatment across the cancer pathway. The reforms must help and not hinder the close working relationship between primary and secondary care doctors. The role of cancer networks in supporting GP consortiums needs to be clarified before those networks are broken up and their expertise is lost.

Furthermore, we must consider whether we need to redistribute the financial incentives to encourage more focus on the earlier and late stages of the care pathway. In other words, we must ensure that reward matches responsibility. Should a qualities and outcomes framework be realigned so that early diagnosis, survival and people dying in their place of choice are included?

In the last minute left to me I shall mention the cancer drugs fund. I have raised the issue with the Secretary of State before. There appears to be early evidence of disparity of access. When it comes to the cancer drugs fund, access should always be clinician-led. In some regions, approaches can be made to the PCT, and in others they are made to the cancer network, which, in turn, has access to the fund. Elsewhere, GPs are forming panels. May I suggest that best practice from the interim drugs fund is applied uniformly before the main drugs fund kicks off next spring? We do not want to add to cancer inequalities when it comes to access to treatment and drugs.

In the past, rarer cancers have had a very raw deal. I know that the Secretary of State is conscious of that and will ensure that those who suffer from rarer cancers will be treated much more fairly than in the past.

There is not time for the Secretary of State to answer all my questions now, but I hope that he will address them when he speaks at the Britain Against Cancer conference on 14 December, and I look forward to hearing what he has to say.

In short, the refocusing on outcomes is the greatest innovation and benefit to patients since the NHS began. However, that must not be undermined by the problems with GP commissioning.

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[Kate Green (Stretford and Urmston) (Lab)]

Let me begin by wishing the hon. Member for Winchester (Mr Brine) and his partner well for the pending new arrival. I am sure that they will receive an excellent service in their local NHS hospital, and that the whole House wishes them the very best.

I should like to use this opportunity to raise a few of the concerns that have been brought to my attention by people in my constituency. Many do not fully understand how the new proposals will work to deliver the outcomes we hope for, and I hope that the Minister can answer for them this afternoon. Essentially, people are anxious that where they live and who they are will begin to determine the level and quality of their care.

I am sure we all agree that consistency and guarantees of standards must be an integral part of the operation model that the Government seek to introduce. That is especially important in relation to health outcomes for the poorest and most vulnerable. There is a high level of health inequalities in my constituency. The people who live in the poorest wards suffer much worse health outcomes than those in the better-off wards in the south of the borough of Trafford. The local authority was quite slow to recognise that, so how will health inequalities receive strategic attention in the proposed new structures?

What will be the role of the public health director, who will be placed within the local authority? I am keen to know how that public health role in the local authority will devolve and relate to those at the sharp end in all health settings—those who provide front-line care. I hope that the Minister can fully explain that in his winding-up speech so that my constituents can be clear about it.

My constituents and I are concerned about how the wider drivers of health inequalities—income, education, employment and so on—will be addressed in the new structure, particularly when so many national policies seem to be taking us in the opposite direction, as my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) pointed out earlier.

[Lisa Nandy]

Does my hon. Friend agree that as well as the vast inequalities in life expectancy, the lingering issue of care for those who live longer and longer with chronic illnesses needs to be addressed? Those people are suffering now. Does she agree that it is an absolute disgrace that the Government have decided to tinker with the structures rather than put in urgent investment to help those people, including people in my constituency of Wigan?

[Kate Green]

Labour Members want to know whether the money spent on the restructuring of front-line care in our communities is the best use of that money. As the Health Secretary himself pointed out, we continue to have poor health outcomes and standards compared with our European neighbours, so why does it make sense to put more money into reorganisation and less directly into front-line care? I look forward to hearing what the Minister says about that.

The second issue that I want to address involves patient voice. That, too, has been raised in my constituency. A particular concern of mine is to ensure that the poorest and most vulnerable are heard. I am concerned about the lack of voice of those who do not have the sharp elbows and the articulacy to speak up for themselves to secure the best for themselves and their families. We know that that is the fate of many in our poorer communities, and especially of those with mental health problems.

I have been told a number of times in my constituency, including by GPs, that GPs are not particularly expert in, or equipped to deal with, mental health needs. How will those patients’ needs be identified, recognised and responded to in the new structure? What help will be available to enable patients to articulate such needs? There is uncertainty in my constituency on the future structure. How will patient voice, choice and opinion feed in to the new model?

