NHS (Government Spending)

Lilian Greenwood Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

That is rather interesting. The hon. Lady would criticise us if we said that we would do this through general taxation, but when we show where the money will come from—pound for pound—she criticises that as well. I want to hear the Conservatives say where they will get the extra money from for the NHS. I will come to that in a moment, but I will first give way to my hon. Friend.

[Lilian Greenwood (Nottingham South) (Lab)]

A moment ago, my hon. Friend was talking about the risks of privatisation. I know he shares my concerns about health services in Nottingham. What advice does he have for the voters of Nottingham who, as a result of the outsourcing of our hospital’s world-renowned dermatology department, which was then broken up, can no longer access acute dermatology services locally? How should our constituents vote on 7 May? [Interruption.]

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Mr Garnier, I am not going to tell you again. You are on a warning now. You make lots of interventions. Members show you respect, and I expect you to show it to others when they make their points.

--- Later in debate ---

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

I apologise for not being in the Chamber for the beginning of the debate.

The issues raised in today’s debate about the challenges of providing health care for a population that is ageing and living longer with complex health conditions in a context of fiscal austerity and rising costs are some of the most pressing ones facing us as policy makers. We all acknowledge that it is difficult and there is no easy soundbite solution to the long-term challenges, but I do not believe that those challenges are insurmountable if we are prepared to prioritise health spending and address pressure points in the system.

[Lilian Greenwood]

It is interesting that the hon. Lady was talking about the costs of an ageing population. Is she aware of Monday’s report by Action on Hearing Loss, which showed that as a result of budget cuts and rising demand two out of five audiology departments offer patients a reduced service? The chief executive of Action on Hearing Loss described that as having a cruel and senseless impact on people with hearing loss. Should the Government not respond to that?

[Dr Whiteford]

I was not aware of that report, so I am grateful to the hon. Lady for pointing it out.

We all know that we do not have one NHS in the UK—we have national health services in each of the home nations that operate independently of one another and are accountable to the devolved institutions—but it is worth noting that in recent years our distinct national health services have gone down divergent policy paths. Those of us who remain committed to comprehensive health care, available free at the point of need, understand that the model is under ideological threat. I have been horrified by the NHS reforms in England that have removed the statutory duty of care, and that, as we speak, are enabling the creeping privatisation of services. For the sake of the peoples of these islands, those reforms need to be reversed, because the reality of devolution is that Westminster still holds the purse strings. The funding formula by which the devolved Governments receive their block grants is directly related to budget decisions made for England in devolved policy areas, so decisions to cut spending in NHS England, or to privatise services, have a direct knock-on effect on the money made available to the Scottish Government.

There has been a 10% cut in Scotland’s fiscal resource budget since 2010, and a 26% real-terms cut in Scotland’s capital budget. Nevertheless, the Scottish Government have increased the health resource budget by 4.6% in real terms, and every penny of additional budget consequentials accruing from health spending has been spent on health. This coming year, health spending in Scotland will break the £12 billion barrier for the first time.

The practical consequences of increased health spending in Scotland can be seen in record staffing levels—up 6.5% overall, with record numbers of consultants, over 1,700 more nurses and a 7% increase in GPs. We have cleaner hospitals—cases of MRSA are down 88%, and C. diff is down 81% in elderly patients since 2007. Our waiting times for in-patients and out-patients have improved dramatically. More than 97% of in-patients were treated within the 12-week target in the last quarter, and 90% of patients are now being seen and treated within 18 weeks of initial referral. Perhaps most telling of all, there has been a drop in the hospital standardised mortality ratios of almost 16% since 2008 and a sizeable reduction in premature deaths in the most deprived areas. And we have honoured our pay commitments to our NHS staff.

The Minister and other Members have today made many comparisons between the NHS in England and the NHS in Wales, but there have been no comparisons with the NHS in Scotland. That is because across a range of indicators the Scottish NHS is outperforming the NHS elsewhere, precisely because we have not gone down the privatisation route.

Just yesterday the brand-new Southern general was handed over to the NHS—an NHS hospital, paid for without the use of discredited private finance initiative or public-private partnership schemes that have been an atrocious waste of public money and are still costing NHS Scotland over £225 million a year. In the north-east, anyone visiting Foresterhill can see all the building work that is going on to improve facilities. Under previous Governments, NHS Grampian was severely short-changed by the funding formula, but the SNP Government have been closing that gap and next year will put in an additional £49 million, a 6% funding increase to bring it into line with other health boards.

We cannot be complacent about the pressures on our NHS. Despite the best efforts and commitment of staff, our NHS is under strain and it does not always get it right. As MPs we often see when things go wrong, but we need to see that against a background of increasing patient satisfaction overall and continuing improvement in patient care, despite enormous pressures. We heard earlier today that some of the pressure on A and E emergency care is a consequence of people having problems accessing primary care. Another area where pressure in one part of the NHS has extensive knock-on impacts is in relation to delayed discharge, which puts tremendous strain on patients, whether they are stuck in hospital desperate to get home, or stuck at home desperate to get into hospital for treatment, because no beds are available.

The Scottish Health Secretary announced an additional £100 million earlier this month to address delayed discharges, but the underlying issues are not just for the NHS. Back in 2010 the report of the Christie commission highlighted, among other things, the need for joined-up services between health boards, local authorities and others, and preventive early interventions to meet the challenges of rising costs and changing demographics in the context of tight public finances. In Scotland, much progress has been made since then, but nobody would pretend that there is not a lot still left to do, or that the process is straightforward. However, we just need to look at how the non-means-tested free personal care has enabled thousands of people to live at home to see the human benefits of what is increasingly being recognised as a cost-effective policy.

It is precisely those efforts to join up health and social care that are threatened by the austerity agenda and the promises of further cuts that both Front-Bench teams seem to have shackled themselves to. Local authority budgets are already under pressure, and further cuts to the public services that they provide, including social care and preventive early intervention work, risk driving up still further the acute pressures on our NHS. Our NHS is precious. Most of us depend upon it. We need to prioritise it and provide the resources that it needs to meet changing demands on it.

A and E (Major Incidents)

Lilian Greenwood Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

The hon. Gentleman makes an important point. In fact, I was talking with someone senior at the Royal Cornwall hospital on Monday about the particular pressures there. Indeed, some of the funding that we allocated to the NHS in the autumn statement for next year is designed to do precisely that—to allow hospitals to maintain bed capacity while we ramp up facilities in community and primary care. It is very important to get the timing absolutely right.

[Lilian Greenwood (Nottingham South) (Lab)]

Yesterday the emergency department at Nottingham’s Queen’s Medical Centre faced such intense pressure that the trust was forced to enact its internal incident plan and cancel planned operations and out-patient clinics. Higher than expected admissions and delays in discharging patients who are well enough to leave hospital have been creating problems for many months. How can we resolve what is now a crisis if the Secretary of State will not even acknowledge that his Government’s deep cuts to social care are undermining the efforts of our dedicated NHS and social care staff?

