Social Care
Huw Merriman Excerpts(6 years, 6 months ago)
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Barbara Keeley
That is absolutely the case. In fact, in a recent meeting with Unison, I was told that, in our area in Greater Manchester, one person could be paid more for putting toppings on to pizzas at Morrisons than for providing care—often to people with dementia or to those who really need that help.
Huw Merriman (Bexhill and Battle) (Con)
The hon. Lady talks about a squeeze in funding. On that basis, does she agree that it would be right to ask those who do have the means to contribute more towards their social care in the home?
Barbara Keeley
No, I do not agree with the hon. Gentleman. That is one of the reasons why his party’s dementia tax policy failed so badly. Suddenly to bring hundreds of thousands of people into means-testing using their homes was one of the biggest flaws in the policy that the Conservative party floated.
I will now make a little bit of progress on the state of care, because the fragility of the care sector is a key issue. We heard from my hon. Friend the Member for Luton North (Kelvin Hopkins) about closures in his area, but councils cannot even influence these closures much any more because home care providers are handing back contracts. Indeed, one in five councils in the ADASS survey reported closures in all three services: home care, residential care and nursing home services. There are also serious issues of care quality in many areas of the country.
The survey reported that 70% of the councils surveyed had experienced quality issues across all three types of care services. ADASS estimates that 28,000 people have been affected by care-quality issues or by a change of service due to contracts being handed back. We know that it is a big issue for a person with dementia to have a continual change in the care staff visiting them. Those arguing in favour of cuts need to think about those 28,000 lives affected negatively by cuts to local authority budgets. Worryingly, the Care Quality Commission now reports that almost a quarter of care services are not meeting standards on safety, and nearly a fifth of services require improvement overall.
I said earlier that budget cuts mean that more than 400,000 fewer people are now getting publicly funded care. Of course, councillors, council leaders and social workers have had to make difficult decisions about cutting budgets and cutting support to local people. It is of great credit to councils and council leaders that so many still continue to prioritise adult social care in their budget setting, but the overall position is one of cuts. There will be a real-terms loss of £6.3 billion to adult social care by the end of this financial year, and we heard earlier from my hon. Friend the Member for Manchester, Gorton (Afzal Khan) about the level of cuts in the city of Manchester. The cuts have an impact on staff working in social care.
Barbara Keeley
As I said earlier, I will come to our proposals; I do not want to jump around in my speech too much more.
Going back to staff working in social care, it is important to remember and think about social workers, not just care staff. A recent study found that less than half the social workers surveyed felt that decisions about a person’s care and support were being left to their professional judgment; it is now all about budgets. More than a third said that they had felt unable to get people the care they need. Less than half felt supported to have necessary difficult conversations about changes to care with people needing care and their families.
The social care crisis is a direct result of the cuts that this Government have chosen to make. The King’s Fund, the Health Foundation and the Nuffield Trust estimated that there would be a funding gap in social care budgets of £1.9 billion for this year, but the extra funding in the Budget was only £1 billion, so there is still a funding gap of £900 million this year. Labour pledged an extra £1 billion for social care this year to start to deal with that funding crisis. However, the Government have chosen instead to put the pressure on local authorities and hard-pressed local council taxpayers to deal with that social crisis, which was made in Downing Street.
Delayed transfers of care due to social care cuts increased by more than a quarter in the 12 months to August this year, putting extra pressure on local councils. Now, sadly, Ministers are threatening councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care cannot be met. Indeed, ADASS reported that half the social services directors it surveyed believe that their targets for delayed transfers were unrealistic. It is barely believable that the Government’s response to the social care crisis is to threaten to make the situation worse by cutting funding for social care even further. Some councils experiencing problems meeting targets were even summoned by NHS leaders last week to a meeting to review their performance challenges.
Many people have said that the approach of blaming and penalising local councils is not sustainable. The Conservative chair of the Local Government Association, Lord Porter, said of the warning letters sent from Ministers to councils:
“No council wants to see anyone stay in hospital for a day longer than necessary. These letters are hugely unhelpful at a time when local government and the NHS need to work together to tackle the health and social care crisis.”