The Trafford patient LINk—local involvement network—service is uncertain about its future role and status. I very much hope that Ministers will be able to give us more information about how we will get a clear opportunity for advocacy, so that every patient’s voice can be properly heard, and for proper support for patients who are perhaps less able to articulate their needs and secure services for themselves.

I am concerned also because I know—not just from my constituency, but from my long experience of supporting and working with vulnerable families—that different values pertain among different doctors and practitioners. I am particularly concerned, for example, for the young woman who may present herself to a GP who does not feel it appropriate to offer her advice on contraception or abortion. How can those minimum standards be protected, so that everybody—wherever they live, whoever their doctor is and whatever the structure is—knows that they will be guaranteed the care that they need.

Thirdly, I would like to raise with Ministers the issues that have been raised with me by health practitioners and professionals—and which have been highlighted in this afternoon’s debate—relating to GPs’ ability and willingness to take on the management aspects of their commissioning role. Many GPs have said to me—perhaps the Minister will be able to reassure them this afternoon—that what they see tanking towards them is a heavy burden of management, albeit without the additional resource with which to manage it. Many GPs have said to me that they have not really had the training—they lack the expertise—to be health managers as well as good-quality health practitioners and providers of front-line health care. I am interested to know whether Ministers have plans for training GPs and developing those skills and abilities in GP practices, or whether, as many of us on the Opposition Benches fear, the proposal will in fact be used as an opportunity to privatise that management function. If that is the case—this is not an ideological point, but an efficiency point—I shall be keen to know what financial model Ministers expect to operate if a substantial amount or even a proportion of the money that would otherwise be held in GP practices will go to fund the profits of private providers.

Those are the issues being raised with me in my constituency. They are issues that I am afraid I do not feel equipped to answer, because I do not fully understand how the new structures will work well in practice and, in particular, how they will work well for the poorest.

In concluding, I would like to highlight a point that has been made by a number of my hon. Friends this afternoon. The injection of extra uncertainty and disruption into our national health service at this time is further—and considerably—stretching our capacity to deliver excellent front-line care. I would urge Ministers to listen to the many GPs who have said to me—and who I am sure are saying to them—that what is proposed represents an element of change and disruption that they cannot yet see the benefits of. What they can see is that there is considerable uncertainty in the way that they are now working. There is certainly concern in my primary care trust. I hope that Ministers can offer some reassurance on that point, because at the moment there is considerable instability, and that cannot be good for any patient outcomes.

Supporting Carers

Kate Green Excerpts

Thursday 1st July 2010 Westminster Hall

[Kate Green (Stretford and Urmston) (Lab)]

I am pleased to have the opportunity to speak in this debate, not least because it is an important chance for us to pay tribute to the tremendous contribution made by carers across the country. I pay tribute particularly to the carers in my constituency.

As the Minister rightly said, many people do not even identify themselves as playing a caring role, yet they make a substantial contribution to supporting family members. That, of course, saves the public purse an enormous amount of money, but it frequently puts such individuals and their families under great pressure and stress.

I want to highlight the importance of providing carers with the financial support needed to participate fully in a life beyond care. That is at the heart of all the other forms of engagement and support rightly identified by the Minister, such as service support and measures enabling carers to get out into the community and, if they want to and can, to take up paid work.

I am concerned that carers are facing a raw deal financially. Many carers are placed in a position of relative poverty as a result of their caring role. I am concerned that recent announcements and the effect of the spending cuts that are still expected could put them in a yet more difficult position.

I am particularly anxious that, in the medium term, linking the value of safety net benefits to the consumer prices index will depress the value of carers’ income. I think that we would all agree that carer’s allowance is far from generous. Many other benefits important to families that include carers will be hit by the same constraint. The financial resources available to carers are a concern. Clearly, adequate financial resources are a prerequisite of every form of social participation: for example, the ability to take time out to go to the cinema, to go swimming or even just to have the pleasure of a cup of coffee in the town centre down the road.

The second issue about which carers have expressed concerns to me, not because it directly affects them individually but because of its effect on the people for whom they care, is the Government’s intention to test eligibility for disability living allowance. Carers recognise that their entitlement to carer’s allowance is affected in many cases by the assessment made of the individual for whom they care and whether that person is entitled to DLA.