[Mr Hunt]

We are doing an enormous amount to support social care. Some £3.9 billion of NHS funds has been given to the social care system over this Parliament, and we have strongly encouraged local authorities to ensure that any savings they have to make are done through efficiency savings, not cuts to front-line services. The hon. Lady’s local hospital has received £11 million in funding to help it through the winter. We are doing a huge amount to support the NHS through a difficult period, and she should support those efforts.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 25th November 2014 Commons Chamber

[George Freeman]

My hon. Friend makes an important point. Dementia is one of those diseases where the loved ones and the carers of patients often suffer every bit as much as the patients. That is why, under the Prime Minister’s leadership, we have launched the G8 dementia summit to bring together the world to tackle the disease. We have launched a dementia strategy. Diagnosis rates in Britain have gone from 42% to 55% in two years. We have launched a new dementia service and doubled research spending. We will have 250,000 staff trained by next March, and, from April, we will be investing £3.8 billion into the Better Care fund. It is an important disease that deserves our priority.

[Lilian Greenwood (Nottingham South) (Lab)]

The Ear Foundation recently published a report that estimates that the real cost of adult hearing loss is at least £30 billion a year. I hope that the Minister has read it. What is he doing to ensure that adults who could benefit from improved hearing technologies, including cochlear implants, do so, and when does he plan to publish the action plan on hearing loss that has long been promised?

[George Freeman]

I am not aware of the veracity of the £30 billion figure, but I will happily look at it, and I happily undertake to look at the progress of the report and the work that the hon. Lady raised.

Five Year Forward View

Lilian Greenwood Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

That is a very good point and I agree with my hon. Friend that we should aspire to a smoke-free Britain. We are making remarkable progress. The point the report makes—this goes alongside what my hon. Friend has said—is that we need to integrate our thinking about public health with our thinking about the services the NHS delivers. The better care fund has shown how it is possible to get excellent collaboration between local authorities and the local NHS for the delivery of social care. Transformational things are happening up and down the country right now. I would like to see the same thing for public health as well.

[Lilian Greenwood (Nottingham South) (Lab)]

Alcohol abuse costs the NHS in Nottinghamshire more than £55 million a year and cuts in social services are making the pressures worse, especially for emergency departments. Dr Stephen Ryder, consultant hepatologist at Nottingham University Hospitals NHS Trust, wrote to me recently to express his deep concern that the Government are not taking forward the introduction of minimum unit pricing. Why are this Government ignoring advice and clinicians and ducking the issue of dealing with cheap alcohol?

[Mr Hunt]

We are doing a number of things to tackle alcoholism. Alcoholism rates have continued to fall under this Government, so we are making good progress. The approach to alcohol is different from that to cigarettes, because responsible drinking is perfectly okay for a person’s health; it may even be good for their health, depending on which doctor they speak to. We want to be careful that our alcohol policies do not penalise responsible drinkers who may not have large salaries and worry very much about the pennies their shopping basket costs.

NHS Services (Access)

Lilian Greenwood Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

My hon. Friend is right. We heard the commitment that the Deputy Prime Minister gave last week, and I am sure that he means it, but people will ask why they have not done anything about it in this Parliament. It is lip service. We introduced talking therapies and many other things. The key point is that they cut it faster than they cut the rest of the NHS. Worse still, they introduced a tariff decision this year that will cut it even further and make the problems even worse. It was Labour that proposed parity of esteem between mental and physical health in law. The Government accepted it, but they have done absolutely nothing about it.

[Lilian Greenwood (Nottingham South) (Lab)]

One of the groups most affected by cuts to mental health services is children. On this Government’s watch we have seen increasing numbers of children with mental health difficulties treated on adult psychiatric wards. Is that not completely unacceptable?

[Andy Burnham]

My hon. Friend puts it very well. If mental health is the poor relation of the NHS, then child and adolescent mental health services are the poor relation of the poor relation. How can that be the case when we are talking about children who need the best possible support—the most vulnerable children—being denied the services that they need? My hon. Friend the Member for Leicester West (Liz Kendall) discussed at a shadow health team meeting a constituency case where a family were trying to find a bed for a child who was in a crisis and not one bed was available for that child in the whole country—not one bed. She is nodding. That is the reality. I wish that Government Members would focus on that rather than making complacent statements.

No amount of spin from the Government can disguise the fact that the NHS is heading for the rocks and urgently needs turning around, so the question is how we get it back on track. I have two positive proposals to put before the House on policy direction and on funding. Let me take each in turn. Instead of just admitting privately that the reorganisation was a mistake, the Government should be actively working with us to begin to put it right—and they will soon have a chance to do so. In five weeks, my hon. Friend the Member for Eltham (Clive Efford) will bring a Bill before this House to repeal the worst aspects of the Health and Social Care Act 2012. When the Government’s reorganisation was going through, their mantra was “Doctors will decide.” The Prime Minister repeated this in his “Today” programme interview during the Conservative party conference when he said:

“there’s nothing we’ve done which makes it more likely there’ll be private provision in the NHS”.

--- Later in debate ---

[Mr Hunt]

The right hon. Gentleman is quite wrong. My right hon. Friend said that there was a list of three providers, all with private provision involved. When the right hon. Gentleman was Health Secretary, he accepted that all-private shortlist for the Hinchingbrooke decision. In other words, the biggest privatisation in NHS history happened because of a decision taken by the shadow Health Secretary.

Government Members are not ideological. We believe there are times when we can learn from the independent sector, but, normally, people use the private sector when they are looking for innovation or better value. Only a Labour Government would sign deals with the private sector, paying 11% more than the NHS rate, and ending up paying more than £200 million for operations that never happened. What a shocking waste of money. When the right hon. Gentleman next talks about privatisation, instead of inventing a privatisation agenda that does not exist, will he apologise for a botched one that existed when Labour was in office?

Finally, there is a comparison that Labour never wants to make when talking about NHS performance: what happens over the border in Wales. That is where the policies that the right hon. Gentleman supports are put into practice. Let us see the difference. A record one in every seven Welsh people find themselves sitting on an NHS waiting list, compared with just one in 17 people in England. The urgent cancer waiting time target has not been met once since 2008 in Wales, but it has been missed in England in only two quarters in the whole period. A and E waiting times have been met every year in England, but they have not been met since 2008 in Wales.

[Lilian Greenwood]

Will the Secretary of State give way?

[Mr Hunt]

No, I will finish this point.

The British Medical Association, no friend of the Conservative party, described the NHS in Wales as being in a state of imminent meltdown. The point is that the NHS in England, like the NHS in Wales, faces huge pressure, but politicising operational problems in England, while denying much greater failings in Wales, is the worst kind of opportunism. For Labour Members, good headlines for Labour matter more than poor care on Labour’s watch. They are playing politics with our NHS. That not only scares people in England, but betrays people in Wales.

I shall conclude—

[Lilian Greenwood]

Will the Secretary of State give way?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The right hon. Gentleman is not giving way. He must be allowed to speak.

