NHS Care of Older People

Lilian Greenwood Excerpts

Thursday 27th October 2011 Westminster Hall

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Betts. Like the hon. Member for Mid Norfolk (George Freeman), I must apologise that I have to leave at 4.30 pm, so I may not hear all the contributions that are made.

I congratulate the hon. Member for Stourbridge (Margot James) on securing this vital debate and on asking many important questions about quality of care and patients’ experiences of hospital. In addition, I welcome the contributions that have been made by other Members, which have been very important in fleshing out those issues.

I will make quite a brief contribution to the debate. Hon. Members have rightly recognised that, although there are some serious concerns about the care of older people within the NHS, there is also good practice that we can build on. So I will limit my remarks to giving one example of good practice that I hope will be of interest to hon. Members.

Earlier this year, I visited Queen’s medical centre, which is one campus of Nottingham University Hospitals NHS Trust. For those who are not familiar with it, it is a major acute and teaching hospital in Nottingham. While I was there, I visited ward B47, which is an acute medical ward for patients with dementia and delirium. Ward B47 has received a national health and social care award for mental health and well-being, and it was highly commended for putting patients and the public first.

While visiting ward B47, I met Professor Rowan Harwood, who is a consultant in health care of the elderly, Caron Swinscoe, who is the clinical lead for dementia, the ward’s matron, Ali Cargill, and Louise Howe, who is an advanced practitioner in occupational therapy, specialising in mental health services, and who spent 10 years working in mental health before she came to work on the ward.

Queen’s medical centre set up the medical mental health unit as part of a collaborative research project between Nottingham University Hospitals NHS Trust and the university of Nottingham, which was funded by the National Institute of Health Research and the Department of Health. The unit at Queen’s built on earlier work in 2005 by the Royal College of Psychiatry, which had shown that patients with dementia and delirium formed a large proportion of in-patients in acute general hospitals and that they had much worse outcomes than those in-patients with less complex problems. The unit was specifically designed to start to address that situation.

Ward B47 is a 28-bed ward, with three registered mental health nurses, a specialist mental health occupational therapist and an activities co-ordinator. Those staff members are working together with an existing multidisciplinary team, which includes an occupational therapist with experience in discharge planning. That new team was set up in January 2010. In addition, the environment of the ward was changed and all staff were given additional training in person-centred care.

In this debate, hon. Members have quite rightly spoken about the Care Quality Commission’s findings in relation to quality of care and about what are, in some cases, the extremely distressing experiences of their own constituents and families. Even where care is good—I am pleased to say that, in most cases, it is good—hospital admission can be a distressing and frightening experience. For older people with dementia, hospitalisation can be even more difficult and confusing. Families often report concerns and anxiety about the effect that a stay in hospital has on their loved ones, even where care is good.

My first impression on entering ward B47 was that it was different from other wards that I have seen. It was a calm but stimulating environment, and I will say a little more about the physical aspects of the ward. The most obvious difference was that there was a central activities room where a number of patients were taking part in activities supported by the co-ordinator and other staff. Even in the short period that I was there, I could see that the activity that was under way—patients were playing a game that involved throwing beanbags on the floor—encouraged physical activity. Obviously, people’s abilities were different, but the staff encouraged those who could participate to do so. The activity prompted conversation, interaction and engagement, preventing people from becoming isolated and allowing other staff to spend time with the more unwell patients who required more attention—a subject that other Members have touched on.

The ward’s staff explained how and why they were doing things differently. In making my remarks, I draw specifically on an article by Louise Howe, the occupational therapist, published in OTnews in May 2011. In it she states that the staff had observed that many patients lost their ability to function independently during a stay in hospital, and she gives a typical example. An elderly woman who had been living independently was admitted to hospital and, although forgetful, was able to carry out daily tasks such as preparing a meal. After a month, the occupational therapy team carried out an assessment and found that she was having difficulties recognising and using everyday items. The team was concerned that when she was discharged she would struggle to live safely in her own home—to cook and be around hot objects—and that prompted Louise and the OT service to come up with an approach to maintain patients’ abilities while in hospital. Essentially, they would assess patients’ level of function on admission—how able they were to wash, dress and self-care—and develop an individual care plan that all staff would work to, to help patients to maintain activities and skills. Patients would then be reviewed on discharge to see whether the actions had been successful.

The team also started to change the environment to make it more enabling for patients with dementia, with clearer signage on the ward, large clear clocks—people like to be able to assess how long things take—redecoration to make the individual bays look unique so that patients could distinguish their own beds, and memory boxes above beds to display personal items and make the environment more welcoming. The ward also commissioned photographs, showing staff and patients talking, completing self-care tasks and participating in group activities, and they were displayed around the ward to provide comfort and reassurance. Although that might sound like a small thing, staff and patients and their families reported that it was a welcome and positive move.

