Health Services (Cornwall)

Sarah Newton Excerpts

Tuesday 11th December 2012 Westminster Hall

[Anna Soubry]

With 50 seconds remaining, this is a perfect opportunity for any other Member to stand up and make exactly the same point. It is a good point, and it is about to be made again.

[Sarah Newton (Truro and Falmouth) (Con)]

I am pleased that we have made a lot of progress through the coalition—the gap has decreased from minus 7 to minus 2 —but a great enough rate of change to get Cornwall up to where it should be within this Parliament is essential for the people of Cornwall.

[Anna Soubry]

I am grateful for my hon. Friend’s intervention. She makes a good point. Like others who have spoken in this short debate, she advances her county’s cause eloquently and undoubtedly with some merit. I cannot make any promises, but I can ensure on my return to the Department that the matter is raised yet again at the highest level so that we can see whether we can make some progress.

Regional Pay (NHS)

Sarah Newton Excerpts

Wednesday 7th November 2012 Commons Chamber

[Mr Hunt]

That is a funny way of defending the principle of national pay: legislating to give foundation trusts the ability, for the first time ever, to set their own terms and conditions. I do not know how the right hon. Gentleman defines it, but that does not seem to me to be in any way logical.

[Sarah Newton (Truro and Falmouth) (Con)]

I represent an area with a very high cost of living. Does my right hon. Friend agree that trusts trying to balance their books should not do so at the expense of modestly paid care assistants and nurses?

[Mr Hunt]

I agree that I want local trusts to have the freedom to get the best health care for people in their areas, including my hon. Friend’s constituents. I agree that that means recruiting and retaining the very best staff and ensuring that they are highly motivated. My hon. Friend makes an important point: we must think about areas where the cost of living is lower, but we must also think about areas where it is higher. People in my constituency who work for the NHS have to commute from Portsmouth because they cannot afford to live near the hospitals and community health centres where they work. That is why an element of flexibility is a very important principle.

--- Later in debate ---

[Dan Rogerson]

Absolutely, and of course the process of trusts becoming foundation trusts was just under way—it has gathered pace over the last two years—and they were bedding down. It is likely—especially given the challenges of efficiency savings that his party would still have imposed if they had won the 2010 election—that the same set of circumstances would have prevailed. In fact the managers in those trusts who are taking those decisions are the same people who would have been in post had Labour won. It is nonsense to say that because the coalition is in power, those people woke up one day and made those decisions. Those things would have happened anyway. To be fair to the right hon. Gentleman, perhaps we should say that we cannot know what would have happened because we are not in that world. We are in the world in which his party lost the last general election. However, the NHS that he left behind is the one that is allowing this to happen, and it is the one that we have to deal with.

We have private providers next door to the NHS treatment centre I mentioned. Bodmin hospital is full of great staff. It was built under a PFI contract and is now staffed by Peninsula Community Health, a community interest company on the social enterprise model. It had to move those nurses into the private sector—or the social enterprise sector, depending on how one views that form of body—on the basis of the provider/commissioner split in the primary care trusts that was set up by the right hon. Gentleman’s Government.

We also have the issue of funding, which is the background to much of this debate. It is no accident that trusts in Cornwall are looking at this. I disagree with them, and I agree with the hon. Member for Plymouth, Moor View about the process they are engaged in, but one of the reasons they are doing it is that the “distance from target” for NHS funding was massive for trusts in the area under the last Government. I have to say that I am not satisfied that our coalition Government have tackled that problem either. The problem also existed under the previous Conservative Government—health funding in our region has been lower than it should have been for decades. Trusts such as the Royal Cornwall Hospitals Trust are having to deal with the problem of funding for those historic reasons. It is not something that has suddenly been invented.

[Sarah Newton]

I am sure that the hon. Gentleman is proud, as I am, to be part of the coalition Government who have put lots more money into the NHS in Cornwall, so that the distance from the England average has really shrunk. Like him, I will not be happy until we hit the target, but it is now just 2% less. Under Labour, it was a maximum of 7%.

[Dan Rogerson]

I agree with the hon. Lady up to a point, in that there has been a narrowing in the “distance from target” figure. Of course, it is much easier to get closer to target when there is more cash around and more money is being put into the NHS—in the good times. That is when the distance from target should have been tackled. We are obviously very much not in the good times in terms of the economic circumstances, for reasons that all parties would agree with.

If the trusts continue down this path, and create efficiencies by doing so—as well as making life much more difficult for their valued employees—we run the risk of what I call the boa constrictor approach. Snakes that kill by constriction wait until their victim breathes out and then tighten up, so they cannot breathe in again. My worry is that if trusts in Cornwall make these changes first, before other areas, they will make it easier for the distance from target funding to continue. The view will be, “Well, they don’t need the cash now, because they’ve dealt with the problem.” But the burden will have been borne by NHS employees, and that cannot be right.

I think this process is wrong because, as hon. Members on both sides have pointed out, there is an existing process for NHS employers and employee representatives to engage in to examine terms and conditions and pay levels, and see where savings can be made.

--- Later in debate ---

[Mr Jamie Reed (Copeland) (Lab)]

NHS staff are among the most valued and respected members of any work force, public or private. Like so many public sector workers—the police, firefighters, teachers, social workers, and many more—they make a crucial and often critical difference every day to the real lives of ordinary people in communities throughout our country, wherever they may be and whatever their wealth. In so many ways, these universal services and the values that they both represent and live by are our national values. They support us, they strengthen us, and they bind us as one nation.

The values of the national health service were celebrated as an article of faith in what it means to be British by Danny Boyle during the opening ceremony of the Olympics. When the eyes of the world were upon us, we showed the world that the NHS and the values that underpin it are part of what makes us British—not Cornish, not Cumbrian, not Lancastrian, but British. It is little wonder that the new Secretary of State tried to have that tribute removed from the ceremony. He knew what it meant then, he knows what it means now, and his support for regional pay in the NHS—revealed at the Dispatch Box today—shows that he is determined to fragment the service.

Since the Government came to power, NHS staff have been marginalised, trivialised and ignored. Reorganisation was imposed upon them with no mandate, no support and no warning. Since then more than 6,000 nursing posts have been lost, and billions of pounds have been taken away from the NHS front line to pay for redundancies and a reorganisation that nobody wanted—a reorganisation that was hidden from the electorate before the election.

Despite all that, these people still achieve remarkable results in the most trying of circumstances every single day. They continue to succeed, despite the incompetence of the Prime Minister and his Health Ministers. NHS workers can surely be forgiven for having had enough of the Government being on their backs; but, not content with being on their backs, the Government now want to be in their pockets as well.

Regional pay is demotivating, demoralising and wrong. It will harm the NHS in the parts of our country that are most in need, not only in the NHS and not only in local NHS services, but in the local economies where those NHS services are located. The London Evening Standard’s city editor, Russell Lynch, wrote last week that the regions

“still account for more than three-quarters of the economy. And if I were in Middlesbrough, Manchester or Leeds right now, I’d be more worried about the mugging that’s on the way from the Chancellor over regional pay in the public sector.”

