Managing Risk in the NHS

Grahame Morris Excerpts

Wednesday 17th July 2013 Commons Chamber

[Mr Hunt]

This is the appalling fact: we have inherited from the previous Government a system of compensation payments with no significant financial penalty on trusts that have to pay out litigation claims. The focus on patient safety, the biggest discipline of all that any trust should have is to reduce patient safety incidents, should be the thought of having to pay compensation. That disincentive was removed. Absolutely, we will look at that.

[Grahame M. Morris (Easington) (Lab)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I am going to make some progress and I will give way more later.

Francis also talked about compassionate care. We are going to follow the advice of Camilla Cavendish’s study on training for health care assistants, so we can be sure that no one is giving basic care to our NHS patients without proper training on how to treat people with dignity and respect. We have also proposed that, subject to pilots that are starting in September, every student who wants to receive NHS funding for their nursing degree will first work for up to a year as a health care assistant, so that before they open the textbooks they learn real care and compassion at the coal face.

--- Later in debate ---

[Charlotte Leslie]

I absolutely agree, although there is a distinction to draw between managerial staff, who I think have been leant on heavily to make their hospital look good, and the ground-level staff, many of whom have been battling over the last decade to be able to put clinical priorities ahead of management and political priorities.

[Grahame M. Morris]

Will the hon. Lady give way?

[Charlotte Leslie]

I am going to make progress, if I may.

I am surprised when many on the Opposition Front Bench talk about the welfare of staff, because one of the things Labour did that was so disastrous was take the medical royal colleges out of inspections. That happened after one hospital in particular was found to be lacking. Alan Milburn at the time—in the early 2000s—removed the medical royal colleges from the inspection regime, and did so perhaps, we have to ask, because they might come up with some very unpleasant truths. I am delighted that the Secretary of State is looking to reverse that decision in respect of those who know and will give Governments of all colours a good kicking if things go wrong.

There has also been, unfortunately, a culture of cover-up—I would love to be proved wrong on this; there is still time, there is information that I am still seeking, and anyone can come to me with it—about the three reports that were commissioned on the 60th anniversary of the NHS. The right hon. Member for Leigh shakes his head but I would very much like to meet him to see whether he can show me the minutes of the meetings which he must have attended, at which these reports were discussed. [Interruption.] I will make progress while he talks at me from the Opposition Benches.

It is ironic that on the 65th anniversary we have cupcakes. On the 60th anniversary there were three reports which warned, I remind Members, of a culture of fear and compliance—that sounds familiar; hitting the target and missing the point, which also sounds familiar; and inadequate regulation and inspection. Goodness me, doesn’t that sound familiar? The reports were exhumed only after freedom of information requests. I have put freedom of information requests to the Department of Health which, oddly, have been obstructed. I seek the help of the Secretary of State and of the shadow Secretary of State, if he would like to set the record straight, in seeking information. Who was present at those meetings where those reports, which cost the taxpayer £500,000, were discussed? They were by international experts, including Don Berwick, whom we are now putting at the centre of our NHS on the zero-harm strategy.

--- Later in debate ---

[Grahame M. Morris]

Will the hon. Lady give way?

[Charlotte Leslie]

I am terribly sorry. I will make progress.

I would also like to set the record straight on who knew what about hospital trusts. The right hon. Member for Leigh says that he took astute action. He knows, because I have the e-mails, as he does, that he was written to by Professor Sir Brian Jarman about 25 trusts about which he had concerns. He said he was concerned that the CQC was not doing its job. Seven of those were investigated by Sir Bruce Keogh. Fifteen of those trusts were in marginal seats and one, as he will know, was in the constituency of the right hon. Member for Leigh.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

My hon. Friend has campaigned long and hard on issues of accountability, and I agree with her basic case, even if I do not agree with her about all the individuals she mentioned. One issue that will arise during today’s statement is that of how people are held accountable. That has been missing in our NHS, and we must put it right.

[Grahame M. Morris (Easington) (Lab)]

There has been much talk about action plans and I am sorry that the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), is not in his place. Is the Health Secretary aware that Mencap has expressed concerns that the Government’s response to the “Six Lives” progress report by the Department of Health does not set goals or time scales for tackling the issues highlighted in that report?

[Mr Hunt]

I know that the care services Minister would have liked to be here but he is at his son’s graduation today. I will pass on the hon. Gentleman’s question and ensure that he receives a full response.

Hospital Mortality Rates

Grahame Morris Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

There were repeatedly high mortality rates in all these 14 hospitals, and it took the public inquiry that Labour did not want to demonstrate to the world just how important hospital standardised mortality ratios are. They are the smoke alarm that was ignored in the case of Mid Staffs, and which could have led to the prevention of thousands of tragedies if we had taken action earlier. That is why we immediately insisted on this review by Sir Bruce.

[Grahame M. Morris (Easington) (Lab)]

I think there is widespread respect for Sir Bruce Keogh and his report and I certainly welcome it, but it is a cynical move by the Secretary of State to try to besmirch the reputation of my right hon. Friend the Member for Leigh (Andy Burnham). May I point out that on this Government’s watch clinical negligence claims are up 50%, A and E waits are at a nine-year high and “never events” have tripled? What is the Secretary of State going to do about them?