The occupational therapy team has strengthened links with community mental health services to ensure continuity of care after discharge, and has built links with bodies such as the Alzheimer’s Society, which provides a weekly advice and support service on the ward. The unit’s work is being researched by the university, which is looking at a number of measures—with a properly assessed control group—to compare mental state, delirium, pre and post-admission function, quality of life and carer feedback. The response from staff and visitors has so far been positive, the findings look good, and the team is looking to develop the ward further, for example by providing a more comprehensive programme of activities, including in the evenings when patients can become particularly distressed. It is also considering breakfast and afternoon tea groups to encourage patients to maintain their domestic skills, and the provision of sensory stimulation for patients who find interaction difficult and relaxation for those who find the environment over-stimulating.

I appreciate that my contribution has focused on one ward in one hospital and that there are many issues to address, but I hope that where there is good practice in the care of older people in an NHS hospital it can be used effectively to improve quality of care and patient outcomes across the wider health service and that we have the resources to enable that to happen.

Health and Social Care (Re-committed) Bill

Lilian Greenwood Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries]

There are lots of comments being made from a sedentary position, Mr Speaker, but The Times has actually fed that divide directly and repeated much of the information it has been given. I want to answer some of the accusations made about me in response to the amendment. I do not have the press barons’ money to mount and fund a campaign. I have not received a penny. In fact, I am broke. My office has not received a penny in funding.

[Lilian Greenwood (Nottingham South) (Lab)]

Will the hon. Lady give way?

[Nadine Dorries]

No.

I have also been accused of being a religious fundamentalist. Like 73% of the country, I am a member of the Church of England and have Christian beliefs, but I am not sure when that became a crime and prevented me from having an opinion. On Saturday, The Guardian printed a flow chart showing the conservative Christians who are supposed to be mounting a sphere of influence with the amendment. I did not know who 95% of the people mentioned were or the organisation they represent. If I followed Islam or Judaism, I wonder what the response would have been to such a flow chart in The Guardian. I found the chart absolutely reprehensible and disgusting.

Southern Cross Healthcare

Lilian Greenwood Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

I made it clear in my statement that the Department has taken steps, working with landlords, Southern Cross and others, to ensure that each party is clear about its responsibilities, and clear on what actions they would take in the event of business closure. However, I also want to be clear that as we move forward, we need to ensure that we learn lessons from this in the context of regulation, and to ask how this was allowed to occur in the first place. Now is not the time for those questions. My focus, as the Minister, is ensuring a successful restructuring of the business, and ensuring that the business remains focused on the welfare of residents.

[Lilian Greenwood (Nottingham South) (Lab)]

I am sorry to press the Minister again on this, but I think he recognises that changes to care, even when well planned, have a serious impact on the health of care home residents. Can he guarantee that if those commercial discussions fail, residents will continue to be cared for in their existing homes?

[Paul Burstow]

The Government have made it clear that in no circumstances will we allow the residents of any of those care homes to find themselves made homeless without good continuity of care. That is the pledge that we make.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

The key point that I take from the hon. Gentleman’s question is the importance of ensuring that there are clear benefits for those who rely on mental health services. Obviously, I cannot prejudge any decisions that are being made locally, because they may well come to a Minister for a decision in the future. I will, however, undertake to consider further the point that the hon. Gentleman has raised, and if necessary to write to him with more detail.

[Lilian Greenwood (Nottingham South) (Lab)]

18. What assessment he has made of the potential role of (a) competition and (b) co-operation and collaboration in the NHS.

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

Co-operation and competition both have important roles to play in improving services for patients. We want to see better integration of services to improve quality and increase choice for patients. Following the listening exercise, we are awaiting the report on the best way forward.

[Lilian Greenwood]

The Deputy Prime Minister says that he wants Monitor to promote co-operation and collaboration, while the Secretary of State says that competition can lead to a far greater degree of integration. It is good that the Deputy Prime Minister has finally caught up with the views of the public and health professionals—but which of those fundamentally contradictory views will end up in the Bill?

[Mr Burns]

First, we all want co-operation and competition based on quality. We have had a listening event, and we are awaiting the recommendations of the forum set up under Professor Steve Field. Until we see that report, we cannot comment. I can tell the hon. Lady, however, that we do not want the kind of system of competition in the health service that leads to an independent sector treatment centre in Nottingham being paid 18% more than the NHS for the services provided, and getting £5.6 million for not doing a single operation.

Social Care Services

Lilian Greenwood Excerpts

Tuesday 17th May 2011 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I look forward to serving under your chairmanship, Mr Brady. I am pleased that we have the opportunity to debate this important subject, which is being discussed more widely around the country by families and individuals who fear for their future.