Of course he was right, and the fear is palpable. That is why this is so important. That is why the Government must intervene, stop regional pay taking hold, and uphold the principle of national pay agreements within the NHS.

As we have heard, 60 academics recently wrote to The Times damning the Government’s regional pay proposals. Let us examine why. The public sector wage bill last year was £162.5 billion for the employment of approximately 6 million people. The aim of the Prime Minister, the Chancellor and, I assume, the Health Secretary is to remove what they claim is an 8% disparity between the wages in the public and private sectors. As usual, that is a heavily disputed figure with no real basis, but let us assume that it is correct. If the Government succeed in removing the difference that they imagine exists, 6 million people will have a cumulative £13 billion less to spend. That is almost 1% of our total economy.

In an age of austerity, when the parts of our country that already rely heavily on public spending are feeling the cuts most acutely, what madness it is to take even more money away from those economies, those homes and those families. Talk about killing demand in the regions! This will not just hurt the public sector and damage local economies; it will bludgeon local private enterprise—those who work in partnership with the public sector, who have contracts with the public sector, who trade with the public sector, and who sell their products to local people paid by and working in the public sector. The insidious desire to divide and rule ignores the fact that one nation has one economy.

Let us consider what regional pay in the NHS could mean for the future of NHS services. The Government have encouraged privatisation to run amok in the NHS, deliberately and ideologically. Whereas we used the private sector in a targeted, limited and structured manner, the Conservatives want to let it run riot like the Bullingdon Club in a china shop. It is no wonder that private health care provides so many funds for the Conservative party.

One of the more flimsy Treasury claims about regional pay is that it would stop private firms being crowded out by the public sector, but how is this applicable to the NHS? Is the real purpose of the NHS regional pay proposals to allow the Government to facilitate faster privatisation of NHS services by hollowing out NHS terms and conditions? Unless the Government intervene —as they should—to halt this development, it will appear that part of the agenda underpinning regional pay is, indeed, to enable the easier privatisation of NHS services. Instead of seeing NHS staff for what they are—the best partners any Government committed to improving the NHS could ever have—this Government see them as surplus to requirements in too many parts of the country, with terms and conditions that the Government see as acting as a roadblock to further privatisation.

[Sarah Newton]

Will the hon. Gentleman give way?

[Mr Reed]

I am afraid I do not have enough time.

Let us concentrate on the impact of regional pay proposals in the south-west. Because the Government have given their clear approval through their submission to the NHS Pay Review Body, 20 trusts across the south-west have already each committed £10,000 to form a consortium—a cartel—designed to reduce staff pay and to break away from the established NHS terms and conditions. That is money that should be spent on patient care. Is the Secretary of State satisfied with that state of affairs? Some £200,000 is being spent in an effort to reduce the pay and conditions of NHS staff in the south-west—one of the lowest paid areas in England—against the backdrop of almost 1,000 nursing posts being lost in the south-west since this Government came to office.

It is barely credible that this Government should use the south-west as a laboratory in which to experiment with regional pay. It is a Liberal Democrat stronghold. The Liberal Democrat leader has said that regional pay will not happen, yet it is happening. It may call itself a coalition, but this is a Conservative Government in all but name, and with NHS regional pay they are treating south-west England in the same way that the last Tory Government treated Scotland with the poll tax. I know Members from the south-west see that, and I hope that they will vote with us to stop this gruesome experiment in its tracks.

Regional NHS pay is not being introduced only in the south-west, however. It is also being proposed by a series of trusts across the north-east, which is another region that cannot afford to let this Government pick its pocket. NHS trusts in Oxford, Birmingham, Cheshire and Manchester are also threatening to break away from the national pay agreements established under “Agenda for Change”.

This Government have lost financial control of the NHS, unless it is to cut it. They are now refusing even to try to control the demoralisation of NHS staff as their terms and conditions are denigrated. That is shameful. Why is this happening?

All roads lead back to the Government’s hated Health and Social Care Act 2012, with a £3 billion reorganisation at a time of an already unprecedented financial savings challenge. As trusts are plunged into financial turmoil, they are forced to look at opting out of national pay structures. And that is not all. The Treasury’s own figures show that real-terms NHS spending has been reduced under this Prime Minister year on year, as broken promise follows broken promise.

Regional pay in the NHS is opposed by the Royal College of Nursing, the Royal College of Midwives, NHS Employers, the British Medical Association and more. More importantly—[Interruption.] All Members would do well to listen to this point. Surveys show that 2 in 3 voters across the political spectrum believe that regional pay should be dropped: over 70% of Labour and Liberal Democrat voters and just over 50% of Conservative voters believe that.

That opposition is mirrored across this House. The Deputy Prime Minister claims to be against it—we will see—but Liberal Democrat MPs for Manchester, Withington, for Southport, for Torbay, for St Austell and Newquay, for St Ives and for North Cornwall are against it, and Conservative MPs for areas such as Torridge and West Devon, Hexham, and Brigg and Goole have also spoken out against these ruinous proposals. I commend the argument put forward by the hon. Member for Hexham (Guy Opperman). He has said:

“Our current pay system, which sets a base pay rate, already allows for adjustments in high cost areas like London”,

and

“I do not believe reducing public sector pay will help stimulate private economic growth.”

He added:

“I am very concerned that regional pay would lead to a reduction in the pay packets of some public sector workers in the North East.”

I share that view entirely, and the same can be said for communities across England.

Let none of us forget the disproportionate effects of regional pay on women, because this is also a gender issue. Not for the first time, working women around the country will be asking themselves just what this Prime Minister has against them. Do they all have to lend him a horse before he offers them some protection? Women make up 65% of the public sector work force and they account for more than 80% of NHS staff covered by “Agenda for Change”. Regional pay will hit women disproportionately. That is not right or fair. It is being done knowingly, and the Prime Minister will pay a heavy price if these proposals are not stopped.

We again find ourselves in the midst of a slow-moving disaster that the NHS can do without. We find ourselves having to deal with a Government who command no trust on the NHS, whether from the public or from health professionals. It is a disaster of the Government’s own making. As usual, the areas that can least afford to, and, most importantly, NHS patients, will end up paying the price for this ineptitude. The Secretary of State knows that regional pay will damage the NHS, he knows that the country is opposed to it, and he knows that he should intervene to stop it. A refusal to do so will demonstrate a failure to understand the values, principles and purpose of a truly national health service, and will illustrate his desire to undermine those very values. I commend the motion to the House.

Oral Answers to Questions

Sarah Newton Excerpts

Tuesday 17th July 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am sure that the hon. Gentleman is very familiar with the alcohol strategy and has read it in detail. It is one of the things that we need to do. Brief interventions, specialised treatment, the NHS alcohol check and, of course, changes to licensing will all make a difference. As I say, the alcohol strategy, a cross-Government document, is out. We will respond further in due course.

