Social Care

Baroness Winterton of Doncaster Excerpts

Wednesday 25th October 2017 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Before I call the hon. Member for Central Ayrshire (Dr Whitford), who is speaking for the SNP, let me say that we have a lot of speakers this afternoon, so after her speech I will bring in a time limit. The time limit will be five minutes to start with, but it may have to be reduced later.

--- Later in debate ---

[Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)]

Nearly every day, my office is introduced to a new case in which a constituent and his or her family are facing the harsh and difficult realities of a social care system in crisis, but this is not a crisis born out of necessity. Unfortunately, it is the cruel consequence of an ideologically driven cost-cutting agenda in action. It is a crisis that has been created at the heart of No 10.

The Tories have presided over an unprecedented attack on social care budgets. Some £4.6 billion has been taken from adult social care budgets since 2010, at a time when demand is growing. Reports by the King’s Fund make it clear that the adult social care system as it stands is

“failing older people, their families and carers”,

and that it will have a funding hole of £2.1 billion by 2019-20 which, if left unresolved, will continue to fuel the crisis. The same pattern is found in my home town, Sheffield, where there is a growing population of over-65s, all with a longer life expectancy than ever before. Sheffield City Council’s budget has been cut to the tune of £352 million since 2010, and further cuts are on their way.

As a result of the cuts, councils have had to make difficult decisions. Across England, 400,000 fewer people are able to access publicly funded social care, and one in eight older people is living with unmet care needs. The impact on people and their families in our communities has been harrowing. What is more, the deep cuts inflicted by No. 10 are not only cruel, but nonsensical and ineffective. For example, councils are having to limit the hourly care fees paid to providers.

A recent case in my constituency has highlighted the doubly negative effect of limited administration and care payment resources. My constituent has significant daily care needs, and she and the council have struggled to keep up with resourcing those complex needs. Care providers have withdrawn at short notice, leaving the council and the patient’s family frantically trying to find a new provider. The under-resourcing of social care creates the dual problem of a higher than acceptable turnover of providers, and councils without the resources to step in effectively. That causes much upset and pain to the most vulnerable in our society.

Another consequence of the deep cuts is the level of the duty of care that is being placed on unpaid carers, and, as we know, women are largely bearing the brunt of that work. In one case, a granddaughter cared for her grandmother for 100 hours per week, and when she applied for a care package in the hope of receiving some financial support, it took six months to come through. The long-winded process often leaves carers with no support at all. That is not an isolated case; in fact, there are 6.5 million unpaid carers in the UK.

I am proud that in Labour’s election manifesto we pledged to increase carer’s allowance for unpaid full-time carers to align the benefit with jobseeker’s allowance rates. That is a practical and sensible solution, which also seeks to highlight the valuable work that nurses, social care workers and carers do for our communities. Too often, they are sidelined and their efforts shunned. They need a Government for the many, not just the privileged few, to stand up for them.

Crucially, the knock-on effects of a social care crisis are felt acutely by the NHS. Indeed, this year’s general election was the ultimate litmus test for the social care policies presented by the Tories and the Labour party. Labour not only pledged to invest £8 billion to alleviate some of the immediate problems facing social care, but promised to build a new national care service bringing together health and social care, which we would implement following a cross-party consensus. In a civilised society, it is vital for us to pool the risk, and not allow the most vulnerable to fend for themselves in old age.

Meanwhile, the Prime Minister launched a nasty campaign against older people the likes of which we have not seen in decades. Following their U-turn on the dementia tax, the Tories have now turned their attention to blaming and threatening councils with fines and sanctions—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I am afraid that I am going to have to cut the time limit on Back-Bench speeches to three minutes as a lot of speakers are still waiting to get in.

--- Later in debate ---

[Mike Amesbury (Weaver Vale) (Lab)]

The benchmark of a civil society is how it treats its elderly, its vulnerable and those who need support the most. Those are the values that underpin the outstanding work that happens every day in my constituency, Weaver Vale, and in constituencies across the country.