The Government will try to boast that they are providing extra cash for social care, but that is not how people out there see things. “Hardest hit”—that is how the thousands of disabled people who marched in the streets outside this place last week described themselves. One woman from Billingham in my constituency, who has been blind since the age of 18, was among those who made the long trek to Westminster, and she told me about her anxieties and the effect that the cuts will have on her life. She and the other demonstrators had every right to be angry; they will be the hardest hit by the Government’s proposed cuts to disability benefits and the hardest hit by the swingeing cuts to council services that began this year, with more to come over the next three years. That means four years of anxiety and dread for families and individuals whose way of life depends on services with an uncertain future.

Last year, adult social care services helped 1.7 million adults to do things that most of us take for granted. Those 1.7 million adults remember the Chancellor speaking of his £6 billion cuts to local government grants and saying:

“Not a single penny will come from the frontline services that people depend on.”

How hollow those words ring today. I am sure the Minister intends to refer to the £1 billion that the Government are giving councils over four years to spend on social care services and to the £1 billion that doomed primary care trusts are supposed to spend on them over the same period—cash they are expected to take directly from the health budget, which the Prime Minister claims to be so protective of.

The trouble is that even the Conservative-led Local Government Association calculates that £4.6 billion is needed just to stand still and to maintain services as they are today. The reality is that the £530 million of additional funding that the Government have provided for social care in their first year is dwarfed by the £3 billion that councils have had to cut. According to the Financial Times and the Association of Directors of Adult Social Services, £1 billion of that has been cut from adult social care.

[Lilian Greenwood (Nottingham South) (Lab)]

Adult social care accounts for £1 in every £4 that my local authority in Nottingham city spends. Does my hon. Friend agree that it is inevitable that social care services will be affected when a local authority’s budget is cut by more than 16% in just one year, as Nottingham’s has been?

[Alex Cunningham]

It most certainly is. My hon. Friend says that social care accounts for £1 in every £4, and a 16% cut represents a considerable reduction in the amount available to spend on social care.

ADASS also concludes:

“savings on this scale simply cannot be achieved through doing the same things more efficiently or by trimming management costs”.

As for the money that has gone to PCTs, can the Minister tell us, hand on heart, that he has any idea how much of it will be spent on social care this year? Given the revolution unleashed by the Health and Social Care Bill, PCTs have had other issues on their mind as they have sought to protect services during a transition period that will see them abolished. More importantly, this transition period threatens to reverse the progress made on health and social care over the past few decades. I just wonder what guarantees there can be that we will have properly commissioned and funded care once PCTs have gone and have been replaced by consortia that do not have the expertise and understanding of our community’s wider health and social care needs.

Media reports just this weekend outlined the profits that some think can be made from the health and social care system, effectively taking hard cash from the front line. The Prime Minister’s senior adviser, Mark Britnell, told a New York conference attended by the giant private health care providers that dominate in north America that the changes over the next two years will provide a “big opportunity” for the profit-making sector. As I am sure hon. Members will know, no one can make profits without taking cash out of the system. I look forward to hearing what reassurance the Minister can give those who will be hardest hit. What is his guarantee that profiteers will not have their way with the NHS and related social care services?

I know that Ministers get fed up with MPs from the north highlighting the divisions in our country, but the BBC is highlighting them now. In a survey released last week, it identified a new north-south divide, with social care spending this year falling in the north while actually rising in the south, although I will question the value of that so-called rise later. The BBC’s findings reflect the differential impact of the cuts, with councils in the midlands and the north more reliant on central grants and thus hardest hit. The findings may also reflect demographic differences and the effect of falling property values on people’s ability to self-fund.

In the north, spending will fall by 4.7% in the current financial year alone. Then there are deprivation factors to be taken into consideration. Local authorities in the most deprived areas—many are in the north, but they are elsewhere as well—have the worst mortality figures and the highest incidence of long-term ill health, but they are suffering the deepest cuts in spending power. Front-loading the cuts means that huge changes must be brought in quickly, giving little time for consultation with staff and service users over the best way to minimise the impact on front-line services. That said, I would not like anyone to get the impression that things are rosy in the south. The 2.7% increase in spending in the south is about half the rate of inflation and does not keep pace with need. Nor will it be enough to prevent real people from losing real support—support that, in the Chancellor’s words, they depend on.

My main purpose in securing the debate, however, is to consider the human impact of social care cuts, not just to debate dry spending figures.

[Alex Cunningham]

Yes, I agree that there is a considerable risk. I should say that I have been much impressed by the role played by local authorities in health scrutiny. I hope that the Minister will answer the hon. Lady’s question directly later.

The successful judicial review against Birmingham city council’s adult social care cuts looks set to be hugely significant. The Minister might be tempted to hide behind a carefully drawn veil of localism, but does he really consider it acceptable that Birmingham should seek to withdraw support from 5,000 people? Many of those people could be in a situation where abuse or neglect have occurred, or will occur, or they could be unable to carry out the majority of their personal care or domestic routines. They will be the real losers in all this.

