Oral Answers to Questions

Lisa Nandy Excerpts

Tuesday 27th November 2012 Commons Chamber

[Norman Lamb]

I acknowledge the hon. Gentleman’s work on promoting the case for psychological therapies, including mindfulness, and would be happy to meet him and a delegation of experts. The Government have massively increased psychological therapies—nearly 1 million people in the past two years accessed psychological therapies through the improving access to psychological therapies programme. We are totally committed to improving access to psychological therapies to cure the imbalance in access to services for people with mental health problems that has existed for a very long time.

[Lisa Nandy (Wigan) (Lab)]

16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The budgets for individual ambulance trusts are set by local health care commissioners. In 2012-13, the budgets are increasing nationally by £2.5 billion. To ensure patient safety, ambulance trusts are required to meet national performance standards in respect of their response times.

[Lisa Nandy]

Does the Minister share my concern that 100,000 more patients than two years ago wait more than half an hour to be transferred from ambulance to A and E? If so, how on earth can he justify making his top-down reorganisation of the NHS a priority rather than sorting out that appalling situation?

[Dr Poulter]

The priorities for local ambulance trusts and the funding allocations are set locally. The hon. Lady will be pleased that between 2010-11 and 2011-12, an additional £9 million was put into the front line of the ambulance service in her area to help address some of the problems she outlines. Under this Government, more money is going to the NHS than before and more money is going into local ambulance services—£2.5 billion nationally. We should contrast that with the approach taken by the right hon. Member for Leigh (Andy Burnham) on the Opposition Front Bench, who said that to increase spending to address those problems would be irresponsible.

Oral Answers to Questions

Lisa Nandy Excerpts

Tuesday 17th July 2012 Commons Chamber

[Anne Milton]

As the hon. Lady will know, we are consulting on a range of options to modernise the operation of the scheme. The cost rose to £53 million in 2010-11, and is due to rise to about £67 million in 2012-13. Given those massive increases, we need to look at the scheme’s operation to ensure that we are getting good value for money.

[Lisa Nandy (Wigan) (Lab)]

10. Does the Minister accept that the cost may well have risen because more children are receiving free milk? Because the consultation is being launched during the school holidays, it will be extremely difficult for schools to respond. If this is a genuine consultation which aims to ensure that milk reaches the children who need it, will the Minister consider extending the deadline into September and October?

[Anne Milton]

The consultation has been running for some time now, and I should have thought that local authorities in particular would have had plenty of time in which to respond. Given that 8,962 settings are paying more than 90p for a pint, which is an outrageous amount, it is extremely important for us to hear from everyone. If the hon. Lady feels that there has been any problem with responses to the consultation and would like to drop me a line, I shall be happy to respond.

Adult Social Care

Lisa Nandy Excerpts

Thursday 8th March 2012 Commons Chamber

[Andy Burnham]

The two systems do not work in such situations. The health service is intrinsically tied up with the social care system, and if it collapses the health service cannot discharge people from hospital. It is a false economy.

As for what is happening on the ground, the Minister commented on funding nationally, but in reality eight out of 10 councils now provide care only for those with substantial or critical needs: they are restricting their eligibility criteria. Age UK estimates that that leaves 800,000 people without any formal support, representing plenty of unmet need, and the situation also leads councils to increase charges for home care. The average cost for a disabled or older person paying for 10 hours a week of home care is now £7,015 a year. Never mind a death tax, that is a stealth tax—or a dementia tax, as people pay more and more for the costs of care while they are alive. It is not fair, it is not right, and we should do something about it.

That is why we say to the Government that we must address the question of the local government baseline alongside that of Dilnot. There cannot be a choice; we have to do both. If we do not and we fund only Dilnot, a larger number of people will pay increased charges but with a cap on what the charges might be, and that will not feel like the leap forward or the social progress that the Care and Support Alliance and others are looking for. It will not help us to drive up quality in the care system, either, but we desperately need to do so.

