“No voice unheard, no right ignored”: Government Response
Alistair Burt Excerpts(8 years, 6 months ago)
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The Minister for Community and Social Care (Alistair Burt)
The Government are today publishing their official response to the consultation paper “No voice unheard, no right ignored—a consultation for people with learning disabilities, autism and mental health conditions.”
“No voice unheard, no right ignored” was presented by the previous Government because not enough progress had been made to transform the care of people with learning disabilities, autism and mental health problems as promised in the wake of the Winterbourne View scandal.
The consultation posed questions primarily related to:
assessment in mental health hospitals for people (all age) with learning disability or autism;
adult care and support, primarily for those with learning disability but also for adults with autism (and the links to support for children and young people); and
all those to whom the Mental Health Act 1983 currently applies (including children and young people).
We have listened to the views expressed in response to the consultation, and agree there is a need for further action to realise the vision of everyone being treated with dignity and respect by health and care services, and enjoying the same rights as everyone else.
The response comprises a number of phases of activity, namely:
early actions that seek to sustain momentum generated, chiefly through the use of existing powers and building on work currently underway;
further changes, including proposed legislative changes that cannot be achieved via existing powers (these changes relate principally to the Mental Health Act 1983); and
a third phase, which explores more radical solutions to longer-term issues, together with ongoing monitoring and review, and a clear back-stop that the Government will intervene further via legislation if the improvements sought are not being realised in practice.
The proposals in this document go hand in hand with the substantial programmes of work being put in place under the transforming care programme, including the recently announced “building the right support” national transformation plan. This was published on 30 October by NHS England, the Local Government Association and the Association of Directors of Adult Social Services to reduce reliance on inpatient capacity and increase community-based provision. A national NHS England fund of £45 million will be available to transforming care partnerships over the next three years to aid the transition, focusing on ensuring that the right support is available in local areas to enable the first discharges. Central to the progress set out by the plan over the next three years will be new, high-quality, community-based services. The plan predicts that, as these services are put in place, there will be a reduction of up to 50% in the number of inpatient beds, meaning that some units will close altogether.
The proposals for action are put forward in the context of, and subject to, the Government’s comprehensive spending review. We will continue to engage with stakeholders and those with expertise by lived experience in a spirit of co-production as we take these proposals forward.
The consultation was undertaken by the Department of Health in England. However, as the Mental Health Act applies across England and Wales, it recognised that any changes to the law in Wales would have to be agreed by the National Assembly for Wales.
A copy of the Command Paper (number 9142) entitled “Government response to No voice unheard, no right ignored—a consultation for people with learning disabilities, autism and mental health conditions” is available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office, online at:
https://www.gov.uk/government/consultations/strengthening-rights-for-people-with-learning-disabilities.
Attachments can be viewed online at: http:// www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-11-10/HCWS302/
[HCWS302]
NHS (Charitable Trusts Etc.) Bill
Alistair Burt Excerpts(8 years, 6 months ago)
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Wendy Morton (Aldridge-Brownhills) (Con)
I beg to move, That the Bill be now read a Second time.
Let me begin by thanking all the Members who are present for giving up a Friday in their constituencies to take part in what I believe will be a very important debate, and all the Members on both sides of the House who have sponsored my Bill. It was a tremendous honour, and also a surprise, for me, a new Member of Parliament, to be drawn in the ballot for private Members’ Bills the day after making my maiden speech. I am not normally drawn in a raffle, so this was something of a coup.
As many colleagues had warned me would happen, a raft of suggestions for Bills came flooding my way, on to the internet, into my inbox, and as text messages. All of a sudden I was the No. 1 favourite MP, and enjoyed a few minutes of fame. After some consideration, however, one Bill caught my eye, the one that I should like to be referred to as “the Peter Pan Bill”.
Wendy Morton
Indeed. I had often wondered why my mum and dad named me Wendy, and that was obviously the reason.
Like many other people, I knew of the tremendous work of Great Ormond Street hospital. Each year, children from all over the United Kingdom, many of whom suffer from rare, complex and life-threatening conditions that cannot be treated elsewhere, go to that specialist hospital to benefit from its specialist care. Sadly, for many children Great Ormond Street is the last hope, and, although it is one of the world’s leading children’s research hospitals, for some of those conditions there are no known cures.
I was also aware of the very special link with J.M. Barrie, whose generous bequest to the hospital consisted of the royalties for commercial publications and public performances of his play “Peter Pan”. What I did not know, however, was that legislation was needed to enable the right to those royalties to be given to the new, independent Great Ormond Street Hospital Children’s Charity to which the current NHS charity is in the course of being converted. The right to the royalties is currently conferred on the special trustees for Great Ormond Street hospital who are appointed by the Secretary of State. Baroness Blackstone first raised the need to amend legislation to enable Great Ormond Street hospital to continue to benefit from the Barrie bequest during the passage, in the other place, of the Bill that became the Deregulation Act 2015, and the Government agreed to introduce legislation at the earliest opportunity. My Bill will do that by amending the Copyright, Designs and Patents Act 1988.
I have to say that my warm and comforting thoughts of Great Ormond Street vanished temporarily when I read more of the briefing that had been prepared for the Bill, and discovered a proposal to remove powers from the Secretary of State for Health. I was a little concerned. Could I have been handed a Trojan rocking horse? Well, I can assure Members that if I had been, I would not be presenting the Bill today, because it also paves the way for sensible housekeeping on the part of NHS charities, the Secretary of State and his Department. As a new, eager and enthusiastic Member of Parliament, and one who wishes to see less bureaucracy, less duplication and less Government interference, I think it fair to say that the opportunity to remove some of the Secretary of State’s powers had a certain attraction.
Before I deal with the details of the Bill, let me assure you, Mr Speaker—and I hope you will not be too disappointed—that this Wendy will not be flying through the sky, or indeed the Chamber, on an adventure with a mischievous little boy called Peter Pan and a fairy named Tinker Bell, although I shall remain firmly on my guard for Captain Hook and ticking crocodiles.
Let me start with the background to the Bill, which, although it might seem technical in parts, is necessary and important. NHS charities are regulated under charity law but are also linked to NHS bodies and bound by NHS legislation. They are charitable trusts established under NHS legislation and have as their trustee an NHS body such as a foundation trust or trustees appointed by the Secretary of State for an NHS body. NHS charities are distinct from independent charities, which are established solely under charity law. As we would expect, funds donated to the NHS must be held separately from Exchequer funding provided by the taxpayer. These charities exist to support the beneficiaries and there is a special relationship between the charities and the trusts with which they are associated.
The first part of the Bill makes provision to remove the Secretary of State for Health’s powers to appoint trustees for NHS bodies in England and to appoint special trustees in England for specific hospitals. It also amends primary legislation in this regard. It fulfils a Government commitment made in 2014 following a 2012 Department of Health review and consultation on the governance of NHS charities. The outcome of the consultation was that NHS charities should be allowed to convert to independence should they so choose and the Secretary of State for Health’s powers to appoint trustees to NHS bodies under the National Health Service Act 2006 should be removed at the earliest legislative opportunity.
You may well ask why, Mr Speaker, and I can understand that question, but please let me try to explain. A number of the larger NHS charities called for reform because they were concerned that the NHS legislative framework limited their freedom to grow and develop their charitable activity to best support their beneficiaries and to demonstrate to potential donors visible independence from Government.
Wendy Morton
Let us hope so. Many artists and authors around the country have preferred charities to which they donate and give their royalties, but by highlighting the work of J. M. Barrie and Great Ormond Street Children’s Hospital Charity the measure may, fingers crossed, lead to more of them doing so.
The Minister for Community and Social Care (Alistair Burt)
Before we leave the Scottish dimension, may I say that my granny was born in Angus, fairly close to where J. M. Barrie comes from?
Mr Speaker
Order. We are learning quite a lot about Members’ family circumstances, and it is very illuminating.
Kevin Foster
I could not have put it better myself. My hon. Friend is right that although the Secretary of State might appoint someone independent with skills and abilities such that they become a trustee by another route, the fact that they are appointed by the Secretary of State makes it appear that they are the Government’s person, even if they are diametrically politically opposed to the Government of the day. I am sure that the Minister will be able to think of examples of Government appointments who are not the most supportive of the current Administration.
Kevin Foster
Indeed. This is a bit like the reforms to school governors, where we have reduced the number of local authority appointments. Although some were very independent minded and focused solely on the school and its interests, in other areas it was almost a tradition to have a certain number from Labour, a certain number from the Conservatives and a certain number from the Lib Dems.
The Minister for Community and Social Care (Alistair Burt)
I congratulate my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) on securing her place in the ballot and on her speech. This is the NHS (Charitable Trusts Etc) Bill, but it will forever be known as the “Peter Pan and Wendy Bill”, and we shall all do our best to refer to it in that way as we proceed.
I thank colleagues for what they have said during the course of the debate. I welcome the hon. Member for Ellesmere Port and Neston (Justin Madders) to his place and thank him for his brief support for the Bill, which is appreciated.
Those of us who have known my hon. Friend the Member for Aldridge-Brownhills for some years—I think we first knew each other when we were working in Rwanda together—will appreciate that there is a lot of her personality in this Bill: a determination to support the right causes, a fierce and deep commitment to the charitable objectives represented by the NHS, and her usual diligence in introducing the Bill and working very hard to secure support for it and to discuss the issues involved. I thank her very much for the way in which she has done this.
A number of J. M. Barrie quotes are appropriate, and we may hear them during the debates in Committee, if the House wishes to progress the Bill. The one that caught my eye was,
“one girl is worth more than twenty boys.”
I am not sure whether it is currently acceptable to make such a comment from the Dispatch Box, but I use it in its historical context as a sentence from the book, “Peter Pan”. I think that my hon. Friend has well demonstrated her worth in relation to what she has brought forward today.
The hon. and learned Member for Holborn and St Pancras (Keir Starmer), in whose constituency lies Great Ormond Street hospital, made a very decent and correct response to the Bill in which he proudly supported his hospital, as of course he, and we, would wish to do.
Kevin Foster
The Minister says “his hospital”. He is obviously right that it is based in the constituency of the hon. and learned Member for Holborn and St Pancras (Keir Starmer), who sadly is not in his place, but it is actually the whole UK’s hospital given the services it provides.
Alistair Burt
My hon. Friend makes a point that I would have gone on to make and was emphasised by him and several others. Of course, Great Ormond Street hospital covers not only the areas of London but the rest of the country and, indeed, the world. That is one of the reasons we are so proud to support what my hon. Friend the Member for Aldridge-Brownhills proposes.
My hon. Friend the Member for Newton Abbot (Anne Marie Morris), in supporting the Bill, commented on the history of Barrie, not least making the link with the childhood tragedy of the death of his brother leading to the chain of thought about a young boy living forever, which was certainly in his mother’s mind. My hon. Friend brought us that little bit of tragedy to remind us of the origin of the story.
My hon. Friend the Member for Cheadle (Mary Robinson) concentrated on the technical aspects of the Bill, to which I will turn later in my remarks.
My hon. Friend the Member for Telford (Lucy Allan) raised some of the work done by the local charitable trusts in her area. She spoke of the Friends of the Princess Royal Hospital, Telford and the substantial sums that that charity has contributed to the work of the hospital.
My hon. Friend the Member for Erewash (Maggie Throup) spoke of the League of Friends of Ilkeston Community Hospital and Treetops Hospice Care. She reiterated the point that although we have an almost uniquely taxation-based system of support for the health service in this country, that does not completely absolve people from the desire to make their own contribution to hospitals in a charitable manner, as they do in extraordinary ways.
Maggie Throup
Does my right hon. Friend agree that we are richer as a nation because of the unique combination of our free-at-the-point-of-care NHS and all the charities that support it, which all come together to make us bigger and better?
Alistair Burt
Yes. I do not think I am trespassing on any party political ground in saying that we should recognise that people’s desire to give is built on more than just paying their taxes; it is built on an innate desire to help their communities and their neighbours. That is an instinct that cannot and should not be stopped, and it will always find its way into other areas where there are services funded by the state, but it adds a dimension that is very special. Each is valuable in its own way, and my hon. Friend is right to draw attention to that.
My hon. Friend the Member for Yeovil (Marcus Fysh) spoke of his young days visiting hospitals as the son of a paediatrician. My dad, who might be watching this debate, is a retired general practitioner and I also remember visiting hospitals with him. Perhaps, like me, the sight of needles and machines that go “ping” were sufficient to put my hon. Friend off going into medicine, which means he has ended up in the same place as me. Those days, however, were valuable and we are grateful to all those who work in the health service and have made a contribution. As a senior paediatrician, my hon. Friend’s father will have certainly done a lot of good throughout his career.
My hon. Friend the Member for North Dorset (Simon Hoare) also supported the change in the law and invited us to comprehend the risks involved in various trustees supporting Lucky Lad at Uttoxeter. Unfortunately, my brief does not extend to whether that is common practice among trustees or whether it was a major inspiration for the Bill, but my hon. Friend made his point well and it is covered by what we will go on to do.
My hon. Friend the Member for Torbay (Kevin Foster) spoke of the importance—he has also just mentioned this in his intervention—of recognising that Great Ormond Street hospital serves so many of us. He also spoke of the Torbay Hospital League of Friends and its “This is critical” campaign, which is a perfect example, as my hon. Friend the Member for Erewash has said, of a combination of people who recognise that funds are available through the national health service, but who want to make an extra contribution on top of that. We wish that and similar campaigns well.
Anne Marie Morris
We have heard today about a great number of institutions that undertake such voluntary work. This is a timely debate, because we are approaching Christmas, a time when more and more of this sort of work, volunteering and giving takes place. Does the Minister agree that it is absolutely on point for us to be debating the Bill at this time of year?
Alistair Burt
My hon. Friend makes her point well. This is traditionally a time when people look very hard at what they plan to give, both for the Christmas season and for next year. A number of appeals will be run and local hospitals recognise that this is an important time for them. I imagine that many charities will benefit from the sentiment described by my hon. Friend.
Kevin Foster
The Minister is making an excellent speech, as predicted during my own speech. Does he agree that the core issue is that charitable funds are not just giving extra to patients in the NHS, but going beyond what would be funded by the NHS? This is not about replacing taxpayers’ money; it is about giving that extra boost and extra bonus.
Alistair Burt
It is about exactly that. In a world of never-ending resources, there would be no need to look for charitable funding. As I have said, charitable funding covers not just finance but the instinct to give and support. Even if it was not about finance, plenty of people are able to support their local communities and local hospitals, not because they contribute financially, but because they give their time. Leagues of friends and others are perfect examples of that instinct.
My hon. Friend the Member for Stafford (Jeremy Lefroy) spoke characteristically succinctly about charities making a real difference in his hospital and health community. My hon. Friend the Member for North East Somerset (Mr Rees-Mogg) made a vigorous defence of the private Member’s Bill as an example of Conservative principles and values. I am not sure whether he wanted to convey that a vigorous defence of fundamental Conservative principles is best and appropriately summed up in a Bill about Peter Pan and Neverland. Perhaps he recognised that those principles are reflected in the fact that the most successful example of the genre is everlastingly popular. I am sure that is exactly what my hon. Friend meant to convey.
Members can imagine my shock at my hon. Friend’s suggestion that an anonymised, bureaucratic element in the NHS might be pursuing a seemingly puzzling and unnecessary course of action to add to bureaucratic difficulties. Although I do not necessarily recognise the exact unit of which he speaks, I will look into his concerns, just in case it can be identified.
My hon. Friend the Member for Eddisbury (Antoinette Sandbach) spoke of the contribution of Alder Hey hospital, which was also welcomed and supported by the right hon. Member for Knowsley (Mr Howarth). My hon. Friend spoke of the new hospital and the charity work being done there. I am sure that most Members present would wish to recognise her contribution to a debate earlier this week in very different circumstances. She was immensely brave and her remarks will no doubt lead to much good. In today’s debate, she pointed out that charities can make a contribution to the running of even the best known hospitals.
Finally, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who had a personal reason for her particular interest in the Bill, referred to this country’s extraordinary pioneering work in medicine. That was exemplified by the news just this morning of genetic editing and the happy outcome for one little girl in particular. That reminds us of this country’s extraordinary reputation in medicine and medical research, and of the work of medical academics and all other health professionals. Every day we are appreciative of everything they have done for and contributed to this country’s reputation.
Wendy Morton
My Bill focuses on the 16 charities that are either moving to independence or reverting to corporate trustee status. The number fluctuates a little, but there are at least 260 NHS charities. During this debate, we have heard fantastic examples of the work being done right across the country. Although we are focusing on the 16, the model of independence is available to other corporate NHS charities. Highlighting the work they all do is a great way for us as parliamentarians to learn from the wealth of experience out there.
Alistair Burt
My hon. Friend neatly sums up her Bill, which I will now address, and reminds us of the work of so many different trusts.
Before I finish my tributes, may I briefly mention the work of the Bedford Hospitals Charity and Brian Woodrow in my constituency? They have made an immense contribution to my constituents and those around Bedfordshire, not least through the Primrose appeal and the magnificent Macmillan cancer treatment centre that resulted from it.
Although I intend to go into the technical details of the Bill, because that is important, I also want to speak in the following debate. I do not want to take an unreasonable amount of time, but I hope the House will appreciate that there are things I must cover.
I am delighted we have the opportunity to debate and discuss NHS charities, which provide support to our health system that is crucial to the delivery of better care for patients. Thanks to the generosity of the people of this country, NHS charities have been able to deliver valuable enhancements to the wellbeing and experience of patients and staff for many decades. I hope that today’s debate has helped to publicise the valuable work the charities do, and that it will encourage more people to give them their support.
This Government have listened to NHS charities and delivered the opportunity for those that wish to have greater independence in order to evolve and grow to meet the needs of their beneficiaries. A number of charities have seized the opportunity to become independent, with others planning to do so in the near future.
The Bill puts the last pieces of the jigsaw in place to deliver the vision the Government set out in 2014. When the previous Government came to office in 2010, a number of NHS charities and their representative bodies and interest groups were calling for reform. They were concerned about the NHS framework and inflexibility. The Government were also committed to deregulation, promoting localism and the big society, and freeing the NHS from central Government controls.
Following a review in 2011, the Government consulted in 2012 on options for changes to the regulation and governance of NHS charities. The fundamental aim of the proposals was to review the legislative powers relating to the governance of NHS charities, to preserve and extend their independence from central Government.
In their 2014 response to the consultation, the Government noted that the majority of respondents supported the principle of the proposals for the transition of NHS charities to independent charity status. They concluded that it would be appropriate to allow those NHS charities that wish to do so to convert to become an independent charity.
Anne Marie Morris
One of the questions we have not touched on is how that transition will be made. Will the Minister add a few words about how, in practical terms, we will move from having two sets of trustees and pots of money to one set? We clearly want that to be as unbureaucratic as possible.
Alistair Burt
It will be. The procedure is very simple. Some of it is laid out in the Bill and some of it will be discussed in Committee. The intention is to make it very simple for trustees, and some charities are already moving that way. It is certainly not the intention to let any bureaucracy get in the way of the process, and there is no reason why it should do so.
The Government concluded that where trustees have been appointed by the Secretary of State, the provisions for the appointments will be repealed as soon as possible. I am pleased that the Bill will remove those powers. The Bill will confer the rights to the play “Peter Pan” on the new independent charity for Great Ormond Street. That will enable the charity to complete its conversion by removing the statutory obstacle preventing Great Ormond Street Hospital Children’s Charity from becoming fully independent.