Does the Minister consider it acceptable that 2,145 elderly and vulnerable people in Lancashire will have all care and support removed, as part of cuts that are the subject of another judicial review? Does he consider it acceptable that desperate families are being forced to go to the High Court to try to prevent devastating damage to their quality of life or that of family members?

In West Sussex, the “Don’t Cut Us Out” campaign has brought people together to campaign against eligibility cuts. If Members visit its website, they can read testimony from Tony, who has limited mobility. He must carry an oxygen cylinder wherever he goes and he is susceptible to blackouts and periods of deep depression. He will lose all the benefits and support currently provided by West Sussex county council. He says:

“My current care package...provides for 13 hours of care support each week and has kept me out of hospital for much of the last two years, saving the Country hundreds of thousands of pounds. Before, I was in hospital for six months at a time, and once discharged was being re-admitted every two weeks or so. I can’t imagine what my life will be like without this support.”

Back in the north, local people, service users and staff have been campaigning to halt the closure of Leeds crisis centre and the threat to mental health day services in Armley and Hunslet. At a packed campaign meeting organised by Unison, a campaigning trade union of which I am proud to be a member, a service user said, “I am saving the council money by using these services; when living in London, where there weren’t these services, I had many hospital admissions; I have had none since living in Leeds.”

Mencap provided me with a graphic example of what the cuts mean for George and his daughter, who are from Rotherham. George’s daughter has profound and multiple learning disabilities. Due to her disability, she is doubly incontinent and requires the use of many disposable items of medical equipment. She lives with her dad, and as part of her care package, the council picks up all body and medical waste from the household. The waste includes faeces, urine, blood and vomit. Mencap says that Rotherham council has gone from collecting the hazardous waste once a week to once every 14 days and has reduced the amount that it picks up by 50%. The council has also stopped providing specialist waste bags for the disposal of the waste, leaving the family to cover the additional cost themselves. That bodily waste now goes into black bin bags mixed with household waste, which are sent to landfill. These stories illustrate the fundamental truth: these cuts are a false economy with devastating human, social and economic costs.

In a recent national survey by a group of charities, including Carers UK and the Alzheimer’s Society, half the respondents said that increased charges for care meant that they could no longer afford essentials such as food and heating, and more than half said that their health had suffered as a result. We must consider the services run by voluntary organisations—dare I say it?, the big society—that offer early help for people who do not necessarily qualify for assessed council support. Day care centres, meals on wheels, support groups and drop-in centres are being cut because they are losing grant funding.

Jackie Dray used to run four support groups called “Elders with Attitude”—I love that name—in Birmingham, but she was told in March that her £30,000 council grant was to be cut altogether. She now runs only one group and is desperately looking for alternative funding. She said:

“They are cutting luncheon clubs or groups like mine that could make a difference between somebody remaining in the community or sinking into clinical depression and residential care. For a small amount of money, you could delay the point at which people have to go into hospital. I see a lot of clinical depression in carers and cared-for alike. People are teetering on the brink. There’s a lot of frustration, worry, lack of sleep.”

Before we can consider the future of social care services, we have to consider the consequences fully.

While we await the Dilnot commission report on long-term funding and the Government’s response to the Law Commission review, the Government are, in effect, already re-engineering the infrastructure of care and support. As services are razed, my fear is that capacity is being lost, services are being withdrawn and staff are being lost—capacity and skills that cannot easily be recreated. The Government are seeking to soften people up and lower their expectations, to get them to accept a return to reliance on family and buying from the open market with their own funds, or a patchwork of precarious charitable provision from a third sector suffering its own cuts and challenges.

I want to turn to the ideal, which I thought all the parties shared, of personalisation in adult social care. I fear that that ideal is being lost. The cuts mean that the policy, which promised much, is fatally undermined. Social workers and care managers tell their union that they are being expected to reassess personal budgets with a view to cutting them. I know that they need to consider value for money for all care packages, but they believe that they are expected to make cuts to get the budgets down.

A forthcoming report on a survey that Unison conducted with Community Care will highlight the fact that the paperwork and bureaucracy associated with personal budgets is excessive and inaccessible for service users. I question the Minister’s decision to prescribe from Whitehall that personal budgets be provided in the form of direct payments. That appears to be at odds with his claim to be a champion of local determination and removes choice from people who wish to have a managed budget. It appears to be linked to the aim of completely withdrawing state provision. Individuals will be expected to navigate the market or take on what many will see as the onerous and stressful responsibility of becoming an employer. I urge him to reconsider the prescription of direct payments, as there is evidence that it will restrict choice, but more importantly, distress some of our most vulnerable people, who already have enough challenges in life.