Councils are being forced to stretch inadequate budgets ever more thinly, and that is leading to corners being cut. I shall illustrate that directly with an example from my constituency. Several years ago, Wigan council contracted out home care services in our borough, and staff were transferred to a number of private providers, which have changed hands over the years. Just after Christmas, home care workers in Leigh came to my surgery and told me how things had broken down over the Christmas period, leaving vulnerable people, frankly, unsupported. They showed me the timesheets that they had been given by the company they were working for, and one of them included four simultaneous bookings for 12 o’clock—a point that I think my hon. Friend the Member for Worsley and Eccles South made—on different sides of town, with no travel time built in. Impossible. If we look at the whole day, we find appointments within 10 or 15 minutes of each other, which are meant to include travel time as well as time for looking after older people. That is fundamentally unacceptable.

I was told about staff working extra hours because of that situation, and then not being paid. They said that equipment such as aprons and gloves was not being provided, and that staff were funding them out of their own pockets, which again is absolutely wrong. They also raised concerns about rotas being issued only the night before, and care assistants not having keys to get in to meet the service-users they were visiting. Across the board, there were terrible problems and vulnerable people were being left without support.

Members might think that the company in question is a small, local one, but in fact it is Alpha Homecare Ltd, which is wholly owned by Carewatch Care Services Ltd, a national company with 154 offices nationwide. That is an example from Leigh, but I bet that other Members could cite similar ones.

[Lisa Nandy (Wigan) (Lab)]

I too have been visited by employees of Alpha Homecare in my neighbouring constituency. Does my right hon. Friend agree that one of the real concerns is that because those women are so dedicated to their work and often pick up work out of hours, without being paid to do so as they told me, it masks the fact that the situation is probably much worse than it appears on paper?

[Andy Burnham]

That is absolutely the point. This is not responsible capitalism; it is the worst kind of capitalism—making money by leaving vulnerable people unsupported and, as my hon. Friend says, taking advantage of the commitment and vocation of those on the front line, who will not walk away from the people they care for. It is unacceptable to not pay them and let them buy their own equipment, and to make profits off the back of that kind of behaviour.

National Blood Service

Lisa Nandy Excerpts

Tuesday 15th March 2011 Westminster Hall

[Jim Dobbin]

If that were the case, it would make it much more dangerous for those patients who were waiting to receive that blood or organ. I would not like to see that happening.

The National Blood Service has created a strategy for each of its departments as it strives to improve its service and, looking at the review in great detail, in my view, it is succeeding. It is aware of the current economic situation and the constraints that it is working within over the next few years. It is planning more developments in future years. The question that has to be asked is why sell off something that is working so well. I understand that scientific staff have been angry about these moves. They have blasted the Government plan and demand changes to the Health and Social Care Bill, which will let private companies cash in on lucrative Government contracts.

[Lisa Nandy (Wigan) (Lab)]

Does my hon. Friend share my concern about the staff who currently work in the National Blood Service? Many of them opt to work in such services because they believe in the public good and in the common good. Does he share my concern about the impact that privatisation will have on them?

[Jim Dobbin]

Yes. That is exactly right. Those staff, who are well trained specialists in their area, are very concerned about the damage that this proposal would do to the blood transfusion system and they are very angry about what is possibly going to happen. Of course, they also fear that donors will walk away. There are 1.4 million volunteer donors at the moment. They donate about 200,000 units every year, which is a huge amount of blood, and all of it is donated voluntarily. Privatisation of the blood service has been tried in New Zealand and it drove down the number of blood donors. It deterred them from making that contribution freely, because donors do not like to see their organs or blood as part of a private sector business.

Why should the private sector profit from blood that is given freely? There is no private sector organisation that has the expertise to provide the range of services—blood supplies, tissue, organs and specialist products, plus the specialist research expertise—that are provided by the NHS blood transfusion service.

NHS Reorganisation

Lisa Nandy Excerpts

Wednesday 17th November 2010 Commons Chamber

[Rosie Cooper]

It would help if I could hear the right hon. Gentleman, but never mind.

The difficulties are topped up with increasing demand for services, an ageing population, an increase in the number of people with complex illnesses and the rising cost of treatment. That is all very worrying.