The president of the ADASS, Margaret Willcox, has described the Government’s actions in threatening councils with further sanctions as, “frankly bizarre”. David Oliver, who is clinical vice-president of the Royal College of Physicians and a geriatric consultant, said about delayed transfers of care:
“Some of these delays are due to systematic cuts to social care budgets and provision. Others are due to a serious lack of capacity in community healthcare services…attempts to solve the problem through initiatives like the Better Care Fund or pressure from NHS England have failed”.
Interestingly, Andrea Sutcliffe, the chief inspector of social care at the Care Quality Commission, said:
“I worry that if people focus just on moving people through the system quickly then does that mean that they will force the discharge of somebody that is old and frail into a service which we have rated ‘inadequate’”.
We now have a Government who are driving the NHS to be obsessed with dealing with delayed transfers of care, seemingly above all else. This obsession causes further problems if patients are discharged without planning what they need outside hospital.
Age UK give an example that was brought to it:
“Terry’s father Richard, 85, is in hospital following a stroke. He is ready for discharge and has been assessed as needing rehabilitative care through two home visits a day. However he was then told that there are no reablement services available in his area. Terry has been told to ‘get his father out of hospital’ and to look for and fund the care himself.”
My own local hospital, Salford Royal, sadly seems to have similar issues. Last week, I spoke to a constituent who described her own discharge by saying, “I was thrown out of hospital.” Having had surgery for an infected bite that caused sepsis and a hand that she could not use, my constituent was given no discharge summary, no advice on how to manage her wound and no advice about her recovery. When she struggled to get dressed, she was told that she had to get out quickly, otherwise, “This will count as a failed discharge.” This a theme we may remember from last winter.
I remind the Minister that the British Red Cross talked then of a humanitarian crisis whereby people were sent home without clothes or into chaotic situations. Those chaotic situations involved them falling and not being found for hours, or not being washed because there were no care staff to help them. Ordering patients out of hospital when there is no reablement service for them, without advice about wounds or recovery, or to a care facility rated as inadequate just to meet unrealistic targets on delayed discharge is a recipe for an even worse crisis this winter.
Huw Merriman
The social care and hospital budgets have been merged in East Sussex, where my constituency is. As a result, the A&E is now the fastest-improved A&E department in the whole of England. That change is working. Would the hon. Lady’s local authority consider the same model?
Barbara Keeley
My local authority has the most advanced example of an integrated care organisation in the country—we have already transferred all our social care staff to work for Salford Royal. I have just quoted a situation that shows how the pressure being put on hospitals because of delayed transfers of care is causing them to treat people such as my constituent in the way I described. Conservative Members ought to listen to that, because it is their Government and their Ministers who are causing this pressure to be put on hospitals.
We know that demand on social care is increasing as more people live longer with more complex conditions. The number of people aged 75 and over is projected nearly to double by 2039. That ought to be something to celebrate, but instead the Government have created fear and uncertainty for older people by failing to address the health and care challenges raised by those demographic changes. Indeed, the Conservative party is spending less money on social care now than Labour was when it left office in 2010. The Government seem to have no plan to develop a sustainable solution to the funding of social care in the longer term; they have talked only of a consultation followed by a Green Paper.
Furthermore—and this is raising real fears—the focus has been entirely on the needs of older people, without consideration being given to the needs of the 280,000 working-age people with disabilities or learning disabilities in the social care system. That is profoundly short-sighted, because the financial pressures on local authorities due to the increasing care needs of younger adults with disabilities or mental health problems are now greater than those due to the need to support older people.