An informative debate has taken place and, as I have said, I thank all hon. Members for their speeches. I thank my hon. Friend the Member for Aldridge-Brownhills for all the hard work and endeavour she has put into presenting the Bill today. We salute her for the way in which she has applied herself, her diligent research and her time spent engaging with NHS charities. I also want to pay tribute to Baroness Blackstone for her foresight and determination in securing Great Ormond Street Hospital Children’s Charity’s rights to the royalties from the play “Peter Pan” so that current and future generations can benefit from J. M. Barrie’s generosity.
As several Members have mentioned, the work of NHS charities often goes unheralded. The charities play a crucial role in supporting the NHS in a wide range of initiatives and projects, including research, new buildings and equipment, and helping to provide services over and above those provided by the NHS. Some have large sums at their disposal, many have much less, but they all make a big contribution to improving the lives of patients and staff.
Thanks to the generosity of the public and the hard work of its fundraisers, Birmingham Children’s Hospital Charities reached its £2 million target for its children’s heart appeal. It will make Birmingham the only children’s hospital in Britain with its own hybrid theatre, which will enable two procedures to be done at the same time so that children do not have to go back in for a second operation at a later date. Fundraising helped to build the hybrid theatre and a new catheterisation laboratory, where keyhole cardiac surgery can be carried out, and it will increase the number of intensive care beds from 20 to 31. The trust invested some of its own funds in the project, and its supporters raised the final £2 million in a variety of imaginative ways, from sponsored abseils and a freezing Snowdon swim to major corporate donations and half marathons. The new theatre is now in use and has treated 126 patients so far, many with hugely complex heart problems. It will treat an extra 300 patients a year, and there are plans for more in the future. That is a perfect example of how the work of a hospital and a charity can coincide, and of how work done in one area can benefit other areas throughout the region.
The Sheffield Hospitals Charity has provided funding for a revolutionary bionic exoskeleton suit in the spinal cord injury centre. This revolutionary suit enables paralysed patients to experience standing and walking, sometimes for the first time, with the suit’s assistance. The University College London Hospital Charity supported the construction of the Cotton Rooms, the first four-star, purpose-built boutique hotel for NHS patients. Opened in 2012 at a cost of £4.5 million, it has 35 rooms for patients and their partners. Over 1,000 patients a year typically stay at the hotel, spending between one and 25 nights.
Some charities support vital research work. The Chelsea and Westminster Health Charity is supporting the Borne programme, which has two ambitions: first, to prevent death and disability in pregnancy and childbirth, and secondly, to create lifelong health for mothers and babies. In the UK alone, one in 10 babies is born too soon; that is nearly 80,000 babies a year. Premature birth is responsible for 70% of disability and death in new-born babies. The charity has raised £3 million, which has enabled it to identify treatments that could reduce the risk of pre-term labour in high-risk pregnancies from 35% to 10% or less. It has also supported a study highlighting the link between maternal diet and a baby’s brain development.
NHS charities are supporting and enhancing mental health services. Poor mental health is one of the major challenges facing society today. Never in my political life have I noticed a time when mental health has been given so much attention in so many quarters of the House and by Members from all the different parties. I think that the cross-party contribution to the development of advancements in mental health treatment will be one of the signature features of this Parliament. I welcome the interest that has been shown by those, including Front Benchers, on both sides of the House.
Anne Marie Morris
I am delighted that the Minister has raised the issue of mental health, because what we achieve in Parliament is not just done through legislation and regulation or by debate in the House. Does he agree that communities have taken this issue on board? I have been involved in dementia-friendly projects in two of my towns, whereby everybody in the street is made well aware of what they can do to help the confused or those with mental health problems.
Alistair Burt
My hon. Friend makes a very important point about the community’s engagement and the way in which it can work with existing health services. The renewed attention paid to mental health will provide many further such opportunities.
Kevin Foster
The Minister is being exceptionally generous in giving way to colleagues. Given the rapidly ageing population, which means that there are likely to be more demands on services because of age-related illnesses, does he agree that the Bill is very timely? That is particularly true in a ward in my constituency where 9% of the entire population is aged over 85.
Alistair Burt
My hon. Friend makes a significant point about the use of the health service and the relationship of charities to its work. I am sure that many of us have similar contributions in mind. I appreciate how the Bill brings those two things very closely together.
I think it would help the House if I made some progress on the technicalities of the Bill. As I have mentioned, the Bill delivers commitments announced by the Government in response to the consultation on the “Review of the regulation and governance of NHS charities”, published in March 2014. Charities were given the opportunity to seek greater independence under the sole regulation of the Charity Commission, so removing themselves from dual regulation under NHS legislation and charity law. Six NHS charities have converted to become independent and others are progressing towards independence.
The Government response to the consultation made it clear that, given the new freedom for NHS charities to become independent, the Secretary of State’s powers to appoint trustees were no longer necessary and that they would be revoked as soon as possible once a legislative vehicle became available. This Bill is that legislative vehicle. It completes the reform of the regulation and governance of NHS charities, and it delivers the Government’s commitment to repeal the Secretary of State’s powers to appoint trustees to NHS bodies that hold charitable property.
The Department of Health has stated that it will not appoint trustees to any further bodies that are not already named in existing trustee appointment orders. It will, however, continue to enable the replacement of trustees for NHS bodies that currently have Secretary of State-appointed trustees until the appointment powers are repealed. The Department has said that the provisions removing the Secretary of State’s powers, if the Bill passes into law, would be brought into force in April 2018. That will allow charities with trustees appointed by the Secretary of State a generous period of grace in which to decide whether to become independent or to revert to corporate trustee status with the board of the NHS trust or NHS foundation trust as the trustee.
The Bill confers powers on the Secretary of State to make regulations to transfer charitable property from the trustees of an NHS trust or NHS foundation trust to the trust itself. This power will enable the Secretary of State to ensure that, prior to the repeal of his powers to appoint trustees, any trust property held by trustees can be transferred back to the trust to which the trustees were appointed. It is hoped that all charities with trustees will have resolved their future status, either by becoming independent or by reverting to corporate trustee status, before the Secretary of State’s powers are revoked so that the powers will not be needed.
The Bill amends the provisions of the Copyright, Designs and Patents Act 1988, which conferred in perpetuity the rights to royalties, and other remuneration as agreed, from the play “Peter Pan” on the special trustees appointed by the Secretary of State for Great Ormond Street hospital. J. M. Barrie’s gift of the rights to “Peter Pan” has provided a significant source of income for the charity. I do not want to linger for too long on “Peter Pan” because we have said quite a bit about it, but in deference to my granddaughter, who may be watching this debate, I wanted to mention that I am proud to be able to take this Bill through its initial stages and, hopefully, beyond.
The quality of the gift provided by J. M. Barrie has been mentioned by others. It was an almost unique charitable gift. I hope that through our talking about it, others will be encouraged to do the same. There are many generous benefactors from show business and the business and economic community, but to provide an endowment to a hospital in the manner that J. M. Barrie did was remarkable. He was a remarkable individual. I think that colleagues in the House know a little more about him now than they did before the debate. One of the quotations that is worth leaving with colleagues is:
“When a new baby laughs for the first time a new fairy is born”.
I suspect many of us have had the pleasure of saying that to our own children and grandchildren. This is an appropriate opportunity to discuss such issues.
Great Ormond Street Hospital Children’s Charity was eager to take the opportunity to become independent. It became partially independent on 1 April 2015. It is, however, unable to complete its conversion to an independent charity because the original NHS charity has to be kept in existence until the Copyright, Designs and Patents Act 1988 is amended, so as to avoid its statutory rights to the “Peter Pan” royalties being lost. The Bill will confer those rights on the new independent charity for Great Ormond Street hospital.
Retaining the original NHS charity causes a number of complications for Great Ormond Street Hospital Children’s Charity. Most significantly, running the two charities side by side creates a risk that legacies to the charities may fail. It also duplicates the governance arrangements, requires the production of separate accounts and may require the submission of duplicate returns to the Charity Commission.
Transferring the rights to “Peter Pan” also clears the way for removing the Secretary of State’s powers to appoint trustees to NHS charities. The Government will not remove those powers until such time as Great Ormond Street Hospital Children’s Charity no longer needs its Secretary of State-appointed trustees to receive royalties from “Peter Pan”.
In considering this Bill, the House needs to reflect briefly on the evolution of NHS charity legislation. Charities played a key role in the provision of healthcare before the NHS was created. In the years before 1948, people relied on a mixture of charitable provision and some limited national and voluntary insurance schemes. Prior to the NHS, many hospitals and other healthcare services were organised on a charitable basis, with their property and assets held in charitable trusts.
On the appointed day, 5 July 1948, the NHS took control of 480,000 hospital beds in England and Wales. The National Health Service Act 1946 transferred virtually all existing voluntary hospitals to the Minister of Health. The effect was that property previously held in clear charitable trusts for a hospital ceased to be charitable property. The 1946 Act also gave hospital boards the power to accept on trust further charitable property, such as donations. It gave the Minister of Health the power to appoint a hospital board as the trustee to hold charitable property for charitable purposes. The structure of the NHS has changed many times since the 1946 Act, but NHS legislation has always ensured that NHS bodies have the power to receive, hold and deal with charitable property.
NHS charities are characterised by the fact that they are bound both by charity law and their statutory objectives set out in NHS legislation, as well as by the fact that the Secretary of State has the power to appoint and remove trustees. NHS charities are linked directly to NHS bodies. In addition to raising funds, they have a special role as the charities that automatically receive money donated by members of the public to the NHS or to their linked NHS bodies. The NHS bodies that can hold charitable property are NHS trusts, special health authorities, foundation trusts, clinical commissioning groups and NHS England.
The statutory objectives of NHS bodies are derived from NHS legislation. They can hold property on trust both for the purposes of their linked NHS body or for any purposes relating to the health service. In reality, the vast majority of funds are held by charities linked to an NHS trust or foundation trust. They therefore hold property both for the purpose of their linked trust and for the purposes of the health service more generally.
As my hon. Friend the Member for Aldridge-Brownhills said, as at March 2015, there were about 260 NHS charities with a combined income of about £320 million and assets with a value of £2 billion. There is considerable disparity in size across the sector, with income heavily skewed towards charities linked to large, high-profile hospital trusts. At the time of the consultation in 2012, the top five NHS charities accounted for a third of the total income and the top 30 for over two thirds. That is why a concentration on smaller charities, such as those that have been mentioned by colleagues today, is so important.
The default position for an NHS charity is the corporate trustee model, whereby property held on trust is held by the NHS body itself, acting as a corporate trustee. The directors of the NHS body act collectively as a trustee for charitable property. The members of the board of the NHS body are not, individually, the trustees of the charity. NHS bodies acting as a corporate trustee are required, under charity law, to act exactly as an independent trustee would—that is, solely in the interests of the charity and its beneficiaries. The vast majority of NHS charities use the corporate trustee model. As at March 2015, of around 260 NHS charities, more than 90% had corporate trustees.
NHS legislation makes provision for the Secretary of State to appoint trustees for NHS bodies, and those appointed trustees carry out the trustee function in respect of that body’s charitable property. Trustees appointed by the Secretary of State have powers to hold trust property on the same terms as NHS bodies. Once in post, the trustees are answerable to the Charity Commission and not their linked NHS body.
The right hon. Member for Knowsley raised a potential issue in respect of the independence of charities and asked whether this provision would in any way deflect them from their other responsibilities. I assure him that that is not the case. Charitable law will still apply. They will still be regulated, but solely under charity law by the Charity Commission. That reduces the administrative burden and cost, and the calls on the time of the charity’s staff, but it does not weaken the essential controls. I hope that I have reassured him.
NHS legislation does not stipulate the circumstances in which such trustees should be appointed. The Department’s policy has been to establish bodies of trustees only where the charity holds such significant assets that it justifies the engagement of people with relevant expertise. The most recent Department of Health guidance, which was issued in 2011, said that assets of more than £10 million and an annual income or expenditure of £l million would provide a clear case for the appointment of separate trustees.
As hon. Members have mentioned, issues of charitable control are very much in the minds of the House at the moment and, I suspect, will continue to be so as we look into the background of Kids Company. It is important that when trustees are appointed, the importance of their role and the duties they have to perform is recognised. There should be extreme caution about appointing people to boards just for the sake of it, now more than ever.
Kevin Foster
There has been a National Audit Office report on Kids Company and I believe that the Public Administration and Constitutional Affairs Committee is looking into it. This Bill is about ensuring that the charities affected have the freedoms and benefits that all other charities have. There is a wider discussion to be had, perhaps at another time, about how charities should be structured to ensure that they operate appropriately and have good corporate governance.
Alistair Burt
That is absolutely right. The House will be pleased to know that I do not intend to go further down that road. In the context of recent discussions, it is important to ensure that the misuse of charitable funds is the exception to the rule. It is important that people retain confidence and faith in what charities do. That is why it is important to have a rigorous examination whenever allegations are made about things being wrong. In the NHS, such confidence is vital.
In practice, the Secretary of State has delegated his responsibility for making trustee appointments to NHS bodies to the Trust Development Authority, which is a special health authority. In addition to having powers to appoint trustees to an NHS body, the Secretary of State retains powers under NHS legislation to appoint special trustees for certain university hospitals or teaching hospitals. Those special trustees have narrower objectives than other NHS trustees. The special trustees’ objectives are limited to holding property on trust mainly or wholly for the hospital for which they are appointed, or for any other part of the NHS associated with hospitals. In contrast, all other NHS trustees may hold property for any purposes relating to the health service, as well as for the purposes of their linked NHS body.
As the House has heard, following the Government’s response to the consultation, there is now a process for NHS charities to convert to independent status. NHS charity trustees need to assess how they see the NHS charity’s future in order to decide whether or not to convert. There are a number of advantages to conversion. An independent charity’s liability can be limited. One main issue with the current position is that trustees appointed by the Secretary of State risk unlimited personal liability, and that can impact negatively on moves to attract new trustees with the relevant experience and expertise. Moving to independence allows trustees to form structures, such as limited liability companies that provide them with limited liability, thereby enabling them to tackle more significant and innovative projects.
Furthermore, in the eyes of a potential donor, an NHS charity can be seen as too close to Government. Experience has shown that donors—especially major donors—can be reluctant to give if they think the charity is simply seeking money that could or should be provided by the Exchequer. Some grant-giving charitable foundations will not entertain applications from NHS charities simply because of their connection to Government. An independent charity is able to adopt wider charitable purposes in respect of funds raised after it has become independent, and enter into more innovative fundraising initiatives, collaborations and mergers.
Independence removes the need for the charity to comply with NHS legislation, and enables it to be regulated solely under charity law by the Charity Commission. That reduces the administrative burden, costs and calls on charity staff time. It also removes the need to be tied to the “Agenda for Change” pay structure. “Agenda for Change” was not designed for charities and for some it hampers their recruitment of suitable staff at an appropriate salary.
There are, however, some drawbacks to converting to independence and some costs to conversion. There may be additional costs to being an independent entity, some minor VAT disadvantages, and the NHS body may fear a loss of influence over its charity. Each set of trustees has to decide what is best—whether to convert to independence or have corporate trustee model arrangements. Conversion involves the creation of an independent charity outside the NHS. As my hon. Friend said, conversion to independent status involves the creation of a new charity, usually in corporate form, either as a company limited by guarantee or a charitable incorporated organisation in relation to which Secretary of State has no powers. Alternatively it could involve the transfer to the new charity of all the charitable property of the NHS charity, or the winding up of the NHS charity.
The relationship between the NHS body and the independent charity is important. The conversion process requires a formal agreement, or memorandum of understanding, to be in place. The content of that is to be decided between the parties, but there must be a binding obligation on the NHS body to transfer all charitable donations it receives to the independent charity. The Department is also of the view that the NHS body should have some involvement in the new charity’s governance arrangements, for example by having a specific place on the board. That is because of the commitment for all future donations to be transferred to the independent charity, and because the independent charity’s objectives will continue to relate to the NHS.
The independent charity’s governing instrument—such as articles of association or its constitution—must ensure that the existing objects of the independent NHS charity are the same as those applying to the funds transferred from the former NHS charity. It will, however, be possible for the independent charity to have wider objects for new funds raised after independence. Prior to completion of the conversion, the Department must be satisfied with the final memorandum of understanding, and see evidence that the NHS body’s board has considered and approved the conversion.
As the House has already heard, five NHS charities with appointed trustees have converted to independent status: Barts Charity, Alder Hey Children’s Charity, Guy’s and St Thomas’ Charity, Birmingham Children’s Hospital Charity and Great Ormond Street Hospital Children’s Charity. Of the 16 remaining charities with appointed trustees, six have formally notified the Department that they are converting to become independent, one has formally decided to revert to corporate trustee status, and the other nine are at various stages of deciding the best way forward. One NHS charity with corporate trustee arrangements, Royal Brompton & Harefield Hospitals Charity, has already converted to independence, and Yeovil District Hospital NHS Foundation Trust charitable fund has notified the Department that it has decided to convert to independence—my hon. Friend the Member for Yeovil will know it well. The Department is aware of other charities with corporate trustees that are actively considering conversion to independence.
In summary, the Government have listened to the NHS charities and given them what they asked for. NHS charities can, if they so choose, do away with dual regulation, and gain greater independence under the sole regulation of the Charity Commission. Alternatively, they can have corporate trustee arrangements that provide a tried and tested means of managing charitable funds. This Bill makes good on the Government’s decision to repeal the Secretary of State’s powers to appoint trustees to NHS bodies. They are no longer needed. It also provides powers for the Secretary of State to transfer, by regulations, property from the appointed trustees to their linked trust, if any Secretary of State-appointed trustees are still in place when those powers are repealed.
The Department of Health has told the NHS that the powers to appoint trustees would not be revoked before April 2018, to provide a period of grace for trustees appointed by the Secretary of State to decide the most appropriate legal form for their charity in future. As we have extensively discussed, the Bill amends the Copyright, Designs and Patents Act 1988 to provide for the right in perpetuity for royalties from the play “Peter Pan” to be conferred on Great Ormond Street Hospital Children’s Charity. This Bill will enable the charity to complete its conversion to full independence.
I appreciate the points that have been made today and the way that the House has handled the Bill, and many colleagues have contributed. The Government are supportive of the Bill’s intentions, not because it delivers what we want, but because it helps to deliver the model and freedom that charities themselves have asked for.
I will conclude with one final quote from J. M. Barrie—[Interruption.] It is a final quote:
“Those who bring sunshine into the lives of others cannot keep it from themselves”.
Those of us who know my hon. Friend the Member for Aldridge-Brownhills, will know that that is certainly true about her, and I commend her Bill to the House.
Off-patent Drugs Bill
Alistair Burt Excerpts(8 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dr Whitford
There is indeed a risk, as my QC expert has muttered. Part of the case would be that the doctor had prescribed an off-licence drug.
Experts in the field will prescribe many drugs that are off-patent for the treatment of secondary cancers. We are aware of the evidence, and we will use such drugs when we have the experience, but general practitioners will not. If a drug is not in the British National Formulary, they cannot check the dose, which might be different from the dose for the other usage.
We are seeing more and more non-doctor prescribers. We are seeing nurse prescribers and physio prescribers. We do not want to limit the use of future drugs that may be discovered by not sorting out the present position. It should not be beyond the wit of man. The NHS is surrounded by organisations, such as quangos, that could surely be used to deal with it.