At the Select Committee the Secretary of State spoke about increasing autonomy and accountability in the NHS. I have raised that with him on a number of occasions and I tried to intervene today. It is a further example of the two health policies of the Administration, one mythological and the other the reality. Perpetuating the myth, the Secretary of State said at the Select Committee that

“the conclusion that we reached was that we could achieve democratic accountability more effectively by creating a stronger strategic relationship between the general practice-led consortia and the local authority.”

We might imagine that that meant patients and elected representatives at the heart of decision-making, and that the consortiums would operate with councillors on the board, who would be able to vote, but no. Scrutiny will come from well-being boards, which means that patients and councillors will not be there offering their opinions and able to vote. Well-being boards, like the current NHS overview and scrutiny arrangements, may as well not exist because they will be nothing more than a focus group.

I said at the Select Committee that those arrangements were nothing short of throwing snowballs at a moving truck—they would make little or no difference. The Government are giving a budget of more than £80 billion to GPs who just want to practise medicine and not get involved in the experiment.

[Lisa Nandy (Wigan) (Lab)]

May I mention the issue of GPs and safeguarding, the key role that GPs play in keeping children safe, and the fact that if they are spending time commissioning services, who will fulfil that vital function?

--- Later in debate ---

[Yasmin Qureshi]

We are told by the Government that the reorganisation is not ideologically driven, but is somehow a way of maximising efficiency and making the systems better. At a time when we are being told that there is not enough money, commentators and experts are saying that this reorganisation will cost at least £3 billion. We are not talking about a small amount of money; we are talking about £3 billion.

[Lisa Nandy]

In my constituency of Wigan, despite the extreme and visible progress that we have made in the past 13 years of Labour Government, there are still significant health inequalities. In fact 129 per 100,000 people in my constituency die of coronary heart disease, compared to 90 nationally. I know that my hon. Friend shares my concerns, but does she agree that, at a time when we should be addressing those health inequalities and continuing to invest in the NHS, it is an absolute scandal that we are spending the amount of money that she suggests?

[Yasmin Qureshi]

I entirely agree with my hon. Friend. She and I have almost adjoining constituencies, and many of the issues and problems of her constituents are very similar to those in my area. When we were in power, £345 million was set aside for disabled children, for respite and all-night breaks. All of those children will now suffer because the White Paper makes no mention of funding for disabled children after March 2011. Yet, we have £3 billion to pay for reorganisation. On 2 November 2009, the Prime Minister, then Leader of the Opposition, told the Royal College of Pathologists that under the Conservatives, there would be no more restructuring of the NHS.

On 20 May, the coalition Government said:

“We will stop the top-down reorganisations of the NHS that got in the way of patient care.”

What are they doing? They are carrying out exactly that reorganisation. If the Government want to make some real improvements to the NHS, the principle of “no decision about me without me” should be considered. The Health Secretary should reconsider the NHS reorganisation and try to think of a better way to use that money for patients.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

Let me begin by wishing the hon. Member for Winchester (Mr Brine) and his partner well for the pending new arrival. I am sure that they will receive an excellent service in their local NHS hospital, and that the whole House wishes them the very best.

I should like to use this opportunity to raise a few of the concerns that have been brought to my attention by people in my constituency. Many do not fully understand how the new proposals will work to deliver the outcomes we hope for, and I hope that the Minister can answer for them this afternoon. Essentially, people are anxious that where they live and who they are will begin to determine the level and quality of their care.

I am sure we all agree that consistency and guarantees of standards must be an integral part of the operation model that the Government seek to introduce. That is especially important in relation to health outcomes for the poorest and most vulnerable. There is a high level of health inequalities in my constituency. The people who live in the poorest wards suffer much worse health outcomes than those in the better-off wards in the south of the borough of Trafford. The local authority was quite slow to recognise that, so how will health inequalities receive strategic attention in the proposed new structures?

What will be the role of the public health director, who will be placed within the local authority? I am keen to know how that public health role in the local authority will devolve and relate to those at the sharp end in all health settings—those who provide front-line care. I hope that the Minister can fully explain that in his winding-up speech so that my constituents can be clear about it.