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[Lilian Greenwood (Nottingham South) (Lab)]

Earlier today, my hon. Friend the Member for Darlington (Jenny Chapman) asked the Prime Minister about the mothers from her constituency who marched 300 miles this summer to show their anger at this Government’s wasteful mismanagement of the health service. He dodged her question of course, because he has no answer to it. Is it reassuring that members of the Cabinet have finally realised what the rest of us have known for four years—that reorganising the NHS was a big mistake? I do not think so. There is disgust and anger out there, but not surprise. I was proud to walk alongside the Darlo Mums when their long march passed through Nottingham. The T-shirt I wore that day has a slogan on it. Sadly, I am not allowed to wear it here. It says, “Never trust a Tory with your NHS”. That is good advice.

We all remember what the Prime Minister promised before the election—no more top-down reorganisations. That promise did not last long. The reason I am angry is not just because that was not true, but because the reorganisation was the wrong policy at the worst possible time. We know that the finances are difficult. With both an ageing population and increasingly complex and expensive treatments available, the NHS faces unprecedented challenges. But instead of focusing on achieving the best possible outcomes for people with the resources available, the Prime Minister caused chaos: 4,000 staff were laid off and rehired; nurse numbers have not kept pace with demand; training places were cut; there are not enough GPs; training has been scaled back; hospitals are tied up in competition law; and savage cuts have been made to local authorities, leading to a crisis in social care and so pushing more and more elderly people into A and E when they should be getting the care they need at home. It is no wonder that morale is low when half of nurses say that their wards are dangerously understaffed; Ministers undermine the independent pay review body; and managers are being rehired after having six-figure pay-offs. But what makes me really angry is the impact that this wasteful reorganisation has had on my own constituents. I am proud of the NHS in Nottingham—whether in primary care, mental health services or our two acute hospitals. I know that we have great staff working incredibly hard for the people who need them, but at every level they face unbelievable pressure, and, in places, they are really struggling to cope.

The chief executive of Nottingham University Hospitals NHS Trust was very blunt when he met local MPs a couple of weeks ago. He told us that the trust faces the toughest ever cost-reduction plan, that this year he is planning for a deficit of £19.1 million—the first time the trust has been in that position—and that targets are being missed.

The accident and emergency department at Queen’s has missed the four-hour waiting target every month since August last year, and it reached its worst performance this June, in the middle of summer. I know our local hospital is planning for winter, but the crisis is already here. The reasons for the crisis are not simple, but it is clear that patient flow, both through and out of the hospital, is creating particular problems. Hundreds of patients who are well enough to be discharged or who should be receiving care and support at home or in residential care are still in hospital because their discharge is delayed. That is because, despite a commitment to joint working, social services cannot cope. The deep cuts to social care are having a real and direct impact on the NHS in Nottinghamshire and on my constituents.

NHS privatisation is now taking hold as commissioners are forced to put services out to the market. Let me tell the House about patient transport and my constituent, Jean. Jean is 84 years old and very unwell. She needs four hours of dialysis three times a week. Since a private company took over patient transport, she has been late for appointments, and had to wait for hours to be taken home. Such poor service has a knock-on impact on other patients in our city’s hospitals and the clinical commissioning group tells me that Jean’s experience is typical of feedback from other patients.

Last week, the chair of the hospitals trust described meeting a patient at 10 o’clock at night. That patient had been waiting since 10 o’clock in the morning to go home where his wife was waiting for him. Patients deserve so much better. Next May, they will have a chance to vote on the service, because Labour has a plan for the NHS. We will raise £2.5 billion for an NHS “time to care” fund. The money will come not from ordinary working people, but from ensuring that hedge funds and other tax avoiders play by the rules, and from asking those at the top to pay more and introducing fees on tobacco companies. The £2.5 billion will be used to employ enough doctors and nurses with the time to care for patients—20,000 more nurses to ensure that we get the basics right with safe staffing; 8,000 more GPs to help people stay healthy outside hospital; and 5,000 new home care workers and 3,000 more midwives. We will ensure better access and guarantee GP appointments in 48 hours or on the same day for those who need it. We will repeal the Tories’ NHS changes that put private profit before patients, so that our health service does the things that it should, such as care for patients and not argue about competition law. We will give patients and the public a real say over local services, and bring together physical health, mental health and social care into a single service to meet all of a person’s care needs —whole person care.

The message from the Darlo Mums to the Government was clear: hands off our NHS. It might not fit on a T-shirt, but my message today is equally clear. Labour built the NHS, Labour will save the NHS, and only Labour can transform it for the future.

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[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to conclude this debate and to speak to the contributions of hon. Friends and hon. Members. It is a pity that when we have NHS debates, they sometimes become unnecessarily tribal and partisan. Some Labour Members often seek to talk down the local NHS rather than to stand up for their hard-working NHS staff who deliver high-quality services on the ground.

I want to talk about some of the successes this Government have delivered for our NHS and then I shall address some of the points raised in the debate. We know that even in these difficult economic times, this Government have protected our NHS budget with £12.7 billion more during this Parliament. That was something that the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham) called “irresponsible”, but it is not irresponsible to make sure that we continue to support and protect the NHS front line. We have stripped out over £5 billion-worth of bureaucracy and reinvested that money into front-line patient care. That has been audited by the National Audit Office, but the hon. Member for Leicester West (Liz Kendall) did not choose to highlight that point in her remarks. It has been confirmed and we know it is true.

I make no apology for the fact that we as a Government have focused ruthlessly on having a more efficient health service that frees up as much money as possible for front-line patient care. We have reduced the number of administrative staff by around 20,000, increased front-line clinical staff by over 12,500 and set up a cancer drugs fund that has helped 55,000 people who would not have received cancer drugs to receive them. There has been an unrelenting focus on promoting a more joined-up approach to care, to help deliver more care in the community for people with long-term medical conditions, particularly the frail elderly.

Let me deal with some of the comments and contributions to the debate. I would like to reassure my hon. Friend the Member for Morecambe and Lunesdale (David Morris) that the hospital in his constituency is, of course, not going to close and that any local scaremongering by the Labour party is wrong and misplaced. I would also like to reassure the hon. Member for North Durham (Mr Jones), who raised concerns about the north-east ambulance service, that the service has generally been performing well. In 2013-14, it met all its national targets. I urge the hon. Gentleman to write to me if he has any further concerns on behalf of local patients.

We heard strong contributions from my hon. Friend the Member for Norwich North (Chloe Smith), who made important remarks about the services delivered at the Norfolk and Norwich hospital, and I look forward to accepting her invitation to visit that hospital once again in the near future, and from my hon. Friend the Member for Bosworth (David Tredinnick) who made one of his regular pleas for more alternative medicine in the NHS. Importantly, he talked about the benefits of clinically driven commissioning. Under this Government, we have put doctors and nurses in charge of our NHS to make sure that services are delivered at local level. Patient services are run by doctors and nurses, not by bureaucrats, which has been a tremendous step forward. My hon. Friend the Member for St Ives (Andrew George) made a considered contribution about the previous Government’s record on encouraging private sector providers in the NHS—a point to which I shall return.

