Community Pharmacies

Anna Turley Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Dr Whitford]

If this is introduced badly, the cost will be greater in the long term. When the Minister talks about a more service-based approach, I think that he aspires to something more like the Scottish model, which I would commend. I just feel that this is being done “backside forward”.

[Anna Turley (Redcar) (Lab/Co-op)]

rose—

[Dr Whitford]

I need to make a bit of progress.

We need to design the services with the people who work in them. Some 18% of Scotland’s population—nearly 1 million people—are registered with and do access the minor ailment service, which takes pressure off accident and emergency, because there is availability out of hours, and GPs. The fourth service that we have is the public health service, with 70% of all smoking cessation work in primary care being carried out in our community pharmacies. These four services together—minor ailments, chronic medication, acute medication and public health—represent a huge breadth of service for a community. It is important that pharmacies in England that are currently just retail and dispensing pharmacies are encouraged to go in that direction, because it brings benefit for the NHS.

My biggest concern is the random nature of how this process might develop. If the Government simply cut and let the dice fall where they will, the problem is that they will not end up with an integrated service. Scotland still has health boards, so if a community pharmacy is to open there, an application needs to be made to the health board. When the project started, the boards decided which places got to become community pharmacies, and they decide whether there is a need to open a new community pharmacy. The biggest mistake in this scheme is its randomness.

One issue raised by the hon. Member for South West Wiltshire (Dr Murrison) was the profits made when drugs are sold on. The Government could look at the vertically integrated wholesalers—the big chains. In the mid-2000s, they were not considered. The Government do not know how much profit they make or where that profit is made, and the system is totally unregulated. These chains control about 40% of the pharmacy market. One of the biggest chains, Walgreens Boots Alliance, has declared profits of almost £1 billion, yet it has somehow been able to reduce its tax bill by more than £1 billion in this country. We are talking about people who are make almost half their profit from taxpayers yet do not pay their full share of tax. I absolutely agree that under this proposal the big chains will survive and the small, independent, very community-based pharmacies will be lost.

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

I should say that I am chair of the all-party pharmacy group. I am sure that many of my colleagues will today talk about the savings and services that community pharmacies provide to the national health service. Although that is an important point, it is also essential that we highlight the good that they provide to patients. They do so much more than just deliver prescriptions to people. Let me just highlight the scale of their operations. Some 11,800 community pharmacies dispensed more than 1 billion prescription items in 2015.

Community pharmacists are well prepared to adapt to many different problems with which they are presented. They help people to give up smoking, alter their diets, become healthier and manage their cholesterol. Effectively, they are on the frontline as far as the health of the public is concerned.

[Anna Turley]

My right hon. Friend makes an extremely important point. Pharmacies are right at the heart of their communities. As has already been mentioned today, access to those services is vital. In some areas—such as our two constituencies—bus services are being cut and people are finding it increasingly difficult to access services. It is nonsense for the Minister to say that it is a matter of seconds between pharmacies. Will my right hon. Friend comment on how important access to pharmacies is to our communities?

[Kevin Barron]

It is very important, and the mechanism that has been put in place will not solve everything. We may get Boots in Gatwick airport supporting it, but there is the potential that others may drop off the line because they are just outside the geographical area. We need to look at that.

Let me turn to population health. This cannot be done by central distribution centres or a pharmacy based miles away, as they have no link with the locality. I am pleased that the idea of major companies getting involved in prescribing has been dropped. Pharmacists know their customers well and are familiar with their medications and, consequently, the customers feel confident in asking them for their advice.

The Government’s figures show that the £170 million cut could force up to 3,000 community pharmacies—one in four across the country—to close their doors to the public, so people would have to travel a lot further to their pharmacist and not have the local connection that I mentioned previously. Community pharmacy is the gateway to health for some 1.6 million patients each day. If anything, that is something we need to get a grip on.

A core component of current pharmacy services supports the public to stay well, live healthier lives and self-care. Pharmacists play a central role in the management of long-term conditions. They carry out medicines use reviews, for example. We must remember that more than 70% of expenditure on our national health service at both primary and acute level is spent on people with long-term conditions. There could not be a better gateway for those people to get the assistance they need to manage those conditions than through local pharmacies.