Whether care workers, nurses, social workers or volunteers who look after their neighbours, these people are motivated by a simple principle. As a country, we should care for, and care about, everyone in our society. Sadly, the reason we are having this debate today is that, when it comes to sharing and showing support for those values, this Government have let down the very people who deliver them and have failed those who rely on them.

Year after year, as they delivered their cuts, the Government who claimed that we were “all in it together”—remember that one—took aim at the most vulnerable instead of protecting them. Councils in my constituency have seen their budgets cut by 43%, with the most vulnerable struggling to access the care they need. Like many former councillors in this Chamber, I saw at first hand what cuts did to services and the effect on the people who relied on them. Now, as an MP, I witness this all too often. That effect was ignored by this Government again and again, until the Prime Minister was finally forced to listen. Even then, the action offered failed to deliver what was needed, putting the burden once again on local councils and residents, rather than on Downing Street, the only place that can deliver the proper funding needed to rectify this crisis.

The good news is that with proper, decent funding we can make a difference, by providing our amazing social care staff with the support they so desperately need. That is why we need a Labour Government. Earlier this month, I met the integrated care team in Cheshire West and Chester. Based at a local medical centre, they bring together district nurses, care workers, social workers, occupational therapists and co-ordination staff, providing excellent integrated care. The innovation and dedication of the team is exemplary, but unfortunately the funding is not. The workload exceeds staffing resources. The team needs six district nurses, but it typically operates with three or four. Recruitment is a struggle, and there is a shortage of carers in the area. Patients can be ready to leave hospital but no care packages are in place because of the lack of funding. This is the consequence of years of cuts and of pay freezes, zero-hours contracts—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

Valproate and Foetal Anticonvulsant Syndrome

Baroness Winterton of Doncaster Excerpts

Thursday 19th October 2017 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. If colleagues could stick to around nine minutes, we will be able to get everybody in.

Contaminated Blood

Baroness Winterton of Doncaster Excerpts

Tuesday 11th July 2017 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. May I remind hon. Members that Mr Speaker asked that speeches be kept to about five minutes?

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I do not want to impose a formal time limit, but I would ask Members to try to keep to four minutes. I will not then have to impose a formal time limit.

Oral Answers to Questions

Baroness Winterton of Doncaster Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I am pleased that my hon. Friend raises that point, because when we discuss mental health we often talk about services provided by mental health trusts but do not give enough credit to the work done in primary care, both in community hospitals and by general practitioners, who have a very important role as a first point of contact. He is absolutely right to make that point.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

Will the Green Paper look at the role that educational psychologists could play not only in providing support and assistance to young people with mental health problems but in preventive work? Cuts in local authority budgets have meant that the service has become quite fragmented, but there are practical ways in which it could be improved to help young people with mental health problems.

[Mr Hunt]

The right hon. Lady is absolutely right. We have looked into this and realised that there are two issues when it comes to improving children’s and young people’s mental health. The first is improving access to specialist care for those who need it. The other is prevention: the work that can be done by teachers within schools and in training people in mental health first aid. Those kinds of things can make a huge difference and we want to make sure we do them both.

NHS and Social Care Funding

Baroness Winterton of Doncaster Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dame Rosie Winterton (Doncaster Central) (Lab)]

The debate so far has shown the huge level of concern from the public and NHS staff about the crisis in the NHS and social care. The hon. Member for Totnes (Dr Wollaston) reflected some of the views of the Select Committee, but I ask all Government Members to take those concerns seriously and not to dismiss them. All hon. Members must surely be receiving representations from staff and patients about what is happening locally.

I want to pay tribute to all the health and social care staff in Doncaster, in particular those at Doncaster royal infirmary whose work I have seen at first hand. I know how dedicated and committed they are to caring for patients in these most difficult of circumstances. At the end of December, they had managed to achieve 90% against the 95% target and had good ambulance handover times, as well as good support from the council and community partners, but they are facing real pressures and they are fearful about the pressures still to come, especially if, as predicted, there is a cold spell. That is why the mixed messages from the Secretary of State have been extremely damaging.