Huw Merriman (Bexhill and Battle) (Con)
East Sussex has the second-highest proportion of over 85-year-olds in the country, and that number is expected to grow by 14% by 2021. As for the care homes in my constituency, 55 of them are rated good, but unfortunately 29 require improvement and one is inadequate. Not only does East Sussex have a large population of people who need to be looked after, but the system is clearly not working as it should. In my constituency, 33% of the working-age population are on the living wage, so to continue to expect council tax payers to fund the social care model will not help them get on in life and will not help intergenerational fairness. I was therefore pleased to hear the Prime Minister talk at the Dispatch Box about the short-term impact of the Government’s £2 billion announced in the previous Budget and the council tax levy. However, due to the situation with council tax payers and the small tax base that I have in East Sussex, I support her when she talks about the need for medium and long-term reform.
In the medium term, East Sussex’s model is to work as a Better Together partnership, where the council, the NHS trust and clinical commissioning groups all work as one. Indeed, they are all on one email and have emailed me over the past couple of days about what can be done, which shows that they really are working together.
As I have mentioned, our accident and emergency team is the most improved in the last six months because the Better Together partnership is now working. People are now getting out of hospital earlier and, indeed, are not having the trips, slips and falls that cause them to go to A&E. The model works well.
However, I have one ask of the Minister, who has a background in compliance. The NHS trust is managed by NHS Improvement and the clinical commissioning group is managed by NHS England, and the regulators are not working together. Those organisations therefore sometimes struggle to work together, such as on billing, contractual challenge and payments, because the regulators are telling them different things. I would like a single accountable regulator for the entire sphere, and I hope that my leaders will be able to meet the Minister to discuss their challenges and what can be done.
Cross-party consensus is surely the way forward. I hope the Opposition will note that I have not once attacked them. I have heard some fantastic speeches. In particular, the hon. Member for Leicester West (Liz Kendall) talked passionately about what we can do together. In reality, we will have no majority for these five years, and social care will be reformed only if we work together. Please, can we do so?
Valproate and Foetal Anticonvulsant Syndrome
Huw Merriman Excerpts(6 years, 6 months ago)
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Norman Lamb
I thank the hon. Lady for her intervention and pay tribute to her for her work on the all-party group for valproate and other anti-epileptic drugs in pregnancy, and for her campaigning. Yes, the response she got from Sanofi two years ago was unacceptable. It had the effect of hiding from women the full extent of the risk. Women should be presented with the evidence so that they can have a full discussion with the clinician about what steps to take. The September 2017 survey also found that 18% of women did not know of the harm—it was not that they had not received the toolkit, but that they still did not know. The system is failing those women.
Huw Merriman (Bexhill and Battle) (Con)
I stand here as an advocate for my constituent, Ms Carol Short, who describes her son as a 26-year-old locked in a man’s body, but unable to do much more than a 10-year-old. Does the right hon. Gentleman agree that it is shocking, with the clinical commissioning groups and all the funding that comes from the public sector, that we still cannot get this message through? Might one solution be shorter length prescriptions, to increase the likelihood that women receive more regular advice?
Norman Lamb
That suggestion is worth exploring. There certainly should be regular reviews—discussions on the woman’s intentions about childbirth, and on the appropriateness of the treatment for that woman at that place and time.
I acknowledge an important danger. If all the focus is on the risk of valproate, there is a risk that women will simply give up and take no medication during pregnancy, and that there will be a rise in unexpected deaths through epilepsy. SUDEP Action raised that really important issue. Already, every year, 1,200 people die sudden unexpected deaths in epilepsy, and of that total SUDEP Action estimates that about 42% are avoidable. We definitely do not want any increase in that number. For me, that points to the need for all women—indeed, all people—with epilepsy to have access to specialist teams, wherever in the country they live. My worry is that access is haphazard and variable.
Last Friday I met a specialist team in Norwich. It is a very good team, and they explained to me how they have managed to reduce the use of valproate by women in the childbearing years to a very small number. They say it is only a very small subset, for whom there is no alternative. Thus they can focus all their attention on those women. They said that there is considerable variability around the country—that many women do not get access to a specialist team. I would like the Minister to commit to the publication by the Government of data for every CCG showing the level of prescribing of this medication, to enable us to pinpoint where over-prescribing is taking place.