[Mr Hunt]

We spend more than £1 billion every year on clinical negligence because the hon. Gentleman’s Government changed the rules so that trusts suffer no financial penalty when they have to pay a clinical negligence claim. That is something we really need to look at, because it is removing one of the biggest possible incentives for trusts to treat people safely.

Health and Care Services

Grahame Morris Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

It is always a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell) who chairs the Health Committee with such authority and distinction. He gave a thoughtful and helpful explanation of the Committee’s report, and made some suggestions about integrating commissioning and budgets. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Bosworth (David Tredinnick) also highlighted several issues, and I am proud to serve with them on the Health Committee.

We need to look at the background of what is happening because in many respects, the Government have created a situation in which the NHS is in crisis. I often refer to how we measure satisfaction with the national health service, and one established measure was the public satisfaction survey. We have seen a record fall in public satisfaction with the NHS under this Government.

The hon. Member for Bosworth referred to evidence that the Secretary of State gave yesterday to the Health Committee, in which he cited the cost savings that reorganisation had brought about. However, we must also think about some of the hidden costs of that reorganisation such as clinicians’ time. How many clinicians carrying out a management function in clinical commissioning groups in other providers find that their time is not accounted for properly? What about the opportunity cost in skills and training applied for the benefit of patients if those clinicians are engaged in a management capacity? What about the loss of experience for managers at every level? Some people may have spent a number of years working in the health service and taken an interest in structures, but we seem to be going round in circles. We broke up what we described as large monolithic structures, formed separate mental health trusts and separated community services. It seems that the wheel has now turned full circle and we are realising the benefits of efficiencies of scale and integration.

With the new structure, however, we have lost some management expertise in commissioning, organising and troubleshooting—again, that point was highlighted effectively by the Health Committee. The Secretary of State and his team respond that there has been a cost saving, but in fact the vacuum had to be filled by new structures. Strategic health authorities—an unloved institution—were swept away, but local area teams were created. It is necessary to have a strategic dimension to plan health care, particularly restructurings and reorganisations.

In my view and, I suspect, for many Members across the House, this top-down reorganisation—it was not initiated by people on the ground—has impacted on front-line services and resulted in considerable expense and disruption at a time when the NHS is facing unprecedented pressures due to budgetary constraints and growing demands on the service. We have seen that manifested at the coal face, the fulcrum, in the crisis in accident and emergency departments. Unless we seriously address those issues, there is a risk to the long-term financial stability of the NHS.

Yesterday in Committee I put on the record a rather controversial point about the Government’s claim to be maintaining funding in real terms, despite NHS inflation, which is higher than inflation in the normal economy. As right hon. and hon. Members have said, there are also a number of financial manoeuvrings—I do not know whether that is an accounting term. One concern relates to how the underspend is reallocated or returned to the Treasury, and I suspect that despite assurances from Ministers, we have seen an actual reduction in funding.

Let me draw the House’s attention once more to the letter sent to the Secretary of State by Andrew Dilnot CBE, chair of the UK Statistics Authority, following representations by my right hon. Friend the Member for Leigh (Andy Burnham). Mr Dilnot wrote that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

[Mr Dorrell]

rose—

[Grahame M. Morris]

The right hon. Gentleman has risen to the bait and I will happily give way.

[Mr Dorrell]

The hon. Gentleman might like to read the next sentence from the same letter.

[Grahame M. Morris]

I am grateful for that. We have argued for a number of months about the real position, and we have had a number of debates in the House about whether there has been a real-terms increase or a small decrease. I heard the arguments about NHS inflation and so on as recently as yesterday.

[Mr Dorrell]

The next sentence.

[Grahame M. Morris]

I will not read that out because I will come on to the issue in a moment. First I want to talk about integration, so I will press on. Statistics published in Public Spending Statistics in July 2012 show that real expenditure on the NHS fell by 0.02% in 2011-12 and 0.69% in the fiscal year before that. I understand that those are small percentages, but we are dealing with a budget of £105 billion, including the capital element, and I think the public would be concerned because those sums are not insignificant. Those percentages equate to £740 million over two years, and we should think about what that money could buy. In my area, one of the first schemes to be cancelled when the coalition came to power was a new hospital. It was not funded through a private finance initiative but through Department of Health capital resources. That hospital would have cost £464 million, but we are still waiting for it. The figures I mentioned would have built two such hospitals.

[Mr David Ward (Bradford East) (LD)]

When talking about budgets, the focus is all on integrating health with social care, so we cannot really consider the overall picture unless we also look at local authority budgets.

[Grahame M. Morris]

That is an excellent point, and my hon. Friend the Member for Worsley and Eccles South mentioned evidence presented to the Health Committee that showed that £2.7 billion of expenditure or allocations has been removed from local government budgets and social care. That has had a huge impact on the service and resulted in changes to eligibility and thresholds, and charges for transport and other things.

[Mr Jim Cunningham (Coventry South) (Lab)]

I apologise to my hon. Friend for arriving a minute after the start of his speech. The hon. Member for Bradford East (Mr Ward) raised an interesting point about social care, particularly in relation to local authorities. Given the one-third cut, plus the 10% cut, in those budgets, I see a major problem for local authorities in buying care for elderly people. Indeed, it has been a major problem over the past two or three years.

[Grahame M. Morris]

That is an excellent point. I am sure that Members across the Chamber will have experience of that. On Friday gone, we had a crisis meeting of the county MPs and senior politicians in my local authority area of County Durham to determine how to cope with a further tranche of cuts. The situation is becoming serious. It is said that the allocations have been ring-fenced, but the local authorities’ discretionary spend is all being absorbed into social care and expenditure for children and the elderly, and there is very little room for manoeuvre.