--- Later in debate ---

[Michael Dugher (Barnsley East) (Lab)]

It is a pleasure to follow the right hon. Member for North East Bedfordshire (Alistair Burt), who tried to be extremely helpful to the current Minister—most ex-Ministers have ex-Ministeritis and tend to be extremely unhelpful to current Ministers, but not so the right hon. Gentleman. However, he did use that figure of 3,000 pharmacies—one in four—facing closure. He has attempted to qualify it now, and his defence seems to be that he made the estimate without properly thinking it through. To that extent, there is remarkable continuity with his successor, who makes a number of assertions without remotely thinking them through. However, if we are now told that we have to disregard what the previous Minister said, why on earth we should believe what the incumbent says? Who is to say that, in a year’s time, after some reshuffle, the Minister’s successor will not come to the House and tell us at the Dispatch Box, “You don’t want to pay any attention to what the fellow before me said. He never knew what he was talking about.”?

The Government’s impact assessment is worth closer examination, because it states:

“the potential impacts…are assessed on the basis that there is a scenario where no pharmacy closes”—

not one. That scenario is not shared by anyone else. Even the Minister, when asked how many would close, told the House, “I do not know.” The impact assessment goes on to concede:

“There is no reliable way of estimating the number of pharmacies that may close as a result of this policy.”

The Department literally has no idea. According to the impact assessment, the Department is officially clueless as to the impact on pharmacies.

[Anna Turley]

Does my hon. Friend agree that an impact assessment of the knock-on effects for the NHS more broadly would have been useful? One in four patients will probably seek with a GP an appointment they would have sought with a pharmacist. We have heard nothing from the Government about what the knock-on effect would be or what investigation they have done into that.

[Michael Dugher]

My hon. Friend makes an excellent point. It would have been helpful to have had an impact assessment as the basis for debate, rather than having something that was published on the day of the announcement.

My hon. Friend alludes to the fact that the impact assessment on community pharmacy says that cuts to community pharmacies will increase patient health benefits

“by reallocating savings from community pharmacy funding to other uses”—

a point the Minister made—

“ensuring that patient health is unaffected”.

Yet, polling commissioned by Pharmacy Voice shows that one in four patients would make an appointment at a GP if their local chemist was closed—a figure rising to four in five in more deprived communities such as my own in Barnsley.

There is no consideration whatever in the Government’s assessment of the potential downstream costs to other parts of the NHS budget, such as the pressure on GPs and A&E. The Department’s impact assessment does say that these cuts are

“expected to lead to reductions in the employment of pharmacists, pharmacy technicians and other pharmacy staff”,

so the Government are clear at least that local pharmacists—the people many of our constituents rely on—will go because of these cuts.

The impact assessment predicts that there will be a “corresponding increase” in other NHS employee numbers, so there will be “no net effect” on the NHS. That is completely without foundation. Are the Government really trying to tell us today that, for all their talk about the importance of community pharmacies and all the evidence about the pressures that will result on GPs and A&Es, which are already overstretched, the work of pharmacists in our local communities will, and should be, taken up by a corresponding increase in other NHS staff?

The impact assessment says:

“the modelling does not take any account of potential reduction in opening hours which may also affect access.”

You bet! New research published today and carried out by the National Pharmacy Association shows that, when faced with the Government’s budgetary cuts, 86% of community pharmacies are likely to limit or remove the home delivery of medicines to housebound patients; 77% of chemists say they will probably become more retail focused to deal with funding shortages—exactly the opposite of what the Minister hopes to achieve; and 54%—more than half—are likely to reduce their opening hours, which will limit patient access and put more strain on our already overstretched GP surgeries and A&E departments.

To sum up, the Government’s own impact assessment, which is well worth a read, if only for comedy value, reads as though it was written in haste on the back of a cigarette packet. The Government—rather like the Minister—are making up the policy as they go along. What Ministers are actually asking us to do today is to make a leap of faith: to turn a blind eye to all the evidence; to disregard all the warnings; to ignore the unanswered questions, the contradictory statements and the glaring omissions in the Government’s own case; to brush away expert opinion; and to dismiss the concerns of the public. Based on the Department’s own impact assessment, how can any right hon. or hon. Member possibly support the Government in the Lobby today?

North East Ambulance Service

Anna Turley Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

I wish to make a brief contribution to the debate. It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing a debate on a matter that is of importance throughout the north-east of England. This is an important service, run by good people under extraordinary pressure. To give an example, on Monday 7 December last year, there were 1,837 emergency calls to the service. That is equivalent to new year’s eve and was a 46% increase on the year before. That was accompanied by 1,664 calls taken by the 111 service.

The service is fast becoming a gateway to healthcare as others become more difficult to access and some, such as walk-in centres, are no longer there at all. Repeated requests to the public to call the service only in life-threatening situations can do only so much. I accept that a certain amount of problems are caused by hoax calls and other misuse of the service. People who do such things are completely irresponsible and stand to be condemned, but that is not at the heart of the problems faced by the service in our region.