[Sarah Newton (Truro and Falmouth) (Con)]

Last week, the Royal Cornwall Hospitals NHS Trust cleared an important milestone towards becoming a foundation trust. An historical debt remains, largely as a result of punitive accounting measures under Gordon Brown. Will my right hon. Friend the Secretary of State do everything that he can to ensure that when the Royal Cornwall becomes a foundation trust, it is debt-free?

[Mr Speaker]

I think the hon. Lady was referring to the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown). For future reference, we do not refer to Members of the House by name.

Adult Social Care

Sarah Newton Excerpts

Monday 16th July 2012 Commons Chamber

[Liz Kendall]

I want to make a little more progress.

According to yesterday’s edition of The Sunday Telegraph, Andrew Dilnot has said that the delay has left older and disabled people in fear and misery. He expressed serious concern about the possibility that the Government will set the cap at a far higher level than that proposed by his commission—at £75,000 or even £100,000 rather than £35,000. He also said:

“if you go beyond £50,000 it is less effective in giving reassurance to the population and ceases to be a way of helping people with lower levels of assets.”

Instead of making real progress on funding reform, the Government trumpeted proposals for a national deferred payment scheme, providing loans to cover the costs of residential care.

[Sarah Newton (Truro and Falmouth) (Con)]

Does the hon. Lady recall what the Secretary of State actually said when he announced his proposals last week? He made it very plain that, if the hon. Lady’s party sat down seriously with Ministers and reached the consensus that the whole country is clearly crying out for, the necessary mechanisms could be introduced in the Bill and the funding could be found in the comprehensive spending review. We need less party politics and more consensual conversations.

[Liz Kendall]

It was Labour Members who proposed cross-party talks, and it was Government Members who decided unilaterally to publish the progress report on which we had been trying hard to agree. The hon. Lady accuses Opposition Members of not being serious about funding reform. We are, and I will set out what we would like to happen so that those talks can proceed.

The deferred payment schemes that were announced last week already exist in some parts of the country and are currently interest-free, but according to the Government’s plans interest will be charged, which will make loans more expensive than they are now. Many councils remain utterly unclear about how they will find the money to pay for those schemes. As the Local Government Association says,

“Councils are not banks and the implication of this level of debt in an already overstretched system needs urgent attention.”

The truth is that the Government have so far ducked the care challenge, and the reasons for that are clear. First, owing to their disastrous economic policy, they are now borrowing £150 billion more than they originally planned to borrow. The Treasury has pulled the plug, and has kicked long-term care funding into the long grass.

--- Later in debate ---

[Sarah Newton (Truro and Falmouth) (Con)]

I am delighted to follow the hon. Member for Scunthorpe (Nic Dakin), as I completely agree that this issue is about leadership. Some of my hon. Friends alluded to a better-tempered debate, such as the Back-Bench business debate, to which all parties made thoughtful contributions, based on a great deal of expertise from different walks of life—whether from people in the medical profession, those who had spent their life in social services or those who had a personal point of view from being a carer. We heard some heartfelt contributions in that debate, so I think we are united in the desire to do something about this issue.

What I have found deeply disappointing about today is the fact that this debate was called in the first place. There was significant and genuine desire by this coalition Government to solve once and for all this problem that everyone agrees needs to be solved. Everyone agrees that it needs cross-party support—for reasons that are obvious to anyone sitting in the Gallery or watching this evening’s debate and to all the various voluntary organisations that have been very substantially misquoted or very selectively quoted this evening. There is a unity of purpose, but it is not being served by the Opposition who are tabling Opposition day debates, falsely dividing the House.

If the Opposition were to put their efforts into working closely with the two parties that form this coalition to come to a sensible solution, I believe that measures would be in the White Paper, but we are still seeing sledging and negative comments from Opposition Front-Bench Members as we have seen all day. It is deeply disappointing that the Opposition are so thoroughly letting down the people whom they claim they represent. I do not believe it is too late, and I really urge them to get back to the table and to be more positive about the steps that the Government are taking—[Interruption.] Here we go again; I cannot even finish a sentence without Opposition Members chuntering.

The fact is that I worked very closely with a number of Opposition colleagues. Various Members have talked about the very good work we did in the inquiry led by the all-party group on local government that looked at this issue. There was an all-party agreed proposal that identified many measures—which the Government have picked up in the draft White Paper—that we can achieve together. The effort should be focused on what we agree on, so that we can offer the reassurance that is needed by the desperately worried people all around the country that have been quietly identified this evening. People are worried not only about the social care system now, but the social care system in the future. We should be reassuring these people and giving them hope that this House has the necessary combined will and determination. I do not think any of us want to face the electorate at the next general election saying that this problem has not been solved.

As to the timetable, yes, I would love to be able to stand here today and congratulate the Government on finding every penny to fund a long-term solution. If we can get the cross-party talks into gear in September, we should be able to put in place the mechanism that, as confirmed by the Secretary of State, could be built into a Bill and put before Parliament. When all parties have agreed on how this is to be funded—as many people have rightly said, it will cost billions of pounds every year and we are in a very difficult financial situation, so all parties must agree on how those billions can be found—there is every possibility that such a Bill will get through Parliament and, when next year’s comprehensive spending review is developed, the money will be found.

Yes, it is frustrating if we have to wait another year or 18 months. Before I entered the House, I spent the best part of my adult life working for Age Concern England and for the International Longevity Centre in the UK, coming up with solutions that previous Governments certainly kicked into the long grass, so this is our best hope in a generation.

[Heidi Alexander]

I respect the hon. Lady’s work on this issue, but does she recognise that there is almost universal agreement outside the House that the big disappointment is that there were no proposals last week on how, in the longer term, we provide the funds that we all want for care for the elderly and those with disabilities?

[Sarah Newton]

I accept that there is genuine disappointment, but people equally understand that all parties in the House must be committed on where the billions of pounds each year will come from, so that the proposals are sustainable for the long term, and so that people can save and invest without fear of the rug being pulled from beneath them.

The proposals are a sticking plaster—there is no doubt about that—but if only people could hear the facts, they would appreciate that more money is being put into the system while the problem is being resolved for the long term. It is not true that all councils are cutting back. Cornwall council has not cut its adult social care. It is working in extremely innovative ways with the NHS and the voluntary sector to ensure that services are improved. I do not accept the shroud waving from Opposition Members, who say that every part of the country is in crisis.

[Richard Graham (Gloucester) (Con)]

My hon. Friend has a high interest in, and knowledge of, these matters. Does she agree that counties such as hers and mine—Cornwall and Gloucestershire—that prioritise adult social services precisely because of their ageing populations, are helping to find a solution to the problem, which is so badly needed by constituents all round the country?

[Sarah Newton]

I agree. I encourage people to read the good report published today by the all-party parliamentary group on local government, because it contains good examples from all over the country of how proper integration of social services with housing and the NHS is beginning. There is every possibility, as a result of HealthWatch and the health and wellbeing boards, that such integration innovation will deliver the joined-up services for families and carers that will lead to an agenda focused on public health and the prevention of the problems that lead people into acute settings such as A and E and hospitals. People currently end up in such settings far more than they need to.