[Mr Kevan Jones (North Durham) (Lab)]

Will my hon. Friend give way?

[Grahame M. Morris]

I will give way to my hon. Friend.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. The hon. Member for North Durham (Mr Jones) has only just come into the Chamber. Interventions are normally about facilitating those who have heard the debate, and it is not appropriate just to walk in and intervene. The hon. Gentleman is experienced enough to know that that is the case.

[Grahame M. Morris]

Okay—

[Mr Jones]

Will my hon. Friend give way?

[Grahame M. Morris]

Am I allowed to give way to my hon. Friend, Madam Deputy Speaker?

[Madam Deputy Speaker]

This is a timed debate. The courtesies of the House, which have been circulated to Members of Parliament a number of times, are not about walking in, spending a few minutes in here, then intervening. Of course the hon. Member for Easington (Grahame M. Morris) can give way if he chooses to do so, but he might want to bear in mind that other Members who have been in the Chamber for some time are still waiting to speak. That was the point I was making.

[Grahame M. Morris]

With all due respect, Madam Deputy Speaker, I know that my hon. Friend was at the same meeting as me on Friday, and he will probably have a relevant point to make about that, so if you do not mind, I will give way to him.

[Mr Jones]

With respect to the Deputy Speaker, the point I wanted to make was that at the meeting last Friday we were told that Durham county council has to take £210 million out of its budget. Does my hon. Friend think that areas such as ours, which has a growing elderly population, will face more pressure than some others?

[Grahame M. Morris]

Absolutely. The pressures are becoming intolerable. Some of our great northern cities, such as Liverpool and Middlesbrough, seem to be shouldering a disproportionate share of the cuts, and it is a difficult task to try to balance the budgets and deliver the services that people require. There has been a discussion about whether the councils are in a position even to deliver their statutory requirements.

As the right hon. Member for Charnwood said, the NHS has been set productivity targets of 4% per year, as the Government seek to make savings of £20 billion over the lifetime of this Parliament. As the report identifies, the Government believe that those savings can be made in part by prioritising competition over co-operation. I find that questionable, and we need a cost-benefit analysis of the consequences in regard to the value for money of outsourcing. There has been a lot of criticism of PFI schemes, and questions have been asked about whether they provide value for money for the public purse. To date, efficiencies have largely been achieved by freezing staff salaries and cutting the tariffs paid to NHS providers. Neither of those is sustainable, and both fail to meet the spirit, if not the letter, of the Nicholson challenge.

There are signs of falling morale in the NHS, and that is due in no small part to the Government’s attacks on pay, pensions and conditions of service. It is not helpful that Ministers seek to blame NHS staff for problems caused by the Government’s cuts and reforms. These are not the innovative changes that we need to see from a restructured NHS. In the main, we are seeing the picking of low-hanging fruit. Some of the cuts are rash and damaging, and they are being made to satisfy the Government’s need for cuts across the board.

I understand that the current Secretary of State for Health has joined his predecessor in receiving a vote of no confidence from the health care professionals at the British Medical Association conference. I only hope that the next Secretary of State for Health will seek to work with health care professionals, not against them.

The NHS Confederation’s survey of NHS chief executives indicated that 74% of respondents believed that the NHS’s financial situation was either the worst they had ever seen or “very serious”. Despite the Government’s claim to have ring-fenced funding, which has been called into question, NHS executives are not confident that the situation they face is good for their organisations or their patients, with 85% expecting things to get worse in the next fiscal year.

There is no doubt—the figures are there in the report—that the NHS is facing the biggest financial challenge for a generation, as a result of unprecedented demographic changes, an increasing demand for health and care services, co-morbidities, and people living longer with chronic illnesses such as diabetes and dementia. The Nuffield Trust has warned that, unless we improve the way in which services are delivered, growing care needs will result in a shortfall of up to £29 billion a year in NHS funding by 2020.

The NHS faces new challenges in the 21st century. The last Labour Government corrected the chronic under-investment following 18 years of the previous Conservative Government. Investment in the NHS trebled under Labour. We built more than 100 new hospitals, replaced much of the ageing infrastructure, and developed the new walk-in centres, primary care centres and a new generation of modern community hospitals. There were extended GP opening hours, and more doctors and nurses than ever before.

[Mr Jim Cunningham]

Does my hon. Friend agree that, unless something realistic is done about the health service, we could find ourselves back in a pre-1997 situation, with a shortage of beds and with people sleeping on trolleys?

[Grahame M. Morris]

I am grateful to my hon. Friend for that intervention. There is certainly a crisis in emergency care. The causes of that are multi-faceted, and I certainly do not agree with the Secretary of State’s analysis that it is simply the result of the change in the GP contract in 2006. Some of his comments to that effect have caused great offence to the medical profession. We are in crisis in many respects, including in the area of recruitment. It has been pointed out in recent evidence to the Select Committee that the NHS is not recruiting enough people into emergency care, or enough GPs. We are storing up bigger problems for the future if we do not have the necessary cohorts of trainees going through medical school.