The Minister for Community and Social Care (Alistair Burt)
Given the hon. Lady’s experience in this area, her presence in the House provides me with an opportunity that is too good to miss. Let me ask a question that goes to the heart of the reason for the Government’s concern about the Bill.
If I understand the hon. Lady correctly, it is not impossible to prescribe off-label if there is an indication that, say, the prevention of breast cancer may be aided by the use of tamoxifen. There is nothing to preclude that, although it may be difficult in the circumstances that she has described because of possible considerations of liability. Is she arguing that there should be no off-label prescribing because everything should be licensed, or not? I do not know whether it should be one or the other—[Interruption.] It is not a stupid question. We believe that if it is possible to prescribe off-label, the Bill is not necessary, but if it is not possible because of the difficulties that the hon. Lady has identified, perhaps that should not happen. Her experience is vital in this regard.
Dr Whitford
As I was trying to suggest, someone who is an absolute expert in a field will be comfortable prescribing off-label, because they are using the drug every day, and they know exactly what it does and how to use it. But our patients spend the majority of their time in primary care, and a GP, who is unable to look up and check the dose or indication, will be a little more uncomfortable. People who are non-consultants—those at staff grades, who are at other grades—will be less comfortable. We see that exactly in the prevention of breast cancer; this drug has not come on stream at the speed that would have been expected, because people are uncomfortable. There is certainly not enough protection to mean that nurses are going to prescribe a drug that is not licensed, and the vast majority of drugs do not have guidelines, so what the Minister describes is not a protection.
Alistair Burt
I just want to be sure about this. If I understand the hon. Lady correctly, that hesitation could apply to any off-label prescribing now, but off-label prescribing goes on—doctors and GPs do find the information and do it. I would not want to take the implication from her that off-label prescribing is wrong. It just needs the appropriate amount of information to make sure that it is right—otherwise, we do have to license everything.
Dr Whitford
When a drug is proven and is going to be in common usage, it should be licensed—otherwise, we are suggesting, “Why bother with licensing any drug?” We are talking about drugs that could make a big impact, but they will do that only if they are in common usage. Expecting doctors to face any potential that they are signing away their mortgage on their house by prescribing something is simply bizarre. Of course there is off-label prescribing as a drug develops, but once we have something with rock-solid evidence behind it, which we expect everybody of every grade and every profession within the NHS to use, we should give them the reassurance of licensing.
The Minister for Community and Social Care (Alistair Burt)
I thank the hon. Member for Torfaen (Nick Thomas-Symonds) for the way in which he introduced a Bill brought forward last year by my good friend Jonathan Evans. I thank all the right hon. and hon. Members who have made a contribution today.
The Government are in a difficult position. To take a position contrary to that of a breast cancer charity or a number of charities, and to resist action requested by a number of right hon. and hon. Members who speak with knowledge and passion, the Government must be pretty sure of their position and their actions. The hon. Gentleman has had a meeting with the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), the charity and others, and he knows that the Government still do not support the Bill. I will defend that position.
No sensible Government would seek to resist people having access to drugs in any way. The reason for resisting what is proposed is that the Government believe that there is another pathway. However, I am also persuaded by what I have heard today and feel sufficiently uncomfortable about the current situation to know that this is not an end of the matter. I will resist the Bill today, but my advice to colleagues in the Department of Health will certainly reflect the mood of the House and what has been said.
Albert Owen
I am disappointed by what we have heard so far from the Minister. If he will not listen to me, will he listen to his hon. Friends on the Government Benches who have made a plea for the Bill to go through to Committee? He talks about difficult decisions, and the Prime Minister and his colleagues have been at the Dispatch Box saying that there are difficult decisions to take. I ask the Minister to take a difficult decision by doing a U-turn and supporting the Bill.
Alistair Burt
The difficult decision is to stick to the position that I believe to be correct. The onus is on me to explain why, in the face of the debate, I believe the Government’s position is right, and that is what I intend to do. I want to be very upfront about the situation. I have heard the debate very loudly, from colleagues on both sides of the House, and I have heard nothing that is not deeply felt and passionate. It is not always the case that something brought forward by a charity, and indeed advocated passionately by colleagues, is the answer. The difficult decision in government is often to say, “That is not the answer; this is the way forward.” We have all been in that position. I also understand the degree of concern about this—I listened carefully to the hon. Member for Central Ayrshire (Dr Whitford)—and I want to reflect on it.
In the time available before half-past 2—and I make it very clear that I will talk until then, because that is the procedure here—[Interruption.] Well, that is what I am following. In the time available I want to explain why the Government think that what is available to people now is access to the drugs. The most important message that I want to come out of this debate is not that drugs are not available, which I think is highly dangerous, but that treatment is available. If the message that comes out of this debate is that there is only one way forward for people, then there is only one way forward for hope, as colleagues have said, and that is through the Bill. I do not believe that is correct. If it stops anyone from seeking treatment because they think that doctors cannot or will not provide off-label, I think that is wrong. That is what I will set out, because that is the evidence we have.
Several hon. Members rose—
Alistair Burt
I will take interventions, but it is only fair to the House that I respond to the debate and answer some of the charges that have been made—[Interruption.] It is not disgraceful; it is the right answer.
Nick Thomas-Symonds
Will the right hon. Gentleman accept two points? First, he made clear his objections to the Bill, and they were firmly answered by the expertise of the hon. Member for Central Ayrshire (Dr Whitford). Secondly, the Government have had a chance to put forward a non-legislative solution to the problem in the past year, but they have completely failed to do so, so why is he still refusing to allow the Bill to proceed to Committee?
Alistair Burt
After I have dealt with the other interventions, I will deal with the actions since last year’s Bill.
Mark Durkan (Foyle) (SDLP)
We listened to a debate earlier in which we heard about many much-loved fictional characters. This Bill is about real people with real conditions and making real-life differences for them, and we are yet to hear a real argument against it. I remind the Minister of what he said at the conclusion of the last debate about not denying sunshine. Why is he acting as an agent of darkness on this Bill?
Alistair Burt
Because if the message that goes out from this debate is that there is only one way to get these drugs, and if people feel that they cannot get them because of what has been said here, that would be darkness indeed. That is not the truth. That is not the position.
Dr Whitford
I find it bizarre that the right hon. Gentleman says that we must not bring in this change because it would undermine access to other drugs, because that tends to suggest that we should not have any licensing at all. Why is he happy to have drugs licensed but also feels that we should have unlicensed drugs?
Alistair Burt
Because current medical practice appears to be that drugs are available on licence for indications that are already there, but it may then become clear that some drugs are also useful for things that were not previously indicated. If the patent position is as we have discussed, then no licence process is put forward and people can prescribe off-label, as they do in many cases. Accordingly, the system works with both. The Government’s worry about this Bill is that, because of the attention paid to what is being said, it will be suggested that there is some sort of prevention mechanism that does not enable people to get the treatment they need. I am very anxious to state that that is not the case, as I think the hon. Member for Central Ayrshire also said. These drugs can indeed be prescribed. That has to be the message.
Alistair Burt
I will give way, but then I want to set out what the position is rather than what it is believed to be.
Dr Whitford
As I said, there is still an implied risk to people, and those who are distant from the research will not do this. The only reason these drugs are not licensed is that it is not worth the company’s while. Surely letting the Bill go into Committee would allow us to iron out all the issues to the satisfaction of the Government.
Alistair Burt
The issue about licensing could apply to any off-label prescribing. What we are talking about for some would, in theory, have to apply to all, because there is a risk to everything. That suggests a provision of licensing for all, which is not where we are going. This matter is not closed—let us be quite clear about that. If this measure does not go through today, the matter is not closed.
Alistair Burt
I will deal with these two interventions, and then, if colleagues do not mind, I will have to make progress.
Paul Flynn
I have long known the right hon. Gentleman and greatly respect him, but today the House has spoken on this with one voice, from both sides, with expert opinion and personal opinion. Only one voice has been silent in this debate, and that is the voice of the industry, the ABPI, which has an interest in its profits. Is its plea to keep its profits intact the only reason he is making this piffling objection to the Bill?
Alistair Burt
I have known the hon. Gentleman for a long time, and that last bit was rather unworthy of him. I have not seen anything from the ABPI, but having picked up this measure from my colleague, the Under-Secretary of State for Life Sciences, dealt with the evidence, as I have seen it, and had conversations with officials, I am perfectly convinced.
Peter Dowd
I have been sent here by my constituents, and the Minister said on his website, in response to a constituent regarding the Assisted Dying (No. 2) Bill:
“I believe that human life is intrinsically valuable and sacrosanct.”
I respect that view, but does he not agree that having rejected that Bill just a few weeks ago, this House has a responsibility, through this Bill, to facilitate, without reticence, access to medicines that would give practical and humane effect to the will of this House for those who have a terminal illness or for the prevention of that terminal illness?
Alistair Burt
Yes, of course. Why would a Government not wish to do that? I quite understand the hon. Gentleman’s point. I am trying to explain that that is exactly what happens now, and that to suggest otherwise carries a degree of risk.
Marcus Fysh (Yeovil) (Con)
Am I right in thinking that the Government’s position—it may from one point of view be a valid one that needs to be considered—is that what we are saying today does not affect the current prescription of off-patent drugs? I do not quite understand why the Government will not at least allow us the space to try to fix this Bill and try to make it law.
Alistair Burt
When I get a chance to make a little progress, I can explain to my hon. Friend why that is the case.
Mr Chope
I am grateful to my right hon. Friend, and I feel his pain. He says that he is concerned that he will not have sufficient time today to explain the Government’s position. In that case, why does he not allow this Bill to go into Committee, where he would have oodles and oodles of time in which to explain fully the Government’s position?
Alistair Burt
Because I still do not believe fundamentally that the passage of legislation is what is needed in order to reassure people that they have access to the drugs that they need.
Let me make a little progress and deal first with the concerns expressed by the hon. Member for Torfaen about what has happened since last year.
Alistair Burt
No, I will not on this occasion, because I have taken every intervention since I stood up and I cannot do my job unless I explain what people are concerned about.
As the Government promised when similar measures were discussed in the House this time last year, we held a round-table discussion bringing together some of the key stakeholders. We looked at what action short of legislation the Government could take.
Albert Owen
On a point of order, Madam Deputy Speaker, the Minister said earlier that, according to the procedure of this House, he is able to speak until 2.30 pm. I think that is incorrect. Can you give me some guidance? If the Minister sat down one minute before 2.30 pm, would my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) be able to put the question so that we can have a vote and the democratic will of this House can be heard?
Madam Deputy Speaker (Natascha Engel)
The hon. Gentleman is absolutely right. That is not procedure, but it is the choice of the Front Bencher how long they speak for. He has put it on the record.
Alistair Burt
I am happy to be corrected in relation to procedure. The procedure of the House allows the Minister to speak until 2.30 pm. [Interruption.] I am not obliged to do so—that is correct—but I am choosing to do so because I believe that I would not be performing my duty if I were to allow a Bill that I think is wrong and potentially harmful to go through.
Alistair Burt
I am not going to take any further interventions; otherwise, I will take it that the House does not want to hear from me. I have to make some progress.
Carol Monaghan (Glasgow North West) (SNP)
How many people will die as a result of this?
Alistair Burt
Oh, shroud waving—thank you very much. That’s all we need.
On action flowing from last year, the Government had an extremely useful meeting that brought together the National Institute for Health and Care Excellence, Breast Cancer Now, the Cure Parkinson’s Trust and Cancer Research UK.
Mr George Howarth
On a point of order, Madam Deputy Speaker. Given the context of the Bill, do you not think that the use of the term “shroud waving” is at the very least inappropriate?
Madam Deputy Speaker
I think what is happening is that the Chamber is getting very passionate and very heated. Members on both sides of the House ought to calm down the debate a bit. We are discussing very serious matters and we are being watched not just by people in the House but by people outside the House as well. I think all of us need to calm down a little bit.
Alistair Burt
I withdraw the remark immediately and apologise to the hon. Member for Glasgow North West (Carol Monaghan).
I am seeking to find a bit of space to explain, in the face of a House that plainly does not accept it, why the Government hold their position. I am very anxious to convey it, because I believe there is a risk that people outside will take the view that something is preventing people from getting access to drugs that they may want. I think that that position is wrong, and that is why I want to make clear the Government’s position.
Since last year, the Government have had a series of meetings with the people involved. We have received input from the MS Society and the General Medical Council. It is clear from the conversations the Government have had that this is a very complex area with a number of factors at play, including easy access to robust evidence for prescribers; information about licensing status and what it means; and clear and more accessible information for researchers and charities on how to get research findings into the system and through to licensing, if that is the approach they wish to follow. What is also clear is the genuine commitment to work together to make those things happen and to investigate whether there are other non-legislative improvements that can be made to support appropriate medicines use and benefit NHS patients.
We know that there are issues with access to medicines, but they are in no way unique to unlicensed or off-label medicines use. There are areas where there is far too much variation in the use of licensed, NICE-appraised medicines, and we are working hard with the NHS to address that, but there is no single magic bullet. The measures before us today are more likely to impede access than to facilitate it. What is more, they would be of benefit to only one medicine, one condition and one group of patients at a time.
We are committed to working with NHS England, the Medicines and Healthcare Products Regulatory Agency, NICE, the GMC, the all-party group on off-patent drugs, and patient and professional groups, to address the issues that the round-table group identified. MHRA, NICE and the GMC are committed to working together to improve the understanding of the differences in licence status and how clinicians can practically work with that. The GMC is preparing a topic for its website to dispel myths and confusion about off-label prescribing and to explain how its guidance applies. NICE and the GMC are also considering further joint work to support clinicians in discussing and sharing knowledge.
As doctors may prescribe unlicensed medicines where it is necessary to do so to meet the specific needs of individual patients, and given that patients need sufficient information to allow them to make an informed decision along with their doctor, NICE is looking at making more use of patient decision aids further to support implementation of its clinical guidelines, to help individuals work through the pros and cons of different treatment options.
We are looking at how we might provide better information to help researchers and other stakeholders know how they can propose subject matter for NICE’s clinical evidence summaries and for updates to NICE guidance. NICE will be working with the “British National Formulary” to ensure that off-label uses are included where there is robust evidence to support them and that they are presented in a standard way to help clinicians to use them.
We are committed to working with the research community to set out the pathways and options for bringing research evidence to the attention of clinicians more systematically. This will involve working with a number of bodies in the research community, including the Association of Medical Research Charities, and I know there is a commitment to do so. The outcomes of the accelerated access review will also feed into that.
Let me say a little on the detail of why I do not think the Bill is the right way forward and about what is the best way forward. The Government do not support the Bill, just as the then Government did not support the virtually identical measure introduced by Jonathan Evans last year. I want to be absolutely clear about why that is the case: when it comes to the primary objective, which is to make sure that our NHS can treat everyone according to the most up-to-date and robust evidence, the hon. Member for Torfaen and I are in complete agreement. However, legislating in this way is not the way to achieve that goal.
There are clear benefits in using licensed drugs based on evidence about their safety profile, side effects, efficacy and so on. The guidance from the Medicines and Healthcare Products Regulatory Agency and the General Medical Council is clear that a licensed medicine being used within its licence indications should be the first choice for patient care, and that is exactly as it should be. However, the guidance also makes it clear that clinicians are free to use their clinical judgment to treat their patients with a licensed medicine used outside its licensed indication—off-label prescribing—or, indeed, an unlicensed medicine where such a medicine is the best clinical choice for the patient or there is no licensed medicine to meet the particular need. In fact, the guidance from the MHRA and the GMC sets out a hierarchy of medicine use.
Paul Flynn
The right hon. Gentleman prays in aid the MHRA, which is entirely funded by the pharmaceutical industry. Why does he not confess that he has taken this cruel and unfair stand of following what the industry has told him to maximise its profits and put patients last?
Ian Blackford
On a point of order, Madam Deputy Speaker. Will you give us some guidance? Given the feelings being expressed throughout the Chamber, what can we do to move a closure motion so that the views of the House can be expressed properly in this debate?
Ian Blackford
claimed to move the closure (Standing Order No. 36), but the Deputy Speaker withheld her assent and declined to put that Question.
Alistair Burt
The guidance says that in treating their patients, clinicians must first consider using a licensed medicine within its licensed indication. If that will not meet their patient’s needs, they can consider a licensed medicine outside its licensed indication, and only if that is not suitable should they consider using a medicine that is not licensed at all. We know that a great many medicines can offer benefits to patients when prescribed outside their licensed indications.
Alistair Burt
Not at the moment, because this point is absolutely crucial to put on the record.
Prescribing in that way is part and parcel of normal, everyday clinical practice, as the hon. Member for Central Ayrshire confirmed. It is very common in prescribing for children and in treating some forms of pain. Most doctors, particularly GPs, will do it every day in their clinical practice. That has already been covered in relation to tamoxifen and raloxifene for the prevention of familial breast cancer. As was rightly identified by the hon. Member for Torfaen, the issue is compounded when drugs come off patent and new evidence suggests that they would be appropriate in the treatment of new indications.
The hon. Gentleman has gathered a lot of support for the Bill, but it does give the impression that such drugs are not being made available to patients. It also suggests that licensing is required to make these drugs available for patients, and that a NICE technology appraisal is required as well.
Alistair Burt
If the hon. Gentleman is happy to say that that is not the impression given, I am pleased to correct what I said.
Nick Thomas-Symonds
I never said that the drugs were not available. I said that they could theoretically be prescribed, but that it did not happen consistently by sector or across the country. That is what I said. It is on the record.
Alistair Burt
In that case, I am more than happy to again let the message go out from the Chamber today that these drugs are available and can be prescribed. Where it is clinically appropriate, they should be prescribed. Seeking this legislation will not change that availability.
Members of the House are doing a highly effective job of bringing their constituents’ concerns to the attention of Ministers and asking our help to resolve this issue. We are not aware of colleagues bringing examples of people who have been refused treatment. It is vital to know if there is evidence of people being refused treatment. As I said, the clinician’s letter that the hon. Member for Torfaen read out was wrong. Unless there is a clinical reason for not supplying the drug, there is nothing to prevent the doctor from doing so.
Dr Philippa Whitford
I simply make the point that we are now not just talking about doctors prescribing. It is unrealistic to expect physiotherapists and nurses to prescribe drugs off licence. It just will not happen.
Alistair Burt
I understand that point. We want more people to have prescribing powers and the information that they have will be vital.
A number of our exchanges have raised the questions of what information there will be and how easy it will be for clinicians to access it. We maintain that such access will be possible. The Access to Medical Treatments (Innovation) Bill will assist that still further.
Matthew Pennycook (Greenwich and Woolwich) (Lab)
The Minister has been exceptionally generous in giving way. I hold him in very high regard personally. However, given the weight of evidence that has been brought to the Chamber, he is doing himself a disservice. I appeal to him personally, as someone who has constituents who would benefit from the Bill, to allow it to go to Committee.
Alistair Burt
I certainly did myself a disservice with a silly, offhand remark. I entirely accept that. It is not like me and I apologise.
The stance that I am taking as the Minister representing the Government is that I do not believe this is the right vehicle to achieve what Members want. I am also concerned—
Nick Thomas-Symonds
On a point of order, Madam Deputy Speaker. With the greatest of respect to the Minister, he has had a bit more time since the last point of order and it is quite clear that he has run out of arguments and is now talking to the clock. I beg to move that the Question on closure be put.