I am confident that, in a years’ time, hon. Members on both sides of the House will come here to share best practice from those parts of the country that grasp the opportunities of the Health and Social Care Act 2012 and make the most of the changes. We can then encourage other parts of the country that do not prioritise those matters to do the best they can for older people and carers in their societies. All hon. Members want them to have higher-quality and better care so that they can live in dignity for the rest of their lives.

--- Later in debate ---

[Dr Poulter]

My hon. Friend makes an important point. Social care and NHS care do not recognise county borders, which is why portability is so important. They certainly do not recognise the boundaries between England and Wales or between any other parts of the United Kingdom. We have devolved responsibility for the NHS, and the fact that there are different funding priorities in the different parts of the UK, with the Government in England supporting investment in the NHS and the Labour Administration in Wales cutting NHS spending, highlights the importance of my hon. Friend’s point. I am sure that the Minister will be able to reassure us that the coalition Government are taking steps to ensure that portability can take place across those borders wherever possible.

The White Paper also contains a commendable commitment to improving integrated care and ensuring that more joined-up working takes place between the NHS and social care.

[Sarah Newton]

Would my hon. Friend like to comment on some of the Opposition’s assertions that the efficiency savings from reductions in management levels in NHS are not being put back into front-line services to enable integration, and that they are somehow being siphoned off to the Treasury? I do not believe that—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I must ask the hon. Lady to turn round so that the microphone can pick up what she is saying. I know that she is finding that difficult, but she should be heard by everyone in the Chamber.

Care and Support

Sarah Newton Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

We have consulted not only the Local Government Association but my colleagues at the Department for Communities and Local Government, and I can assure the hon. Lady that that is indeed the case.

[Sarah Newton (Truro and Falmouth) (Con)]

There is much to be welcomed in today’s announcement. After so many years, people all over the country will be pleased that so much progress has been made, particularly for carers and in improving the quality of care and professional standing of paid-for carers. Will the Secretary of State confirm what I think I heard him say—that if the Opposition were to redouble their efforts and the whole country were to engage in the debate that today’s announcement will trigger, the mechanisms to solve the bigger problem of how the funding can be provided could be included in the forthcoming Bill within the next 12 months?

[Mr Lansley]

Yes, and I am grateful to my hon. Friend. I will not reiterate what I said in response to the Chair of the Health Committee, but I hope that as we make progress we will be able to see what legislative provisions are required and make them available at the earliest opportunity. She makes an important point, because we must not lose sight of the opportunity to improve quality. There are certain things that require resources, such as access to quality profiles of care providers so that people can make proper assessments of the quality of service that they will receive, increasingly using their personal budgets or direct payments. There is dramatic potential in that. Starting today, quality profiles of 12,000 care providers will be made available.

EU Working Time Directive (NHS)

Sarah Newton Excerpts

Thursday 26th April 2012 Westminster Hall

[Amber Rudd]

Anecdotal evidence is absolutely relevant. We get such evidence from talking in our hospitals to consultants, patients and surgeons. That is much more relevant sometimes than the box-ticking consequences from a more desk-driven survey.

Our 24-hour health service has had to make dramatic changes to how hospitals are staffed. The effects of the reduction in hours have been further compounded by the Jaeger and SiMAP rulings of the European Court of Justice, referred to by my hon. Friend the Member for Bristol North West. Those decree that all time spent in the workplace should be regarded as work, whether at rest or not, which is a dramatic change from previous arrangements. As a result, hospitals have had to scrap all on-call arrangements in favour of full shift rotas, which is creating a multitude of problems. Consultants at the Conquest hospital in Hastings told me that, in order to staff a full shift rota in one department, they now need eight people instead of the six they used to have on the old on-call system. Sometimes there is not even enough work. Indeed, the exposure of each doctor to training opportunities in the day is diluted, and the extra doctors are employed purely to service a working time-compliant rota.

The rota and the system are driving health arrangements, which is surely wrong. It is an inefficient and costly way to manage doctors, and it is damaging to the quality of their training. It is particularly harmful for district general hospitals such as my own, the Conquest, which find that they are no longer able to support certain specialties, such as the neurology department in my example, which has now largely moved to the nearby Eastbourne general hospital. Unfortunately, as we have heard from other Members, the same impact on certain specialties is being experienced in their district hospitals. The doctors at the Conquest do a fantastic job, and I am extremely grateful for the hard work and commitment that they put in; but, from my conversations with the consultants, I know that those doctors are being stretched too thin.

[Sarah Newton (Truro and Falmouth) (Con)]

I have the privilege of representing a constituency in which the Royal Cornwall Hospitals Trust has another of the district general hospitals described by my hon. Friend. Does she agree that in remote rural areas with sparse populations, the impact on patient care of having to travel many miles to access specialist care will have a detrimental effect on treatment?

[Amber Rudd]

I wholly agree with my hon. Friend, who makes an important point about that particular problem for rural hospitals.

The shift system means that, instead of continuity of care, patients see—as we heard earlier, and I shall repeat the unpleasant phrase—a conveyor belt of doctors. Doctors do not get what they want either, which is to see patients through to treatment. Each time one shift ends and another begins, we have the handover process. As a consultant surgeon from the Conquest hospital said to me, someone unfortunate enough to be admitted to hospital at 7 pm on a Sunday evening would see four different sets of surgeons in just 24 hours. I know that there have always been handovers, but there are now more than ever, and each handover creates a risk of vital information being missed. We heard earlier about Chinese whispers, when expertise and important details may be lost. What is more, doctors are now under time pressure to clock off, so the chances of further mistakes are increased.

The Health and Social Care Act 2012 rightly puts doctors at the heart of the NHS, because they are best placed to manage the service and to deliver better results for patients. It is the doctors who are calling out for regulation to be relaxed, and it is essential that we listen to their cries for help. I am calling for a compromise and some flexibility that allows individual doctors and departments to make sensible decisions. Surgeons are asking for a maximum of 65 hours a week, including time spent on call, and that seems sensible.

We also need flexibility in how on-call time and compensatory rest for trainees are calculated. If a trainee wants to stay after their shift to watch an operation, to learn, and to benefit their training, they should be able to do so. We all want tomorrow’s doctors to be as good and as experienced as today’s doctors, so we must allow them to be the doctors that we expect them to be. We trust doctors with our lives, so we should trust them when they tell us they need more time to train.

Adult Social Care

Sarah Newton Excerpts

Thursday 8th March 2012 Commons Chamber

[Sarah Newton (Truro and Falmouth) (Con)]

I beg to move,

That this House believes there is an urgent need to reform the current system of providing and paying for the care of adults in England and Wales; recognises that social care, unlike the NHS, has never been free at the point of need irrespective of income; notes the central role of informal carers in the provision of care; welcomes the Coalition Agreement pledge of reform and legislation; further welcomes the plans for better integration between adult social care services and the NHS; welcomes the extension of personal budgets; urges the Government to ensure that fairness is central to reform, including access to advice, advocacy, assessment of need, care services as well as funding options; recognises the need to break down the barriers to portability; and further urges the Government to publish its White Paper as soon as possible, and to bring forward legislation.