[Lilian Greenwood]

What does the Minister think about what happened to the clinical commissioning group in North Staffordshire, which decided not to allow people with mild to moderate hearing loss to have hearing aids, even though that was clearly not the view of the local health scrutiny committees or local patients? Is that not precisely putting in jeopardy preventive services, which would keep people in work and keep them active in the community rather than being isolated? It is stopping those people from participating.

[Dr Poulter]

If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.

The right hon. Member for Leigh (Andy Burnham) referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.

We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.

Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, of whom the right hon. Member for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.

Hospital Car Parking Charges

Lilian Greenwood Excerpts

Monday 1st September 2014 Commons Chamber

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on securing this debate. I start with the point on which she finished, which is that the NHS is supposed to be free at the point of use. When we set sometimes exorbitant charges at different hospitals, we are effectively taxing the ill and their families.

Members have talked about the families of patients in hospital for the long term, with all the costs involved for relatives who visit them. This is honestly not a party political point, but in 2009, when my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) was Prime Minister, the Labour party suggested that those who had family members in hospital for a long time should get special permits to enable them to visit without having to pay each time, but that was scrapped in 2010 when the current Government came in. I ask them to reconsider that proposal. One way in which they could act very positively would be to have a similar provision such that the family of those in hospital for the long term can get and use special permits. That would certainly deal with the problem of the long-term ill.

There is another group of people whom we have not mentioned. We now have an elderly population and most older people have not just one health issue, but several health complications, so they often end up having to go to hospital to see consultants and doctors for six, eight or nine different illnesses or health issues. Each time they go, they or the person accompanying them has to pay hospital parking charges.

I give the example of my mother, who is 82 years of age. She has several different health issues, and every time I take her to my local hospital—I am her carer—it costs £3, just for five or 10 minutes. I am in the privileged position of being able to afford that, but there are many people in my constituency, who have caring responsibilities for adult and often elderly family members, who may only be on the minimum wage.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that for the many elderly people who do not drive, public transport is a really important issue, just like parking charges? Is she aware that Queen’s medical centre in Nottingham is soon to have the first dedicated hospital tram stop, which will improve access for older and disabled people in particular?

[Yasmin Qureshi]

I did not know about the Nottingham tram, but I am pleased that people there will have a tram stop to deal with the problem. Something like that would be brilliant in my constituency. There is a bus that goes to my hospital, the Royal Bolton, but because of its location the service is not frequent, so getting there is quite difficult. Such public transport solutions can help people as well. My hon. Friend is absolutely right that many older people cannot drive, so they also have that challenge.

Perhaps we do not think enough about the number of appointments most older patients have, as do those who are generally ill and have to go in and out of hospital for appointments numerous times. The way forward may be to abolish car park charging full stop, so that a scheme can be applied nationally. The minute we have a discretionary system and leave each hospital trust to decide for itself, some—perhaps because where they are located means they have a large parking space—can charge a small amount, such as 50p, while other hospitals that lack space because of where they are must charge a bit more. Leaving things to discretion means having, as everyone says, a postcode lottery. A better solution might be to make special dispensation, across the whole country, for those going to hospital appointments or those who are in hospital for some days.

Although I have a legal background, I am not normally an advocate for a lot more law, because it is not always a good idea to have loads of legislation. In this case, however, it is worth thinking about having legislation or a directive with the even more novel approach of abolishing such charges altogether. At the end of the day, nobody goes to hospital for pleasure; they go out of necessity and because they are unwell. Therefore, a hospital that raises £500,000 or £1 million, with all the budget it has—

Care Homes

Lilian Greenwood Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for his question. Of course the work has to go way beyond just what the CQC can do. I mentioned in response to my right hon. Friend the Member for Banbury (Sir Tony Baldry) the fact that organisations focusing particularly on compassionate care now carry out inspections and make reports. I have also mentioned NHS Choices, which means that any member of the public can give their comments on the care experience of a loved one. The more people use their power to highlight unacceptable things that are happening in care homes, and indeed great things, the better.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituent Maureen Pycroft witnessed appalling standards in the home where her husband Barry was meant to be cared for, and she was horrified to learn that the same care provider went on to run other services and abuse other vulnerable people some years later. Will the Minister assure me that the CQC now has powers to ensure that when there is abuse in homes, the providers who run them will be barred from running homes in the future?

[Norman Lamb]

The hon. Lady is absolutely right, and that is why we are introducing the fit and proper person test for every director of every care or health care provider. If they have been complicit in unacceptable standards or prosecuted for unacceptable care, the CQC can require them to be removed from the board of a care provider. The new standards should help considerably.

Hearing Loss in Adulthood

Lilian Greenwood Excerpts

Tuesday 12th November 2013 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

I am glad that we are debating an issue that affects all our constituencies, and I know that it is a matter of real concern to many Members in this House and in the other place.

I would like to begin by paying tribute to the work of the Ear Foundation, a cochlear implant support charity in my constituency. I was glad to secure the debate, and I hope that it will draw attention to the vital work it does to support adults and children with hearing loss.

One in six people in the UK experience hearing loss, and seven in 10 can expect to be affected by the time they reach their 70th birthday. That means that 10 million people live with hearing loss, and an ageing population means that that number will rise in the years ahead. To communicate is to be part of society. Losing one’s hearing is not just about the absence of sound—if not addressed, hearing loss can result in the loss of our social life, cutting us off from family, friends and work.

Deafness in adulthood is linked to depression, unemployment, poor mental and physical health and an increased risk of other conditions, including dementia. Hearing loss is a constant condition, and in most cases there is no cure. It is no exaggeration to say that it can destroy lives. People with hearing loss can find it difficult to negotiate everyday challenges in the workplace, on the bus, at the supermarket, or in the local doctor’s surgery, leading to isolation, exclusion and frustration.

Research carried out by Action on Hearing Loss has found that adults who lose their hearing are likely to withdraw from social activities. When they do take part, communication difficulties can result in feelings of loneliness. Hearing loss can also damage personal relationships. Many deaf people find it difficult to join in with family conversations and jokes. Couples say that they feel more distant from their friends, and partners of people with a hearing problem describe feelings of loneliness and frustration. Travelling on public transport becomes a challenge, and a platform alteration or a delayed connection can be a major problem if someone misses the announcement. That can leave deaf people feeling anxious and vulnerable when travelling, and worried about being stranded or lost. The debate among policy makers focuses mainly on quality-of-life issues, but failure to address hearing problems has implications for society as a whole.

[Jim Shannon (Strangford) (DUP)]

I have sought the hon. Lady’s permission to intervene in the debate. In Northern Ireland, 300,000 adults experience deafness or tinnitus—a sixth of the population, which is similar to the rest of the United Kingdom. Does she agree that a UK-wide strategy—and perhaps the Minister would respond to this—would benefit the core of the community across the United Kingdom, especially people with deafness?