Alistair Burt
The reason I said earlier that I would go on until 2.30 and beyond is that I have not even begun to deal with the licensing arguments and the problems—[Interruption.] Hon. Members just said that I had run out of arguments, but I have not even covered the difficulty of the Secretary of State being put in the position of being the regulator and someone who applies for licences. There are plenty more arguments that need to be put and I think that we will run out of time.
Antoinette Sandbach
Given the Minister’s clear support for the principles behind the Bill, will he agree to meet the various organisations to see whether there is a non-legislative means of achieving the aims of the Bill?
Alistair Burt
I am certain that the Under-Secretary of State for Life Sciences will meet people soon at my request to carry on our discussion. It is clear that the House is not in any way comfortable with the Government’s position in resisting this Bill, so before the matter is considered again it is essential that the Government look at it further. If a message had gone out from the House that there was only one way for people to get access to the drugs they need, that would be wrong—
Care Homes (Regulation)
Alistair Burt Excerpts(8 years, 6 months ago)
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The Minister for Community and Social Care (Alistair Burt)
It is a great pleasure to serve under your chairmanship, Ms Vaz. You will not find a lack of consensus here today; I am glad to start off in that way.
I congratulate my hon. Friend the Member for North Devon (Peter Heaton-Jones) on securing this debate, which has been really good. Colleagues have made some very moving and pertinent points. I find myself in the position that Ministers find themselves in; understandably, I have responsibility for an inspection and regulatory regime that we are all working hard to ensure does its job of protecting people in the manner that we all described. Inevitably, however, the issues that arise are always the things that go wrong. The question is how to strike the balance between, on the one hand, giving an assurance about the chief inspector of the Care Quality Commission, and the assurance that our degree of concern about what happens in care homes is absolutely appropriate, and, on the other hand, in no way being complacent about the issues that colleagues spoke about, and about where the problems are. That is what I hope to address.
I am really appreciative of the contributions made. I will come to the contribution of my hon. Friend the Member for North Devon in a moment. The hon. Member for Strangford (Jim Shannon) spoke with his usual decency and compassion. He wants speedier action, and he recognised our non-partisan sense of interest in those who require care. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) made a number of interesting points, including about managers in care homes. When I have spoken to CQC officials and others, I have found that issue to be vital. If there is good management, it will be a good care home; if there is not, it will not be. The lack of registered managers is a genuine problem, and we are on to that. The issue of commissioning is also underplayed.
My hon. Friend the Member for Brigg and Goole (Andrew Percy) spoke movingly about the issue of loneliness and isolation. He talked about someone who was taken from a home in an emergency, needing urgent care, who found themselves on their own. That raises questions about the extent of care delivered to individuals in those circumstances, and I hope that anyone who heard that would question their procedures to ensure that it did not happen to anyone they were looking after.
This morning, I met Unison officials in the office and we had a word about training standards. We have to be absolutely certain that training is available for all who are active in care homes. As we know, there is the skills care certificate. However, I am led to believe that we cannot be sure that everyone is getting the training they need, and as a result of this conversation, I am really interested in finding out what more we can do to ensure that training is available for all.
Andrew Percy
One area of training where we really could help to take the pressure off the ambulance service is in relation to falls, which place a huge demand on our local health services. Paramedics often say to me that they feel those falls could be dealt with more appropriately by care home staff—or even avoided—if staff were trained properly.
Alistair Burt
I take my hon. Friend’s point, which confirms what I was saying about the need for training, and for appropriate treatment and rehabilitation to be available after falls. The role of occupational therapists should not be minimised after such incidents.
I am all too willing to hear from the hon. Member for Glasgow East (Natalie McGarry). The fact that this matter is devolved is of no interest; what is important is that we share best practice and best standards of care. I very much appreciate her contribution. The hon. Member for Worsley and Eccles South (Barbara Keeley) again challenged me on what we are doing, and really that is the meat of the remarks I prepared to give in response to the comments of my hon. Friend the Member for North Devon; I am grateful to him for sharing those with us before the debate.
Let me put one or two things on the record. The Government are committed to improving the quality of adult social care, and to ensuring that people receive high-quality and compassionate care. We have taken a number of firm steps in that regard, and that is partly because of the sort of issues raised today. However, we are in a relatively early phase of the use of the new powers given to the CQC, and in a sense this debate reflects the sort of baseline from which we all have to work.
My hon. Friend referred to the experiences of his constituent, whose mother died in a local care home, and he spoke powerfully about the frustration that his constituent experienced in raising concerns with the care home provider and other bodies, such as the CQC and the local clinical commissioning group. We offer our condolences to my hon. Friend’s constituent, and I share his frustration that the experiences of service users and their families have not always been central to the provision of care or the oversight of regulation. I know that my hon. Friend’s constituent has met senior staff at the CQC on more than one occasion, and I hope that those meetings were helpful to him. However, I appreciate that this debate is not an opportunity to reopen this case, which I know the CQC has investigated extremely thoroughly.
Picking up on some of the concerns expressed today, I want to reassure my hon. Friend that we have come a long way; we have made real improvements in the regulation of adult social care in quite a short time, but of course there is more to do. Our reforms to the CQC have been central to those improvements. The regulation of adult social care has three key roles: first, to identify poor practice and take action to protect service users from the risk of harm; secondly, to encourage improvement by identifying areas of weakness; and, thirdly, to highlight and share good practice and success. All these roles are built on the foundations of effective use of data and rigorous inspection. In that respect, the CQC has been transformed in recent years, not least by having been given new powers in 2014, which is obviously not all that long ago. Those powers need to be built on.
The CQC has put in place specialist inspection teams under the leadership of the chief inspector of adult social care. These teams include “experts by experience”—people who have personal experience of care—and inspections now take particular account of the views and experiences of the users of services and their families.
The great majority of CQC inspections are unannounced. In a very small number of cases, when there are good practical reasons for doing so, notice may be given, but in the vast majority of cases services are not tipped off or warned that an inspection team is on its way. Providers registered with the CQC are required to meet a new set of fundamental standards that govern the quality and safety of services. These standards only came into force on 1 April, but they are the standards of safety and quality that providers must always meet. The CQC has a range of enforcement powers that it can use against providers that breach these fundamental standards. These powers vary from issuing warning notices and fines and imposing conditions on a provider’s registration, to cancelling registration, which withdraws a service’s permission to operate, thus closing it.
The new fundamental standards include two important new registration requirements. The first—the duty of candour—requires providers to be open with service users about all aspects of their care, and to inform them when there are failures in their care. The second—a “fit and proper person” requirement for directors—ensures that accountability for poor care can be traced all the way to the boardroom if necessary.
The CQC’s model does not just assess whether providers are meeting the fundamental standards. The CQC asks five key questions of each service: is it safe? Is it caring? Is it effective? Is it responsive? Is it well led? All inspections deliver a rating for each of these five key questions on a scale running from “inadequate”, through “requires improvement” and “good”, to “outstanding”. Inspections also result in an overall rating for each location.
There was much talk about what has been found so far in relation to those ratings, with a small number of providers deemed to be “outstanding” and more providers deemed to be “good”. However, a number of providers were deemed to “require improvement” or be “inadequate”. In starting its inspection process, the CQC looked first at those providers that might have more difficulties than others. The CQC is aware of what is going on, and it started its inspections at the end of the scale where it expected to find difficulties. That was designed not to force closures, but to recognise where improvement and support, which my hon. Friend the Member for Newton Abbot mentioned, is so important. In 40% of those cases, improvement has been made; on a subsequent inspection, things were found to have improved. However, that still leaves a percentage of those providers having not improved, and I think it is those providers that have been highlighted today.
Having met Andrea Sutcliffe, I am quite confident that her determination is exactly the same as that of everyone in this room. However, it is clear that there are so many places to cover that we have to be certain of ensuring that the standards that we have spoken of, and that the CQC is working to, will be delivered by all providers. Those are standards in training, management and ensuring effective monitoring.
My hon. Friend the Member for North Devon used the phrase, “There’s nowhere to go”, in relation to someone having concern about an individual. I would not want that to be the message; I would not want anyone to feel that they had nowhere to go if they felt that someone was at risk of being, or was being, ill-treated in a care home. That is not the case. The truth is that if someone has such a fear, they can contact the CQC, which will act if it agrees that a person’s safety or wellbeing is at risk, and if need be the CQC will contact the police. I would not want anyone to think that if they knew of someone in a care home being ill-treated, there was nothing they could do as of this moment. They can and should do something.
However, it is also clear from the nature of the debate that if the CQC’s most recent report has set a baseline, there are things that we need to do and improve. The sort of information available to us through our constituents, and the sort of interest that specialists such as those here have taken, will give me good guidance on how to ensure those improvements are seen through.
Sight Tests in Special Schools
Alistair Burt Excerpts(8 years, 6 months ago)
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The Minister for Community and Social Care (Alistair Burt)
It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) not only for securing this debate but for the usual thorough and highly competent way in which she has presented her case, which was full of facts, information and understanding, and informed in particular by her visits. It will be slightly easier to respond to one or two of her requests than to others, but I will come to that in my remarks.
Before anything else, I acknowledge what everyone recognises, which is that, although all our senses are precious, sight is probably the one that we value most. Sight is the key way in which children learn about the world. Ultimately, as the hon. Lady said, undetected sight problems can lead to a reduced quality of life and unnecessary damage to the eyes, which we all wish to prevent. The risk is that the vision of children with learning disabilities can be overlooked and assumed to be just part of their overall condition and behaviour. There is no doubt about the background to the campaign she mentioned.
We all share the desire that all children should be able to access sight tests, especially that group of children for whom we know that visual impairment is much more possible. There are more than 100,000 pupils in special schools in England. New arrangements have been introduced for children and young people with special educational needs or disabilities to develop more integrated approaches to meeting need. There is rather more variability than the hon. Lady suggests, and that variability is necessary to cope with the different conditions we are talking about.
A new framework was introduced in September 2014 that will see commissioners and local authorities working together to agree arrangements for meeting the needs of children with special educational needs. That includes publishing a local offer of services and ensuring that health and education professionals undertake a co-ordinated assessment of a child or young person’s needs that will inform an education, health and care plan. The plan has to consider the aims and aspirations of the young person and focus on the outcomes that will have the biggest impact. It has to include the needs of a child or young person with a visual impairment. That approach has tremendous potential for stimulating much more joined-up approaches in local care settings; meeting children’s needs; and helping health commissioners and local authorities to understand jointly how population needs can be supported by more flexible delivery methods.
The hon. Lady spoke about a postcode lottery, which is the term commonly used when anything that is provided in one area is not provided in another. I am slightly hesitant about using that term, because it suggests that nothing can be done and implies that it is an accident of fate, when in fact it is not. The difference in provision in different areas often depends on the ability of the leadership and management in an area to recognise a problem and the local determination to make a change. We get change around the country when somebody takes a lead and does things differently, often because they have been stimulated by changes at a national level and have taken the opportunity to do something differently. I recognise that, at its worst, the term “postcode lottery” implies that people get less of a service in one place than another. However, we lever up standards by pointing to what is done best. If we did not allow for some variation, we would not be able to learn. I take the hon. Lady’s point, but SeeAbility’s work in London demonstrates what can be done and shows others the way forward.
David Mowat (Warrington South) (Con)
The Minister is right that the term “postcode lottery” can be pejorative. We need centres of excellence that can be spread out more widely. Warrington hospital is well-funded in that regard, and it considers itself a centre of excellence, at least in Cheshire. For that spreading out to happen more quickly, we need a national programme or some kind of national impetus, which is where the Minister might come in.
Alistair Burt
I am delighted to recognise the centre of excellence about which my hon. Friend speaks so powerfully. I will talk about the national side when I get to the conclusion of my remarks. I will illustrate how we are moving forward and what we are doing, which will address some of the concerns raised by the hon. Member for Mitcham and Morden and my hon. Friend.
Let me turn to the issue of children with learning disabilities and problems with vision. It is widely recognised that children with learning disabilities have a greater risk of a wide range of eye problems, including refractive errors that require correction with glasses, squints, cataracts and glaucoma. All children under 16 and those between 16 and 18 in full-time education, including children with learning disabilities, are entitled to free NHS-funded sight tests. Sight tests are an extremely valuable heath check of the eye that can pick up a need for glasses and early signs of eye conditions, many of which can be treated if they are found early enough.
As the hon. Lady said, NHS England is responsible for commissioning the NHS sight testing service. I will come on to the work that NHS England is doing with SeeAbility in a moment. The hon. Lady said that she is concerned that an optical practice is not necessarily the best environment for undertaking a sight test on a child with learning disabilities. I agree, which is why we want greater use to be made of different ways of providing sight tests for children with learning disabilities. The NHS can contract with providers for mobile, funded sight tests for children, which can take place at special schools. We appreciate that that provides a familiar environment for the test, as the hon. Lady said, which best serves the child. Any provider can apply for a contract with NHS England to provide those services, provided they meet the conditions for holding a general ophthalmic services contract. I will come on to the point about payments in a moment.
However, I am aware that, even with current provision, the concern remains that children with learning disabilities may find it more difficult than other children to access services. SeeAbility has been doing valuable work in that area to develop evidence and promote awareness of the specific needs of children with learning disabilities. I am pleased to accept the invitation to meet SeeAbility and visit one of the schools in which such work has been going on. It will not be my first visit. I visited it when it was the Royal School for the Blind when I was Minister with responsibility for disabled people 20 years ago, and it will be nice to renew the acquaintance.
I am also aware of SeeAbility’s “Children in Focus” campaign, which seeks a nationally commissioned service to provide sight tests and glasses for that important group of people in special schools. In addition, I understand that SeeAbility has recently been awarded a contract by NHS England to provide eye care services at a number of special schools in London.
Reducing health inequalities is a key part of the five-year forward view and NHS England’s 2015-16 business plan. In that context, I know that NHS England recognises a growing body of evidence that suggests that access to sight tests and glasses is an issue for some children and that regular eye tests and the wearing of appropriate glasses make a vital contribution to those children’s health, educational progress and general quality of life.
As the hon. Lady said, NHS England has been in dialogue with SeeAbility about sight test provision for those pupils, and it has met Dr David Geddes, the head of primary care commissioning. I welcome the engagement between the NHS and patient groups. As I said, SeeAbility has recently been awarded a contract by NHS England to provide eye care services at a number of special schools in London. NHS England is keen to see how that work is going, so that it can consider what can be built on it and see whether the model of care that is right for that cohort of parents can be rolled out elsewhere. Some good early work has been done, but it is early days. It is appropriate that NHS England carries out some longer term work with SeeAbility to assess how that contract is working and see what can be done. Although we would all like to see rapid progress, it is early in the contractual relationship, and NHS England needs to develop the evidence base further.
The hon. Lady rightly spoke about fees. SeeAbility has pointed to a structure that is considerably higher than the current fee of £21.31 per test. We all recognise that the current financial stresses in the NHS mean that a robust case has to be built before further funding is committed. NHS England is happy to work with SeeAbility to understand better what financial model best contributes to those patients’ needs. Its view is that SeeAbility has done some very good early work, but it is only two months into the contractual relationship. We therefore need to take a little longer to find out what is actually happening and what more can be done. NHS England expects to have concluded that work by next spring, and it will be in a position to consider the need for changing the current arrangements and possible service developments.
I hope that gives the hon. Lady a sense of where this is going. First, we all recognise the scale of the problem. Secondly, because there is now more variability in the NHS’s ability to meet this need, some things are being tried out to see how they work—particularly through the contract with SeeAbility. I am keen to see how it works in practice, which is why I am happy to accept the invitation to see some of the work it is doing in schools. I will work with NHS England on how it is assessing the work and on the next steps.
In closing, I reiterate that I recognise the importance of properly considering the needs of children with learning disabilities in service planning. If children are to be given the best chance in life, it is important that any vision problems that could affect or impair their development are identified and addressed. I am pleased that NHS England is closely looking at this issue and is already in discussion with SeeAbility. I look forward to hearing about the outcomes of NHS England’s work in this area and its proposed way forward.
The early day motion that the hon. Lady mentioned states that, as a start, it
“encourages the Government and the NHS to work together to create a comprehensive national programme and a properly-funded system to make sight tests available in all special schools in England”.
In the spirit of encouraging the Government and NHS England to work together to see what can be done, the hon. Lady can be sure that that is indeed happening.
I look forward to meeting SeeAbility and NHS England to pursue this matter further. I am sure the House will have a further opportunity to discuss it in the future. Once again, I thank the hon. Lady for securing the debate and conducting it in her normal thorough and effective manner.
Question put and agreed to.
Hospital Parking Charges (Exemption for Carers) Bill
Alistair Burt Excerpts(8 years, 6 months ago)
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The Minister for Community and Social Care (Alistair Burt)
It is a pleasure to respond to the debate. I want to make some general comments before I go into the details of the Bill and before time beats us, but let me first congratulate the hon. Member for Burnley (Julie Cooper) on her success in the ballot, and on using it to present this Bill. I am very grateful to her for discussing it with me in advance—we have met twice—and for prompting others to take an interest in it.
I think I have made it clear to the hon. Lady from the outset that the Government cannot support the Bill, for reasons that have been mentioned by my hon. Friends in connection with the discretion that we need to give to hospitals. I shall say more about that shortly. I think that I also made it clear to the hon. Lady—and she was very generous in remarking on this—that we were willing to change our guidance principles, which I shall read out later in order to show where the changes have been made. Those changes are amendments, and as far as I am concerned, they are the “Julie Cooper amendments”, because if the hon. Lady had not presented them to us, we would not have had them. Although I cannot support a change in the legislation, a material change will be made, and I hope that trusts and hospital authorities will take advantage of it when they feel that that is in their interests and also the right thing to do.
Let me now say a few words about carers. The hon. Member for Worsley and Eccles South (Barbara Keeley) knows a great deal about the subject, having spent considerable time dealing with carers’ issues over the years in her previous role as consultant to the Princess Royal Trust for Carers and on the local council. She understands the carer’s world very well, and I pay tribute to her for that.
Although I will say a little bit about carers, I want to say something about the car parking aspects of the Bill as well. There is no dispute between anyone in this House about the value associated with carers. I felt it was reasonable for me to mention the support I believed carers had from the Government at present. I did that not only because of what we say about valuing what carers do but because of our recognition that the system could not exist without them. However, the system could not exist if it had to compensate carers for every particular cost; that just cannot be done.
The 2011 census identified 5.4 million carers in England. To put that in context, the state spends £16 billion each year on adult social care. The total market is estimated to be worth £22 billion. The Office for National Statistics has valued informal care at about £61.7 billion. Whatever the actual figure may be, it is immense and this could not be done without the voluntary contribution of carers.
Philip Davies
If it is the case, as the shadow Minister seems to be indicating, that the only way one can show recognition towards what carers do is to support this Bill on hospital car parking charges, does the Minister agree that the shadow Minister ought to explain why in 13 years of a Labour Government they never passed legislation to exempt carers from hospital car parking charges?
Alistair Burt
My hon. Friend, who made a strong contribution to this debate, makes a fair point. The difficulties of life are such that, no matter that we have a string of things we would like to do, the finances do not enable us to do them. It is amazing that when we are in opposition we find things we were unable to do when we were in government.