I am pleased that both the care Minister, the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the shadow Health Secretary will be joining us today, and that they have entered into talks to agree a way forward on the reform of our social care system. It is vital that today we show our Front-Bench teams just how much support there is in all parts of this House for their important work. Both teams need to know how important this Parliament feels it is to continue and conclude the talks, so that a White Paper and Bill can be produced as soon as possible.

Today’s debate should also be about our vision: our vision to enable adults living with disability or a chronic illness, or those people who are frail in their later life, to have the support they need to live as full a life in their community as possible. That is something that concerns us all, as it strikes at the heart of the values of our society. There are Members here today who have a lifetime of experience, inside and outside Parliament, tackling the issues we will be discussing today, so I will keep my remarks short to allow their valuable contributions to be made.

Central to this debate is the person who needs care and the people around them supporting them, principally their family members, close friends and neighbours, and the wider community. Of course, care provided by nurses, care workers and other professionals is vital, too. In the few minutes available, I shall focus on the care of the elderly, as colleagues with greater knowledge than I will talk about the care of younger adults, those with chronic illnesses and those living with disabilities. Too often in debates about social care we delve straight into the design details of the services provided by local and national Government. Often, such services were designed many years ago, in response to a very different society, when people died of illnesses and conditions that are now lived with; a society where people lived shorter lives. One of the greatest achievements of the 20th century was a significant increase in life expectancy and the challenge of the 21st century is to respond and to redesign care and support services so that they are fit for this century and the next. That is important not only for the people who need them now but for the young people who have already been born who will make it into the 22nd century.

Let us be honest: if we were designing services to support families who care for their elderly and disabled family members, would we have designed the system we have today? Despite the undoubted good intentions of previous Parliaments, our system has developed in fits and starts since the 1920s. It is disjointed and does not deliver joined-up help for the cared for or for carers and it can be utterly frustrating for care and health professionals.

It has been estimated that a total of £145 billion a year of public money is spent on the elderly in social care, NHS and welfare payments. That is £3,000 for every man, woman and child in this country. It does not appear to me that elderly people and their carers are receiving the quality of services and care that such a sum could provide if it were spent differently and more efficiently.

[Harriett Baldwin (West Worcestershire) (Con)]

Is my hon. Friend going to make the point that this problem will keep on increasing? We are all living longer and one in three girls born today can expect to live to the age of 100.

[Sarah Newton]

Yes. As I mentioned, it is a great achievement that people are living longer, but that will obviously present huge challenges in adapting our society as people live for so much longer.

Unfortunately, growing old or living with an illness or disability is frightening to too many in our country today—frightening both to the people involved and to their loved ones who support them. There is fear about physical and mental frailty, about the quality of care they will receive from the NHS and social services and about whether they will have to pay and how they will afford to do so. We need to alleviate as much of that fear as possible by creating services and a way of paying for them that are fair and easily understood by people of all ages, that deliver high-quality care and support to carers and in which those who are employed feel respected and appreciated.

To achieve that aim requires a vision and a plan that everyone understands. That plan should be fair and should offer a route from where we are today to where we want to be. It will then require all political parties, over a period of time, to implement it. That will deliver the lasting, consistent and sustainable reform that despite many good intentions has eluded all Governments for many years.

I believe that the Government have recognised the challenge and taken a number of steps forward. There is a pledge in the coalition agreement to reform care services and funding and, following the excellent work of the Law Commission and the commission led by Andrew Dilnot, we have been promised a White Paper this spring and a Bill soon after. That process will very much depend on the determination of the Opposition to work constructively with the Government.

The Government have also ensured that while a longer- term solution is found to the current funding issues more money is being given to councils, and they have committed £2 billion. The Health and Social Care Bill will enable the integration of social and health care and, through the health and wellbeing boards, local commissioning of new care pathways will be made possible. I have seen some highly effective piloting work in Cornwall through the “Changing Lives” approach to joined-up services, which is based around the person and their carers.

The Government have launched a carers strategy and a dementia strategy with funding attached, but it is very frustrating that the money provided for those services is not always finding its way to the people who need it most. I am a passionate supporter of localism and returning power from Westminster to people and their communities. I believe that services for people in Cornwall should be designed and delivered in Cornwall, but we must recognise that this is a revolution. Although some professionals in the NHS and councils are relishing the new opportunities, some are not, as many of them have served in these important public services for years and are used to the command and control management of the past. It is difficult for some people to change and these are big cultural changes.

At a time when large-scale efficiency savings are needed in the services that support older people, reform is more important than ever. The nurses, social workers and carers I know are all motivated to deliver a high-quality service but I think Ministers will need to give clear direction about the commissioning of new pathways—new pathways that explicitly deliver integrated and joined-up care and new pathways developed on the evidence from the innovative work being provided not only by doctors, nurses and social workers but in partnership with other organisations such as Age UK, Macmillan and a host of other not-for-profit organisations. Within the new framework of outcomes, new outcomes should enable better integration.

Those new outcomes and pathways will need funding. We know that for every £1 spent on social care, £2.65 is saved from the NHS budget, so not addressing the inefficient split of funding between the NHS and social care will mean that we continue to waste more and more money.

[Mary Macleod (Brentford and Isleworth) (Con)]

On funding, does my hon. Friend agree that we should look at having more respite care for carers, especially elderly carers, some of whom do a 24/7 job and need extra support?

[Sarah Newton]

My hon. Friend makes a very good point, which has been addressed in the carers strategy.

Each year we should aim to use more NHS money on social care, and more money from the NHS budget could be given to councils for the integration of services led by health and wellbeing boards. Eventually, I would like to see the pooling of budgets. Social care has never been free at the point of need, and we know that the NHS will always be free at the point of need irrespective of anybody’s ability to pay. That is enshrined in the Health and Social Care Bill. Despite that, however, most people do not think they will have to pay for care and it can come as a dreadful shock, especially to the one in 10 people aged over 65 who end up paying more than £100,000 for care. Dilnot came up with a framework of shared and capped costs for individuals needing social care—shared costs between the individual and the state. I am sure that framework is receiving a great deal of attention from the Front-Bench teams, but I expect that however well the cross-party talks are going, it will take several years to introduce such a system if agreement can be reached. In the mean time, there is an urgent need to design a fairer system based on shared responsibility to pay.

There are uncontroversial steps that would not require substantial new resources and that could be taken now as part of a longer term plan. The legal framework and assessment processes that are used to decide who is entitled to what help could be sorted. We also need to fix the means test that we use to decide what we expect people to pay. That would help families to understand what help will be available and who needs to pay for what. Families would then be able to plan accordingly. The Government could ensure that people had access to independent advice on the best way of planning and paying for care and they could bring in a universal deferred payment scheme that would tackle the issue that so many people dread—selling their home to pay for residential care during their lifetime.