My constituents and I are concerned about how the wider drivers of health inequalities—income, education, employment and so on—will be addressed in the new structure, particularly when so many national policies seem to be taking us in the opposite direction, as my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) pointed out earlier.

[Lisa Nandy]

Does my hon. Friend agree that as well as the vast inequalities in life expectancy, the lingering issue of care for those who live longer and longer with chronic illnesses needs to be addressed? Those people are suffering now. Does she agree that it is an absolute disgrace that the Government have decided to tinker with the structures rather than put in urgent investment to help those people, including people in my constituency of Wigan?

[Kate Green]

Labour Members want to know whether the money spent on the restructuring of front-line care in our communities is the best use of that money. As the Health Secretary himself pointed out, we continue to have poor health outcomes and standards compared with our European neighbours, so why does it make sense to put more money into reorganisation and less directly into front-line care? I look forward to hearing what the Minister says about that.

The second issue that I want to address involves patient voice. That, too, has been raised in my constituency. A particular concern of mine is to ensure that the poorest and most vulnerable are heard. I am concerned about the lack of voice of those who do not have the sharp elbows and the articulacy to speak up for themselves to secure the best for themselves and their families. We know that that is the fate of many in our poorer communities, and especially of those with mental health problems.

I have been told a number of times in my constituency, including by GPs, that GPs are not particularly expert in, or equipped to deal with, mental health needs. How will those patients’ needs be identified, recognised and responded to in the new structure? What help will be available to enable patients to articulate such needs? There is uncertainty in my constituency on the future structure. How will patient voice, choice and opinion feed in to the new model?

The Trafford patient LINk—local involvement network—service is uncertain about its future role and status. I very much hope that Ministers will be able to give us more information about how we will get a clear opportunity for advocacy, so that every patient’s voice can be properly heard, and for proper support for patients who are perhaps less able to articulate their needs and secure services for themselves.

I am concerned also because I know—not just from my constituency, but from my long experience of supporting and working with vulnerable families—that different values pertain among different doctors and practitioners. I am particularly concerned, for example, for the young woman who may present herself to a GP who does not feel it appropriate to offer her advice on contraception or abortion. How can those minimum standards be protected, so that everybody—wherever they live, whoever their doctor is and whatever the structure is—knows that they will be guaranteed the care that they need.

Thirdly, I would like to raise with Ministers the issues that have been raised with me by health practitioners and professionals—and which have been highlighted in this afternoon’s debate—relating to GPs’ ability and willingness to take on the management aspects of their commissioning role. Many GPs have said to me—perhaps the Minister will be able to reassure them this afternoon—that what they see tanking towards them is a heavy burden of management, albeit without the additional resource with which to manage it. Many GPs have said to me that they have not really had the training—they lack the expertise—to be health managers as well as good-quality health practitioners and providers of front-line health care. I am interested to know whether Ministers have plans for training GPs and developing those skills and abilities in GP practices, or whether, as many of us on the Opposition Benches fear, the proposal will in fact be used as an opportunity to privatise that management function. If that is the case—this is not an ideological point, but an efficiency point—I shall be keen to know what financial model Ministers expect to operate if a substantial amount or even a proportion of the money that would otherwise be held in GP practices will go to fund the profits of private providers.

Those are the issues being raised with me in my constituency. They are issues that I am afraid I do not feel equipped to answer, because I do not fully understand how the new structures will work well in practice and, in particular, how they will work well for the poorest.

In concluding, I would like to highlight a point that has been made by a number of my hon. Friends this afternoon. The injection of extra uncertainty and disruption into our national health service at this time is further—and considerably—stretching our capacity to deliver excellent front-line care. I would urge Ministers to listen to the many GPs who have said to me—and who I am sure are saying to them—that what is proposed represents an element of change and disruption that they cannot yet see the benefits of. What they can see is that there is considerable uncertainty in the way that they are now working. There is certainly concern in my primary care trust. I hope that Ministers can offer some reassurance on that point, because at the moment there is considerable instability, and that cannot be good for any patient outcomes.