One or two colleagues also made the point about the basic economics of this. It is tempting to add up a cost and say that because the value given by carers to the national economy is as it is, therefore everything can be netted off against it and it is a benefit. The economics just do not work that way. As hospitals would have to find the money to maintain their car parks and everything else, it is not netted off by the benefit to carers. So tempting though it is, and an understandable argument though it may be, it does not actually work. It only works when we do the difficult things that some of my colleagues have pointed out today, which seem to be very tough. After all, who would not give free car parking to carers? Indeed, who would not give free car parking at hospitals to everyone, which the hon. Member for Heywood and Middleton (Liz McInnes) went down the road of saying? That ignores the fact that it was not done when her Government had a chance to do it, and it ignores the fact that trying to find something like a quarter of a billion pounds when the NHS is stretched is going to be very difficult. These things are lovely to talk about, but they cannot always be done. It is much better to concentrate on what we can do.
Barbara Keeley
This is about more than just sending a message. We are increasingly not exempting carers who are on this very low basic income of carer’s allowance—only £3,229 plus whatever extra benefits they might qualify for. They are not exempt from the bedroom tax because the Government have not made them so, they are not exempt from the benefit cap, and now they are not exempt from car parking charges. Some hospitals can do this: Torbay can make concessions, and Scotland and Wales can do it, so clearly it is not impossible.
Alistair Burt
No, it is not impossible, but the whole point of what we are talking about is to provide discretion, and I will come back to one or two of the elements related to carers.
As I have discussed with the hon. Member for Burnley, we are looking at the strategy for carers in the round, and I have got the responsibility of doing that. We will look at all sorts of things for the future. The economics will come into it—I take that point—and I think it is best to look at this as an overall strategy. I have offered to involve the hon. Lady, who has agreed; indeed, I would like one or two Back-Bench colleagues from all parties to assist me when that consideration of strategy gets up and going because of their particular interest in the subject. The overall impact on carers of all sorts of things that are happening at present can be taken into account. There will still be finite financial limits, which I will come to soon, but where life can be made easier, we obviously are looking to do that.
The hon. Member for Worsley and Eccles South mentioned the bedroom tax. The relevant rules already take account of the needs of carers. For example, non-spouse resident carers plus others who need to stay overnight are allowed an extra bedroom—[Interruption.] Well, if that is not true, perhaps the hon. Lady would like to intervene on me, but that is what the law says. Discretions are also offered by local authorities, and that too provides an opportunity to take account of what carers might need.
Barbara Keeley
The figure of 60,000 carers who are having to pay the bedroom tax comes from the Department for Work and Pensions. There are at least 60,000 of them who have to pay.
Alistair Burt
As I have said, the opportunities for discretion exist, but perhaps the way in which discretion is exercised is something that the carers strategy can look at.
It was this Government who passed the Care Act 2014. For the first time, carers—as well as those they were caring for—were given the right to be assessed by a local authority. We gave an extra £400 million for respite care, to be used by those who needed it during the last Parliament. It is therefore reasonable, given the availability of the carer’s allowance and the other measures I have mentioned, for the Government to indicate that carers are valued in ways that they have not been in the past. There has been an incremental increase in support for and recognition of the carer’s role over the years.
I stand four-square behind what my colleagues have done. The Secretary of State’s determination to devise a new carer strategy, on top of what is already there, is a recognition of the fact that more might well need to be done, but it also recognises the value of carers. Nothing we have heard today on either side of the House, including some graphic examples, has suggested that we do not value carers.
Before I respond to the points on car parking charges, I should like to mention the speeches that have been made today. The hon. Member for Burnley set out her case extremely well, and I shall come back to that in a moment. My hon. Friend the Member for Shipley (Philip Davies) is a necessary piece of grit in the oyster of the workings of Parliament. Mrs Thatcher said that every Government needed a Willy, but in addition, every Parliament needs either an Eric Forth or a Philip Davies. They remind us that, at the end of the day, this is not a game. If we pass a piece of legislation, it has consequences and, accordingly, it has to be right. Occasionally, my hon. Friend will say things that people find uncomfortable, but he is just doing his job.
The process of a private Member’s Bill is not easy. Indeed, as I go on talking for a while this afternoon, there will be plenty who say that these processes should be handled differently, but they are not. This is the way in which some things are examined. My hon. Friend made a good speech. Above all, he talked about the problems of economics that I referred to earlier. There are many things that we would all love to do, but often we cannot. We have to make choices. When the Government of the hon. Member for Worsley and Eccles South were in office, they had to make choices, and so do we.
The hon. Member for Birmingham, Perry Barr (Mr Mahmood) made a strong personal plea for the Bill. He mentioned patients on dialysis, and I would like to reassure him that those patients are already covered in our principles as frequent out-patient attenders. The amendment that we have just made to our provisions will ensure that carers of patients on dialysis will be covered by the guidance.
My hon. Friend the Member for Bury North—God bless it!—(Mr Nuttall) went into forensic detail about the Bill. I ask him to convey my good wishes to all at Fairfield hospital, which I remember very well. Both my children were born there, and my wife still has a plaque up on the wall from when she opened a piece of equipment there. My hon. Friend also went into forensic detail when he described the difficulties that would be created by the Bill. He gave it a necessary examination.
The hon. Member for Heywood and Middleton (Liz McInnes), whom we should thank for her services to the NHS over many years, made it clear how passionate she felt about this issue. In a perfect world, everything would be wonderful, and she finished by saying that it would be great if everyone could park for free at hospitals. They cannot do so, however, because the money would have to be found from somewhere. I will come back to that point in a little while.
My hon. Friend the Member for Solihull (Julian Knight) detailed his own personal campaigning for fairer charges in his constituency. He is a perfect example of how an MP of any party can take up an issue and how, when something is wrong that can be worked through, it can be done in a local capacity. He provided a series of perfect examples of what to do as a local Member.
The hon. Member for Ealing Central and Acton (Dr Huq) made a passionate plea for change. My hon. Friend the Member for Christchurch (Mr Chope) examined the Bill in depth, especially in relation to clause 1. He gave examples of where the present discretionary arrangements could work to people’s advantage, and we will come back to those later. If there was no example anywhere of guidance and of opportunity for discretion being used, then the strictures of the hon. Member for Burnley would be much stronger. The fact is that discretion is used in some areas. Various figures were quoted: some 63% of hospitals do not charge, and some 86% or 87% offer discretion. That allows local areas to take notice of the principles and make their own decisions about what is necessary.
May I just add a word about the phrase “postcode lottery”, which is a favourite of mine? A postcode lottery implies a situation in which there is no chance to do anything about it. Many of the things in modern political life that we term postcode lotteries are not postcode lotteries at all, because they all contain the opportunity for people to make a difference, or to change things. The point of local discretion and of transparency in the delivery of services is precisely that it enables people who represent an area to say, “Why isn’t it as good here as it is next door? What is it they are doing that we are not?” They can then apply pressure locally to get something done. They should not always run to Government to say, “It is your fault. You must standardise everything.” Neither should they throw their hands up in the air and say that there is nothing they can do about it. Therefore, I reject the term postcode lottery on most of the times that it is used. This is an example of where, if discretion is used in some areas, why is it not used in others, and what will people do locally to encourage it? Clearly, it happens in some, but not all, places, and it is not always the responsibility of Government.
My hon. Friend the Member for Shipley said that he longed for the day when Ministers could stand up at the Dispatch Box and say, “It is nothing to do with me.” Actually, local discretion is nothing to do with me. All too often people come running towards Government and demand that something is done, when, actually, the answer lies in their own hands, their own constituents’ hands, their own local decision-makers’ hands and, in this particular case, the hands of those who are making decisions about hospital charges. It is fair that responsibility is very widely spread.
Let me move on and say a little bit about the car parking matter. I will do my best to be quick. Everything that the NHS does is on an epic scale, and that is true even in relation to car parking. At hospitals alone, there are around half a million car parking spaces to finance, manage and maintain, and every day, millions of users need to be seen safely on and off the sites. Parking is an amenity that the NHS has to provide if the service is to function properly—or indeed to function at all. Problems are particularly thorny in large acute hospitals, but they also exist in others. Our aim is always to see that parking provision is sufficient, efficient and fair.
The level of car parking provision required is a reflection of massively increased car ownership. When I was a boy and used to go with my father, a GP, to visit our local hospital, there were no car parking charges and the car park was half empty. I was born and brought up in the late ‘50s and early ‘60s, and life was very different. The more people who use our hospitals, the more car parking spaces we will need. Very recently, I went to the Lister hospital, a local hospital used by my constituents, and saw its new car parking facilities, which make a huge difference, but they have to be paid for.
Car parking, like any other service, is provided at a cost. Owning land costs money, so hospitals have to meet finance costs as well as maintenance, lighting, security and so on. Across the NHS, we now see better and better facilities. It is inevitable that some form of charge needs to be levied to cover those very real costs. From this perspective, it is perhaps remarkable that the average cost of parking across the NHS is only £1.15 an hour—and has fallen slightly this year. Once we accept that there is a real and unavoidable cost associated with parking we have to ask ourselves, “If hospital parking costs are not paid for by drivers, who are they paid by?” Again, that was a hard question asked by Members on the Government Benches.
Julie Cooper
I just want to clarify that the Bill is not asking for free car parking for all; it is asking to protect a vulnerable group who suffer great financial hardship from car parking charges. Despite the figure he has just mentioned, I am sure that the Minister will agree that the average car parking cost is £39 a week and significantly higher in some areas. Should the most vulnerable—those on the lowest incomes, who are already providing invaluable support to the NHS—be made to carry that burden?
Alistair Burt
As the hon. Lady knows, we have adjusted our principles to ask trusts to consider carers as a particularly special category. I do not think the Bill will work because of the technical issues that colleagues have mentioned and the difficulty of defining carers. I know how the hon. Lady wants to do it, but others would want to stretch it further. There is also the question of whether it is right to pick out particular groups in legislation and not others, a case that has been made very strongly. I entirely accept that she is not asking for free car parking for everyone, although some are, but the question remains that if this group is advantaged in this way, what might others work towards?
The principle remains the same. I do not think that anyone disagrees that if local hospital authorities can provide carers with free car parking within their budget without affecting any of their other costs, that is good and we would like to see it. However, that is not the view that we believe is held by all and, accordingly, we think that it is a matter for local discretion.
Let me briefly mention a couple of issues relating to the provision of car parking. I said that we had changed the principles. The principles, which my hon. Friend the Member for Shipley also mentioned, are delivered by the Government to the NHS and used to read:
“Concessions, including free or reduced charges or caps, should be available for the following groups…disabled people…frequent outpatient attendees…visitors with relatives who are gravely ill…visitors to relatives who have an extended stay in hospital…staff working shifts that mean public transport cannot be used”.
The “Julie Cooper amendments” mean that the reference to visitors with relatives who are gravely ill will now include the words
“or carers of such people”.
Where the principles refer to visitors who have an extended stay in hospital, the words
“or carers of such people”
will be added, and a new line has been inserted reading
“carers of people in the above groups where appropriate”.
The word “carers” has been inserted in the principles for the first time, and that is due to the hon. Member for Burnley. I hope that the examples we have heard of where discretion has been exercised might be used by others.
It is reasonable to suggest that if the NHS as a whole had to find costs upwards of £180 million, perhaps even towards £250 million, they would have to come from somewhere. It is therefore reasonable to ask who else would pay for them and whether that would be done through higher charges for others or at the expense of other parts of the NHS. I think that that is a matter for local discretion.
We heard about Scotland and Wales, and the devolved Administrations have decided what works for them. I also understand, however, that their free car parking policy has brought its own problems. Since charges were abolished at Edinburgh’s Western general hospital, the car park has been constantly full and staff have resorted to parking in nearby residential streets. In the first three months of free car parking on the Western general site, 70 complaints were received whereas before there were no complaints at all. In some areas, residents were complaining that people were parked in front of their driveways and Lothian health board has already had to employ wardens to police the overcrowded car park and is now paying for new car parks to be built.
The question of where car parks are sited was also raised, and the majority of hospital car parks where there are charges are in city centres. It is fanciful to believe that if free car parking was available in a city centre near a station or shopping centre, it would not be used by people who were not going to the hospital. There would have to be another method of policing it. Although the free car parking in Scotland and Wales sounds wonderful, it has its problems and we need to be clear about that. It is not an option for many hospitals in city centres.
The Bill was examined in relation to who might be eligible and who might not. Carers and those with underlying access to carer’s allowance include nearly 1 million people, which raises salient questions about where the costs would be diverted to.
I want to talk a little about the availability of car parking and access to it. A sensible, measured approach to car park charges can dramatically increase the availability of spaces. This matters to people who are looking for a car park space in a busy place at a busy time. It is in no one’s interest for a very small number of people to be able to park for free if everyone else, including, potentially, large numbers of carers, are then denied the chance to park at all. Quite reasonably, people who have cars expect to be able to use them to carry out their daily routine, but the available land for parking is limited and we cannot make it grow at the rate we wish. More people driving means more people competing for space, and hospitals have to find a way to make sure that as many people as possible can have access.
Without fair charges, car parks become congested and there is no turnover of spaces. Patients who arrive at 8.30 am may find that they can park, but those whose appointments are for later in the day are likely to be faced with a long and ultimately fruitless search for somewhere to leave their car. This cannot be fair. The Government take the view that it is not sensible to impose central requirements in relation to car parking. We cannot possibly know what each local situation requires. In city centres the cost of the land may be too high, if land is available at all. We are all familiar with St Thomas’ just across the bridge. It has 900 beds, yet has only 380 parking spaces. Those spaces have to work hard, and to do that they need to be in constant turnover. The situation is repeated again and again across the country. I am sure there is not one of us in the House who has not heard of a friend, colleague or loved one who has struggled to find a place to park at a city-centre hospital.
Hospitals outside the cities might well have more space for parking, but they have increased demand from people who have no viable alternative to driving. My hon. Friend the Member for Solihull, speaking about the importance of local transport provision, again made an important point which will benefit carers, patients and others alike. Some will never be able to travel by public transport—it will not be suitable—but others will, and the car will not always be the most convenient option. NHS organisations must have the autonomy to make their own decisions.
These challenges are not an excuse to ignore the principles which, as I mentioned to the hon. Member for Burnley, now include her amendments. Patients, carers and visitors deserve to have consistent concessions across the NHS. The charges may vary, but we can all agree on the groups of people who should benefit. As I indicated, we have identified five groups for whom we believe concessions can enhance access. By adding carers to those principles, we will have made a valuable contribution, very much as a result of what the hon. Lady has done.
A further area of concern for me is the way that car parks are managed and charges set. One aspect that concerns me is when patients, carers and visitors report unfair charges when appointments overrun, through no fault of their own. A number of colleagues have mentioned the problem faced by people trying to decide how much time they are going to spend at hospital, and the need to make sure that people are not worried about making that decision when they are under stress. That is why our principles support pay-on-exit schemes where drivers pay only for the time that they have used. Too often, patients are forced to guess how long their appointment will take, with the consequence that some of them put too much money in, just to be on the safe side. Others run back and forth between clinic and car park, adding money as their time runs out. How much more reassuring it would be for them to know that the amount to be paid will exactly reflect the time spent at the hospital. Over half of our hospitals currently have pay-on-exit systems and we expect that to increase.
In the time allowed to me, I have tried to indicate our support for the principle of what the hon. Lady has said. That is why we have changed our principles. However, we consider that a national decision is not right. The reason why I am carrying on speaking is that I am not going to leave it to any of my colleagues to do the procedural business of talking the Bill out; that must fall to me. What we have done by changing the principles is to recognise what the hon. Lady has done. I hope that authorities have listened to the examples given by colleagues, showing what their authorities have been able to do, and I hope we see more.
I am sure that the shadow Minister will play a keen part and take a great interest as we work through the carers strategy. I am sure that we will find a strategy that recognises some of the other issues that she mentioned. I hope that in doing so we will be able to keep a cross-party, cross-House sense of the importance and value that we associate with carers, while recognising that the hard economics of the world mean that we cannot provide everything and so must provide the things that are of most advantage.
Cities and Local Government Devolution [Lords] Bill
Alistair Burt Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Nuttall
With the authority of my hon. Friend the Member for Altrincham and Sale West (Mr Brady), and having listened carefully to the Minister’s comments, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 5
Functions
Amendments made: 5, page 4, line 26, at end insert “, or
(c) so far as authorised by an order made by the Secretary of State—
(i) for a person appointed as the deputy PCC mayor by virtue of an order under paragraph 3(1) of Schedule 2, or
(ii) for a committee of the combined authority, consisting of members appointed by the mayor (whether or not members of the authority),
to exercise any such function.
‘( ) An order under subsection (3)(c)(ii) may include provision—
(a) about the membership of the committee;
(b) about the member of the committee who is to be its chair;
(c) about the appointment of members;
(d) about the voting powers of members (including provision for different weight to be given to the vote of different descriptions of member);
(e) about information held by the combined authority that must, or must not, be disclosed to the committee for purposes connected to the exercise of the committee’s functions;
(f) applying (with or without modifications) sections 15 to 17 of, and Schedule 1 to, the Local Government and Housing Act 1989 (political balance on local authority committees etc).”
This amendment makes provision for a mayor to arrange for the person appointed as the deputy PCC mayor or a committee of the combined authority to exercise a general function which is exercisable by the mayor, if authorised to do so by an order made by the Secretary of State.
Amendment 6, page 4, line 39, leave out paragraph (b) and insert—
“(b) in accordance with arrangements made by virtue of this section or section 107DA.”
This amendment provides for a general function exercisable by the mayor for the area of a combined authority to be taken to be a function exercisable by a committee or by the deputy PCC mayor, where arrangements have been made under provision inserted by amendment 5 or new section 107DA, inserted by amendment 8.
Amendment 7, page 5, line 3, at end insert—
“() provide that functions that the mayoral combined authority discharges in accordance with
arrangements under section 101(1)(b) of the Local Government Act 1972 (discharge of local
authority functions by another authority) are to be treated as general functions exercisable by
the mayor (so far as authorised by the arrangements).”
This amendment enables the Secretary of State to provide by order that functions of a mayoral combined authority discharged in accordance with arrangements under section 101(1)(b) of the Local Government Act 1972 are to be treated as general functions exercisable by the mayor of the authority.
Amendment 8, page 5, line 16, at end insert—
“107DA Joint exercise of general functions
(1) The Secretary of State may by order make provision for, or in connection with, permitting arrangements under section 101(5) of the Local Government Act 1972 to be entered into in relation to general functions of a mayor for the area of a combined authority.
(2) Provision under subsection (1) may include provision—
(a) for the mayor for the area of a combined authority to be a party to the arrangements in place of, or jointly with, the authority;
(b) about the membership of any joint committee;
(c) about the member of the joint committee who is to be its chair;
(d) about the appointment of members to a joint committee;
(e) about the voting powers of members of a joint committee (including provision for different weight to be given to the vote of different descriptions of member).
(3) Provision under subsection (2)(b) to (d) may include provision for the mayor or other persons—
(a) to determine the number of members;
(b) to have the power to appoint members (whether or not members of the combined authority or a local authority that is a party to the arrangements).
(4) Provision under subsection (2)(c) may include provision as to the circumstances in which appointments to a joint committee need not be made in accordance with sections 15 to 17 of, and Schedule 1 to, the Local Government and Housing Act 1989 (political balance on local authority committees etc).
(5) In this section references to a joint committee are to a joint committee falling within section 101(5)(a) of the Local Government Act 1972 that is authorised to discharge, by virtue of an order under this section, general functions of a mayor for the area of a combined authority.”—(James Wharton.)
This amendment enables the Secretary of State to make provision by order enabling the combined authority to enter into arrangements to discharge general functions of the mayoral combined authority jointly with one or more other local authorities or combined authorities.