[Margot James (Stourbridge) (Con)]

I congratulate my hon. Friend on securing this debate and on all the work she does on this issue. Under the present system, people do have to sell their homes sometimes; does she agree that in such cases it would be far better if some of the accommodation were available to purchase on a leasehold basis so that the individual would still have an asset to pass on?

[Sarah Newton]

That is an extremely interesting idea, and I would expect no less from someone with such knowledge in this area. I am sure the Minister will want to take that point on board.

Going back to means-testing, we really need to face up to one of the biggest problems facing families—the meanest of means tests in this country: the test for residential care. Making the simple change of raising the upper threshold of the means test to £100,000 would benefit those on modest incomes who are heavily penalised under the current system. It would enable families who have worked hard all their lives and accumulated relatively modest assets—often the first generation of their family to do so—to have something to pass on to their children and grandchildren. It is an understandable and human desire to want to help the next generation. That change would cost £100 million. In this economic climate, such a figure might be too much all at once, but a staged increase in the upper limit would be a step in the right direction.

We are taking this approach to delivering the excellent policy of increasing the personal allowance for taxpayers to £10,000. Apart from spending NHS money more efficiently, there are other sound economic reasons for redirecting public money into social care. While the vast majority of care is given freely, more than 1.5 million people are employed in providing care. We need to recognise better the valuable and challenging work they do. I know that the Minister is doing good work on training and quality standards. Many care workers are paid low wages, so investment in this sector would have the direct impact of putting more money into the pockets of some of the poorest paid workers.

We also need to enable more working age informal carers to combine their caring responsibilities with paid employment. This is even more important as the pension age rises. Much emphasis is put on enabling working age parents to care for their children and remain in paid employment—with flexible working, help with child care costs and financial support through the tax system. We need to put as much emphasis on enabling working age people with other caring responsibilities to remain in employment. Otherwise, we are going to have ever-increasing out-of-work benefit costs to pay.

While I do believe that the Government are starting to develop the processes that could deliver better and fairer access to services and higher quality care, bolder and more determined action is needed to enable more rapid change. I hope that the Minister and the shadow Secretary of State for Health will listen carefully today and bring back to Parliament a shared vision and a clear plan on how together we as a country and as a society are going to create a good place for us all to grow old in.

--- Later in debate ---

[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.

[Sarah Newton]

I hesitate to intervene because it is important that the many Back Benchers who are here today are able to share their views. However, although none of us could support the appalling situation that the right hon. Gentleman described, he will be aware that the commissioner—the local authority—has a responsibility for the quality of the service. If he is concerned about it—I would be absolutely furious if I were the local Member of Parliament—he can take it up with the council so that the contract can be cancelled, and ultimately refer it to the Care Quality Commission.

--- Later in debate ---

[Sarah Newton]

This has been an excellent debate in the breadth and depth of its contributions. We have seen the experience, passion and commitment of Members from all parts of the House.

In particular, I thank the hon. Member for Worsley and Eccles South (Barbara Keeley), with whom I work in the all-party parliamentary group on social care. The contributions have been wide-ranging. We have heard from my hon. Friend the Member for South Derbyshire (Heather Wheeler), the hon. Member for Blaenau Gwent (Nick Smith), my hon. Friend the Member for Kingswood (Chris Skidmore), the hon. Member for Mansfield (Sir Alan Meale), my hon. Friends the Members for Southport (John Pugh) and for Banbury (Tony Baldry), the hon. Member for Luton North (Kelvin Hopkins), my hon. Friends the Members for Congleton (Fiona Bruce), for South Thanet (Laura Sandys), for South Northamptonshire (Andrea Leadsom) and for Totnes (Dr Wollaston), and our famous rear gunners, my hon. Friends the Members for Hexham (Guy Opperman) and for South Swindon (Mr Buckland).

There can be no doubt from this debate about the cross-party support for delivering a re-engineered care system for the people who need care and for our vital carers. The system needs to be shaped around the person who needs care and their carers. I wish the Government and Opposition teams good fortune in their vital work to negotiate a new system for providing and funding care, so that we can all be proud to have created a society that we all want to grow old in.

Question put and agreed to.

Resolved,

That this House believes there is an urgent need to reform the current system of providing and paying for the care of adults in England and Wales; recognises that social care, unlike the NHS, has never been free at the point of need irrespective of income; notes the central role of informal carers in the provision of care; welcomes the Coalition Agreement pledge of reform and legislation; further welcomes the plans for better integration between adult social care services and the NHS; welcomes the extension of personal budgets; urges the Government to ensure that fairness is central to reform, including access to advice, advocacy, assessment of need, care services as well as funding options; recognises the need to break down the barriers to portability; and further urges the Government to publish its White Paper as soon as possible, and to bring forward legislation.

NHS (Private Sector)

Sarah Newton Excerpts

Monday 16th January 2012 Commons Chamber

[Mr Lansley]

No.

Individual staff in the NHS have a duty not to allow their private activity to be to the detriment of their NHS activity. Foundation trusts will have an obligation to be transparent in accounting for the two sources of income, and they will have an obligation to report at their general meeting how they have used their private income to benefit their NHS patients.

I am afraid that what the right hon. Member for Leigh says is a tissue of nonsense. The 49% amendment was introduced only to make it abundantly clear that if the principal purpose of a foundation trust is the provision of NHS services, by extension that would not be consistent with the balance of its activity being private rather than NHS activity—hence 49%. There is no specific intention that NHS foundation trusts should increase their private income to any specific degree.

[Sarah Newton (Truro and Falmouth) (Con)]

Is it not true that the cap is “up to” 49%? Does my right hon. Friend agree that the best decisions are made not at the Dispatch Box by plucking numbers out of the air, but by patients, clinicians and hospital trusts?

[Mr Lansley]

My hon. Friend is absolutely right. The Labour party appears to be going backwards. Its 2010 manifesto said:

“We will support an active role for the independent sector working alongside the NHS in the provision of care”,

but tonight’s motion says that Labour has abandoned that policy. I quoted earlier the Labour party’s commitment to giving patients the choice of the best available provider. Its policy tonight is to abandon patients, including the 81% who told a survey that they want to exercise choice. Labour’s manifesto said it would give foundation trusts freedom to expand and increase their private services. It has now abandoned that policy.

Why does Labour do that? Why did it abandon those policies? Perhaps it is because the Labour party is a wholly owned subsidiary of the trade unions. Labour is interested not in patients or the NHS, but in the trade unions, because its policy is all about the protection of trade union interests—vested interests. The guarding of the vested interests is the remaining activity of the Labour party, but it will diminish over time.

Let me tell the shadow Health Secretary very simply what we are setting out to do. Under this Government, the power to choose will increasingly lie in the hands of patients, doctors and nurses, and incentives will encourage all providers to integrate their care and improve the quality of their care. The result is not a fragmentation of the NHS or inequalities, but better, higher-quality care, and integrated NHS care that offers everyone the very best care available. We will use choice—patients’, doctors’ and nurses’ interests in delivering that choice—and the best quality provision to deliver better outcomes for patients. That is why I urge the House to reject the Opposition motion.