I would like to touch briefly on a number of issues. The first is commissioning, which is not one of the strongest features of the Government’s national health service reorganisation. How focused are the commissioners on the service they are supposed to be in charge of? Are they working alongside the chief executive in a supportive and encouraging way? When has their role ever been reviewed or carefully considered by those in charge? There is a case for looking at that and at staff morale, as my hon. Friend rightly said, and asking ourselves why it is as it is. Surveys of the service show that 90% of staff are stressed. That is consistent with the picture that came from her address—and no doubt will come from colleagues—of a service that is trying to do its best under enormous pressure.

Like my hon. Friend, I welcome the establishment of the diploma of higher education in paramedic practice, which will start in September at the University of Sunderland. That two-year course has been created to try to meet the shortage of paramedics in the region as well as the national shortage. Evidence suggests that the grading of posts may be too low, and I would be interested to hear the Minister’s views on that. It seems odd that, in a region such as the north-east, where unemployment levels are still higher than the national average, there should be a persistent vacancy rate of between 10% and 15% in the service.

[Anna Turley (Redcar) (Lab/Co-op)]

One of the issues raised with me on recruitment challenges is that it costs £1,200 to get a driving entitlement for C1 vehicles. For many people, that cost is extremely prohibitive and constituents have said to me that that has put them off applying for those kinds of jobs.

[Mr Brown]

My hon. Friend is on to a good point. There is something odd if, in a region of higher than average unemployment, it is difficult to fill those vacancies not just in a single moment in time but persistently. We should look at all barriers to entry into the service. I accept what she said, but I harbour the thought that gradings may have been set too low and that there is a case for upgrading the job.

I have two other points to mention briefly. Legal highs are again putting more pressure on the service as young people in particular misuse them. I suggest that it is not a good idea to take them at all, but taking them results in the ambulance service being called out. There were something like 20 incidents, including a cardiac arrest, in a single day—8 February—and so far this year there have been about 300 call-outs because of the use of legal highs. I harbour the view that they should not be legal, but perhaps that is a different debate.

Finally, I want to mention the pressures that will be put on the service if the supported accommodation proposals that the Government are considering come to pass. If vulnerable people who are housed in projects and given support to lead their day-to-day lives are denied that support and left to their own devices, the consequence for the police, accident and emergency services at hospitals and ambulance services will be much greater, rather than lesser, pressure. That is not the right direction of travel for our society.

--- Later in debate ---

[Anna Turley (Redcar) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I, too, thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), not just for securing the debate, but for the passionate and thoughtful speech she gave, which got right to the heart of the issue. She articulated something that has been brewing among my constituents since I was elected last May. It gives me great concern and I want to share some experiences I have had.

Like my colleagues, I have become deeply concerned about the pressures on the North East Ambulance Service and their impact on my constituents. If someone is waiting for an ambulance, they are probably at one of the most distressed and vulnerable times of their life. Every minute waiting for an ambulance feels like an hour. Every moment is precious—vital; and there is a critical impact on people’s distress levels, and, as we have heard, their chances of survival. The Government must look at the situation to make sure that the service improves. I have heard far too many stories from constituents about people waiting several hours for an ambulance to arrive. As others have mentioned, that has affected elderly people particularly, and not just in minor cases—people who are elderly and vulnerable.

I want to mention a recent case, which happened just last month. A 72-year-old woman in Marske in my constituency fell and fractured her hip in the street in the centre of the village. She was left lying in immense pain on the pavement in the freezing cold. It is a seaside town and she was left virtually on the sea front for three hours. Thanks to members of the public and many local business owners who came out of their shops, she was cared for by the community; but we can imagine not just her distress but the distress and horror of the community at seeing such a thing happening in their village—someone at a vulnerable time in her life, waiting in agony for the ambulance that they had paid for with their taxes, and which they expected to come to support a community member. It was completely unacceptable that she had to wait in pain for so long.

Another constituent, an elderly lady of 99 years who was born during the first world war, fell in her home at the end of last year, breaking her arm in three places. She was in so much pain that her family did not want to transport her themselves so they called an ambulance. Again, it arrived three hours later. She was 99 years old. What sort of society are we? If a 99 year-old woman who has had a fall and broken her arm is not an emergency and top of the priority list, I cannot imagine who is. Thankfully, she was at home in the warmth of her house and not outside on a pavement, but who is to say that she would have been any more of a priority if she had been outside on a stone-cold pavement.

As many of my colleagues have said, something is wrong with the prioritisation of people, particularly of elderly people, who have paid, worked and strived for their whole lives. How can we as a society look ourselves in the eye when that is how we treat someone who was born before the NHS started and has contributed to the system?