A new approach is needed if we are to meet today’s challenge of the rising demand for health care in an ageing society. We will certainly need more co-operation, not more competition. We will need to see the integration of health and social care services, not more fragmentation, and we will need more whole-person care. In many respects, the Government’s reforms will make that harder, with markets fragmenting services and an open-tendering free-for-all meaning more providers dealing with smaller elements of a person’s care, without the necessary overall co-ordination.

We know about joint budgets. We have seen the Government transfer resources from the NHS to social care. However, what we need is a single budget. I should like to see a national health and care service, a co-ordinated service that focuses on an individual’s physical, mental and social care needs from home to hospital. We need a new focus on prevention: people who are at risk of being admitted to hospital should be identified and supported in their homes. The Select Committee has been looking into the policies and interventions that have enabled that to be done in other countries. We need to end costly migrations from home to hospital, and from there to expensive care homes where, in many cases, the individual must bear a huge financial burden. That is good for neither the taxpayer nor the individual. The integration of services will allow significant savings to be made. Investment in early intervention will limit more costly hospital admissions, as well as helping people to lead healthier lives.

There is a real choice. While the coalition Government are pushing for a free market in health care, Labour is calling for the full integration of health and care services. While the coalition talks of choice, it is delivering fragmentation. In contrast, Labour supports co-operation between doctors, nurses, social workers and therapists, all working together with a single point of contact.

There are huge risks, and the first news stories about them are beginning to surface. If we do not deal with the present situation, the need for fees may arise, and we may end up with a two-tier system. Top-up payments for treatment may be required, especially as more private companies enter the market. We may even see the re-emergence of an insurance-based free-market private health care system. I believe that we should remain true to the founding principle of the NHS: that it should be a health service funded from general taxation and provided free at the point of use. Ministers may shake their heads, but they should remember their last promise, that there would be no more top-down reorganisations.

The NHS, whose 65th birthday we celebrate this weekend, is Labour’s greatest achievement. We created it, we protected it, and we saved it after years of Tory neglect and under-investment. We must continue to protect and transform our most cherished public service, so that we can meet the challenges that we face in the future.

Carers

Grahame Morris Excerpts

Thursday 20th June 2013 Commons Chamber

[Norman Lamb]

I completely agree. That is why the whole-family approach is so important. When dealing with the care needs of one individual, we need to look at the impact of those care needs on the whole family.

[Grahame M. Morris (Easington) (Lab)]

rose—

[Norman Lamb]

I will give way, but I then need to reach the end of my speech.

[Grahame M. Morris]

I am grateful, and I compliment the Minister on his response. Does he recognise that, particularly in relation to young carers, it is quite right to place additional duties and responsibilities on local authorities, but local authorities must be given sufficient resources to discharge those additional duties and responsibilities?

[Norman Lamb]

I am not sure whether the hon. Gentleman was present when I said that we need to be much smarter about how we use the money available. One of the things we need to do—I think there is a degree of agreement here—is integrate health and care. It is a crazy silo situation that we face. We are not using the money effectively. We could achieve much better support if we combined the disparate parts of the system to provide support shaped around the needs of the individual and their family.

The last spending round provided local government with a challenging settlement. That is why we decided to provide extra funding to help local authorities maintain access to services. However, local authorities ultimately have discretion over how they use their resources. Improving care and support is not simply a case of more money. Local authorities must look at how they can transform care through innovation and new ways of working. As I said earlier, collaboration with the voluntary sector is critical to this. Many local authorities are successfully integrating health and care services to improve quality, and we are developing the concept of “pioneers” to act as exemplars to support the rapid dissemination and uptake of lessons learned across the country.

Some hon. Members talked about the role of doctors and other health care workers. I agree that much more needs to be done. We can look at incentives such as the GP survey mentioned in the exchange that I had with the shadow Minister, the hon. Member for Leicester West, and we have provided funding for the Royal College of General Practitioners and others to encourage GPs to think about the role of carers, but what we see from examples around the country, such as Changing Lives in Cornwall, is that once GPs start to collaborate and work as a partnership—as a team—with carers and the family, they begin to see that their burden is relieved because others can help them in the role that they have to perform. That is the essential change that it is so important to achieve.

My right hon. Friend the Member for Sutton and Cheam referred to the £400 million funding over four years for carers’ breaks. It is deeply frustrating that that has not been used as intended in all parts of the country. There are some areas, including Surrey and many others, which have done good, innovative things as a result of that. The Department asked the policy research unit in economic evaluation in health and care intervention to conduct a survey of a number of PCTs to gain their views on the benefits of NHS support for carers’ breaks. The findings will be published shortly and will help inform our understanding of what has happened. The early indications are that there may be more good things happening than we sometimes recognise, but clearly there have been significant gaps and much more needs to be done.

I appreciate that time is almost up. I entirely agree with my right hon. Friend and many others about the importance of work. I make the point again that providing help and assistance to enable people to remain in work is in employers own self-interest, as they maintain the skills in the work force while enabling that person to continue their caring responsibilities.

This has been a good debate. There has been some informed discussion and I am very grateful to hon. Members for their contributions.

Health and Social Care

Grahame Morris Excerpts

Monday 13th May 2013 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I thought that, rather than speaking about Europe or votes for prisoners, I might make a couple of points about health and social care.