Oral Answers to Questions

Sarah Newton Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Burns]

I am grateful to my hon. Friend for his question, although I will disappoint him by saying that I will not be led from my chosen path and start to voice an opinion. I will say, as I did say during the earlier debate that he attended, that of course it is not set in stone that there will be only four options chosen, as and when—the number could be more. That is dependent on the consultations and the decision of the JCPCT, but he will appreciate that I cannot seek to influence those decisions.

[Sarah Newton (Truro and Falmouth) (Con)]

4. What steps he is taking to reduce the burden of debt for NHS hospitals.

[The Secretary of State for Health (Mr Andrew Lansley)]

Although the overall financial position remains healthy, we will continue to focus on the small number of organisations in the NHS that are struggling to manage their finances. We are working to help all NHS trusts to be sustainable providers of high-quality health care and move forward to foundation trust status. That will include, where appropriate, agreeing solutions to resolve the regrettable legacy of debt from the previous Government.

[Sarah Newton]

Despite the fact that the staff of the Royal Cornwall Hospitals NHS Trust have made big strides forward in improving patient care while delivering efficiency savings, the trust is saddled with historic debt, largely as a result of Labour accountancy measures. Does my right hon. Friend agree that that is grossly unfair and will he meet me to find ways of writing off the remaining Labour debt so that my constituents can stop worrying about the future of the only acute hospital in Cornwall?

[Mr Lansley]

I am grateful to my hon. Friend and completely concur. I have had the privilege of visiting Treliske hospital and seeing the good work that is being done there. In the course of the last financial year, the trust returned a surplus and it is projecting a surplus this year. As she knows, it has a legacy of debt that is being financed by a working capital loan. As with other NHS trusts, we are looking to ensure that through the process of becoming a foundation trust it will move from having legacy debts from the previous Government’s regime to being financially sustainable year-on-year while meeting the viability and balance sheet criteria for foundation trust status.

Social Care Funding

Sarah Newton Excerpts

Thursday 10th November 2011 Westminster Hall

[Sarah Newton (Truro and Falmouth) (Con)]

It is a pleasure to speak under your chairmanship, Mr Robertson, as it will be to speak under Mr Bone’s chairmanship later. I thank hon. Members for coming along to the debate. Given the importance of the debate in the main Chamber on armed forces personnel, the level of support in this Chamber shows how important this topic is to our constituents and to people throughout the country.

The question of who pays for care has vexed politicians for decades. There has been no shortage of good ideas, based on evidence garnered from the many Government reviews and commissions over the years, but there has been a failure in political will, resulting in only limited action being taken. However, demographic change and its impact is now an issue moving rapidly up the political agenda. All parties have signalled a desire for a long-term, all-party solution to the care crisis. It is clear that now is the time for us to take action.

During the debates on the Health and Social Care Bill, there was little dissent from the view that the integration of health and social care is a good thing. In the Budget debate, there was no opposition to NHS money being given to councils to integrate services. The Care and Support Alliance, made up of more than 52 major organisations representing older and disabled people, those with long-term conditions and their families, has come together to support reform. Polling evidence from ICM last year showed that 62% of the public saw care reform as one of the most important issues for the Government to focus on, and more than 50% of people felt that political parties were not doing enough to work together to improve care for older people. There is therefore a clear mandate from the people whom we represent to work together to find solutions to the problems.

The coalition Government clearly understand, and are committed to reform. They set up the Commission on Funding of Care and Support under the leadership of Andrew Dilnot, who was supported by Lord Norman Warner and Dame Jo Williams. Their report, published in May, described the care funding system in England as “not fit for purpose” and needing “urgent and lasting reform”. From our constituency work, we all know that there is great uncertainty and that people are worried about the future, but most people are realistic. Just as they know that they should save for their old age, they know that they will need to make contributions to the cost of their care in later life. They crave a clear path, set out by the Government, that shows them how the costs will be fairly borne—how they will be divided fairly between themselves and the state. Above all, people want to be relieved of the fear and worry about the availability and quality of care as well as how they will pay for it should they need it.

[Penny Mordaunt (Portsmouth North) (Con)]

I congratulate my hon. Friend on securing the debate. Does she think that our constituents are also ambitious about what they want care in the future to look like, and that the challenge for the Government is not just about finding ways to fund what currently goes on, but about considering how we meet the massive unmet need in dementia care, for example? I am thinking of bathing facilities and all the other things that we want our constituents to have but that too many of them do not have access to at all.

[Sarah Newton]

My hon. Friend makes an excellent point about the fact that there is inconsistency across the country in the quality and type of care available. The best care, which some people experience, should be available for everyone. We all want that for our constituents. As people in their 50s grow older, they will have far greater demands, which will be different from those of the generation now in their 90s or over 100. They will be looking to technology and innovation to come up with a range of services that will support them in leading life to the full, and in living healthily and productively as part of society, for as long as possible, so I agree with my hon. Friend’s point.

We know from our debate in this Chamber last week on the quality of care that elderly people experience in some parts of the NHS and from other care providers that the vast majority of people of all ages want elderly people and people with disabilities to be shown far greater kindness and respect. The commission says that the main failings of the current system are that it is confusing, is perceived to be unfair and is unsustainable.

[Glyn Davies (Montgomeryshire) (Con)]

I thank my hon. Friend for allowing me to intervene, particularly as I have indicated that, unfortunately, I cannot stay for the whole debate, which I had wanted to do. I hope that we can emphasise the point that as people are living much longer, it is an exponential curve. The incidence of dementia and Parkinson’s disease means that the need is far greater than a simple look at the graph would suggest. The cost is going to just take off. We need a Government policy that deals with that and recognises the huge changes that we will face.

[Sarah Newton]

My hon. Friend makes a very good point, reminding us that people are living much longer, because the causes of mortality that prevented people from living so long in the past—especially cardiovascular disease and some cancers—are now more survivable, so people suffer from other conditions, which are sometimes far more complex to live with and to treat, especially diseases such as dementia and Parkinson’s. The fact that people are living well into their 80s and 90s and beyond 100 presents new challenges for the NHS and a range of other services—indeed, for society as a whole—so my hon. Friend makes a very good point.

The commission goes on to say that most people are unable to plan ahead to meet their future care costs. Assessment processes are unclear. Eligibility varies according to where people live, and there is no portability if people move between local authorities. The provision of information and advice is poor, and services often fail to join up. All of that means that people and their families often do not have a good experience.

[Neil Carmichael (Stroud) (Con)]

My hon. Friend is absolutely right in what she has said. One of the key tools is integrating the NHS with social care, so that we can have a much more seamless approach to caring for people, and they understand where they can go for support. I am talking about breaking down the unnatural barriers between local areas, as well as about the funding that is necessary and a more transparent understanding.