A local district nurse told me recently of another incident, involving a bed-bound patient with a suspected ruptured bladder. Although a blue light was not needed, the patient required an urgent ambulance. They were given an initial response time of one hour, but the ambulance eventually arrived after five hours. That waiting time was completely unacceptable; and again, there was an issue of the ambulance being diverted.

That is important. If ambulances keep being diverted to more important calls, the original call becomes increasingly more urgent. The knock-on cost of the crisis in the service and the level of support that people need falls on the NHS, but more crucially on those affected, in the increasing danger they are in while waiting longer and in the agony and the tragedy they experience. That is where cuts have a serious impact, because they cost more down the line, as the service becomes increasingly crisis-led and ambulances are diverted to more urgent calls. What was a lesser priority becomes more urgent and more costly to the NHS and the individual’s life.

In highlighting these cases, I am not criticising the work of paramedics and switchboard staff, because they do a fantastic job on the frontline that I do not think I could do. We owe them a massive debt of gratitude. They work under extreme pressure, dealing with people in life-or-death situations, and often in dangerous situations. Many are underpaid or struggling with their terms and conditions. They sometimes have to deal with distressed or angry families, and who can blame those families when they have waited hours and seen their loved ones in agony while failing to get the most basic service they need?

I want to comment on the failure of the North East Ambulance Service NHS Trust. According to the ambulance clinical quality indicators, the North East Ambulance Service takes longer than any other region in the country to answer calls. It also has the highest number of abandoned calls in the country. Colleagues have given plenty of examples showing that the service is in crisis and cannot continue as at present. Our elderly and vulnerable constituents are suffering.

Constituents have told me that a crew said that the Teesside service has a lower headcount than it should have and that ambulances have had to come from Durham, which is why we get delays. Parts of the north-east are geographically spread out and rural, and it is just not acceptable that ambulances are having to come from Durham. The morale of our ambulance workers is low. They are overstretched and, despite their heroic efforts, pressure is leading to targets being missed and patients and our constituents suffering.

I look forward to hearing from the Minister what the Government plan to do to tackle the problem and ensure that the investment they have promised for the NHS will go to this vital, front-line service in the north-east to save the lives of our most vulnerable constituents.

NHS Bursaries

Anna Turley Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

I entirely agree with my hon. Friend. I think the Government’s problem is this: they have failed to back up their claim with any evidence and they are now faced with a breadth of opposition to this proposal, not just from Members but from the Royal College of Nursing, the Royal College of Midwives and Unison, while organisations such as MillionPlus, the association for modern universities, are also questioning the assumptions on which the Government base this policy.

[Anna Turley (Redcar) (Lab/Co-op)]

Does my hon. Friend agree with my constituent Zoe, who is training to be a nurse and is particularly concerned about mature students? She feels that about 50% of their time is spent in unpaid clinical placements in hospitals in the community, so they do not have the opportunity to do part-time work to support themselves as many others do. Will they not be disproportionately affected?

[Heidi Alexander]

I agree with my hon. Friend, and I shall make some remarks on that precise point later.

The Opposition’s purpose in calling today’s debate is that we hope the House can rally round what many would view as a straightforward and reasonable proposal— that the Government drop these plans and instead consult on how properly to fund and support the future healthcare workforce.

Let me set out why these plans are bad for students, bad for patients and bad for the NHS. The Government claim that these plans will leave healthcare students 25% better off. What they will not say is that, according to their own consultation, in order to be 25% better off, a student will have to take out a maximum maintenance and tuition fee loan for three years and would graduate with debts of between £48,000 and £59,000.

Contaminated Blood

Anna Turley Excerpts

Tuesday 12th April 2016 Commons Chamber

[Peter Heaton-Jones (North Devon) (Con)]

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate and on the valuable work that her all-party parliamentary group is doing in this area.

All Members, I am sure, receive a huge number of letters and emails from constituents, and hold face-to-face meetings with them on a huge range of issues. Just occasionally, an email arrives that has the power to stop us in our tracks, simply demanding the wider attention of the whole House. On 2 June last year, just four weeks after being elected to this place for the first time, I received just such an email. It came from my constituent Sue Threakall, from Barnstaple. Mrs Threakall is with us in the Gallery this afternoon, one of many who have travelled long distances to be here today. I pay tribute to them all.

With her permission and with the leave of the House, I would like to read a short extract from the email I received from Mrs Threakall, which sums up better than I could the real human impact of this national tragedy:

“my late husband was a haemophiliac who”,

in the 1980s,

“was given contaminated blood and…died in 1991 with AIDS, Hepatitis B and Hepatitis C. His death ripped my family apart and to this day the effects are still there.”