I alert the Minister to the difficulties already arising in the processes for testing people for the new employment and support allowance. If testing is to be widened significantly, it is important that those problems are not replicated and that people’s eligibility for benefits to which they are entitled can be confirmed quickly. It is extremely retrograde to run people through medical tests for a disability living allowance intended not specifically to meet medical needs but to support much wider social participation needs. This is about meeting the extra costs that come with disability and long-term ill health. Medical assessments do not get to the nub of those problems.

Another of the Government’s financial announcements affecting carers that is causing concern is the decision not to continue with the savings gateway. Caring eats into savings, leaving families with little to fall back on. The savings gateway has been a success story, enabling people to set aside modest amounts in the knowledge that their saving plan would be supplemented and supported by Government investment. Many carers are disappointed that it will not continue.

I am sure that my hon. Friends and other hon. Members will also want to speak about the impact on the wider service network available to carers and concerns about the implementation of public service cuts. The cuts must be made in a way that protects carers and ensures that their needs continue to be met. I highlight particularly the concerns in my constituency about the tremendous time lag in assessing family members’ needs that frequently leaves carers without any support at all. Often, in due course, that support is put in place, but it is quite unacceptable that assessments should take weeks, months or, in some cases, even years. In the meantime, carers are put under great pressure to manage as best they can.

Other hon. Members will also want to draw attention to the opportunities for carers to participate more fully in paid work. I was pleased that the Minister referred to the need to ensure that people are aware of their right to request flexible working and acknowledged that we have a significant job to do with regard to employers. I certainly accept his challenge to ensure that the employers in my constituency are well aware of the issue. There is a particular imperative on the public sector to lead the way and to show that it can be the sort of employer that exemplifies the highest of standards in this field.

Of course, the real problem for carers entering paid work is the massive financial disincentive that they face as soon as they earn only a modest amount of money and the cliff-edge threshold that comes in as soon as they are on earnings of more than £97 a week. I think that we can all agree that that is a modest sum—for a large number of carers, work simply does not pay. We cannot afford the carer’s allowance to become the new equivalent of the much criticised dumping ground that, in effect, incapacity benefit became, when it was used as a way of massaging people out of the workplace on to some other form of inadequate benefit. It is important that carers can make work pay through a more generous disregard of earnings and a more gradual withdrawal rate as they move into paid work.

Everyone understands the financial pressures on public expenditure, but it is absolutely wrong that carers, who contribute so much and who are among the poorest, should take the biggest hit. They are being hit by the triple whammy of poor benefits, a difficulty in making work pay and a worry about the future investment in the services on which they rely. Those factors cumulatively add up to a severe limitation on the ability of carers to participate in the activities outside caring that so many of them desire to undertake. I very much hope that the public spending round of the comprehensive spending review will provide more generosity towards that vital group of people than the Budget has given us cause to hope for so far.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Dennis Skinner (Bolsover) (Lab)]

He’ll be the first one to get the sack.

[Kate Green (Stretford and Urmston) (Lab)]

7. What steps he is taking to encourage healthy eating.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I thank the hon. Lady for her question. May I correct the hon. Member for Bolsover (Mr Skinner), who suggested from a sedentary position that one of us might be getting the sack, by saying that I doubt it, because it is the previous Government who have just got the sack? In answer to the hon. Lady’s question, I say that there is no doubt that anything that the Government do must have a strong evidence base. It is for individuals to take responsibility for their health, and that includes healthy eating. However, the Government can help people make better choices—for example, by providing information, advice and so on.

[Kate Green]

I am little disappointed in that answer. Maternal nutrition before and during pregnancy is essential to the birth of a healthy baby. The Joseph Rowntree Foundation has shown that a healthy diet costs a minimum of £43 a week. A young woman on jobseeker’s allowance receives only £51.85 a week, so can the Minister explain what she will do to ensure that young women on such low incomes can choose a healthy diet?

[Anne Milton]

I am sorry that the hon. Lady was disappointed. Clearly, she does not feel that the Government should take a strong evidence-based approach to public health. I should point out to her that although life expectancy has increased, the gap between the rich and the poor has widened. If we look at the difference between spearhead areas and the country as a whole, we can see that the gap went up by 7% for men and 14% for women. We are determined to reverse that.