I was a Health Minister for four years and had responsibility for emergency care. I know how important it is to work with NHS staff to help to implement targets, and not to give the impression that the NHS is somehow giving up on those targets. The lead from the top is incredibly important. There has always been controversy about targets, but as a Health Minister I visited many, many A&E departments. There is absolutely no doubt in my mind that the A&E target led to improved care for patients and that it reduced waiting times dramatically. The evidence is clear: it shows that that is what happened. One striking thing about those visits was seeing how consultants, nurses, ambulance teams and all members of the healthcare team worked together. For example, they would work out protocols so that emergency nurse practitioners could take over some of the work previously done by consultants, to ease the burden and share the work among the team. Triaging—seeing who needed urgent treatment by a consultant and who could be seen by a nurse practitioner—became the norm.

I would ask staff, “Is the target getting in the way, or is it helping?”, and invariably the answer would come back, “It helps us to work together more effectively.” I vividly remember a nurse practitioner saying, “Please don’t abandon the target, because it is making the consultants sit down with us and look at the whole team.” For patients, the difference was crucial, as it was for practitioners’ working lives, because they were not having to see patients who had been sitting around for hours and were feeling thoroughly depressed and demoralised. That made a difference to the healthcare team as well, because it improved their working life as well as patient care.

[Dr Murrison]

Does the right hon. Lady agree that it is not so much meeting the target that is important as getting patients seen expeditiously and well? There is not an A&E department in this country that does not want to improve its position in the league table of response times. The difference that now applies, and which perhaps did not apply quite so much when she was a Minister, is that the level of informatics and comparison is much improved. I suggest to her, ever so gently, that while the four-hour target was important when she was a Minister, its importance has degraded over time, because everybody is trying to see patients more quickly.

[Dame Rosie Winterton]

I do not agree with the hon. Gentleman. The four-hour target led to much better diagnoses and much improved provision of the type of treatment that people needed, as well as better interaction with communities. And I want to come on to that point because the Secretary of State has been trying—perhaps the hon. Gentleman is guilty of this as well—to separate the target for A&E departments from what happens outside, whereas I see the importance of putting the two together. Providing alternative treatment, which is perhaps part of what the hon. Gentleman was getting at, means having proper support in the community. It was bringing those two things together that made it possible to achieve the target, so it was a driver.

[Maria Caulfield]

Will the right hon. Lady give way?

[Dame Rosie Winterton]

I give way to the hon. Lady, who I know has some experience of this.

[Maria Caulfield]

In my experience of trying to meet the four-hour target, it is often—or was in the past—prioritised over everything else, including patient care and clinical need. It was sometimes abused, with huge pressure put on staff to meet the target, and as a result patient care suffered. I saw that myself.

[Dame Rosie Winterton]

It is always important to look at the feedback from clinicians, and I did that as a Health Minister. It started during my time as a Minister, and I remember that we had constantly to consider whether there was a clinical reason for reducing the 95% target. It became clear that some patients needed longer to be assessed owing to their particular condition. In such cases, I could see why the target might need to be reduced, but that was based on clinical need. By contrast, the impression given last week was, “My goodness! We’re going to have to cope with some winter pressures. Let’s reduce the target in order to meet it,” rather than there being an assessment of clinical need. That sent completely the wrong message to the NHS. I think it was the wrong thing to do.

I want briefly to set out some areas in which we can bring the community input together with what is happening in emergency departments to reduce some of the pressures. The first point was that made by my hon. Friend the Member for Leicester South (Jonathan Ashworth), who spoke from the Front Bench. Good social care is vital to ensuring that people do not end up in A&E. I have previously raised problems with the Government’s current proposition to, in a sense, move responsibility for raising money to local councils. That is particularly unfair in areas such as mine, which simply cannot raise the same amount of money through a council precept as better-off areas can. It simply does not work. We need it probably more than any other area, but we will be less able to raise the money.