Her children lead

“compromised lives compared to the ones they should have led. I have severe financial difficulties to this day, despite doing everything possible to help myself recover from a wrecked career as a…teacher, followed by retirement at 50 on a tiny pension. Since then I have worked in hospitals, but following three major surgeries in seven years have now more or less retired.

I have been campaigning for thirty years for truth and justice”.

Those are two crucial elements that we must discuss today: truth and justice.

[Anna Turley (Redcar) (Lab/Co-op)]

I appreciate the hon. Gentleman’s generosity in giving way, and I share his concern about the impact on spouses. My constituent Mr Thomas Farrell was given 11 units of contaminated blood in 1989, and tested positive for hepatitis C nine years later. One of his biggest fears is that his wife will not have the security of knowing that she can pay the mortgage should he pass away before her. Does the hon. Gentleman agree with me that bereaved partners and spouses should have security and proper financial support for the rest of their life?

[Peter Heaton-Jones]

I absolutely agree that we must look beyond those whose are immediately affected personally by the health effects of contaminated blood, and take account of the effects on their wider families and loved ones. I shall say more about that later.

Truth and justice are what this is all about, and I believe that we have reached a stage at which we really could deliver both. The Government’s consultation is under way; the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), Friend made her announcement in January; and there is now a groundswell of public opinion. Those three factors mean that we are at a crossroads, and we may never have this opportunity again. Campaigners acknowledge that since 2010, the Government have listened. We have made progress—more progress than we have made in the past.

This, however, is the position: the Government’s consultation is due to close in just three days’ time, and it is clear that there is still a great deal of unhappiness with the options on the table. The status quo—the existing scheme, with its confusing and inadequate provision—is not acceptable, but neither is the alternative, which would seem to fail to tackle the fundamental problem of fair financial provision both for those who received the contaminated blood and are living with the health consequences and, importantly, the families and loved ones who care for them or grieve for them.

We must be realistic. Like nearly every decision that we make in this place, this does in the end come down to money, and we know that money is tight. It would be unrealistic, indeed irresponsible, to stand here today and ask for a blank cheque to be written, or for funds to be taken from equally worthwhile projects elsewhere in the health budget. What I appeal for today from the Government—on behalf of my constituent, and other constituents who are with us—are two commodities that are perhaps even more precious: time and understanding. I ask for time for these people, including my constituent, to have their cases adequately heard by the Government, and not to be bounced into accepting one of two options, neither of which they believe to be fair or adequate.

Care Homes: England

Anna Turley Excerpts

Wednesday 13th January 2016 Westminster Hall

[Peter Kyle]

I am very grateful for that intervention. I will come to the precept in a moment, when I would welcome further interventions as we talk about the detail of the precept and how it actually, while being welcome on a surface level, will be rolled out in different ways and impact on communities differently. I will keep my eyes open, as the hon. Lady might well want to come back to this when we tackle those issues.

The pressures on care providers will only be exacerbated by the increases in the minimum wage that will come in from this April. However, let me restate my position on the rising minimum wage for the avoidance of any doubt: I believe that those working in the caring professions deserve a pay rise for the fantastic jobs that they do, especially considering that it has sadly become a low-pay sector. I am glad that there is now cross-party consensus on the ambitious rise that is deserved by all those on low pay. However, we must make this work, and it will only work if we are aware of and prepare for what will happen in the areas that this will impact on hardest.

The National Care Association, for example, has estimated that the rise will add at least 5% to payrolls this year and a further 7% year on year by 2020. Without extra resources, local authorities will end up pushing independent, statutorily funded care homes closer to the brink. The excellent ResPublica report from November laid bare the startling and shocking fact that an unfunded living wage could end up with the loss of 37,000 care home places. I know that the Minister and his colleagues will point to two actions that they think will mitigate that, so let me address both of those in turn.

First, there is the social care precept. Introduced in the autumn statement, it gives local authorities the power to raise council tax by an additional 2%, the proceeds of which are ring-fenced for social care. Although all additional funds are welcome, that is a drop in the ocean compared with the additional resources needed. Following the autumn statement, the King’s Fund estimated that the funding gap for social care could be as high as £3.5 billion by the end of this Parliament.

What is more, the precept may well end up generating extra revenue where it is least needed. At present, residential care home funding is split between people who pay for their care themselves and those who have it paid for by their local authority. Self-funders pay 50% more than those funded by councils so, in effect, they subsidise those paid for by the public purse. It is not hard to work out that the homes with a smaller number of self-funders are the ones who are most at risk financially from the cut in funding rates from local authorities. The split varies across the country, but on the estimated figures put together by LaingBuisson in its “Care of Older People UK Market Report”, the number of self-funders in 2014 was only 18% in the north-east, with the majority of other regions hovering around the 40% mark. It is pretty obvious that the power to raise council tax will generate the most revenue in the areas with a higher council tax base, namely the southern regions of England, which—you guessed it—have a higher number of self-funders.