Clause 5, as amended, ordered to stand part of the Bill.
Schedule 2
Mayors for combined authority areas: police and crime commissioner functions
Amendments made: 23, page 26, line 33, leave out
“police and crime commissioner functions”
and insert
“functions of a police and crime commissioner”
This amendment makes a minor drafting change to paragraph 1(1) of new Schedule 5C to achieve consistency with the language used in new section 107E(1) as inserted by clause 5 of the Bill (to which sub-paragraph (1) cross-refers).
Amendment 24, page 26, line 34, at end insert—
‘( ) A duty under this Schedule to make provision by order is a duty to make such provision in an order made at any time before the first election of a mayor who, by virtue of an order under section 107E(1), is to exercise functions of a police and crime commissioner.”
This amendment clarifies that an order made under new Schedule 5C can be made at any time before the relevant mayor is first elected and makes it plain that a Schedule 5C order can be made subsequently to an order under new section 107E.
Amendment 25, page 30, line 12, at end insert—
‘( ) Subsections (5) and (6) of section 107C, so far as relating to the exercise of PCC functions, are subject to any provision contained in an order under this Schedule.”—(James Wharton.)
This amendment ensures that an order under new Schedule 5C can make provision to prevent a person who is acting in place of a mayor with police and crime commissioner functions from carrying out particular PCC functions such as issuing or varying a police and crime plan, consistent with the current position in respect of actin PCCs.
Schedule 2, as amended, accordingly agreed to.
Clauses 6 and 7 ordered to stand part of the Bill.
Clause 8
Other public authority functions
The Minister for Community and Social Care (Alistair Burt)
I beg to move amendment 32, page 9, line 15, at end insert—
‘( ) See also section 19 of the Cities and Local Government Devolution Act 2015 (devolving health service functions) which contains further limitations.”
This amendment inserts a new subsection into section 105A of the Local Democracy, Economic Development and Construction Act 2009 which alerts the reader to clause 19 of the Bill which contains limitations on the power to make an order under that section.
The Temporary Chair (Mrs Anne Main)
With this it will be convenient to discuss the following:
Government amendments 33 to 38.
Clause 19 stand part.
Government new clause 8.
Government new schedule 1.
Alistair Burt
I think this is the first time that I have served under your chairmanship, Mrs Main, and I am honoured to do so. Thank you for inviting me to speak this afternoon. As a former Member of Parliament for Bury North—a constituent part of the Greater Manchester devolution process—and a former sponsor Minister for the cities of Manchester, Salford, Wigan, Bolton and Blackburn, I am pleased to take part in this debate which has acute relevance to that part of the world.
May I too put on record my sadness at the loss of Michael Meacher? As a friend and colleague in the north-west for many years he performed great service for Oldham, and was a good colleague to his friends on all sides in the north-west. He will be much missed, and I am sure that the Committee sends its condolences to his family and all who mourn him.
Clause 19 contains valuable safeguards that will apply to the local devolution of health functions. It was inserted in the Bill by an amendment tabled by Lord Warner in another place. Amendments 32 to 38 will provide further definition and clarity, without altering the spirit or substance of the clause. Lord Warner has confirmed that he is supportive of these further amendments.
Clause 19 provides that regulations under clause 17, or an order under section 115A of the Local Democracy, Economic Development and Construction Act 2009, must not transfer any of the Secretary of State’s core duties in relation to the health service as set out in the National Health Service Act 2006 and the NHS constitution. It makes it clear that whatever devolution arrangements might be agreed with a particular area, the Secretary of State will remain bound by the key duties placed on him in respect of the health service.
Amendment 38 provides further clarity by listing the duties of the Secretary of State that may not be transferred, in so far as they are capable of such a transfer. First and foremost, section 1 of the 2006 Act provides for the Secretary of State to retain responsibility to Parliament for the provision of the health service in England. Others are overarching duties on quality, reducing health inequalities, research, education and training, and on the NHS constitution. They also include Secretary of State’s role under the Health Act 2009 in revising and publishing the NHS constitution, his role under the 2006 Act in setting strategic direction for the NHS in the mandate to NHS England, and his role in overseeing and reporting to Parliament on the health service generally, and in particular on NHS England’s performance.
In essence, although health service functions are capable of being devolved to local authorities and to groupings of local authorities, the main responsibility and overriding duty of the Secretary of State for the NHS is not affected by these arrangements and he remains accountable for them.
Mr Betts
I apologise, but I shall have to go to chair a meeting about black and minority ethnic coaches and managers in football, another issue that I know will be close to the Minister’s heart.
The Minister may be trying to reassure the Committee, but in some ways he is giving me cause for concern. Devolution deals will, in particular, try to link social care and health in a more real way to the benefit of constituents. My concern is that if every line of accountability goes back to the Secretary of State in Whitehall, it will stop local innovation happening. Will not the line of command back to the centre simply stop things happening?
Alistair Burt
That is a good question and I hope I can reassure the hon. Gentleman. No, the whole process being considered is to give powers to the various authorities to be, as he said, innovative in what they would like to do. They will have the powers and the responsibilities to do that. The reason the concern was expressed in another place was to make sure that in the process it would not be possible for the NHS to transfer its core duties and therefore have local authorities do things that are contrary to the main constituent parts of the NHS, such as on issues relating to quality and so on. The accountability of the Secretary of State therefore remains. The ultimate accountability he or she has standing here at the Dispatch Box remains, but it would not stop the work and the innovation. As I shall go on to say, the regulatory powers of organisations such as the Care Quality Commission, Monitor and others will also remain in place to ensure that none of the national quality standards we expect from the NHS will be deviated from. There will be different ways of doing things, but ultimately the quality standard remains a national quality standard.
Mr Betts
I see what the Minister is trying to achieve, but I just worry about whether it will work like that in practice. Given that we are in very new territory here and that things will be done differently with the delegation of powers to individual authorities as well as to combined authorities, does the Minister agree that it would be a good idea, perhaps two years after the devolution powers have been put in place, to have a thorough review of how they are working and whether there is anything in the Government’s proposals that might actually stop devolution working properly?
Alistair Burt
As the hon. Gentleman knows, we can plan to review things at any stage. For devolution to work, the different models that may be put in place, whether big urban city models or more rural models, must of course pass the test of whether they are doing something qualitatively different and better for people. It will certainly be possible and necessary to review that. I think the concern has been to make sure that national standards are not dropped in the process of innovation. That is why the ultimate duty and responsibility of the Secretary of State remain. That was much discussed in another place. The reason for tabling these amendments is to confirm that, under the overall umbrella of wanting greater innovation, national standards will be preserved and cannot be threatened. That is the idea.
Bob Stewart (Beckenham) (Con)
Would it be fair to say that local authorities rule on these matters, but that the Secretary of State might occasionally reign?
Alistair Burt
We must be clear. The Secretary of State’s overarching duty and responsibility for the NHS will not mean a definitive touch. The whole point of devolution, as indeed the whole point of integration of services between local authorities and the NHS, is to give people the powers to make their decisions locally. There will be much discussion between different constituent parts. In that, the Secretary of State will have no part. It will not be possible, however, for a devolved authority to neglect or remove a core part of the NHS and say, “Oh well, we’ve got the power to do so.” That is the reason for the safeguard to which the amendments and new clause 19 refer.
John Mann
Is there anything in the Government’s proposal that would impact on a district such as Bassetlaw —the hospital trust crosses the border into south Yorkshire, but the clinical commissioning group money remains entirely within the district—electing to join Sheffield city region, in another region, where other decisions will be needed? Are there any hidden nasties we should be aware of?
Alistair Burt
No, I do not think so. There are neither hidden nor unhidden nasties. Local decisions will still be made, and CCGs will still be monitored for quality, effectiveness and the like. I am just coming on to talk about the regulation.
Clause 19 provides that the regulatory functions of national bodies held in respect of health services will not be available for transfer to a combined or local authority. This makes it clear that local devolution settlements will not devolve the regulatory functions of Monitor, the Care Quality Commission or other health service national regulatory bodies as defined. This means that a transfer order may not change the way in which our national health service regulators operate to protect the interests and safety of patients. Amendment 38 inserts a provision clarifying that a “health service regulatory function” means a regulatory function within the meaning given by section 32 of the Legislative and Regulatory Reform Act 2006, in relation to the health service. Amendment 35 omits the word “supervisory” but clarifies that the supervisory functions of NHS England in relation to CCGs are also expressly protected from transfer.
The safeguards set out in clause 19 would support the Secretary of State in ensuring in a transfer order that where a combined authority or local authority was to exercise transferred health functions, using the Bill’s new powers, that authority could be held to account as to the exercise of its health service functions, just as NHS commissioners are currently held accountable. Amendment 36 amends clause 19 to require that in a transfer of functions to a combined authority or a local authority, provision must be made about standards and duties to be placed on the authority.
Amendment 38 provides further explanation of the national service standards to which the Secretary of State must have regard when making such provision. These include, for example, those in the standing rules set for NHS England and CCGs, recommendations and quality standards published by the National Institute for Health and Care Excellence, and of course the standards set out in the NHS constitution, which sets out pledges and codifies requirements, statutory duties and rights that NHS services in England must, as a minimum, meet. These include national access standards, including waiting times. Amendment 38 also provides definitions for “national information obligations” and “national accountability obligations”.
As amended, clause 19 provides further clarity about the role of the Secretary of State for Health and what will and will not be included in any future transfer order giving local organisations devolved responsibility for health services. This clear statement in legislation, making provision for the protection of the integrity of the NHS, is intended to provide further confidence for future devolution deals. In essence, they will be underpinned by the basic core duties of the NHS, and that cannot be shifted. Amendments 32 to 38 give further definition and clarity to support the valuable principles behind this clause.
New schedule 1, which inserts schedule 3A in the Bill, provides for amendments to the National Health Service Act 2006, and new clause 8 is a clause to introduce that schedule. These amendments concern the making of arrangements with combined or local authorities for the exercise of health commissioning functions under the 2006 Act, including provisions allowing greater flexibility over how partners to such arrangements may work together. This will enable greater integration of health and care services and support local leaders to take collective steps towards better health and care for their local population.
New schedule 1 also makes small amendments to the 2006 Act concerning the provision that may be made in regulations concerning local authorities’ social care information.
Places such as Greater Manchester and Cornwall are calling for the ability to design and deliver better health and care services, and the ability to make decisions at a level that works best for their communities—locally or, where it makes more sense, at a regional or sub-regional level. As we know, devolution deals will be tailored to the needs and circumstances of a local area. The Bill will already allow the Government to make orders to devolve to a combined authority or a local authority a range of powers and functions currently carried out by Whitehall Departments or bodies such as NHS England.
Peter Dowd
I do not think anyone could disagree with the concept of maintaining standards, but when the Minister talks about what NHS England will be allowed or permitted to do, he needs to go further. The concept of subsidiarity is relevant. Powers should be devolved down, subject to standards, or there should be an onus, almost by default, on transferring responsibilities downwards rather than allowing bodies to pick and choose what they think should be devolved.
Alistair Burt
The order by which powers will be devolved will be subject to parliamentary approval. The safeguard is that the Secretary of State will have the power, as Parliament requests and demands, to put limitations on and conditions into that order. The reason there is no template for which powers must go downwards is that each area will probably have something different. The Bill provides a permissive opportunity for NHS powers to be devolved, but the powers to be devolved will depend on what each devolved administration is looking for. This part of the Bill sets out the ability of the Secretary of State and the NHS to achieve that, and the safeguard applies in respect of national qualities and standards and the regulatory process. The decision on which bits will be devolved down will be made by the Secretary of State and the NHS in consultation with the local areas that want the extra powers. I hope that helps the hon. Gentleman.
Peter Dowd
I would press for further clarity. I understand what the Minister says. The point I am trying to make is that if a local area says, “We think we are best able to provide particular services and responsibilities in a particular way” and NHS England, for example, says that it is not prepared to relinquish those responsibilities, we need a means of mediating that clearly and unambiguously. The assumption should be that the powers will go down to the local area if it wants them—subject to standards.
Alistair Burt
I take the hon. Gentleman’s point. I am not sure, however, that we can be more prescriptive on the face of the Bill. The hon. Gentleman is describing the process by which an area says, “We think that, in addition to the functions already devolved, other things need to be devolved to help local health services work together”, but it is difficult to envisage the circumstances in which NHS England would say, “Well, no you can’t”. At the moment, most are working collectively in any case, so this is a matter for local decision making and agreement between the parties involved. I do not think we can say more than that directly in the Bill at this stage. The whole process of devolution will fall into disrepair if there is continual conflict between an area that says, “Look, we think we can do this”, and a central authority that says, “No, you can’t, there’s no point in that given the process we are going through”. The provision of safeguards is about ensuring that NHS England can be confident of devolving powers, because ultimately the regulatory powers and the safeguards should ensure that patients and constituents are protected by national standards remaining the same. That is how I envisage it working.
John Howell (Henley) (Con)
My right hon. Friend has talked a great deal about the safeguarding of NHS provision. Can he reassure me that the social care element will be protected by the same level of safeguards?
Alistair Burt
Yes, in that the regulatory powers of the CQC and the safeguarding inspection regime will be retained for the social care element that is covered by a devolution deal. Again, the whole point is to give as much flexibility as possible to areas that want to exercise their powers to deliver services differently, with the reassurance that there will no compromise in relation to key standards—not that that would be wished for in a local area, and not that it would be anticipated by any of the devolving powers.
Following discussions with Greater Manchester and other local areas, we are now taking the opportunity to make available further options in legislation for combined authorities and local authorities to work together with clinical commissioning groups and NHS England across a wider area—such as Greater Manchester—to improve the integration of services. Those options will sit alongside the powers provided by the Bill to devolve a range of powers and functions that are currently exercised by Whitehall departments or bodies such as NHS England to a combined authority or a local authority. Crucially, wherever responsibility for NHS functions is delegated or shared in this way, accountability will remain with the original function holder, whether that is NHS England or a CCG. The original NHS function holder will continue to be accountable via the existing mechanisms for oversight, which ultimately go to the Secretary of State, who retains ministerial responsibility to Parliament for the provision of the health service.
Andrew Gwynne
I apologise for the fact that I have only just come into the Chamber for this part of the debate. I have been on Front Bench duty in Westminster Hall.
I am interested in what the Minister is saying about the Secretary of State’s oversight of devolved health in Greater Manchester, which is clarifying one of the issues about which I know a number of Greater Manchester MPs are concerned. May I ask, however, whether any thought has been given to coterminosity? In the case of most of the functions that have been devolved to Greater Manchester, there are coterminous boundaries with the 10 metropolitan boroughs. The NHS is slightly different, in that one of the CCGs—one of my own CCGs, Tameside and Glossop—extends to Derbyshire as well, because Glossop is not part of Greater Manchester.
Alistair Burt
I know the area well, and I know exactly what the hon. Gentleman is referring to. Yes, that is part of the consideration, but it is essentially part of the consideration of the combined authority. Not only will it have to devise the working of its services within the confines of what is commonly known as Greater Manchester, but it will have to recognise that some of the provision of those services is carried out by those with cross-border responsibilities, and work something out with the adjoining areas. Nothing in the Bill speaks to that, because it does not relate to what I am discussing—the control of standards and the like—but the hon. Gentleman is absolutely right. That is part of the process that people will be going through.
Mr Kevan Jones
The Minister has said that the Secretary of State will retain overall control.
Alistair Burt
I have read the report of the debates in the House of Lords on exactly this topic, because there was a lot of confusion. My understanding is that it depends on precisely what the breakdown is. Let us suppose that the breakdown, or failure, is in the way in which services have been put together by the combined authority. This is purely off the top of my head, and does not refer to anything of which I have any current knowledge. Let us suppose that there was a dispute between two constituent areas of Greater Manchester, one of which claimed that there was some inequity between the service that it was receiving and the service being received by the other. It might be claimed, for instance, that the combined authority’s decision was somehow disadvantaging Ramsbottom in favour of Bramhall. In the event of such a dispute, the buck would stop with those who were making the decisions locally, and that is the combined authority. The matter would not go anywhere near the Secretary of State. What the Secretary of State retains responsibility for is the standards and whether or not there has been a breach of NHS duties in relation to anything that falls within his own overall responsibility. So the buck still stops with the constituent authority that is delivering the service. In relation to a CCG that is not performing properly, the buck will stop with the CCG, not the combined authority. If there is a lapse of standards in anything connected with the NHS, ultimately the regulators govern that and the Secretary of State would be responsible. But if it is a decision being taken by those who are responsible for the new combined authority to do with where services go and it is within their remit, it will be a matter for them—the buck will stop with them. The short answer, therefore, is that where ultimately responsibility lies depends on where the breakdown is, but it is clear in relation to each of the services and it does not mean anyone can evade their responsibilities.
Andrew Gwynne
I think my right hon. Friend the Member for Leigh (Andy Burnham) had a better definition of what the Minister is trying to say. He said it is the Secretary of State’s responsibility to set out the “what”, and the “how it is delivered locally” is for local commissioners or the combined authority in the case of Greater Manchester. The “what” remains with the Secretary of State; the “how” is devolved to the local area.
Alistair Burt
I think between the hon. Gentleman’s right hon. Friend, me and the Secretary of State we have probably got where we need to get to in relation to this. I wanted to make clear that there will not be a confusion of who is responsible for what; someone is ultimately responsible for each bit, but who is responsible in each particular case depends on where the breach is.
Jon Trickett
I want to return to the question of coterminosity, which my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) referred to. In west Yorkshire, which is where I am from, the local Pontefract hospital goes across from west Yorkshire as far as York, almost—into Selby. If a combined authority with an elected mayor emerges in west Yorkshire, some of the hospital services for which that person will be responsible will be provided to people who have not had the opportunity to vote for him or her as mayor or for the combined authority. Where does accountability lie? Here is a situation where somebody is responsible for services outwith the area that has elected him.
Alistair Burt
If the mayor was to have responsibility for the services—that is not the proposal for Greater Manchester—the mayor would only have responsibility for the services within the combined area. Anything beyond that would still fall within the remit of those who commissioned services in that area. The decision as to—[Interruption.] That is right: the hospital in that circumstance may well have two bosses because the CCG would be responsible for the whole lot and it would have to come, by agreement, to a decision as to what was being provided within the combined area as well as outside the combined area. So the CCG remains responsible for what it is delivering, but it decides as normal with those to whom it is answerable—in one area it has become a different authority and in another it remains the original one—what services they should provide. The overall security for the quality of what the CCG is providing is maintained by the national regulator, which supervises, and it is ultimately for the Secretary of State to make sure the NHS guidance and duties are not breached, but it is a matter for local decision how this coterminosity is dealt with, because it will occur in more than one area. Certainly, however, I cannot see that legally a CCG outside a combined authority could have any direct line of responsibility to somebody inside the combined authority who is making decisions not about their area. That is how that would work.
Jon Trickett
If there are two adjacent mayoral operations, both taking responsibility for a hospital that is crossing the mayoral boundaries—which is now quite possible it seems to me—is not that a recipe for complex management for the people managing the hospital, and how would those contradictions be resolved?