As we contemplate the future of adult social care services, there can be no under-estimating the scale of the challenges that we face as a society: by 2041, the number of adults with learning disabilities, we are told, will have risen by 21%; the numbers of young people with physical or sensory impairments by 17%; and disabled older people by a massive 108%. We all know that the number of dependent older people is set to increase hugely. The Association of British Insurers says that currently 20% of men and 30% of women will require long-term care at some point. If we add to that the challenges of the increasing number of young adults with complex needs who will need very expensive care packages for decades; the 170,000 people with a learning disability who Mencap tell us live with parents and carers who are already over 70 years old; the growth in the number of people with dementia, which the Alzheimer’s Society says is set to soar by a third to 1 million people by 2025; the costs facing authorities due to alcohol misuse; and the number of people with obesity-related problems, then we can see that the Government’s proposals are destined to fall well short of what is needed.

The director of children, education and social care for Stockton-on-Tees borough council, which serves people in my constituency, says that we have to be mindful of the knock-on effect of the reduction in other funding streams that impact on adults—the independent living fund, the Supporting People programme and affordable housing funding. She tells me that some of the funding streams that have historically been linked with it are being reduced or ceasing, while her department works to maximise people’s independence.

[Lilian Greenwood]

Does my hon. Friend share my concern that these cuts come alongside the cuts to disability benefits outlined in the Welfare Reform Bill, in which Ministers talk about targeting those in greatest need? Is not there a danger that disabled people with moderate needs could lose all support and face isolation and a loss of independence?

[Alex Cunningham]

That is very much the case. A stream of people have come to our surgeries or to see us in Parliament, and there seem to be so many attacks—left, right and centre—on some of the most vulnerable people in our society. As my hon. Friend says, something needs to be done if we are to arrest this situation.

The director of children, education and social care for Stockton-on-Tees borough council says that the result of the cuts, if we have limited extra care and supported living options, will be a further over-reliance on residential provision. An integrated health and social care facility and extra care scheme in Billingham in my constituency was an important part of my council’s strategy for supporting people, but the Government refused the private finance initiative credits to make it happen. Would the Minister prefer his granny, mother or other elderly relative to be forced into residential care when they could have been supported in their own home or an extra care facility and had the independence that I know most older people want?

Another area of concern is the shortfall in funding to support carers. Yes, I know that the Government allocated a welcome £400 million for carers’ breaks, but other funding managed by PCTs to support adults and their carers is not ring-fenced in any way, and although some flexibility is needed, carers, who are often seen as the poor relation, could end up all the poorer.

The sector skills body estimates that the social care work force needs to double by 2025, yet it is a sector characterised by labour shortages, low pay, poor prospects and a poor image. Some 60% of care workers hold no care qualifications, and only 20% have a national vocational qualification level 2; only 10 % have an NVQ level 3. Before anyone intervenes on that point, I should say that I believe that previous Governments, including our own Labour Government, could have done more to address that issue. However, it is not just Governments’ responsibility; other organisations, including service providers, should play their part in driving up qualification standards and meeting the costs.

Is the provision made by such organisations being properly managed or being left to the market? In Stockton, we have over-provision of residential care places, some of which are under financial pressure, including those owned by Southern Cross, which is seeking £100 million from investors to secure its future. Surely we need some kind of controlled management or strategic planning to get this right and ensure that standards are maintained.

We must look to the future of adult social care. We need immediate action to lay the groundwork for genuine reforms to flourish. The Chancellor said that his cuts would not touch front-line services; he should be prepared to say that he got it wrong. There is an urgent need for a new plan that looks again at the local government settlement and works with local authorities to ensure that front-line services are funded to meet need. Everybody agrees that we must do more to give early help because it prevents dependence and saves money on acute care, and yet those services are first in line for the chop. Will the Minister genuinely and strenuously consider the recommendation of a duty to provide early help for adult services such as that which Professor Munro made for children’s services?

The Minister must reconsider the equation of personalisation with the transaction of receiving direct payment. Personalisation is not about ticking boxes and having the right number of people receive direct payment. Trying to make it work in the context of the cuts requires him to spend time talking to practitioners and service users about what is happening on the ground and what they think the priorities should be. We need to get it right for individuals.

We need an improved and comprehensive work-force strategy covering training, development and qualification standards as a condition of provider registration and a commitment to working towards a living wage for all care workers. We must work with work-force representatives to boost the autonomy and confidence of practitioners. I am sure that the Minister will welcome, as work-force regulators have, Unison’s duty of care handbook for health and social care staff. The handbook aims to promote awareness among workers of their duty of care and other professional duties, and of how to raise concerns about poor practice.

Costs, too, need to be addressed urgently. The Association of British Insurers says that the average cost of care in residential homes in the UK is approaching £25,000 a year, with people in England spending an estimated £420 million a year on private home care. This question was not sensibly debated during the general election. We need cross-party co-operation to reach a long-term sustainable solution to the problem.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Brady.