[Anna Turley (Redcar) (Lab/Co-op)]

Does my hon. Friend share my opinion that council tax can be a regressive tax, and that for areas such as mine, which have levels of deprivation and are already hit by a tax that is not particularly fair, this precept is not a progressive tax? Those areas that have already been hit hardest by cuts in local government funding will be hit yet again by this tax.

[Peter Kyle]

I am very grateful to my hon. Friend for making that point. In representing Redcar, she knows better than anyone that people in residential care homes that are heavily reliant on statutory funding will be hit the most because of the cuts that are going into local authorities, and they will be hit again by the precept, which, because of the process that I have just outlined, will be front-loading resources into the areas that need it least. Her area of the country will have people who are more dependent on statutory funding for care home places. The 2% is based on a lower percentage of people paying council tax in the first place and will have to cover more people. That is why the precept is not fair and will not get to the people who need it most.

--- Later in debate ---

[Anna Turley (Redcar) (Lab/Co-op)]

It is a pleasure to serve again under your chairmanship, Mrs Main. I thank my hon. Friend the Member for Hove (Peter Kyle) for obtaining this important debate with his customary determination to tackle the big challenges of the day and his concern for the most vulnerable in society. As everyone on both sides of the House has agreed during the debate, older people deserve the right to live with dignity and decency; but, as has also been discussed, too often that is not the case, and I am afraid the situation seems set only to get worse.

Eighty-six per cent. of care home places are run by the private sector for profit. Local authorities are the largest single purchasers of those places across the country. Because of intense budgetary pressures, which my right hon. Friend the Member for Enfield North (Joan Ryan) and my hon. Friend the Member for York Central (Rachael Maskell) clearly explained, local authorities reduced their fees by an average of 5% between 2010-11 and 2015-16. According to the sector analysts LaingBuisson, the care home sector is closing more beds than it is opening for the first time since 2005, with a net loss of 3,000 across the UK last year. In the north-east we expect to have a substantial crisis in social care as a result of the Government’s failure to grip the issue.

As my hon. Friend the Member for Hove said, the homes most at risk are those dependent on residents paid for by local councils at rates far below those paid by self-funding residents: proprietors say rates are actually below break-even point. In the north-east, only 18% of people requiring care are self-paying, compared with 54% in the south-east. In Surrey, by contrast, only 1% of people in residential homes are paid for by the state.

The Financial Times has noticed that the care home market is highly polarised between lucrative self-pay homes, mostly in south-east England, and those with local authority residents, such as Redcar and Cleveland, which are struggling. Given that disparity between areas such as Surrey and areas such as mine, and since there is a crisis in the funding not of residential care but of state residential care, it is probable that the market will not collapse nationally, but will fall over in areas such as mine where the state is the main payer. If a major provider struggles it is likely to mean that it will close its homes in the north but not the south.

There is no capacity in local government to take over those homes. Any private sector supplier that did so would be taking an unsustainable risk, because they are currently loss-making businesses. At the moment there appears to be no plan B for the Government. I want to ask the Minister whether he accepts the scale of the impending crisis. Crisis point will be reached shortly in our region as demand continues to increase while spending is drastically cut back. The Government’s care legislation will further increase the burdens on councils in England. The only way in which providers can make any money is by cutting services and by squeezing workers’ pay and conditions.

The comprehensive spending review in December 2015 gave councils the option of adding a social care precept of up to 2% to annual council tax bills to raise extra money to pay for adult social care. However, as well as being regressive, as we have already discussed, the precept will at best raise £2 billion by 2020, against a predicted funding gap of closer to £8 billion. Indeed, the King’s Fund estimates that at best the precept will raise £800 million.

I want to use this opportunity to raise some contributory factors to the crisis, which the Government need to address, and I will begin by talking about the care workforce and national minimum wage compliance. The Resolution Foundation has estimated that care workers—both those in care homes and those providing home care—are already collectively cheated of £130 million a year because of sub national minimum wage pay. That is driven by chronic underfunding of the care sector, poor employment practices, poor commissioning practices and the ineffective enforcement of the national minimum wage by Her Majesty’s Revenue and Customs.