There are many provisions that I should have liked the Government to include in their legislative programme. For instance, I should have liked to see a commitment to extending freedom of information requests to private health care companies. I should also have liked to see a commitment to excluding health care from the scope of trade agreements as part of a broader exclusion of public services. I understand that the Prime Minister is involved in negotiations at this moment, and I hope that the trade agreement issue is on his agenda, because there is an increasing fear among Opposition Members that—in that context, and also as a result of the Health and Social Care Act 2012—our health care system is being prepared for privatisation, and the way is being cleared for the mass entry of United States health care multinationals to the UK market.

I am pleased that the Care Bill is to be introduced in the current Session. It will go some way towards helping those who are most in need of social care, as well as their carers, providing as it does the first ever legislative framework for social care. It is a much-needed first step in the right direction, which has been a long time coming. However, it raises a great many issues. As usual with this Government, we need to look beneath the veneer and establish whether an opportunity is being taken or missed, and whether we are taking one step forward and several steps back. It would certainly be a retrograde step to raise expectations only for them to be dashed as people discover that the proposals are really quite limited. We need to be honest about what is on offer.

Members often receive some shocking and surprising statistics in their mailbags, but some of the most surprising pieces of information that I have seen relate to social care. I must thank a range of organisations—including Scope, Age UK, the Alzheimer’s Society, the TUC, the British Medical Association, Barnardo’s and the European Federation of Public Service Unions—for supplying briefings to me and to other Members. It shames me, and I am sure it shames Members in all parts of the House, that in Britain in the 21st century four out of 10 disabled people who receive social care support say that it does not meet their needs. That was established recently by research on social care conducted by the disability charity Scope following the publication of a report by the Joint Committee on the draft Care and Support Bill, on which I served. It is feared that the current provisions, and some of those that are proposed, will not be sufficient.

Other Members have welcomed the Bill. However, it is hugely worrying that local government finance has been hollowed out. That will have major consequences. It has been said that local government allocations for social care are protected, but they are certainly not protected when it comes to provision for transport and other supplementary services that are of value to members of the group involved. Many organisations have pointed out that setting eligibility criteria for care at “moderate” is essential if this framework is to be effective. As the hon. Member for Bradford East (Mr Ward) pointed out, according to the findings of a survey by Scope, by 2012 84% of councils had set their eligibility criteria at the “substantial” threshold. That represents an increase of nearly a third since 2005. As a result, only 14% of people with “moderate” needs are now receiving care, and the findings of recent surveys suggest that the position will only get worse.

According to Marc Bush, head of research and public policy at Scope,

“if we take moderate level needs, there are 36,000 people within the system of working age who, if the reforms go through as they are currently set, would fall out of the care system…if you do not meet need early, people's needs escalate and the costs escalate.”

Mr Bush’s evidence is in paragraph 186 of the Joint Committee’s report. Indeed, the Local Government Association has estimated that by 2019-20, 45% of council budgets will be spent on social care. Unless we increase substantially the amount of resources available—

[Mrs Moon]

There is pressure on people with illnesses and with disabilities if they do not get access to that social care, but should we not acknowledge the wider pressures on their families, who have to fill that gap all too often? That means taking time off from work and reducing the time spent on their leisure pursuits, thereby adding to family tensions.

[Grahame M. Morris]

That is an excellent point. The role of carers and families is absolutely critical; they are an army of unsung heroes.

We cannot build a quality care service based on driving down the terms and conditions of the people who deliver it. I am very concerned about the increase in the number of zero-hour contracts, through which staff are paid the bare minimum. Such contracts are increasingly being used by private care companies seeking flexibility when meeting short-term staffing needs, and they often lead to job insecurity and a lack of appreciation of workers. We are seeing the fragmentation of social care, driven by the pressure to cut costs, which only places obstacles in the way of quality and of integrating services. Contracting out and privatisation also make it more difficult to have joined-up services, and there is a real risk that local authorities will find it impossible to comply with their new duties.

We should be honest about what the Bill can achieve. It is a framework. It is paving legislation. It will not stop people having to sell their homes to pay for care. Under the existing deferred payment scheme, councils can loan money to people to cover their care costs, which has to be paid back by selling the family home after the elderly person has died. The Government propose something similar, but unlike the current system, interest is charged on the loan. The care Bill will not necessarily cap at £72,000 the costs elderly people actually pay for residential care. As has been said, hotel and other accommodation charges are not covered. Many elderly people in care homes will die long before they reach the cap that is being trumpeted as such a success. It certainly will not mean that pensioners get their care for free if they have income or assets worth up to £123,000. Elderly people will get free care only if they have income or assets under the lower means-tested threshold, which is not being increased and will be £17,000 in 2016.

More widely, the care Bill does nothing to address the funding crisis in social care or to help those who face a daily struggle to get the support they need right now. Elderly and disabled people are facing huge increases in home care charges, which are a stealth tax on the most vulnerable people in society. Few older people are getting their care for free, and more older and disabled people are being forced to pay for more vital services that help them to get up in the morning and get washed, dressed and fed.

We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people to stay healthy and live independently in their own homes for as long as possible. That would truly reinstate the idea of people being looked after from cradle to grave—a worthy extension of Aneurin Bevan’s legacy. Labour’s alternative is integrated, whole-person care, incorporating health, mental health and social care in a truly national health and social care service.

A and E Waiting Times

Grahame Morris Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate and compliment hon. Members who have spoken so far, highlighting concerns about the increase in A and E waiting times that are affecting their constituents.