[Lilian Greenwood]

I thank the hon. Gentleman for his intervention. He is quite right: these are issues that affect the whole of society, and I hope that the Minister will respond positively to his suggestion.

A 2006 study estimated that unemployment resulting from hearing loss cost the UK economy £13 billion a year. Too many people are forced to resign, retire or face redundancy as a result of their disability. People with hearing impairment report that their employers often have a passive attitude, providing adjustments and support only when prompted, and a significant number face outright discrimination.

Of the 300,000 people of working age with severe hearing impairment, 20% report that they are unemployed and are seeking work. Another 10% report that they cannot seek work as a result of their condition. As the state pension age rises and more jobs depend on communication skills than was the case 20 or 30 years ago, that vulnerability to unemployment is a growing problem. It represents a worrying underuse of the economic capacity of the nation.

Despite the scale and impact of hearing loss in the UK, adults with profound and severe hearing problems face major challenges when accessing health services. For many people, even seeing their GP can be a challenge, especially when surgeries rely on telephone booking systems and do not use visual display screens. One in seven respondents to an Action on Hearing Loss survey reported missing the call for their appointment while sitting in the waiting room. Poor deaf awareness among health professionals, such as not looking directly at a patient to allow for lip-reading, can lead to patients with hearing loss feeling unclear about the medical advice or information provided. According to the same survey, 28% of people with hearing loss have been unclear about a medical diagnosis and 19% have been unclear about their medication.

Diagnosis of hearing loss among adults is too often down to chance. Many are reluctant to seek help, and evidence suggests that people wait an average of 10 years before doing so. Stigma is a key factor in this delay in taking up hearing aids, which makes some people unwilling to tell others about their hearing loss. An Action on Hearing Loss report found that one element of stigma is the fear that deaf people are seen as less capable. A 2005 MORI poll of more than 20,000 people showed that one in five expressed concern about being treated differently.

Earlier diagnosis is essential to ensuring that people with hearing loss can access the support and services that can help them best manage their condition. A hearing screening programme for people aged 65 would help to overcome some of the barriers that prevent people from addressing their hearing loss. I pay tribute to the hon. Member for Eastbourne (Stephen Lloyd), who has led the Hearing Screening for Life campaign. Research by the consultancy London Economics suggests that such a programme would represent good value for money, so will the Minister consider establishing a pilot hearing screening programme?

There are approximately 4 million people with undiagnosed hearing loss in the UK who could benefit from hearing aids or, in a smaller number of cases, a cochlear implant. However, research suggests that GPs are often reluctant to refer patients for assessment or lack the knowledge to do so. Forty-five per cent. of patients presenting hearing loss symptoms are not referred, so something is clearly amiss. GPs’ lack of awareness of the impacts of deafness in general and a lack of knowledge of the benefits of cochlear implantation in particular give rise to concern. Greater education of GPs and audiologists on hearing technologies and the potential benefits of cochlear implantation for adult patients is therefore vital. I would be grateful if the Minister updated the House on the Government’s plans to ensure that training and updating on hearing technologies is provided consistently across the country.

Despite the obvious need, there is relatively little recognition of the impact of hearing loss or of the latest technologies that can improve hearing. We know that hearing aids improve adults’ health-related quality of life by reducing the psychological, social and emotional effects of hearing loss. For those who are severely or profoundly deaf, and for whom hearing aids offer little benefit, cochlear implants offer the chance of useful hearing.

[Jim Shannon]

I thank the hon. Lady for giving way; she is being very gracious. One of the issues that have come to my attention as an elected representative is that hearing aids are sometimes thought of as a big thing attached to the ear, but thanks to the advance of technology hearing aids are very small now. Perhaps that means that cosmetically they are less noticeable, and people can have the implant and lead a normal life. Is that one of the things that the hon. Lady feels should happen?

[Lilian Greenwood]

My hon. Friend is right. There is a need to increase awareness of what a cochlear implant is, how it operates and even what it looks like.

Despite the digital revolution in the NHS, in which high-quality hearing aids are now routinely fitted, there remains an under-utilisation of implants for adults, notwithstanding comparable advances in implant technology. One person who has benefited is Abigail from Nottingham, who found her implant an enormous benefit to her life. She was born deaf and grew up wearing two hearing aids until her hearing deteriorated, and doctors told her that hearing aids were no longer of benefit to her. Following detailed and intensive assessment she was approved for an implant, and when this was switched on it gave her new-found confidence. It rebuilt her self-esteem, enabling her to communicate more comfortably with her husband, family, friends and colleagues. Having a cochlear implant has given her a new lease of life, without having to rely on others to help her with communication, such as by telephone. It has also helped her immensely at work, where she can now communicate with colleagues on an easier level. It has helped her gain promotion and do a job that she enjoys. The cochlear implant has enabled her to get on with life at home, at work and socially, and with her hobbies, including music. She also does volunteering work in the community.

A cochlear implant stimulates the hearing nerve by means of rapid electrical impulses, which bypass the non-functional inner ear in people who are severely or profoundly deaf. Sounds heard with a cochlear implant are not the same as those heard with a human ear, but with the right support a person with a cochlear implant can adapt to the novel signal and use their implant to understand speech and other sounds, much like normal listening. One cochlear implant recipient said:

“I feel that so much of my previous life and true self has been restored, regaining my pride and ability to contribute actively in society on an equal basis.”

The late Lord Ashley, who is remembered and was rightly held in extremely high regard by many in this place, was known to call his cochlear implant a miracle. Surely it is time that everyone who needs a cochlear implant had access to their own miracle. There are an estimated 100,000 people with profound hearing loss, and 360,000 with severe loss. Although it is difficult to determine the exact number of adults who need an implant, on any of the current measures of profound deafness the current level of provision for cochlear implantation would appear to be significantly below any predictions of need.

The Ear Foundation suggests that as few as 5% of adults who might be able to benefit from an implant are currently getting one, and the UK is fitting only half the number of implants in adults as Germany and Austria. Speaking at last month’s Westminster launch of the Ear Foundation report “Adult Cochlear Implantation”, Dr Andrew Dunlop, a GP who suffered sudden hearing loss himself, described his own experience of deafness, undergoing assessment and receiving a cochlear implant. He said:

“I was fortunate, that as a healthcare professional, I knew my way around the system and was not overwhelmed when dealing with fellow doctors, audiologists and consultants. Sadly, the story for less informed individuals is not quite the same. My return to Practice emphasized to me just how much of an iceberg of unmet need is within the community at large, with many very able individuals assuming wrongly that they have no options after optimal provision of hearing aids and seem reduced to a second class life of social isolation, loss of self-esteem and frequently unemployment.”

Today’s debate is my attempt to chip away at that iceberg.