The interesting and rather concerning point is, if those specialists that I spoke to are right that only a very small subset of women of childbearing age need to take valproate, why is it that still, of the 173,787 people with epilepsy taking valproate, 17,848 are women of childbearing age? That looks like substantial over-prescribing, which is completely contrary to the current guidance. If the guidance is clear that it should not be prescribed to women of childbearing age unless there is no alternative that is safe for the individual woman, why on earth are so many women still being prescribed this medication? It is a scandal, and the Government need to get to grips with it.
We need a holistic approach, so that women have access to specialist care and so that full consideration can be given to the right arrangements to ensure that no woman is on valproate who need not be during those years of childbearing age. Then we might start to see an end to this awful continuing scandal.
Finally, I shall outline the steps that the Government and others should take. First, the toolkit must reach everyone. It must surely be mandatory, not voluntary. Given the clear evidence from the survey of the number of women who are not getting the message, we cannot rely on the current system to work, because it is not working. As the hon. Member for Lancaster and Fleetwood (Cat Smith) said, 400 affected babies have been born since it was introduced. That cannot continue; the warnings must be mandatory, along with raising awareness among GPs, pharmacists, specialists, midwives and health visitors.
Secondly, people should have an annual discussion with their GP or another health professional. The Epilepsy Society has argued that that should happen, and it is very much consistent with the valproate toolkit, which highlights the need for regular review. There should be face-to-face discussion with a health professional before the prescription is renewed.
Thirdly, all women should have access to specialist units, wherever they live. We must end this haphazard, variable position around the country, and we must address fully the concerns raised by SUDEP Action. Professor Ridsdale, a consultant who has specialised in this area of policy, says:
“A useful outcome of this exercise would be that whoever prescribes Valproate agrees to identify and provide regular advice to women and girls at risk. Better still, that policy-makers and providers start exploring how ongoing structured self-management advice might be offered to everyone with epilepsy.”
That is surely the ambition we should set.
Fourthly, we should publish the prescribing rates for valproate for every CCG. The Government say they have a commitment to openness, and this would be a good demonstration of it, because we would be able to identify where the real problems exist and where women are not getting access to good enough advice.
Fifthly, we should ensure that only those women who absolutely have to take valproate do so during their child-bearing years, in accordance with the advice, and that we end what appears to be the significant over-prescribing of this medication for such women.
Sixthly—this comes back to some of the interventions that have been made, including by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron)—there must be a financial support package. In a way, that comes down to the Government’s duty to these people. This has gone on for many decades, so my point is not directed just at this Government, but they have the responsibility here and now to do right by these people. There is an overwhelming moral case for them to do that, and it is not good enough for Ministers to simply say that support is available locally through local authorities or CCGs. These families have suffered an injustice, and the Government have a moral obligation to address it. If it is right for thalidomide victims, it is right for those who have lost out severely as a result of valproate. In France, a €10 million initial fund has been established, and it could be increased. The Government need to take the same step in this country.
Seventhly, there must be a statement of regret or apology for the people who have been let down by the system so very badly.
Finally, there is a case for an inquiry or a Hillsborough-style panel so that we can understand how on earth this outrageous scandal could ever have happened, how it has gone on for so many decades, letting down so many families, and what lessons can be learned to ensure that this never, ever happens again.
Oral Answers to Questions
Huw Merriman Excerpts(6 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
As I previously advised the House, I am in conversation with Together for Short Lives to look at how we improve palliative care for children. This clearly raises a different set of circumstances and sensitivities, and it is essential that we do our best for these children.
Huw Merriman (Bexhill and Battle) (Con)
Do Ministers have any plans to review the “do not resuscitate” guidance for hospitals? I have a constituent who has such an order placed on him, despite the fact that he has left hospital and is in a care home, it cannot be rescinded and his family have not consented.
Jackie Doyle-Price
My hon. Friend is right to raise this issue. Certainly, in CQC inspections in the past, the whole issue of “do not resuscitate” orders has been an area of concern. This is something we will very much look at as part of the end of life policy, but I would like to hear more about the case my hon. Friend mentioned, if he would like to write to me.