Alistair Burt
In the first place, they could decide not to devolve at all. Part of the process will involve those in the combined authority and in those authorities next to each other deciding how to deliver the services. There is a choice. This is all voluntary, and if people want to do it they will work out a way. It is not very different from what has driven the authorities in Greater Manchester together in the first place. These are places that work across boundaries, and agreement will have to be reached on the delivery of the services. Constituents in one area could say, “Hold on a minute! Are we going to lose out over this?” They will make their decisions collectively on what they will pool and what they want. That is no different from what will happen in the areas that will be split. If people cannot agree, there will not be an order that could possibly be signed off. This will work only when there is a conviction that people have made the appropriate decisions. That is a matter for local agreement, and that is where all of us, as local politicians, get involved. So unless people are convinced that the processes are right, there will be no point in signing anything off.
Alistair Burt
I thank the hon. Member for Heywood and Middleton (Liz McInnes) for putting the Opposition’s case clearly and providing me with an opportunity to explain why these measures are so important and, I hope, give reassurance. I start by reminding the Committee that this is an enabling Bill, so nothing in it will force anybody to do anything. Ultimately, if local areas want to take the opportunity to apply for devolution, including the devolution of health services, they can do so, but they will not be forced to do so. Control and standards will be exercised by Parliament in securing the deals. Within that wide remit, I will come to the hon. Lady’s questions, but first let me answer a few specific points that have been raised.
The hon. Member for Bristol South (Karin Smyth) and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—I thank him for the work he did in the Department, which I follow—in a way put both sides of the argument. In a sense, the Government cannot decide some of the issues that both my hon. Friend and the hon. Lady raised. My hon. Friend believes that where these opportunities are used for greater integration and for the best, services will be smoother and able to deliver more locally what people want. Of course, as the hon. Lady pointed out, there will be disputes within each individual area about what might be best for it. A devolution deal will make sense only if decisions have been taken locally and agreement has been reached on how to move forward. If not, I cannot imagine the hon. Lady or her area wanting to support them. Central Government cannot make all the decisions that will ultimately be taken by a group of authorities working together. Some of that will have to be decided locally, rather than at the centre. I will talk in a moment about the check that is made before anyone agrees to transfer anything.
Let me make specific reference to specialised services, which are of particular interest to the hon. Member for Bristol South. NHS England may make arrangements with local partners for the commissioning of specialised services. Those arrangements will be subject to NHS England having regard to certain considerations on their appropriateness in the particular commissioning area. They might involve delegation to local partners, or NHS England might decide to work together with its local partners, who must include at least one clinical commissioning group and a combined authority, or at least one local authority. In all cases, the local partners in an arrangement must exercise the function jointly. That will allow local commissioners to shape services to best meet the needs of their local populations and make it easier to integrate specialist services with other health and social care services. However, NHS England will remain accountable for the delivery of specialised services. It will remain bound by its existing duties to promote the NHS constitution on reducing health inequalities and on effectiveness and efficiency, and to exercise its functions with a view to securing continuous improvement in the quality of services, along with its other overarching duties. NHS England has confirmed that it will be part of any arrangements concerning specialised standards, but national service standards that it sets for the provision of these services will continue to be required. Although there is provision in the Bill to devolve certain specialised services, the control, security and safeguards of the NHS remain. However, it will be possible if it is considered the right thing to do.
Karin Smyth
I am grateful for that clarification. My concern then would be who the Minister sees as driving the development and improvement of, particularly, the specialised commissioners. We are talking in fairly transactional terms about who might be contracting or who might be accountable but, as he will appreciate, these services, as well as others, require a long lead-in time and a lot of consideration owing to their very technical and, by definition, specialised nature. Who is driving this forward—the local group, if they so choose, who may not have the expertise, or the Department?
Alistair Burt
NHS England and the Department must retain the overall control of the quality of the specialised services, and that will not be relinquished if there is no sense that they can be handled any better, because otherwise there is no point. The number of specialised services that are devolved might ultimately be very few. Of course, there is only any point in devolving them if they are going to improve, and that must be demonstrated before they are devolved and moved on.
Let me say a little about the wider concern of the hon. Member for Heywood and Middleton that by devolving these powers and running with the grain of greater devolution, we are losing the “national” in the national health service. We are absolutely determined that that will not be the case. The safeguards that are now in the Bill as a result of concerns expressed elsewhere were never going to be lost, but they are now made more explicit to demonstrate that what she worries about cannot happen. It is not the case that an authority will apply for these powers and they will be handed over without no further consideration, because there is the transfer order that Parliament will be involved in.
What are the Government going to think about when people ask to do this? The Government have invited local areas to develop their own proposals. There is no blueprint for the devolution of health and social care. The substance of devolution deals will be determined on a case-by-case basis, with Government agreeing bespoke deals that correspond to the needs and specific context of each area. There are some important preconditions that we might expect to support the development of local devolution deals, including health and social care. These include a clear vision for the benefits to the local area; a history of successful collaboration and partnership working; support and input from local health and social care organisations for the proposals being put forward; a strong commitment to further engagement with local patients and communities as plans develop; upholding the standards set out in national guidance; and continuing to meet statutory requirements and duties, including the NHS constitution and the Government’s mandate to NHS England. Most importantly, the first overarching principle of any agreement is that all areas will remain part of the NHS. This requirement to adhere to the constitution of the NHS and the ultimate safeguard of the Secretary of State’s responsibilities answers the point about a local area getting hold of NHS money and then deciding to build a new leisure centre. It would not be able to do that because it would not be complying with its duties under the NHS. It would fail and the duties and responsibilities would soon be taken away. That is why the safeguard is there.
To deal with the hon. Lady’s concerns about potential confusion, let me say a little more about the role of NHS England under devolved arrangements. NHS England and CCGs would continue to be bound by their duties under the National Health Service Act 2006 even after devolution of functions. For example, NHS England will remain bound by duties to promote the NHS constitution, and to exercise its functions effectively, efficiently and economically and with a view to securing continuous improvement in the quality of services, including in terms of outcomes.
NHS England must exercise its functions having regard to the need to reduce inequalities in relation to both access to health services and outcomes achieved for patients. When NHS England exercises its functions, it must also promote the involvement of patients and their carers and representatives in decisions made about diagnosis, prevention and care and treatment. It must take appropriate advice and act with a view to enabling patients to make choices with respect to aspects of the health service provided to them.
Those safeguards show that the powers simply cannot be devolved to people who want them without any check or balance on how they would exercise them, even if they persuade people locally that signing a blank cheque for help is in any way acceptable. I cannot see local representatives agreeing to that. That is where the control comes in.
How will the Department of Health and NHS England be involved in agreeing the deals? We have been working closely with other Government Departments to respond to proposals. NHS England has developed its own set of assessment criteria, by which it will assess the potential of proposals from a particular local area. It is not an automatic process: if the deal will not work in terms of the quality of healthcare provided, the House will not pass a transfer order because the proposal will not pass the test set by NHS England and the Department of Health.
Will devolution mean that local areas can set their own strategy for NHS capital estates and management? No, we do not envisage any changes to capital financing and asset ownership.
Finally, I want to address a very important issue raised by the hon. Lady. Who will have the final say over the opening and closing of hospitals and other services? This is issue concerns every single one of us in the Chamber. Reconfiguration of NHS services will continue to be a matter for the local NHS. However, proposals for service change must meet the Government’s four tests: support from local GP commissioners; clarity on the clinical evidence base; robust patient and public engagement; and support for patient choice. The same elements of contest available when reconfiguration has been proposed will remain even after devolution, so nothing is taken away.
I hope that has been helpful. Working with the grain of what people want, we all think this is a better idea, but there are safeguards to make sure that people’s worries will not come to fruition.
Amendment 32 agreed to.
Clause 8, as amended, ordered to stand part of the Bill.
Clause 17
Power to transfer etc. public authority functions to certain local authorities
Amendment made: 33, page 17, line 32, at end insert—
‘( ) See also section 19 (devolving health service functions) which contains further limitations.”—(Alistair Burt.)
This amendment inserts a new subsection into clause 17 which alerts the reader to clause 19 which contains limitations on the power to make regulations under that clause.
Clause 17, as amended, ordered to stand part of the Bill.
Clause 18
Section 17: procedure etc.
Amendment made: 15, page 18, line 6, after “make” insert “incidental, supplementary, consequential,”—(Alistair Burt.)
This amendment provides that the power to make regulations under clause 17 of the Bill includes a power to make incidental, supplementary and consequential provision.
Clause 18, as amended, ordered to stand part of the Bill.
Clause 19
Devolving health service functions
Amendments made: 34, page 18, leave out lines 29 to 33 and insert—
‘(1) Regulations under section 17 of this Act or an order under section 105A of the Local Democracy, Economic Development and Construction Act 2009 (transfer of public authority functions to combined authorities) (“the 2009 Act”)—
(a) must not transfer any of the Secretary of State’s core duties in relation to the health service;”
This amendment confines the limitations contained in clause 19 to the exercise of the power to make regulations under clause 17 or an order under section 105A of Local Democracy, Economic Development and Construction Act 2009. Those powers concern the transfer of public authority functions to local or combined authorities. New clause 19(1)(a) prevents those powers being used to transfer any of the Secretary of State’s core duties in relation to the health service (as defined in clause 19(2) which is inserted by Amendment 38).
Amendment 35, page 18, line 34, leave out “or supervisory”
This amendment removes the prohibition in clause 19(b) on the transfer of health service supervisory functions of national bodies by regulations under clause 17 or an order under section 105A of the Local Democracy, Economic Development and Construction Act 2009.
Amendment 36, page 18, line 36, leave out from “must” to first “the” in line 37 and insert
“, if transferring functions relating to the health service to a local authority or a combined authority, make provision about the standards and duties to be placed on that authority having regard to”
This amendment and Amendment 37 replace the limitation in clause 19(c) with a requirement that regulations under clause 17 or an order under section 105A of the Local Democracy, Economic Development and Construction Act 2009 which transfer functions relating to the health service to a local or combined authority must make provision about the standards and duties to be placed on that authority having regard to certain standards and obligations placed on the authority responsible for the functions being transferred.
Amendment 37, page 18, line 38, leave out from “on” to “being” in line 39 and insert
“the authority responsible for the functions”
See the statement for Amendment 36.
Amendment 38, page 18, line 40, at end insert—
‘(2) For the purposes of subsection (1)(a), “the Secretary of State’s core duties in relation to the health service” means the duties of the Secretary of State under—
(a) sections 1 to 1G of the National Health Service Act 2006 (“the NHSA 2006”) (duty to promote comprehensive health service etc.),
(b) sections 6A to 6BB of that Act (duties regarding the reimbursement of costs of services provided in another EEA state),
(c) section 12E of that Act (duty as respects variation in provision of health services),
(d) sections 13A, 13B, 13U and 223B of that Act (duties regarding mandate to, and annual report and funding of, the NHS Commissioning Board),
(e) section 247C of that Act (duty to keep health service functions under review),
(f) section 247D of that Act (duty to publish annual report on performance of the health service in England),
(g) section 258 of that Act (duty regarding the availability of facilities for university clinical teaching and research), and
(h) sections 3 to 6 of the Health Act 2009 (duties in relation to the NHS Constitution and the Handbook to it),
in so far as those duties would (apart from subsection (1)(a)) be transferable by regulations under section17 or an order under section 105A of the 2009 Act.
(3) For the purposes of subsection (1)(b)—
(a) “health service regulatory function” means a function in relation to the health service which is a regulatory function within the meaning given by section 32 of the Legislative and Regulatory Reform Act 2006,
(b) the functions of the National Health Service Commissioning Board under sections 14Z16 to 14Z22 of the NHSA 2006 (assessment of clinical commissioning groups and intervention powers) are to be treated as “health service regulatory functions” in so far as they do not fall within the definition in paragraph (a), and
(c) functions exercisable by a body by virtue of directions given under section 7 of the NHSA 2006 (functions of Special Health Authorities) are not “vested in” that body.
(4) But subsection (1)(b) does not prevent the transfer of functions of the National Health Service Commissioning Board which—
(a) arise from arrangements under section 1H(3)(a) of the NHSA 2006 (provision of services for the purpose of the health service), and
(b) relate to those providing services under those arrangements.
(5) For the purposes of subsection (1)(c), “national service standards” means the standards contained in any of the following—
(a) the NHS Constitution (within the meaning of Chapter 1 of Part 1 of the Health Act 2009);
(b) the standing rules under section 6E of the NHSA 2006 (regulations as to the exercise of functions by the NHS Commissioning Board or clinical commissioning groups);
(c) the terms as to service delivery required by regulations or directions under the NHSA 2006 for contracts or other arrangements for the provision of primary medical services, primary dental services, primary ophthalmic services or pharmaceutical services under Part 4, 5, 6 or 7 of that Act;
(d) the recommendations or guidance of the National Institute for Health and Care Excellence made or given pursuant to regulations under section 237 of the Health and Social Care Act 2012;
(e) the quality standards prepared by that Institute under section 234 of that Act;
(f) the guidance published under section 14Z8 of the NHSA 2006 (guidance on commissioning by the NHS Commissioning Board);
and such standards are “placed on” a body if the body is required to have regard to or comply with them.
(6) For the purposes of subsection (1)(c)—
(a) “national information obligations” means duties regarding the obtaining, retention, use or disclosure of information, and
(b) “national accountability obligations” means duties (for example, those to keep accounts or records, or to provide or publish reports, plans or other information) which enable the management of a body, or the way in which functions are discharged, to be examined, inspected, reviewed or studied.
(7) For the purposes of this section, a function is transferred by regulations under section 17 or by an order under section 105A of the 2009 Act, if—
(a) provision is made under subsection (1)(a) of the section in question for the function to be the function of a local authority or a combined authority, or
(b) provision is made under subsection (1)(b) of that section for a function corresponding to the function to be conferred on a local authority or a combined authority.
(8) Nothing in this section prevents the conferral on a local authority or a combined authority of duties to have regard to, or to promote or secure, the matters mentioned in sections 1 to 1F of the NHSA 2006 when exercising a function transferred to it by regulations under section 17, or by an order under section 105A of the 2009 Act.
(9) In this section, “the health service” has the meaning given by section 275(1) of the NHSA 2006.”—(Alistair Burt.)
This amendment adds provision to clause 19 which defines terms used in, and clarifies the scope of, the limitations contained in paragraphs (a) to (c) of the clause.
Clause 19, as amended, ordered to stand part of the Bill.
Clause 9 ordered to stand part of the Bill.
Schedule 3 agreed to.
Clause 10
Funding of combined authorities
Amendment made: 9, page 11, line 26, at end insert—
‘( ) In section 105 of the Local Democracy, Economic Development and Construction Act 2009 (constitution and functions of combined authorities: economic development and regeneration), omit subsection (4).”—(Alistair Burt.)
This amendment removes the restriction on orders under section 105 of the Local Democracy, Economic Development and Construction Act 2009 only being able to make provision in relation to the costs of a combined authority that are reasonably attributable to the exercise of its functions relating to economic development and regeneration.
Amendment proposed: 58, page 11, line 26, at end insert—
‘(5) The Secretary of State may by order make provision for conferring powers on a combined authority to set multi-year finance settlements.” —(Jon Trickett.)
This amendment is intended to offer financial stability to city regions, allowing them long-term planning which is something not currently offered by the finance settlement or the funding of local enterprise partnership (LEPs).
Mental Health (Armed Forces Veterans)
Alistair Burt Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Madam Deputy Speaker (Mrs Eleanor Laing)
I call the Minister, Alistair Burt.
The Minister for Community and Social Care (Alistair Burt)
I think, Madam Deputy Speaker, there is another colleague who is going to intervene.
The Minister for Community and Social Care (Alistair Burt)
It is standard to congratulate the hon. Member who has secured the debate, but I really do congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). This has been a very interesting 18 minutes, and my only criticism is that we should have had at least an hour and a half, or maybe three hours somewhere else, but I suspect that might happen. I also congratulate the hon. Lady on raising this subject at Prime Minister’s questions today. If she permits, may I thank her for her service to the NHS and those in difficulties and thank her husband for his service to the country?
I am delighted to be joined by the Under-Secretary of State for Defence, my hon. and gallant Friend the Member for Milton Keynes North (Mark Lancaster), who has also seen active service and we have just heard from my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer). I say to them that there are times when their Minister feels very humble in that their collective experiences outrank mine very considerably. So I will do my best to respond to the debate. Because of the length of the initial speeches, I have slightly less time in which to do that, but that is all right because I want to make some changes to what I was going to say.
I should like to set out what the Government are doing. In doing that, I do not intend to suggest that what has come forward up to now is not valid, relevant, important or challenging to the Government. It would, however, be fair of me to put on record what is going on, although it is palpably not enough. If the hon. Member for East Kilbride, Strathaven and Lesmahagow, with her experience, needs more and if my hon. Friend the Member for Plymouth, Moor View, with his experience, needs more, then it is clear that whatever we are doing—good though it is, and better than it was—is not yet meeting the demands and the needs. It is also clear from the comments of other Members tonight that it is not yet meeting the demands of the House. My hon. and gallant Friend from the Ministry of Defence and I have listened carefully and there will be more to be said.
The Government are fully committed to continual improvement in the treatment of mental health conditions for veterans and the general public alike. We are rightly proud of the courage and dedication of our armed forces. For those who have been injured either physically or mentally, it is our duty to ensure that they continue to receive the very best possible care. As Members have already said, the vast majority of those leaving the armed forces do so fit and well, having benefited from their time in the forces. Members of the armed forces are not significantly more likely to develop mental health issues than those in other professions, but support and clinical care that are geared to the specific needs of veterans need to be available.
Armed forces and veterans mental health provision has vastly improved since the publication of the landmark report “Fighting fit” in 2010. The report was produced at the hands of my hon. Friend the Member for South West Wiltshire (Dr Murrison), who recommended that there should be 30 mental health professionals across England to provide services to veterans. With 10 veterans mental health teams in place across England, we now have significantly more than the 30 professionals recommended.
In deference to the position of the hon. Member for East Kilbride, Strathaven and Lesmahagow, let me now say a bit about Scotland’s provision. Scotland is proud of its commitment to improving mental health, including for veterans and their families. Visibility and awareness of mental health issues have substantially risen in the nation over the past decade. That echoes something that my hon. Friend the Member for Plymouth, Moor View said. There is greater awareness following long-standing campaigns against stigma. We have not gone as far as we need to go, but it is easier for people to talk now. For those with very difficult conditions, however, those are easy words, and it is still very difficult for them.
There is better public awareness of mental illness, suicide prevention and faster access to NHS services and other sources of help. Veterans and their families have unhindered access to all NHS services, enhanced by priority treatment where that applies. Evidence-based care and treatment are provided across community-based settings through support from primary care, with specialist or hospital in-patient services provided as appropriate.
In partnership with NHS Scotland and Combat Stress, the Scottish Government recently renewed funding for the provision of specialist mental health services at the Hollybush House Combat Stress facility in Ayr, for veterans resident in Scotland. The sum of £1.22 million a year over the three years to 2018 will fund a range of specialist clinical, rehabilitation, social and welfare support at the facility. Evidence-based treatment programmes include an intensive post-traumatic stress disorder programme; trans-diagnostic and stabilisation; and anger management programmes.
NHS Lothian secured £2.5 million of armed forces covenant LIBOR funding to support the commitment, and established Veterans First Point Scotland to work with local partnerships to explore how the strengths of the Lothian service could be delivered in other localities. Over the past year, work has been taken forward in 10 health board areas across Scotland to assist each local area to establish key partnerships, identify premises, plan requirements and recruit and select staff. This work continues, with the service in Tayside now open with others to follow.