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate on an issue of huge importance to many of our constituents, who are among the most vulnerable in society, including older people, disabled people and carers—people for whom adult social care services are an essential source of support in their daily lives.

My hon. Friends have eloquently and passionately articulated the real and serious concerns about adult social care services, but I want to focus on the importance of the social work profession in building adult social care services fit for the future.

Labour Members are pleased that the Government have proceeded with the work that Labour started on reforming the social work profession, and I welcome the Government’s decision to continue to support the work of the Social Work Reform Board. As a consequence of cuts to budgets for adult social care services, it now feels as though the very future of social work with adults is under threat. Councils across the country are proposing deep cuts to the number of registered social workers they employ, to be replaced with a range of staff employed in roles such as care co-ordinators and support workers. I know that the staff are committed and caring, but, like my hon. Friends, my concern is that this restructuring is prompted not by seeking to improve the quality of care but by the need to reduce spending on salaries. Like my hon. Friends, I am fearful of the consequences of this loss of capacity. It represents a serious loss of skill and expertise in the work force, at a time when people’s physical, mental and emotional needs and family dynamics are becoming ever-more complex.

It is hard to escape the impression that social workers in adult services are, as my hon. Friend the Member for Blaydon (Mr Anderson) said, the Cinderella service—the poor relations. The media attention given to tragic deaths of children as a result of abuse has served to sharpen public focus on children’s social work, but the consequences of social workers in adult services being poorly managed, supported, valued, trained and developed are just as critical, as my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) pointed out. Excessive case loads, defective IT systems and too much paperwork are also facets of adult social workers’ daily lives, and they get in the way of those workers’ ability to practise effectively.

The Government have said that they have given the Children’s Workforce Development Council £79.9 million for social work initiatives in 2011 and 2012. There is work to develop an advanced professional status in children’s social work to enhance the development of those who want to progress in front-line practice rather than in management, and the Munro review of barriers to direct social work with children and families has come up with some excellent recommendations—all to be welcomed. Does the Minister understand, however, that the lack of similar investment and activity in adult social work is leaving practitioners feeling overlooked, and has knock-on consequences for morale and future recruitment and retention? What plans does he have to address those concerns?

My trade union, Unison, represents 40,000 social workers and has developed a 10-point plan for social work within adult services. I support its call for a “clear political commitment” through “policy and regulation channels”:

“to strengthen the role of social work in adult services”

covering the

“central importance of social work in care and support of adults, and…halting the development of ‘social work on the cheap’.”

Is the Minister willing to give such a commitment?

A survey last year of social workers in adult services found that two thirds of respondents felt that the time they had available to spend with each service user was not sufficient to meet their needs, and that nearly a quarter felt that the time available was very insufficient. An overwhelming 96% of respondents believed that too much of their time was spent on paperwork, and only a third believed that joint working with the NHS was effective in their area. They reported structural difficulties, such as remote management, the marginalisation of social work and the duplication of paperwork required because of incompatible IT systems. Although only 3.5% of social workers in England are directly employed by the NHS, many more are seconded to the service from councils, but the status, standing and representation of social work in the NHS is virtually invisible.

Social work plays a vital role in mental health services, addressing the social needs and safeguarding the rights of patients, and hospital social work is essential in enabling rehabilitation and preventing readmissions. A recent survey by Counsel and Care stated:

“Hospital social workers are being bypassed by health professionals, who in some cases are dealing directly with the family rather than using the social worker service to plan discharge...The hospital teams can sometimes function as ‘brokers’, trying to discharge older people in to care homes themselves without proper assessments being undertaken by social workers.”

Does the Minister agree that NHS trusts should ensure that social work is represented in their management and governance structures to prevent such practices? Health employers need to engage much more closely with the social work reform agenda, accepting responsibility for playing their part in its implementation.

Adult social care services are vital and will be increasingly needed in the future, as my hon. Friends have pointed out. Social work faces a number of serious and pressing issues, and I look forward to hearing how the Minister plans to address them.

Future of the NHS

Lilian Greenwood Excerpts

Monday 9th May 2011 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow the hon. Member for Totnes (Dr Wollaston) and to serve with her on the Select Committee on Health.

I welcome this debate, which is the first chance that the House has had to debate the NHS after the pause—the listening, reflecting and engaging exercise—since Second Reading of the Health and Social Care Bill. Something about this debate made me think of the words of The Beatles song “Hello, Goodbye”. Madam Deputy Speaker, you can imagine the discussion in No. 10 between the Secretary of State for Health and the Prime Minister: “You say stop, I say go. You say, ‘Why?’ I say, ‘I don’t know.’” I promise it sounds better when sung. We can see now why The Daily Telegraph said this Saturday that the Secretary of State was to get first aid from the No. 10 spin doctors.