One employer, which will remain nameless at this stage, has put to its workforce a set of proposed changes to terms and conditions, to prepare for the introduction of the national living wage. Those include withdrawing all bank holiday and overtime enhancements, removing contractual sick pay, scrapping the meal allowance for workers when they are eating with clients, asking workers to pay for their own registration with the Disclosure and Barring Service, enforcing eight hours per annum of unpaid training time, introducing new duties and making changes to existing duties. In care homes non-payment of the national minimum wage is driven by a failure to pay for actual hours worked, such as when staff are not properly recompensed for overnight sleep-ins or time spent training; failure to pay for uniforms; and deduction of money for accommodation that does not form part of an employment contract.

The Financial Times has said that,

“businesses that run care homes for the elderly are at risk of going bankrupt, especially those reliant on revenues from local authority funded places, from a double blow of the imminent increases in the minimum wage and tighter immigration rules, making it harder to recruit from overseas”.

That is the issue I want to discuss next. The care sector is particularly dependent on migrant labour. The latest estimates suggest that nearly a fifth of the workforce are non-British. Unison has highlighted a particular problem in the care home sector with regard to the treatment of migrant workers. In a recent round-table event, a group of Filipino workers reported that they were paying £300 a month each to share a flat with only one toilet and no lounge at the residential care home where they worked. The rate paid for the work they did was £7.02 per hour, but there were then monthly deductions. The deductions were for their uniform—they got one per year but had to pay every month—and for training; that is a breach of national minimum wage law. The cost would normally be more than £200 a month, and it transpired that the workers were not necessarily getting the uplifts in the minimum wage that they were entitled to.

The round table also heard that a working week for the staff could sometimes be as long as 60 hours, depending on staffing levels, despite the fact that they were contracted for 36 hours. They could also find themselves working a 10-hour night shift for a paltry £35, way below the national minimum wage, and with no sleeping permitted. The employer extorted £500 each from that group of workers as their initial five-year period in the job came to an end, on the basis that payments were needed to retain a licence to hire foreign workers and to protect their immigration papers. The staff were also subject to body searches before meeting the employers. To compound matters, they were then obliged to pay fees of £2,000 each for a solicitor to renew their work permits—in cash. The work permits are for work with that one employer, so if the workers lost them they would lose their visa and have to leave the country. Not only is the exploitation of immigrant workers immoral, but it drives down terms and conditions across the sector for all workers and reduces the number of job opportunities for local people.

I want to discuss some wider problems in the care home sector. The social care workforce are predominantly female, with the latest estimates suggesting that 82% of care workers are women and that the percentage is broadly similar across all types of care. Social care is a highly gender-segregated sector, with low pay and poor conditions reflecting, as my hon. Friend the Member for York Central has mentioned, the historic undervaluing of what is deemed to be women’s work. Compared with other sectors, the workforce are also particularly concentrated in the 45 to 60 age bracket. Government-backed attempts to move away from that disproportionately middle-aged demographic have foundered, largely on the basis that the quality of work, pay and conditions is simply not attractive enough to bring in younger staff.

Residential care tends to be based on shift work and there are often problems with short-staffing, with care workers being called on at short notice to cover shifts. That can be particularly problematic for night shifts, where the compensation is often insufficient. There may also be pressure from care providers to work beyond a 48-hour working week. Vacancy rates and staff turnover are high across the sector. Councils are struggling to retain social workers in the face of high caseloads, a blame culture and competition over pay. High turnover has damaging implications for the continuity and quality of care.

There is no English language requirement for care workers whose first language is not English. The overall level of training and qualifications across the care sector is low. There are expectations of induction training for staff but the nature and quality varies considerably. There is less training available in outsourced services, and there are particular concerns about agency staff not receiving training. There are increasing expectations for care workers to carry out medical treatments that have previously been the preserve of nurses or other NHS professionals, but there is no concomitant expansion in training. There are no longer any universal standards for providers to meet benchmarks for percentages of trained staff in their workforces. Without obligations it makes no business sense for providers to do that training voluntarily, because of the high turnover of staff. There is also no central quality assurance mechanism for training, which leads to a lack of faith in qualifications, and no incentive—

[Mrs Anne Main (in the Chair)]

Order. I ask the hon. Lady to bring her remarks to a close in the next few seconds.

[Anna Turley]

I will. In summary, the Government’s crisis in funding for care homes has pushed the sector to the brink. Terms and conditions for the workforce are being squeezed, and the current funding structure for local authorities is simply unsustainable. The Government must get a grip.