On shortages, I have been talking to senior NHS staff in Doncaster, and there are real problems with emergency care staffing. They tell me that although more doctors are being trained—I accept that—it will take years for them to come through. The single most effective step we can take to ease pressure on A&E departments is immediately to increase funding for social care, because it would keep people out of A&E departments, and it could be done straightaway. The personnel are out there; the Government just need to increase the funding, as my hon. Friend said from the Front Bench.

We also have to look seriously at the problem of GP shortages. As others have said, if patients are waiting three weeks to get an appointment with a GP, they are bound to end up in A&E. This needs to be addressed very quickly, with proper forward looks at exactly where the gaps are in GP services. I have said before that PCTs—now clinical commissioning groups—or NHS England should be able to take over practices and employ salaried GPs. That would make a huge difference.

Furthermore, on community pharmacies, if people are confident that going to a pharmacy will save them a visit to A&E, again that will relieve pressure on the system. I hope, therefore, that the Minister will assure us that he is looking seriously at the community pharmacy forward view, which sets out how pharmacies can be integrated into the NHS and social care.

Briefly on mental health, the Prime Minister answered a question today about mental health and the crises that people can get into, which mean that they end up in A&E. She talked, in particular, about young people. I urge the Minister to consider the role that educational psychologists can play in children’s mental health and in keeping them out of A&E.

It was my experience as a Health Minister that we needed people on the ground locally to help organisations across the spectrum—local government through to social care, pharmacies, GPs and ambulances—to work with A&E departments, yet the £2 billion reorganisation that removed PCTs and strategic health authorities has made it much more difficult to drive through the necessary changes. I hope, therefore, that the Minister will look very seriously at what has happened, because local knowledge can be vital.

On the basis of the Secretary of State’s contributions, it seemed that he was trying to use every excuse not to face up to the reality of what is happening. I think that sends a terrible message to NHS staff. I hope that, as a result of today’s debate, the concerns raised will be taken on board by Ministers and the Secretary of State and that they will come back to us with a proper plan that recognises the problems and offers real solutions.

[Several hon. Members rose—]

Oral Answers to Questions

Baroness Winterton of Doncaster Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Clinical leadership is important, but so is openness to the skills of other industries—particularly engineering skills, with which he is very familiar—that can help us to get processes right so that we improve care and safety for patients.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

Does the Secretary of State agree that if the board of Doncaster and Bassetlaw Hospitals NHS Foundation Trust agrees to establish a teaching hospital today, that will enable the trust to train its doctors of tomorrow so that they are more able to move into clinical leadership roles as quickly as possible?

[Mr Hunt]

I thank the right hon. Lady for her question and welcome Doncaster hospital’s aspirations and ambitions. Any final decision will obviously be a matter for the NHS and Health Education England, but it is very encouraging that it is reaching for the stars in this way. Yes, we do need to train more doctors, and I hope that the hospital can make a good contribution.

Social Care Funding

Baroness Winterton of Doncaster Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

I do agree. I had a discussion with the Care Quality Commission on the dataset that is reported, and I hope that over the next months and years we can improve how we do that.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

I think that the Minister completely missed the point made by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) from the Front Bench about the unfairness of asking councils to deal with the problem. A 1% rise in council tax in Doncaster raises 21% less than would the same rise in a council in the Prime Minister’s constituency. Does that not mean that the problem is being pushed on to the areas that can least afford it?

[David Mowat]

The right hon. Lady would be right that I had missed the point, had I not said that that issue is addressed by how we distribute the additional better care funding, which uses a formula that takes into account relative need.

National Health Service Funding

Baroness Winterton of Doncaster Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jonathan Ashworth]

This is exactly the sort of point that we are making; my hon. Friend is absolutely correct. That is why we need to look carefully at all these STPs. Of course, we do not know much about them at the moment, because all we see is glossy brochures that tell us that everything is going to be all right and not to worry. We want transparency. The Secretary of State should insist that every single STP is published and that we have the details of the cuts that will be made in our communities.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

rose—

[Jonathan Ashworth]

I give way to my right hon. Friend the former Chief Whip.