I shall make specific references to my area and to the increase in A and E waiting times. I shall also spend a few moments reflecting on why we are in this situation and will mention the Health questions debate, during which I was bitterly disappointed by responses from the Health Secretary and Ministers to questions from hon. Members regarding increases in A and E waiting times.

An impartial observer might think the coalition Government had inherited a health service on the brink of collapse. The truth is that the Government inherited an NHS that had been transformed from what the previous Labour Government inherited after 18 years of Conservative Government and under-investment. My area was one of many, perhaps including Kettering, that were beneficiaries of considerable investment. There were 100 new hospitals; actual spend on the NHS increased from £30 billion to more than £100 billion; and much of the aged NHS infrastructure was replaced. My area and many others saw the construction of new walk-in centres, primary care centres and a new generation of modern community hospitals. GP opening hours were also extended. We have had the benefit of more doctors and nurses than ever before. We also had NHS Direct.

My contention is that Labour not only fixed the roof when the sun was shining, but laid the foundations and built the new hospitals, ensuring that patients received faster and better treatment closer to their communities. That was reflected in public satisfaction with the NHS, which went from the lowest ever recorded levels in the 1990s under the previous Conservative Administration, to the highest ever recorded levels by the time Labour left office. However, since the coalition Government took office, we have seen the biggest fall in public satisfaction with the NHS, as spending cuts have started to bite. [Interruption.] The Minister is saying no and shaking her head.

[Anna Soubry]

I am not. I am saying, “What?”

[Grahame M. Morris]

The Government have given back to the Treasury some £3 billion over two years. The Government have expended unnecessarily in excess of £2 billion or £3 billion on a top-down reorganisation. Factor in the £20 billion in cuts or efficiencies—however people choose to describe them—and this is a difficult time for the NHS.

[Anna Soubry]

Efficiencies.

[Grahame M. Morris]

Someone’s efficiency is someone else’s cut.

[Anna Soubry]

Will the hon. Gentleman not accept that the efficiencies that he speaks about were agreed between the then Opposition and the then Government—his Government—as savings within the NHS of some £20 billion? Does he also accept that his party, in its last manifesto and in comments by Ministers, stated that it would cut the amount of money going into the NHS? That is something this Government have not done.

[Grahame M. Morris]

I think that the Government are cutting the money that is spent on the NHS, not least with the costs of the reorganisation, which I have already mentioned. That money need not have been spent. We are giving back several billion pounds—some £2.5 billion to £3 billion to the Treasury—which could be spent addressing issues such as this. There are a couple of practical points that I want to raise with the Minister later, but I give way to the hon. Member for Cheltenham (Martin Horwood).

[Martin Horwood]

I agree with the hon. Gentleman about the reorganisation of the NHS. That time and effort would have been better spent trying to work out how to deliver health care more cost-effectively. But does not he rather undermine his case when pretending that there has been a cut to the NHS budget, when an objective analysis of the actual billions spent on the NHS clearly shows that it has gone up? The difference between a cut and an efficiency saving is that an efficiency saving is returned to the NHS budget.

[Grahame M. Morris]

I did not vote for the NHS reorganisation; I spent 40 sittings in Committee trying to resist what is now the Health and Social Care Act 2012 and the damaging changes it introduces. That includes those that are about to be implemented under section 75, on the introduction of competition, which will fragment the service and add to costs and complexities. I do not, therefore, accept the hon. Gentleman’s criticism, but I will press on because I want shortly to raise a couple of issues specifically about County Durham.

Part of our responsibility is to hold Ministers and, indeed, the Prime Minister to account. On waiting times—this was one of his five guarantees—he said:

“We will not lose control of waiting times—we will ensure they are kept low.”

Other Members have quoted the King’s Fund and patient surveys, and the figures clearly show that 32 foundation trust hospitals, out of 88 acute trusts in England with an A and E unit, missed the target in the last three months of 2012. I am not sure whether Kettering was one of them, but those figures should be cause for concern for everybody, including Ministers and the Prime Minister. That is double the number of trusts that missed the target in the same period last year, and four times the number that missed it in the previous quarter.

It is therefore clear that A and E waiting times are spiralling out of control. There have been various surveys, including one conducted by the Care Quality Commission, which found that one in three people spent more than four hours waiting for treatment. It also noted a large rise in the number of patients waiting for 30 minutes or more before seeing a doctor or a nurse.

In my area, The Northern Echo is campaigning on this issue, highlighting the alarming rise in the number of patients in the north-east waiting more than four hours for treatment. That number has almost trebled in the past 12 months. The paper has disaggregated figures from the Department of Health and found that more than 1,000 patients have waited longer than the target time, including 536 in County Durham and Darlington. Compared with 12 months ago, the number of patients waiting more than four hours has increased by 200% in County Durham and Darlington. South Tees and York have also seen increases in excess of 200%, compared with the previous year. However, at the Newcastle foundation trusts, the percentage increase is a staggering 630%. Alarm bells should be ringing for Ministers, because those figures are quite dreadful.

I was concerned by the Secretary of State’s responses at Question Time. One disturbing characteristic of this Government is that they are not taking responsibility or coming forward with proposals to address these issues. Specifically, in response to a question from my hon. Friend the Member for Manchester Central (Lucy Powell), the Health Secretary said:

“We are looking at the root causes of the fact that admissions to A and E are going up so fast”

—I think he quoted a figure of an additional million. The factors he blamed were that

“there is such poor primary care provision…changes to the GP contract led to a big decline in the availability of out-of-hour services…and…health and social care services are so badly joined up.”