Oral Answers to Questions

Anna Turley Excerpts

Tuesday 5th January 2016 Commons Chamber

[Mr Hunt]

First, may I ask the right hon. Lady to congratulate, on my behalf, GPs in Slough, who have benefited from the Prime Minister’s challenge fund? Alongside a number of other schemes, it has had a significant impact on reducing emergency admissions in her area. The answer to the point she makes is that we are investing an extra £8 billion in the NHS over the course of this Parliament—it is £10 billion when we include the money going in this year. We have said that we want more of that money to go into general practice, to reverse the historical underfunding of general practice, which I completely agree needs to be reversed.

[Anna Turley (Redcar) (Lab/Co-op)]

3. What proportion of hospital trusts are in deficit.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Three-quarters of trusts are reporting a deficit for the conclusion of the first half of this financial year.

[Anna Turley]

John Appleby, the chief economist at the independent think tank the King’s Fund, said recently that although the Government claim they will get an increase in funding in the NHS, they have

“in effect, already spent the money”

because of the scale of the hospital deficits. In my South Tees area, the deficit for 2014-15 is nearly £17 million. Will the Minister accept that the Government have totally lost control of NHS finances?

[Ben Gummer]

The first point to make is that this Government have provided the money for the NHS that it has asked for—this is money the Opposition refused to say they would pledge at the last election. The second point to make is that Jim Mackey, the new chief executive of NHS Improvement and one of the best chief executives in the NHS, has said that he will help to get hospital trusts in control next year, and that, with the transformation fund announced by my right hon. Friend the Secretary of State, we are confident we will be able to get hospital trusts into balance next year.

Junior Doctors Contract

Anna Turley Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

My hon. Friend is right. In any quarter there will be puzzlement about support for action that will withdraw the work of junior doctors from their patients. We estimate that between 50,000 and 60,000 elective pieces of work are done every day in the NHS, and such work will inevitably be put off if doctors are not available. Those numbers are individual patients who will not get the care that they are looking for, and that a doctor would want and expect to give. There must be something better than this stand-off, which is why we appeal to the BMA to take up the Secretary of State’s offer and come back to negotiations.

[Anna Turley (Redcar) (Lab/Co-op)]

Given the crisis in morale in the NHS, have the Government estimated how many junior doctors might leave the NHS if they continue to impose this new contract on them?

[Alistair Burt]

No, I do not think it possible to make that sort of estimate or assessment, but the longer that doctors go on working under an unsafe contract that includes long hours, consecutive nights and long days, the more that will add to the pain and pressures of those working in the NHS. That is why a new contract with safer hours is a better option. Encouraging the BMA to return to negotiations and settle this issue, so that the threat of strike action is not hanging over us, is also important for morale.

A&E Services

Anna Turley Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Iain Wright (Hartlepool) (Lab)]

This is the first opportunity I have had to welcome you to the Chair, Madam Deputy Speaker. I am extremely pleased to see you in what I think is your rightful place.

I pay tribute to my hon. Friend the Member for Dewsbury (Paula Sherriff) for her excellent speech. She is part of a very talented 2015 intake—far too talented for my liking, I am afraid to say. She has already demonstrated a strong reputation for standing up for her constituency—often in the face of terrible attacks—in terms of fairness, tolerance and decency in public services. She is a strong asset to this House and I welcome her.

The issue of accident and emergency services is important for Hartlepool, because we lost our A&E in August 2011. That closure has been felt very deeply by my constituents, who now have to travel to North Tees, which is some 13 miles away, for accident and emergency services. Given the appalling provision of public transport, the low level of car ownership and the relative levels of deprivation, that is too far to travel for far too many of my constituents.

[Anna Turley (Redcar) (Lab/Co-op)]

Will my hon. Friend comment on the impact of that A&E closure on, and its implications for, areas below the River Tees, including my constituency? In South Tees, despite the best efforts of our NHS staff, waiting times have increased and the A&E target in particular continues to be missed.

[Mr Wright]

My hon. Friend makes a very important point. Having fewer A&E departments puts further strain on other parts of the system, such as A&E at James Cook hospital, and other parts of the NHS, such as ambulance services. They are queuing up outside James Cook hospital, but it does not have the throughput it needs.

It is important that A&E returns to the town of Hartlepool. Given the level of health inequality, as well as the high proportion of older people relative to the rest of the country, there is a greater risk of accidents and, therefore, I think it is fair to say, greater reliance on A&E than other areas.

To be frank—this is not a party political point—the closure was based on clinical safety factors. The number of medical staff to cover two rotas at both Hartlepool and Stockton was deemed insufficient, and the supervision of junior medical staff was deemed inadequate, as it did not meet modern guidance criteria. Additional resources will need to be provided for adequate staffing to ensure that A&E can return to Hartlepool. North Tees and Hartlepool Hospitals NHS Foundation Trust has a financial deficit of £4 million, which is expected to worsen over the coming years.