It is right that the Government should take on board the voices in this House and outside—those of the experts, the patients, our constituents—not in reselling their proposals, but in fundamentally changing them. I wish to cover three main areas: accountability, costs and other concerns. On accountability, as a member of the Health Committee, which is so ably chaired by the right hon. Member for Charnwood (Mr Dorrell), we have heard evidence from expert after expert—from the BMA, which I promise was not whingeing, to GPs, nurses and public health clinicians—all of whom expressed concerns about the lack of detail on the ideas in the White Paper. Matters did not become much clearer even on Second Reading.

Our latest report, “Commissioning: further issues”, published on 5 April, said that there should be no doubt that the Secretary of State has ultimate responsibility, but that is not clear from the Bill. We have concerns about accountability and the governance arrangements for the consortia that will be responsible for £60 billion of public money, but that issue is not clear in the Bill. There are concerns that private and voluntary providers will not be covered by the Freedom of Information Act 2000, which is not dealt with in the Bill either. Concerns remain about conflicts of interest in respect of GPs who are commissioners and providers, but that is not clear in the Bill.

Some PCTs were working with clinicians to provide a more integrated service. A more evolutionary and cost-effective approach would be to remove the non-executive directors of the PCT boards and replace them with GPs. That would have been not a top-down reorganisation, but a progressive and less disruptive approach.

I am staggered by the uncertainty surrounding how much this reorganisation will cost the taxpayer. The proposals in the White Paper were neither costed nor explained, and the spending is not committed, so it must come out of revenue. Professor Kieran Walshe, of Manchester Business School, put the cost at £2 billion to £3 billion, but the Government’s figure is £1.4 billion. The redundancy costs alone amount to £852 million. Sir David Nicholson said that the running-cost envelope was £5.1 billion for the running of the current service and the development of the consortia. In an written parliamentary answer to me, the Minister said that the spend and operational arrangements of pathfinder consortia are not being monitored. That smacks of fiscal incompetence and a Department that has lost control of its budget. It is so out of control that the head of Monitor wrote to foundation trusts, telling them that the NHS must find savings of 6.5% rather than 4%. That is an extra £1.1 billion on top of the savings demanded by the Department.

Members will be interested to know that the head of Monitor compared the NHS under the Government’s proposals to privatised utilities. Does Ofgem have trouble regulating the utilities? It was ineffective in dealing with companies’ unfair pricing practices and companies that made large profits during the recent severe weather.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that the Government’s plan to abolish the cap on income from private patients is a real concern when hospitals are starved of cash, because it could result in them putting private, fee-paying patients ahead of NHS patients?

[Valerie Vaz]

I absolutely agree with my hon. Friend.

We were told by Sir David Nicolson that very little work has been done on what will happen in 2013-14. Just for the record, the UK had the second-lowest debt in the G7 in 2007-08, before the global financial crisis. Which Government are out of control with their spending?

Finally, there are many unanswered questions. I have tried to obtain the legal advice on whether EU competition law applies to the provisions of the Bill from the Secretary of State, but apparently, it is in the public interest not to disclose that to the public. However, in a recent article in the British Medical Journal, Rupert Dunbar-Rees, a GP, and Robert McGough, a solicitor, say that

“the technical argument reinforces the logical argument that the reforms further open up the NHS to EU competition law.”

Who will account for the training of doctors, and indeed health care professionals? That cannot be left at a local level. In A and E, an increased percentage of patients wait more than four hours, the maternity service in Maidstone has been closed despite GP opposition—

Child Health (Nottingham)

Lilian Greenwood Excerpts

Tuesday 6th July 2010 Westminster Hall

[Chris Leslie]

My hon. Friend takes the words entirely out of my mouth. I was explaining that the problem is still significant, but thankfully some good progress has been made, particularly through partnership work. That crucial support is funded through the working neighbourhoods fund, but recent Treasury announcements suggest that Nottingham’s fund will cut by £1.2 million. The name on the tin—“working neighbourhoods fund”—does not say what it will do; supporting the programmes that help reduce teenage pregnancy is one purpose. It is incredibly important that we hear about its good work as well as about the shocking statistics.

I want to take the opportunity offered by this debate to highlight the issues of poor child dental health. Although the statistics and methodology of calculating such issues change from time to time, recent reports suggest that Nottingham children have, on average, three decayed missing or filled teeth each compared with just over one in typical parts of the rest of England. Shockingly, in some schools in Nottingham, a few children have been reported to have nearly six missing, decayed or filled teeth. Fluoride in toothpaste is improving matters, but the main factors are still poor diet and nutrition and poor oral hygiene. Although programmes such as the City Smiles dental health promotion programme and community-based services have promoted good oral hygiene and the use of fluoride varnish on teeth, much more still needs to be done. I want the funding for the City Smiles campaign to be confirmed and redoubled by the PCT, and I hope that the Minister will pass on that request. Moreover, we must think about the contentious issue of fluoridation of the water supply. In areas where fluoride is naturally occurring or where it is added, there is some protection against dental decay. Although I cannot claim to be a scientific expert in this area, I none the less hope that the PCT and the east midlands health authority will speed up their review and put some options on the table within the next year if possible.