I want to demonstrate that England, too, is recognising and trying to respond to the needs of veterans. Before I say a bit about that, may I thank the hon. Member for Strangford (Jim Shannon) for raising the issue in relation to the Republic? I do not know the answer, but I will find out. I recognise the point that he makes.
Underpinning all that I am saying is the demand for more research. There is some good research. The King’s Centre for Military Health Research has done some good work in identifying the categories of those who might be more at risk. Reservists and their particular issues came up, as did the other groups of veterans, particularly those who have been back for some time. There are ways of picking up those issues, and I will say a little more about that.
NHS England spends £1.8 million a year on mental health services for veterans including the 10 veterans’ mental health teams. Up to £18 million funding is in place to provide the Combat Stress six-week intensive post-traumatic stress disorder programme for veterans, with an additional £2 million of LIBOR funding being provided to Combat Stress to help veterans with alcohol problems, which is a key indicator of problems. Help for Heroes has received £2 million of LIBOR funding for its “hidden wounds” work, offering low-level improving access to psychological therapies services to veterans. Subject to the spending review, a further £8.4 million will be provided over the coming five years to help the most vulnerable veterans who have mental health problems.
Jim Shannon
The Minister mentioned LIBOR funding, and that is something that I have been pursuing through the Defence Committee and other ways. We have been seeking to have some of that LIBOR funding available for Northern Ireland to provide a rehabilitation centre for the many people who have served and who will continue to serve. None of that has been forthcoming to the Province so far. I understand that the Minister cannot give me an answer today, but perhaps he can look at the matter and come back to me.
Alistair Burt
My hon. and gallant Friend from the Ministry of Defence says that there is money available in a bidding programme and he will write to the hon. Gentleman and see what more can be done in relation to that.
I want to say two things as we run towards a conclusion. Many of the servicemen affected will of course be treated by the NHS in the course of ordinary medical treatment. The so-called talking therapies from the IAPT programme have been particularly successful. It is important to ensure that the particular needs of veterans are catered for in this programme. Work has been under way to ensure that that is done. The IAPT programme has been very successful. For the first time, we have standard waiting times and access targets. That will help veterans too.
Martin John Docherty (West Dunbartonshire) (SNP)
Will the Minister give way?
Alistair Burt
I only have a couple of minutes left, but if the hon. Gentleman must intervene, I will give way.
Martin John Docherty
I am very conscious of the time, and I am grateful to the Minister for giving way. We have heard much talk about service personnel, and I completely agree with it, but there seems to be little discussion about the impact of service personnel’s mental health issues on children. Given that the strategic defence and security review is coming up, will there be some commitment to investigations and discussions with the children’s commissioners of the United Kingdom of Great Britain, Northern Ireland, Scotland and Wales to see how they can inform that debate?
Alistair Burt
I note the hon. Gentleman’s remarks. I cannot say anything about the review, but I take his point. It is recognised that anything that affects the mental health of an individual can impact on the family. I hope that the veterans’ work involves that.
May I just say a little more as I have something specifically to say about that? Additional services include: a 24-hour veterans’ mental health helpline that receives more than 800 calls per month; an online peer support, well-being and counselling service called the Big White Wall, which provides support and services to armed forces, their families and veterans 24 hours a day all year round; Combat Stress, of which people are aware; and Help for Heroes’ “hidden wounds”, which is a psychological well-being service offering support to veterans and their families. It is important that these veterans’ services are both sustainable and fully embedded in the mainstream of the NHS so that veterans can move to other mental health services if necessary and at the right time.
In view of what colleagues have said, let me conclude by returning to my original point. There are services in place. They have clearly improved. We have recognised the good work of my hon. Friend the Member for South West Wiltshire some time ago and the demand that has come back, but it is plain from what colleagues are saying that they want us to do more. I do not think that there is a finite limit that we can go beyond in recognition of what has been done for us. I am absolutely certain that the commitment that the Prime Minister made this afternoon in his answer to the hon. Member for East Kilbride, Strathaven and Lesmahagow in which he demonstrated his own deep awareness of the situation is one that we can all rely on. We will continue to meet the commitments of the armed forces covenant and to work closely with all those relevant organisations in the best interest of veterans and their mental health. That is the best way in which we can say thank you.
Question put and agreed to.
Oral Answers to Questions
Alistair Burt Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Bill Esterson (Sefton Central) (Lab)
7. How much additional investment there will be in children and young people’s mental health services in 2015-16.
The Minister for Community and Social Care (Alistair Burt)
We are investing an additional £173 million this year, which includes £30 million specifically for eating disorders. We are taking a targeted and phased approach to the additional investment to develop capacity and capability across health, education and children’s services, from prevention and resilience building to supporting the most vulnerable.
Ruth Cadbury
The Government explicitly promised £250 million for children’s mental health in 2015-16, yet the Department of Health has admitted it will be spending only £143 million by next April. Is this £170 million shortfall not further evidence that while Ministers might talk a good talk on mental health, we should judge them by their actions?
Alistair Burt
No. I take the hon. Lady’s point, but we are committed to spending £1.25 billion over the Parliament. We will not be able to spend the £250 million this year, but it will be included in future years. The reason is that we have to make sure it is effectively and properly spent and it is a phased programme. She will be delighted to know that in her constituency there will be an extra £536,000 for children’s mental health services.
Rushanara Ali
The organisation YoungMinds found that one in five mental health trusts had had to freeze or cut budgets every year in the last Parliament, and at the moment 40,000 young people are being refused mental health treatment. What guarantees can the Minister give that the money promised by the Chancellor recently will actually be made available and that trusts will not continue to cut mental health budgets?
Alistair Burt
The hon. Lady makes a fair point. While we invest money nationally in services, people complain that locally clinical commissioning groups have not been funnelling the money down. Two things should help: first, for the first time the national access and working time targets, which the Government have introduced, will provide a means of monitoring what CCGs are doing; and, secondly, the new scorecard for CCGs will look explicitly to ensure that a proportion of the increase to a CCG goes into mental health services. The hon. Lady will also be pleased to know that in her own CCG area there will be an extra £521,000 for children’s mental health services.
Bill Esterson
Some 23% of the adult prison population were in care as children and many of them have poor mental health. Will the Minister ensure that mental health services are in place for children in care to make the greatest contribution possible to improving their life chances, and not least to ensure we reduce the numbers ending up in prison?
Alistair Burt
Yes, the hon. Gentleman makes a point made by successive Governments: care outcomes are terrible and the earlier the intervention the better. We are encouraging the engagement of early prevention therapies, including for those in care, and for the first time the Government have appointed a dedicated mental health Minister, in the Department for Education, further to promote resilience and work more closely with young children, including those in care.
Andrea Jenkyns (Morley and Outwood) (Con)
Infection control in the community is a great way to reduce preventable illness. In November, I will launch a handwashing campaign in Parliament that I hope will have cross-party support. Will the Minister inform the House what his Department is doing to promote infection control outside the hospital setting?
Alistair Burt
I believe we are. I will check to be certain, as I know the right hon. Gentleman knows a great deal about this, but I believe we are. We have £150 million for eating disorders, and £30 million is being spent this year, with additional beds allocated. I will check that the waiting target times remain because they have made a significant difference. The right hon. Gentleman’s work has been of powerful import in what we do.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Yesterday, the National Society for the Prevention of Cruelty to Children revealed that one in five children in need of mental health treatment are being turned away. Is it not appalling that young people are being denied help, only for them to become more seriously ill later on, and that the number of children turning up at A&E because of mental illness has doubled in recent years? Does the Minister accept that children’s mental health needs more money now—this year, as he promised? I can point to many different organisations across the country that would gladly receive that support now. How is he going to put his broken promise right?
Alistair Burt
May I welcome the hon. Lady to her position, not least her Cabinet position—he said carefully—and welcome the prominence that mental health now has among all parties? Let me say rather gently in response to the tirade that I have just received that under this Government we have for the first time introduced parity of esteem for mental health on waiting times and national access targets. We are spending more money—£1.25 billion over the next five years. We have the highest number of beds for young people in emergency situations; we have the first dedicated education Minister for young people’s health; we have £75 million for perinatal health; and in her own constituency, the hon. Lady will be pleased to welcome from her shadow Cabinet position an extra £1.1 million going to Liverpool for mental health treatment for children and young people. I think that is a significant response.
Mr Speaker
I do not know who writes a lot of this screed, but sometimes a blue pencil needs to be taken to it. The Minister is immensely capable and experienced, but a distillation or an abridged version rather than a “War and Peace” version would be appreciated.
Catherine West (Hornsey and Wood Green) (Lab)
4. What progress his Department has made in introducing a cap on care costs.
The Minister for Community and Social Care (Alistair Burt)
We have introduced primary legislation and consulted on draft regulations to introduce the care cap. Following the decision to delay implementation until April 2020, we will use the additional time to improve the policy in the light of feedback from stakeholders.
Catherine West
Let me first declare an interest as a vice-president of the Local Government Association.
May I ask what assistance the Department is offering local authorities which are currently cash-strapped so that they can implement new minimum wage regulation, which is very welcome, in order to provide first-class social care?
Alistair Burt
It is not possible for me to talk about what may emerge from the spending round and settlement, but I can say to the hon. Lady that local authorities were given extra finance to implement the Care Act 2014. Some £5.3 billion is available to local authorities to work through the new integrated social care and NHS budget. So we are very conscious of the pressures on local authorities, which need the resources to provide the social care we all expect.
Greg Mulholland (Leeds North West) (LD)
The coalition Government agreed a policy of a cap on care costs, and the Conservative manifesto in May said that no one would have to sell their homes to pay for care. Some £100 million has been wasted on this delay, which has betrayed our older people and has simply ducked one of the biggest crises facing this country. Will the Minister and the Department now apologise?
Alistair Burt
There was a consultation on the coalition proposals, which began at the beginning of this year and ran through the election period. The consultation included a very strong representation from the Local Government Association, which said that it did not want to implement the care cap now and wanted extra time. Therefore, the decision has been taken not to cancel, but to delay. It is of course a change from the position we set out. I fully accept that, but we listened to stakeholders and we are now going to use the extra time, at the request of the LGA and others, to find a way through to implement the policy and to use the time for extra financial products.
Johnny Mercer (Plymouth, Moor View) (Con)
8. What assessment his Department has made of progress in implementing the success regime at Derriford hospital in Plymouth.
Christina Rees (Neath) (Lab)
11. What steps he is taking to improve support for carers.
The Minister for Community and Social Care (Alistair Burt)
I am not quite sure what the situation is in Wales, but in England I do not think that carers’ invaluable contribution to society has ever been better recognised. We are working very hard to see the implementation of the improved rights for carers enshrined in the Care Act 2014. I am also responsible for developing a new national carers strategy to see what more we can do to support existing and new carers in England.
Christina Rees
There are more than 6.5 million unpaid carers in the UK, with nearly 11,000 in my constituency. In total, they save the state more than £119 billion each year, which is more than this Government spend on the NHS . Research by Carers UK has found that nearly 50% of carers are struggling to make ends meet, and that is seriously affecting their health. What plans does the Minister have to work with the Department for Work and Pensions and the Treasury, and across government, to ensure that the improvement of carers’ finances will be a key part of the Government’s care strategy?
Alistair Burt
The work I am doing on developing the new strategy involves other Departments, and it will look at not only the economics, but what is happening internationally and where we can take the whole concept of caring for a different society in the future. The economics is certainly important; we could not do without the contribution that carers make, but it would be impossible to replace it with total Government finance.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Yesterday, the Public Accounts Committee heard from officials at the Department of Health about the implementation of the Care Act, which is a bold piece of legislation. They admitted that they were very concerned about the unidentified carers, who need to be found in order to be supported. What is the Minister planning to do to make sure that they are identified and supported?
Alistair Burt
In a way, the self-definition states its own problem: these are unidentified carers. I hope that the new responsibilities in the Care Act will encourage more people to come forward and that the greater work of carer support organisations, such as the one I preside over in Bedfordshire, Carers in Bedfordshire, will be able to identify more carers. We want more young people to come forward because, as the hon. Lady says, people are caring and they do not realise they are. We need a concerted effort all round to try to reveal them, so that more can be done.
Barbara Keeley (Worsley and Eccles South) (Lab)
I am surprised that the Minister believes he is supporting carers in any way acceptably well. The recent personal social services survey found that 38% of adult carers now care for more than 100 hours a week but only one in five of those carers is getting support to take a break from caring. Government cuts have caused a funding gap in social care, which, it is estimated, will be £4 billion by 2020, piling additional pressure on those family carers, and the better care fund and integration will not, in themselves, fix that gap. When will Health Ministers admit that they have got this wrong and argue for more funding for social care, so that carers can get the support and respite breaks they should get?
Alistair Burt
Between 2010 and 2015, £400 million extra was found in order to provide respite for those who are caring for others. Any support that goes into local government, or indeed the NHS, is predicated on a decent economy and decent economic principles in order to fund it—I believe from what happened last night that that has been abandoned by the Labour party. We have to have the resources in the first place. That is what we are seeking to ensure and that is what the work is being done for.
Mr Robin Walker (Worcester) (Con)
12. What steps his Department is taking to manage and meet demand for A&E services in Worcester.
Martin Vickers (Cleethorpes) (Con)
T4. It emerged earlier this month that North East Lincolnshire CCG was operating a primary care incentive scheme intended to reduce outpatient referrals. Understandably, this has met with a hostile reception from my constituents, who fear it may affect decisions on their care. Will Ministers look into this scheme and either offer some reassurance or instruct the CCG to reconsider?
The Minister for Community and Social Care (Alistair Burt)
The north Lincolnshire scheme is designed to try to encourage doctors to make sure that there are no inappropriate referrals to secondary care; it is not designed to prevent appropriate ones. Over the past five years we have seen an increase of 600,000 in urgent referrals for cancer care, for example. We want to see that continue. It will not be helped if there are inappropriate referrals, and that is what the scheme is about.
Andrew Gwynne (Denton and Reddish) (Lab)
Last week senior officials at Monitor reported being leaned on by the Department of Health to suppress the publication of financial figures ahead of the Conservative party conference. This week the Health Secretary has been accused of vetoing the release of impartial independent reports on measures that could reduce our consumption of sugar. Does he not understand that leadership on transparency must come from the very top? Will he now commit to practising what he preaches on NHS transparency and release this report immediately?
Ian C. Lucas (Wrexham) (Lab)
T5. The all- party spinal cord injury group, which I chair, recently reported that very vulnerable patients are being prejudiced by delayed discharges, taking up lots of public money in hospital expenses that should be used to treat more patients. Will the Secretary of State carry out an urgent service review to address this real problem in England, Wales, Scotland and Northern Ireland?
Alistair Burt
Delayed discharge has been a problem across the system for many years. An awful lot of work is going on to ensure that more preventive work is done so that people do not go into hospital, and to ensure that if they do go in they leave quickly. I visited Salford Royal only a couple of months ago and saw the process it has for dealing with discharges more effectively. Learning is going on throughout the system, and more money is in the system for winter in order to cover the problem.
Andrea Jenkyns (Morley and Outwood) (Con)
To continue on the same theme—hopefully I am coming in at the right time, Mr Speaker—I chair the all-party group on patient safety, in collaboration with the Patients Association. We are about to look into hospital infections, and in Parliament in November I will launch a hand washing campaign. What is the Department of Health doing to promote infection control outside hospital settings?
Owen Thompson (Midlothian) (SNP)
T7. What measures is the Secretary of State putting in place to recruit and retain GPs? Given that he has indicated recruiting 5,000, where does he plan to find them?
Alistair Burt
As part of the proposal to see an increase of 5,000 in the number of doctors working in general practice by 2020, work is being done not only to recruit more, but to retain them and to bring back those who have left general practice but want to return. Health Education England is working with the Department on all these plans and proposals. The hon. Gentleman is right to identify that as a key source of those who will come into the service in future.
Dr Sarah Wollaston (Totnes) (Con)
Delayed publication of evidence is as damaging as non-publication, which is why we rightly expect clinicians, researchers and managers to publish their evidence and data in a timely and transparent manner. It is a matter of great regret to the Health Committee that we started our inquiry today without access to the detailed and impartial review of the evidence that we need to make a contribution to this inquiry. Will the Secretary of State please set out when he will publish it?
Cap on Care Costs
Alistair Burt Excerpts(8 years, 10 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister for Community and Social Care (Alistair Burt)
My noble Friend Lord Prior of Brampton has made the following written ministerial statement.
In 2010 the previous Government asked Sir Andrew Dilnot to lead the Commission on Funding of Care and Support to make recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. The commission recommended the creation of a cap system to protect people from the risk of very high care costs. This recommendation was accepted and plans put in place to implement from April 2016.
This Government still accept that recommendation and remain firmly committed to delivering this historic change. However, the proposals to cap care costs and create a supporting private insurance market were expected to add £6 billion to public sector spending over the next five years. A time of consolidation is not the right moment to be implementing expensive new commitments such as this, especially when there are no indications the private insurance market will develop as expected. Therefore in light of genuine concerns raised by stakeholders, we have taken the difficult decision to delay the introduction of the cap on care costs system until April 2020.
This is not a decision that has been taken lightly. A letter from the Local Government Association, dated 1 July, was clear that we need to think carefully about all the options, including postponing new initiatives. I am attaching a copy of this letter and a response from the Minister of State for care services. This is therefore what we will do and further announcements will follow in due course. Furthermore, we will continue with other efforts to support social care, in particular through the better care fund, which will drive the integration of social care and the NHS going forward.
We have an ageing population, which is something to be celebrated, but it inevitably means there are more people who will need care and support and we must ensure that the system can respond. This is an issue that had been ignored by successive Governments for far too long and I remain proud that we are taking on this thorny issue and setting out clear plans to address it.
Vital steps have already been taken to improve the care and support landscape. The first phase of the care and support reforms enshrined in the Care Act came into force in April this year, introducing the biggest reforms to care and support in over 65 years. For the first time ever, we have a single, modern legal framework for care and support that places the person and their health and wellbeing at its heart. There are now national eligibility criteria for care and support across England. Carers now have the right to support to meet their needs. And deferred payment agreements are available across England ensuring that people should not be forced to sell their home in order to pay for their care in their lifetime.
The introduction of the cap on care costs system will be the biggest reform to how care is paid for since 1948 and we must ensure that the new system works from day one. Local authorities and partners have consistently warned us of the risks of implementing this too quickly. We will therefore not be complacent, but work hard to use this additional time to ensure that everyone is ready to introduce the new system and that people can understand what it will mean for them. This includes taking the time to take stock on some of the other elements of the care and support reforms that are intended to support the cap system.
I am able to confirm that we will delay the full introduction of the duty under section 18(3) of the Care Act on local authorities to meet the eligible needs of self-funders in care homes to April 2020 to allow more time to be taken to consider the potential impact on the market and the interaction with the cap on care costs system. I can also confirm that the proposed appeals system for care and support will now be considered as part of the wider spending review. Further announcements will follow in due course.
We will also look at what more we can do to support people with the costs of care. The new pension flexibilities introduced in April create a real opportunity for us to continue to work with the financial sector to look at what other products may be created to help people meet the costs of care, creating even more choice and enabling people to better plan and prepare for later life. To this end I will be holding an urgent meeting with representatives from the insurance industry along with HM Treasury and other Government Ministers to work through what this announcement means for them and how Government can help them to bring forward new products. These discussions will continue over the summer.
Attachments can be viewed online at: http://www. parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-07-20/HCWS145/ .
[HCWS145]