He added:

“That is how we are going to tackle this issue”.—[Official Report, 16 April 2013; Vol. 561, c. 168.]

That really is not good enough. Indeed, Dr Laurence Buckman, who is chair of the British Medical Association’s General Practitioners Committee, has been quite dismissive and scathing about the Health Secretary’s decision to blame the increase in A and E numbers on the changes to GP contracts. He said it was “impressively superficial”—[Interruption.] Well, that is what the man said, Minister. He said that the decision was not based on any evidence. He went on to say:

“Most GPs were not providing personal access out of hours anyway; it was provided through a variety of out-of-hours routes and that has been the case for the past 30 years, so it would be nonsense to suggest that because GPs haven’t been personally responsible since 2004, therefore casualty is full of people. That is just such fatuous nonsense. I question the wisdom of the people briefing the Secretary of State.”

I tend to agree with him.

There is no magic bullet. With a complex organisation such as the NHS, we need a broad-spectrum antibiotic; we need to apply a number of measures. The fragmentation of the service is certainly contributing to the problem. There is also the issue of people not having access to their GP within 48 hours. Like many Members, I have, unfortunately, had experience of close family members and constituents being left with little alternative but to go to A and E, when the GP could have addressed the issue, had they been available in a reasonable period. This issue therefore requires a team effort.

I am also concerned about what the RCN is saying about the reduction in the number of community and district-based nurses, and I hope the Minister will refer to that. Information provided through freedom of information requests shows that the number of nurses in communities who are part of the rapid emergency assessment and co-ordination teams and the rapid response teams that help to keep elderly people, in particular, out of hospital, has been dramatically reduced.

[Heidi Alexander]

Does my hon. Friend agree not only that there are fewer community nurses, but that those who still remain have much enhanced work loads, which means the time spent with each individual patient is reduced? That, too, causes problems with the quality of care provided in the community.

[Grahame M. Morris]

That is certainly a factor, and I thank my hon. Friend for raising that issue. Part of the solution is a more visionary approach and a care model that integrates NHS services with social care in a seamless service. We need to end the fragmentation and to have full co-operation. We do not want people—particularly elderly patients—to be discharged from hospital, only for their cases not to be followed up by social care or primary health care services. That is a key challenge facing the Government. I will leave it at that.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 16th April 2013 Commons Chamber

The Secretary of State was asked—

[Grahame M. Morris (Easington) (Lab)]

2. What progress he has made on the commitment that patients would have access to appropriate radiotherapy wherever they lived.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am pleased to say that from 26 March £22.7 million of the Prime Minister’s fund to improve access to what is called intensity modulated radiotherapy—IMR in short—has already been committed. The money is being used to update machines and ensure that radiographers receive extra training if they need it. We are well on our way, especially as it is now a nationally commissioned service, so there is no reason why anybody should not have the access they need to this treatment.

[Grahame M. Morris]

I thank the Minister for that response, but is she aware that new guidelines released by NHS England for treating patients using stereotactic ablative radiotherapy—advanced radiotherapy—say that only commissioning for early stage lung cancer will be approved, and that other treatments for all other cancers can be paid for only in clinical trials? As no trials are being commissioned in England, can the Minister explain how the treatment for patients with prostate, liver and spinal cancer, who were receiving SABR treatment last month, will be funded in the future?

[Anna Soubry]

What I do know, having had a long meeting with my officials only this morning, is that the evidence, as they have explained it to me, is clear: SABR is effective only in a small number of people who have, unfortunately, a certain small tumour in their lungs, and it is not suitable for other treatments of cancers. However, if the hon. Gentleman wants to discuss the matter further, my door is always open.

Sudden Adult Death Syndrome

Grahame Morris Excerpts

Monday 25th March 2013 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

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

I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) on securing this debate. It is a privilege to follow my hon. Friend the Member for West Lancashire (Rosie Cooper) and other Members who have made constructive contributions. Compared with some other debates that I have been involved with in recent weeks and months, the unanimity today is a refreshing change.

I pay tribute not only to my hon. Friend the Member for Liverpool, Walton and the other Members who are in Westminster Hall today, but to the people—more than 110,000 of them—who signed the online petition that was set up by the Oliver King Foundation. Indeed, I pay tribute to the King family, Jake Morrison and all those who have been instrumental in taking forward the campaign. I also thank the Minister for agreeing to meet campaigners; that is very important. It shows the public interest in and the importance of the issues that we are debating today.

As you might be able to tell from my accent, Mr Amess, I am not actually from Merseyside, Liverpool or the north-west.

[Andrew Percy]

No?

[Grahame M. Morris]

Well, I am fifth-generation from that area actually, so I have a connection with it. However, I am from the north-east and I know that many colleagues from the north-east and from across the whole country are concerned and share the aims of the OK Foundation, so I hope the Minister will support the campaign to provide defibrillators in all public buildings.

My hon. Friend the Member for Liverpool, Walton referred to the protection that we enjoy here in the Palace of Westminster. I tried to find out precisely how many defibrillators there are in the Palace. There are notices about them at the end of every corridor, including my corridor, and I found that there are actually 16 defibrillators in the Palace. Somebody here obviously knows the importance of early defibrillation in the event of a cardiac arrest, and they are to be complimented for that. The general public should enjoy a similar level of protection.