There is not enough time to address all the crucial issues, which include young people leaving care, children with learning difficulties and serious disabilities and how people can access services. I want to pay tribute to the NHS staff who work so hard in Nottingham. They have recently consolidated the children’s services of City hospital with those of the Queen’s Medical Centre to create the Nottingham Children’s hospital at the QMC site with 15,000 inpatient occurrences and 50,000 outpatient contacts taking place annually. The hospital is very strong in renal and urology services, with 13 kidney transplants taking place last year. It is world renowned for its child integrated cancer services, with 135 children being treated there in 2009. There are also cystic fibrosis services and many others. None the less, there is still room for improvement. In particular, there is not enough accommodation for parents whose children are in hospital. It is important that young patients have the support of their family around them. I urge the Minister to find a way to provide capital support for the PCT and the hospital to ensure that more bed space is provided.

I am also concerned to hear that Nottingham’s speech and language therapy budgets, which are supported by the PCT, may be squeezed because of the financial pressures. Tragically, between 5% and 8% of pre-school children have speech and language problems, so there is a lot of concern about the loss of such resources in the Nottingham area.

I hope that the Minister will address recent policy changes. Childhood obesity and poor nutrition is one of the key underlying causal factors that come up time and again. A third of 10-year-olds in Nottingham are overweight or on the brink of the obesity category. Tragically, the free school meals pilot that had been on the cards has now been cancelled.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend not agree that there are concerns over the cut in the health in pregnancy grant from next January? Such a grant can be used to support breastfeeding mothers—breastfeeding is vital to children’s health, and results in fewer infections and reduces the likelihood of children developing allergies. It also protects them from the very thing that my hon. Friend was talking about, which is the likelihood of people becoming obese, developing diabetes and, in the longer term, cardiovascular disease.

[Chris Leslie]

My hon. Friend is entirely right. It looks as if we will lose not only the opportunity to roll out greater nutritional standards through the free school meals pilot but the £190 health in pregnancy grant. To me, that was one of the most pernicious, mean-spirited decisions in the Budget. Young mums-to-be need not just warm words but financial support to back up what can be an expensive change in lifestyle. Folic acid and fresh fruit and vegetables do not come cheap. It is important that the support is there.

When we consider the other changes in the recent Budget announcement, the Minister needs to explain how young families can support some of the costs that are involved in healthy lifestyles. I am referring not only to the change in the health in pregnancy grant, but to the restriction on the maternity allowance to the first child only. Not much thought has been given to the effect that that will have on siblings. Cots, prams and children’s clothes are expensive. Those are all issues affecting the decent lifestyles of young families in our city. From next year, the Government will remove the baby element from the child tax credit and reverse the settlement for one and two-year olds, which was due in 2012 and 2013. When those measures are combined with others, such as the freezing of child benefit and, as a tangent to that, the removal of the child trust fund, there is a sense that children’s issues, which cover good child health, education and well being, are not as far to the front as I would hope.

I have mentioned some exceptionally serious issues and complex health problems. I have run over the key issues that need real action. In particular, I am referring to the partnership working that my hon. Friend the Member for Nottingham North discussed about. It is all very well suggesting that there will be increases in real terms for front-line health services, but health inflation goes far and above the retail prices index plus 0.5%. There will undoubtedly be pressures affecting hospital and ancillary services as well. The cuts in funding for local authorities and other public services—25% over the next four or five years—are unnecessarily fast and steep. Alternative strategies could be used. I fear that we will jeopardise some of the inroads that we have made into these problems. I hope that the Minister will do better than his other colleagues in government. There is a whole range of serious issues affecting child health in Nottingham, and I urge the Government to take them seriously.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 29th June 2010 Commons Chamber

The Secretary of State was asked—

[Lilian Greenwood (Nottingham South) (Lab)]

1. What steps he is taking to improve rates of early detection of cancer.

[The Secretary of State for Health (Mr Andrew Lansley)]

Late detection of cancer is one of several reasons why our cancer survival rates are below the European average. That is why we will focus on improving those outcomes and achieving better awareness of the signs and symptoms of cancer. These aims will be part of our future cancer strategy.

[Lilian Greenwood]

Over half the men who receive a testing kit under the national bowel cancer screening programme throw it away. What action is the Secretary of State taking to improve the take-up of screening, particularly by men, and what provision has he made within the NHS budget for the extra costs of increased take-up?

[Mr Lansley]

I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby—it looks after people in parts of the midlands and the north-west—and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.