The criteria for implants are set by the National Institute for Health and Care Excellence, with guidance last reviewed in 2011. However, the criteria are based on evidence from patients who were predominantly wearing technology from the late 1990s, and since then there have been significant advances in cochlear implant technology. Many clinicians would argue that the criteria do not reflect real world listening, and that more realistic tests should be deployed instead.

Since the last review, there have been supportive studies on the effectiveness of bilateral implants—one implant for each ear—which NICE believes provide too little benefit for adults to justify NHS funding. One patient who was refused implantation described the process as follows:

“The conditions they did the testing in were ideal. It was perfect but they made no allowance for the difficulties you get if somebody is talking from the side, or if there is any background noise…and of course under those circumstances you do very well and it makes no allowances for the problems you run into in real life.”

In addition, the use of sentence tests, rather than monosyllabic words, enables deafened adults to use their previous linguistic knowledge to complete the test, thus appearing to have hearing that is too good for cochlear implantation. Brian Lam and Sue Archbold, authors of the Ear Foundation report, conclude that there is an urgent need to look at the deployment of a wider range of tests. They also argue that testing in noise and assessment of performance with monosyllabic words would be more appropriate. This would reflect current practice in Germany, where criteria are more flexible.

A growing body of evidence indicates that bilateral implants provide added improvements in speech perception in noisy environments over unilateral implantation, and better sound localisation, leading to improved quality of life. The Ear Foundation has recommended that NICE review its current guidance on cochlear implantation, and in particular on the criteria for unilateral and bilateral implants for adults. Will the Minister look into this matter and consider asking NICE to conduct such a review? Does he agree that where a clinician believes that it is in the best interests of an individual patient, there should be some discretion in applying these guidelines?

Charities in the field have welcomed the Department of Health’s development of a national hearing loss action plan, but they are disappointed that it has been delayed by a year. I join those charities in urging the Government to prioritise its publication. Last month the noble Baroness Jolly stated in the other place that the Government aim to publish the action plan as soon as possible. I would be grateful if the Minister updated the House on when it will be published and how its implementation will be monitored. Has he assessed the suggestion of establishing a lead commissioner for audiology so that there is greater focus on good commissioning across all clinical commissioning groups?

The right hon. Member for Gordon (Sir Malcolm Bruce), who chairs the all-party group on deafness, last month challenged the Government, and any Government who come after them, no longer to leave deaf people behind. Today I echo those words. I hope that the Government can help move this issue, which affects all our constituencies, beyond debate and ensure that action is taken to address it.

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[Norman Lamb]

My responsibilities stretch only to England, but clear co-ordination and joint working with the devolved Administrations absolutely make sense on an issue that transcends borders, so I agree with the ambition that the hon. Gentleman sets.

This cannot just be about prevention because that is not always possible; it is also about dealing with the consequences of hearing loss. The Government are committed to delivering health outcomes that are among the best in the world for people with hearing loss. We are developing measures to identify those with hearing loss as early as possible, including the roll-out of a national hearing screening programme for newborn babies that enables the early identification of deafness, providing a clear care pathway for services and allowing parents to make informed choices on communication needs.

Today, however, we are focusing on adults with hearing loss. I realise that there is currently considerable interest on hearing loss screening for adults, which the hon. Lady mentioned. The UK National Screening Committee advises Ministers and the NHS in all four countries on all aspects of screening policy. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria. In 2009, the committee recommended that routine screening for adults’ hearing loss should not be offered because of a lack of evidence to warrant such a screening programme. However, as part of its three-year review policy cycle, the committee is reviewing the evidence for a national adult hearing screening programme. A public consultation will be held shortly and details will be available on the committee’s website. I encourage the Ear Foundation and many others to contribute to that consultation.

We welcome the recent report by the Ear Foundation, which clearly sets out the benefits of cochlear implants for children and adults. Abigail’s story, as told by the hon. Lady, demonstrates what a massive impact that can have on an individual’s life. It completely transformed her life, and no doubt that experience is repeated very many times around the country. The report will be of enormous use to NICE if it decides to update the technology appraisal that it published in 2009. I encourage the Ear Foundation to engage with NICE. I am sure that it is already in touch, but it is very important for it to provide any emerging evidence to NICE to help it to update, if necessary, the guidance provided on implants.

A large number of services are already commissioned for people with hearing loss, and a number of specialist centres in England provide implants for children and adults. It is important that GPs understand the criteria for referral, as well as the obvious benefits of this technology for people with hearing loss. That touches on the hon. Lady’s point about the importance of health professionals, whether GPs or anyone else in the health system, gaining a better understanding of the potential for this technology. There have been considerable improvements to services for people with hearing loss in recent years, including reduced waits for assessment and treatment to within 18 weeks—a significant advance.

[Lilian Greenwood]

I thank the Minister for his positive response to the questions that I posed. What will he personally do to ensure that such training and updating on hearing technologies by health professionals and GPs takes place?

[Norman Lamb]

I do not want to give a bland answer, but I take this issue very seriously. I have noted what the hon. Lady has said. Health Education England is responsible for the training of health professionals. I will pursue the hon. Lady’s point and would be very happy to report back to her.

There is now a greater choice of hearing aid services through independent high street providers—which are easily accessible for members of the public—and the new any-qualified-provider commissioning model offers even greater choice and convenience.

We have also asked NICE to produce clinical guidelines and related quality standards for the assessment and management of adult-onset hearing loss and guidelines for the assessment and management of tinnitus, which the hon. Member for Strangford (Jim Shannon) has referred to in the context of Northern Ireland. Those guidelines will be scheduled into NICE’s development programme over the coming months.

Enabling those with hearing loss to have the same opportunities and to live as independently as everyone else is essential. It is therefore vital that public services are geared up to help and support them. Public authorities, including health and social care bodies, are required by the Equality Act 2010 to make reasonable adjustments for disabled people, to ensure that they can use a service as close as is reasonably possible to the standard usually offered to everyone else. The Department of Health has agreed to explore with its partners what more can be done to accommodate the communication needs of disabled service users.

Work is going on across the Government to support the needs of people with hearing loss. The Department for Transport’s Access for All programme has delivered access improvements at 1,100 stations since 2006, including induction loops at ticket offices and help points on platforms. The hon. Member for Nottingham South mentioned the specific problems that people face when travelling and the anxiety caused by worrying about not hearing an announcement. There will be facilities on platforms for deaf users and systems that show train information on LED display screens. Last year, a further £100 million was announced to extend the programme until 2019.

Courthouses have been provided with hearing loops since December 2012. In policing, police link officers for deaf or hard-of-hearing people use and are qualified in British sign language and work with the community to raise awareness of how to access the police. Staff in Derbyshire have passed level 1 of their training with Action on Hearing Loss, and they accepted an Action on Hearing Loss charter mark, “Louder than Words”, recognising the efforts they have made to communicate more effectively with deaf people. I pay tribute to those parts of the public sector that have made the effort to improve the way in which they communicate. Far more needs to be done, but they are the exemplars that others should follow. For those who do not use BSL, text relay, which enables deaf and hard-of-hearing people to text the police, is in place in most emergency call centres.