This is a matter of life and death. As my hon. Friend said, an estimated 60,000 out-of-hospital cardiac arrests occur each year and, incredibly, of the 30,000 cases attended by medical professionals, fewer than one in five of the people affected receive the life-saving intervention they need following a survivable cardiac arrest. I did not realise until I looked at the numbers involved quite how mind-boggling they are. There are nearly 100,000 deaths each year in the UK due to cardiac arrest, which is more than 250 a day, making it one of the UK’s biggest killers.

Hon. Members have already mentioned the British Heart Foundation’s high-profile “Staying Alive” campaign and information film on hands-only CPR. The House will be relieved to know, Mr Amess, that I shall not attempt to sing it or repeat it, but that was a successful campaign. It is reported that in November 28 lives were saved by people who learnt how to administer CPR from the advert headed up the footballer Vinnie Jones, or were inspired by it to take further lessons and coaching, and I imagine that that number is even higher today.

I was surprised by the UK’s record on emergency life-support skills. A British Red Cross survey found that only 7% of people in the UK have first aid skills, compared with 80% of people in Scandinavian countries and a similar figure in Germany. I was surprised, because in the area where I grew up and have always lived, there was quite a strong tradition with the St John Ambulance, and so on, so I expected the figures to be higher, but perhaps it is a function of the society in which we live. That is a major omission and I hope that the Minister takes note of it.

A further survey of public support carried out by the British Heart Foundation found that 73%—almost three quarters—of schoolchildren wanted to learn how to resuscitate someone and give first aid, and more than three quarters of teachers and parents agreed that it would be a good thing to be taught in schools. I hope that the Minister will speak with her counterparts in the Department for Education and press for these life-saving first aid skills to be a core part of the national curriculum, to ensure that all young people leave school equipped with the ability to save a life. That would be really worthwhile.

We know that time matters when cardiac arrest occurs. For every minute that passes following a cardiac arrest and before CPR is administered, the chances of survival are reduced by around 10%. Although CPR can buy more time, defibrillation is the only effective treatment for cardiac arrest caused by ventricular fibrillation, where the heart quivers and stops pumping blood around the body. The British Heart Foundation has found that, for every minute that passes without defibrillation, chances of survival decrease by 14%. We have heard how CPR can improve the chances of survival. We have also heard about research that shows that applying a controlled shock within the first five minutes of collapse provides the best chance of survival. It is therefore essential that defibrillators are readily available, particularly in places where there is higher incidence of cardiac arrest or where it might be difficult for emergency services to arrive quickly.

I applaud the efforts of one of my local newspapers, The Northern Echo, which has been running the “A Chance to Live” campaign in my region, promoting the use of defibrillators in public places, particularly gymnasiums, where there is a greater risk of cardiac arrest occurring both before and after strenuous effort. I am pleased to note—we did a bit of a survey—that all the local authority and council-run gyms in the north-east have defibrillators and staff trained to use them. It has been reported, however, that 80% of private gyms do not have some form of life-saving equipment available; it does not seem to matter whether it is a small gym or one of the larger, more up-market leisure gyms. When challenged about the lack of defibrillators in their gyms, Bannatynes, headquartered in Darlington, issued a statement explaining that they did not have defibrillators because

“they are a specialist piece of medical equipment, which should only be operated by a qualified medical professional.”

I do not know if hon. Members have any contact with Duncan Bannatyne, or if he will get a copy of this debate, but having heard the comprehensive, complete and compelling case advanced by my hon. Friend, it is clear that it is not necessary to have comprehensive training to use a defibrillator. I hope that in the course of this debate we can put to bed this misconception.

As we have heard, modern defibrillators are designed to be used by untrained members of the public; they provide audio and visual instructions to the user and the machines will automatically diagnose the patient and deliver an electric shock only if it is necessary. To provide a medical opinion, as we have the Minister here, in my area in County Durham, Dr Harry Byrne, vice chairman of NHS Darlington clinical commissioning group, has described defibrillators as the

“single greatest advance in out of hospital cardiac assistance since the invention of chest compressions or CPR…You don’t have to be a trained first aider to use one. You just pull it out of the box and follow the instructions step by step. It even tells you what to do”,

as we have heard, from my hon. Friend and the hon. Member for Brigg and Goole (Andrew Percy).

A defibrillator is an essential life-saving piece of equipment and I hope defibrillators will become common, not just in schools, but in workplaces, too. Hon. Members have suggested that they should be in shopping centres and nursing homes. They should be in community buildings as well. Certainly, though, they should be in schools. I agree with my hon. Friend that they should be as common as fire extinguishers and smoke alarms. I hope that the Minister supports these measures and will be proactive in protecting the public and ensuring that everyone, no matter where they live and work, has the best chance of surviving cardiac arrest.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 26th February 2013 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I thank the Secretary of State for his previous answer. Comparative data are essential in compiling an evidence base on which to plan effective health interventions. Will he use the radiotherapy data sets that his Department publishes as a basis to inform planned investments in advanced radiotherapy systems, particularly in regions like mine which lack such equipment?

[Mr Hunt]

I know that the hon. Gentleman asks a lot of questions about radiotherapy. We use a strict evidence base before we make any investments. We also want to embrace innovation, but our absolute priority is to save as many lives as possible from cancer. He will know that we are in the lower half of the European league tables when it comes to cancer survival rates, and that is something that we are determined to put right.