[Dame Rosie Winterton]

Is not one of the problems with local planning the recruitment of GPs and the lack of GPs locally? Would it not help if we were to amend the Health and Social Care Act 2012 so that clinical commissioning groups and NHS England could provide directly salaried GPs instead of being prevented from doing so, as is the case at the moment? That is a practical example of something that would save money and increase the local provision of GP services.

[Jonathan Ashworth]

My right hon. Friend is absolutely right. Morale among GPs is at an all-time low. She identifies another problem that has emerged because of the 2012 Act. I hope that the Minister will respond to her important point.

Community Pharmacies

Baroness Winterton of Doncaster Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

The right hon. Gentleman is an extremely experienced former Health Minister, possibly the most extreme—[Laughter.] He is definitely not an extremist, but he is possibly the most experienced Conservative former Health Minister apart from, perhaps, the right hon. and learned Member for Rushcliffe (Mr Clarke). It is very noble of him to try to get the Minister off the hook, but the fact remains that he was the one who said that 3,000 pharmacies would close, and we will continue to remind Ministers of that.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

rose—

[Jonathan Ashworth]

I will give way to the former Chief Whip, but then I will make some progress.

[Dame Rosie Winterton]

Doncaster pharmacists have told me that at least 20 pharmacies in the town will close as a result of the cuts. That is their estimate, on the ground. They have also told me that the Government should sit down with pharmacists and engage in meaningful discussions about pharmacy delivery. For example, setting up a minor ailments service and cutting the drugs budget could possibly save the NHS £5 million in Doncaster and £650 million overall.

[Jonathan Ashworth]

My right hon. Friend is absolutely correct. She was not only an exceptional Chief Whip but an exceptional pharmacies Minister in the last Labour Government, and she knows how foolhardy it would be to make cuts in the pharmacy sector.

NHS Sustainability and Transformation Plans

Baroness Winterton of Doncaster Excerpts

Wednesday 14th September 2016 Commons Chamber

[David Mowat]

No, I will not. I have only four minutes left, but the hon. Lady, who worked with me on the Public Accounts Committee, can come and see me.

It is also true to say that if we achieve all those things, there will be lower hospital admissions and more humane and timely discharges. That might save money, but it is not being driven by the need to save money. It is driven by care needs because that is the right thing to do.

Let me deal quickly with the STP process. We have been told that it is a secret process and a Trojan horse for privatisation, and we have heard that we are not going to consult. Well, let us talk about consultation first. The right hon. Member for North Norfolk (Norman Lamb) made some good points about the difficulties involved in change programmes on which proper consultation does not take place. However, we must have something on which to consult that is reasonably agreed and reasonably stable, because if we do not, we shall give rise to expectations that cannot necessarily be fulfilled—in both directions, positive and negative.

When the STPs come back in October after being signed off, they will be consulted on. A document that will be in the House of Commons Library by the end of the week will describe in detail how all the stakeholders will be consulted and what we will do, but in any event—this point was made by my right hon. Friend the Member for Chelmsford (Sir Simon Burns)—no consultation and no engagement will take away the statutory commitments, the need for configurations to be looked at properly, and the requirement for nothing to proceed that has not been locally agreed.

We were told that the plans were secret. In fact, they were so secret that they were announced in December 2015, in the NHS planning guidelines. They were so secret that 38 Degrees, which was responsible for the principal leak, obtained its information from the websites of the organisations that were keeping it all secret. If we ever do something in secret in future, it really will be done better than this.

The STP process is complex. It will not work equally well in all the locations, and there will be issues to resolve. Some plans, if they are not adequate, will not be proceeded with in the same way as others. I say this to Members, however: we need you to engage with the process—

[Dame Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.