I hope that those examples give a flavour of some of the work that is being done across the public sector and confirm the Government’s continued commitment not only to preventing, but to treating hearing loss and promoting and protecting those affected.

[Lilian Greenwood]

Will the Minister give way?

[Norman Lamb]

The hon. Lady is just in time.

[Lilian Greenwood]

Before the Minister concludes his speech, will he address my specific suggestion to establish a lead commissioner for audiology, to ensure that there is a focus on good commissioning across the health service?

[Norman Lamb]

I will discuss that suggestion with NHS England, because that is its responsibility under the new design of the health system.

Let me end by congratulating the hon. Lady again on raising this really important issue, and I repeat that I am happy to engage with her to try to make progress.

Question put and agreed to.

A and E Departments

Lilian Greenwood Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

As I said, we need to address all the problems with 111. The lack of confidence in GP out-of-hours care is one of the contributing factors to a lack of public confidence. The meeting that the hon. Gentleman mentions will be going ahead.

[Lilian Greenwood (Nottingham South) (Lab)]

Eighteen months ago, Nottingham University Hospitals NHS Trust experienced a sustained increase in visits to A and E and hospital admissions, resulting in thousands of cancelled operations. The trust conducted an independent investigation to help it to understand and respond to the crisis, which had multiple causes. Will the Secretary of State confirm that the study did not conclude that poor provision by GPs or the out-of-hours service was to blame?

[Mr Hunt]

If I recall correctly, the study said that there were multiple causes, but it was Nottingham university that said that poor out-of-hours GP provision was responsible for an increase in paediatric A and E admissions, so Nottingham university understands this issue.

Home Care Workers

Lilian Greenwood Excerpts

Wednesday 6th March 2013 Westminster Hall

[Mr Smith]

Absolutely, and I am coming to that point. I could not get myself completely ready in the limited time that some care workers have; some are allocated 15-minute slots for visits.

When things go wrong, it is vital that staff speak out, yet too often care workers feel vulnerable and not in a position to do so. I note that last month, the Secretary of State for Health said that he was “very sympathetic” to extending to home care workers the duty to whistleblow that the Government are thinking of applying to nurses. I urge the Minister to do so.

It is crucial that inspection is extensive, robust and effective. It is all the more so given the importance of care and the fact that it takes place in people’s homes, away from immediate supervision. There are concerns about that in Oxfordshire right now. Our local paper, the Oxford Mail—I am sure you will remember it well, Mr Turner, from your time in Oxford—has highlighted concerns raised by our local patient voice and county councillors about the adequacy of local CQC inspection arrangements. In November, there were just two inspectors for Oxfordshire, and even now there are only five, who between them are responsible for inspecting 447 health and social care institutions and thousands of home care visits.

There is all-party concern. Conservative councillor Jim Couchman, who chairs the county’s adult services scrutiny committee as well as being a member of the health overview and scrutiny committee, said after meeting the CQC:

“We did get pretty worried by what we saw as an extremely ill-equipped organisation to deal with the responsibility accrued to it…The CQC is not a proper inspection team in any way, shape or form.”

Councillor Couchman has also told me since that apart from the enormity of the task required of such a small staff, the most surprising fact was that recruits did not need any experience or knowledge of the NHS, health care or social services. The CQC seemed more concerned about whether new staff had a background in regulation.

I was also concerned that when asked to talk to the Oxford Mail, the Care Quality Commission declined. When such worries are being voiced, it is all the more important for a body such as the CQC to come forward and answer questions as a basic responsibility of public accountability, as well as to take the chance to build public confidence rather than undermining it, as the CQC ended up doing. Will the Minister look into the position on care quality inspection in Oxfordshire? More generally, will he ensure that the commission has sufficient inspectors across the country with the right experience to do the job?

Feedback from users and their families is another important yardstick by which to lever up care standards. Our county council uses individual visits and client satisfaction surveys to inform contract monitoring. However, a wider public satisfaction rating is needed for the plethora of care agencies. One of the paradoxes of modern life is that, if advice is wanted on the standards of service providers such as restaurants, hotels and garages, or of products such as cars and electrical goods, there is no end of reviews out there to guide people, but for something as important as helping someone to find a good care provider, there seems to be nowhere to look for advice. In theory there is competition for provision, but in reality all the customers are groping around in the dark. That is a good reason not to emulate in mainstream NHS provision the privatisation that has already happened in care services.

Underpinning all that, action is desperately needed on the terms and conditions of care workers. They are doing a demanding job, often on the lowest wages and with minimal security. According to the Unison “Time to care” survey, more than half of home care workers overall and more than 80% in the private sector are not paid for travel time or costs; it has been estimated that between 150,000 and 200,000 home care workers are in effect paid less than the national minimum wage as a result. To make matters worse, more than half of private sector home care workers have a zero-hours contract with no guaranteed pay, and more than half of all home care workers reported that in the past year things have got worse for them on pay, working time and the duties expected of them.

[Lilian Greenwood (Nottingham South) (Lab)]

I thank my right hon. Friend for setting out clearly some of the home care issues. Does he agree that zero-hours contracts in particular make it difficult to ensure continuity of care for clients and difficult for a provider to invest in its staff, because they are constantly having to look for alternative work to make up the hours to obtain a decent income to support themselves and their families?

[Mr Smith]

My hon. Friend makes an excellent point, and must be reading my mind, because my next sentence was that zero-hours contracts present real problems for continuity of care, which was the point she made. It is important that vulnerable clients in particular have carers whom they know, trust and have built up a relationship with.

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[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing the debate. It is a pleasure to follow all the speakers, who fully and excellently set out the case for care workers.

When I read the “Time to Care” report, I had an enormous feeling of déjà vu. Before becoming a Member of Parliament, I worked for Unison as a full-time officer. Back in the 1990s, one of my first jobs as a young officer was supporting the Derbyshire county council home helps joint consultative committee. “Home helps” was the name given to home care workers in Derbyshire, of whom there were thousands. The joint consultative committee used to bring together representatives of home care workers from across the county with senior management of social services, including the director of social services, who so understood the important role of home care that he was always prepared to attend meetings to listen to the views of home care representatives. It was an opportunity for them to raise their concerns and the issues that their members faced.

The 1990s was a period of huge change for such workers. The role of home helps was changing immensely: they moved from providing a service that was basically helping older people with cleaning, shopping, meals and even, back then, laying fires, to providing much more intimate personal care and dealing with people with increasingly complex needs. It was also a period of budget cuts, which accounts for the feeling of déjà vu. There was pressure to change services, to make them efficient, obviously, but also to open them to the private market.

I vividly remember Derbyshire home helps raising concerns about a proposed move to a time-recording system. When they arrived at a service user’s house, the first thing they had to do was telephone to tell social services where they were, so that there was much more detailed information on the amount of time they spent with each service user. A concern they raised at the time was that doing so would change their focus, so that rather than their prime focus being on the needs of the service user, their top priority when they arrived was to record their time so that social services could properly cost the service.

I also remember home helps raising concerns about short calls that did not allow them time to care, to listen to what services users wanted or to respond to their priorities.

[Andrew George]

The hon. Lady makes an excellent point about recording arrival and departure times. Often the system simply fails, not only in rural areas, where mobile coverage is poor, but when using the cared for person’s telephone. Carers often cannot get through and calling becomes a greater obsession than providing the care itself.

[Lilian Greenwood]

The hon. Gentleman is absolutely right. I remember well the representative from the High Peak area constantly making that exact point, which was that there was poor mobile phone coverage. They talked about how much of their time would be spent dealing with the telephone instead of focusing on the person who required their assistance. There were also worries about travel time.

I particularly remember the concerns of people who worked alongside private sector care providers where, they reported, staff training was often inadequate and there was often a high turnover of staff. They also reported that the care providers frequently did not provide personal protective equipment; they talked about the lack of rubber gloves and the like. We often had discussions about which tasks home helps were given time to carry out. They often pointed out that their service users wanted and needed things that might not be what the carers were commissioned to provide.

Unison’s “Time to Care” report and the Care Quality Commission’s “Not Just a Number” inspection programme made me wonder whether we should have listened more closely to the concerns and issues raised by those Derbyshire home helps 20 years ago, particularly when, in describing the current context, the CQC talked about the

“increasing pressure on social care budgets and the rise in the number of people with complex care needs and dementia.”

In describing its key findings—as my right hon. Friend the Member for Oxford East said, a quarter of services fell below the standards expected—the CQC said:

“What is concerning is that our findings come as no surprise to people, their families and carers, care workers and providers themselves.”

The findings really do not come as a surprise, because they are exactly the issues that have been raised over many years.

The CQC highlighted several problems, including service users

“not being kept informed about late arrivals, different care workers from one visit to another, not having their preferences clearly documented, a lack of support for care staff to carry out their work, and failure to address the ongoing issues around travel time.”

Those are responsibilities of not just this Government but the previous Government, but the pressure on social services that are commissioning care services is even greater now, and we need to look again at what is required.

There is great similarity between the findings of the CQC and Unison’s “Time to Care” report. Although the care and welfare of service users is the most important focus, the CQC found that staff felt

“unsupported by their management teams and not…able to deliver care in the right way because they are too rushed, with no travel time and unscheduled visits added to their day.”

It also reported a lack of planning and supervision for staff. Training needs were not identified, staff were not confident in using their equipment, and inductions were not always completed following recognised standards.

As the hon. Member for St Ives (Andrew George) said, the voices of care workers are often not heard in debates such as this one. We ought to address that today. I was pleased to see that Unison’s report included many quotes from individual home care workers. It provided an opportunity for them to have a say and to talk about their experiences. My hon. Friend the Member for Wirral South (Alison McGovern) has already quoted one of the home care workers who contributed to the report, saying they did not have time to spend with their service users and they had to rush between calls.

One of the most important issues is about older people. I imagine that many hon. Members have this experience when they are out canvassing in their communities: they knock on the door of an older person, and perhaps the Member is the only person they have spoken to that day. Their priority is to talk to someone who is willing to listen. That was well recognised by one of the care workers who contributed to the report, who said that

“care is not just about duties but communication and many providers do not allow for this…How can half an hour be enough to get someone up, dressed, meds given and have a chat? People are being failed by a system which does not recognise importance of person-centred care.”

There are many quotes in the “Time to Care” report, which I am sure the Minister has read. I hope that he listens to the voices of home care workers and the issues that they raise.

It is vital that, like the director of social services in Derbyshire back in the 1990s, we listen to the voice of home care workers, because they meet service users every day. Most of them are incredibly committed to providing a good-quality service and ensuring that people receive the support that they need. It is also vital that we do not simply listen to them, but act. Will the Minister meet home care workers and their representatives to discuss the findings of Unison’s “Time to Care” and the CQC report? Will he set out today how he intends to respond to the findings of those reports?

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[Norman Lamb]

I totally agree with her. If a worker can aspire to something better—perhaps a progression in their career—they will commit themselves very fully to the role. The idea of a vocational progression towards nursing, even if, at the end of the day, a degree is involved, should be opened up much more than it is at present. I completely agree with her on the points that she makes.

I share the concerns that hon. Members have raised about pay. There have been reports that some home care workers may be working for less than the minimum wage, which is an absolutely disgraceful situation for a vast number of reasons, not least because an illegally low wage will never produce excellent results and it is an exploitation of the worker that we must not tolerate. It is the responsibility of all employers, including home care providers, to pay staff at least the national minimum wage. The Government are working closely with the Low Pay Commission and local authorities to address that issue. I can assure all hon. Members that we will not accept anything less than 100% compliance with the regulations.

When I was a Minister in the Department for Business, Innovation and Skills, I wanted to change the rules to make it easier to name and shame employers who fail to pay the minimum wage. We must regard that as completely unacceptable practice, and any employer who indulges in it should be exposed; it is utterly intolerable.

[Lilian Greenwood]

rose—

[Norman Lamb]

I am conscious that time is tight and I want to address the remaining points.

The hon. Member for Erith and Thamesmead (Teresa Pearce), who is no longer in her seat, raised concerns about potentially bogus arrangements in her constituency in Bexley. I think that she is writing to me on that matter, and I will be happy to look into it.

Care providers are also responsible for ensuring that their services meet the requirements in regulations and essential standards. The regulator, the Care Quality Commission, has powers that it can use to make sure that that happens. The CQC has our full support to use those powers as it sees fit to drive improvements in services. It is worth taking a moment to talk about the CQC report, which we have been discussing this morning. Between April and July 2012, the CQC inspected 250 registered home care providers as part of a themed programme to highlight respecting and involving people who use services and safeguarding them from abuse and neglect. To ensure that everything was examined thoroughly, it involved the people who use the services as well as the people who provide them. It looked at how staff are supported and how standards are maintained. Overall, the CQC found that 74% of the services that it inspected met the standards, and about a quarter did not. That is unacceptable and we must all focus our attention on those services.

The right hon. Gentleman referred to concerns about CQC’s capabilities in Oxfordshire, and I am aware of local media attention on that. My officials have raised those concerns with CQC and they were assured that it is on track to achieve its goal of inspecting 100% of adult social care locations across Oxfordshire by 31 March, that its Oxfordshire compliance team now consists of 10 full-time inspectors and that, after a period of recruitment, CQC has had no vacancies in the area since last December. If concerns continue, I urge the right hon. Gentleman to contact me and I will be happy to look into them further.

The importance of commissioning must be stressed. Commissioning over short periods of time—that race to the bottom—is unacceptable. We must commission on the basis of quality, as the hon. Member for Leicester West said. Finally, let me thank the right hon. Gentleman for securing such an important subject for debate.