[Sarah Newton]

I am sure that that is right. It is certainly a point that the Dilnot commission and people who have responded to it have made. They are very supportive of the Government’s plans to integrate social care with the health service.

It is a major worry for most families that they cannot protect themselves against the very high costs of care. As my hon. Friend the Member for Montgomeryshire (Glyn Davies) pointed out, looking after people with dementia can involve very considerable costs. However, the availability and choice of financial products to support people in meeting care costs is limited.

[Fiona Bruce (Congleton) (Con)]

Does my hon. Friend agree that one of the highest priorities for the allocation of funds should be to support those families who care for elderly relatives at home? They often make great sacrifices and incur great costs. We must ensure that we give them the recognition and appreciation that they deserve, and one way in which we can tangibly do that is by ensuring that they have clear access to support from funds. Often, a very small amount of funding can make a big difference to those families and can ensure that they are able to continue caring for their relatives in their own homes for much longer. Should we not be treating that as a priority?

[John Robertson (in the Chair)]

Order. That was a very long intervention.

[Sarah Newton]

My hon. Friend the Member for Congleton (Fiona Bruce) makes her point very passionately, as she always does, in standing up for the family. Of course, it is the family who take full responsibility in most cases for the care of elderly people, but we must remember that the funding of adult social care is also available for adults living with disabilities. Families are the foundation of all care at the moment. I am sure that, with the Government’s support, they will continue to be the core building block of the care system. She is quite right to raise that issue so that we can all show appreciation for the huge army of people who are quietly getting along each day to provide invaluable support to their loved ones.

The commission made a series of key recommendations. I cannot do justice to the report in the time that I have available, but to help our debate, I will summarise them briefly. The major one is to cap the lifetime contribution that an individual needs to make to adult social care costs to £35,000. Not everyone will be able to afford to make a personal contribution, so the commission recommended that means-tested support should continue and that the asset threshold for those in residential care, beyond which no means-tested help is given, should increase from £23,250, as it is today, to £100,000. Those who enter adulthood with a care and support need should immediately be eligible for free state support.

The commission also recommended reconsideration of the existing benefits that support the elderly. People should contribute to their living costs, which the commission estimated as between £7,000 and £10,000 a year. It recommended that the Government should urgently develop a more objective eligibility and assessment framework and that they should encourage people to plan ahead for later life with an awareness campaign, and develop a major new information and advice strategy to help people when the need for care arises. Carers should be supported by improved assessments, which should take place alongside the assessment of the person being cared for. Finally, the Government should review the scope for improving the integration of adult social care and other services, such as NHS services and housing, to deliver better outcomes for individuals and better value for the taxpayer.

The commission’s report was met by a broad coalition of support from a wide range of stakeholders and was warmly welcomed by all political parties. That contrasts with the acrimonious debates on the issue during the general election campaign. Since the report’s publication, the Department of Health has committed to consult on the recommendations and to consider other important recommendations proposed by the Law Commission.

The Government have recognised that they must take urgent action to address the current funding issues. While real spending on the NHS has risen by £25 billion since 2004, spending on social care for older people and adults with disabilities has simply not kept pace. Figures from the Department show that over the past four years, demand has outstripped expenditure by 9%. Since the coalition came to power, it has clearly understood that that balance in expenditure is wrong. Money for the NHS has been redirected to councils so that they can spend more money to support families, elderly people and adults living with disabilities to live independent lives. Additional money has been allocated for a range of support to enable people to remain safely in their own home and for adaptations that prevent accidents and illnesses that lead to people having to spend time in hospitals.

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate the hon. Lady on securing the debate. She is talking about the additional resources that have been given to councils from the NHS budget. Will she reflect on the scale of cuts that local authorities are dealing with when setting their overall budgets? Does she feel compelled to comment on the claim that that is giving with one hand and taking away with the other?

[Sarah Newton]

The hon. Lady makes a fair point. We all understand that local authorities have had to make some major decisions about the allocation of resources and their priorities in serving their communities. I am proud of my council in Cornwall, which did not cut one penny from adult social care funding last year. In fact, this year, that funding could increase by £3 million or £4 million, although the council has not yet finalised its budget. It is very disappointing that some councils—although not all—have not used the money for such important purposes. It is estimated that approximately 7% has been cut from adult social care budgets across the country.

We have begun to see the effects of the withdrawal of the key services that the money should be funding, and which have been designated to prevent health problems among older people. The withdrawal is contributing to a far greater pressure on hospital beds. Delays in the discharge of people from hospitals are significantly higher than they were in the same months last year. Over 75% of delayed transfers for acute care are for people aged 75 and over. Research by Age UK and WRVS will be published in the next month or so, and it will provide evidence of the impact of councils not using the additional funds that they have been given by the Department effectively and of the additional pressures that that has put on hospitals and families.

[Penny Mordaunt]

Does my hon. Friend agree that whatever the size of a council’s budget, we need to ensure that it makes best use of the money? Some poor commissioning practices have gone on, discriminating against independent providers such as the Alzheimer’s Society and Age UK, which not only do a better job at a lower cost, but can rely on enormous amounts of volunteer and carer support and a whole raft of other stuff. We must ensure that there is a level playing field for those people.

[Sarah Newton]

I agree. My hon. Friend makes that important point extremely well. Local authorities and the NHS have had a silo mentality on commissioning. Undoubtedly, funds that could have driven up the quality and choice of care to support people have been wasted. I hope that the reforms that the Government are setting in train will overcome those issues. When the health and well-being boards come into play, if they link up properly all the providers in a community and set the agenda for commissioning services to improve health outcomes, they could have a powerful impact and achieve some of the things that my hon. Friend has highlighted.

In this debate, when we are talking about the budgets of the NHS and of local authorities, we must never forget that it is families who care for their grown-up children with disabilities or for elderly family members. Informal carers provide more support than any Government could ever afford to pay for. The most recent research from the charity, Carers UK, estimates that there are more than 6 million carers in the UK. The care and support that they provide to help people remain safely in their own home are valued at a staggering £119 billion per year, which is far more than the annual cost of all aspects of the NHS. Support to carers must be central to the future provision of services. It is informal carers, families and, in the majority of cases, women who worry most about cuts to services that enable them to help and care for their elderly and young family members.

Who pays for care is just one of the questions that the Government’s reforms of social care must address. There are issues of quality and regulation of services, training and pay for those working in this sector, as well as choice. The Government’s reforms need to look at finding solutions that work for different generations. Young people who will be saving for their old age and auto-enrolled into pension schemes could be incentivised to make an additional contribution each month to an insurance policy that will pay for their care later in life should they need it. The package of reforms developed by the commission has been welcomed by the financial services industry, which sees opportunities to develop new products to enable people to pay for their contributions towards the costs of their care.

The Dilnot commission’s package of reforms to support families in their caring responsibilities will require an extra £1.7 billion a year—a figure that will rise with an ageing population. Whether or not the commission’s reforms are implemented in part or in entirety, it is clear that more money needs to be found for social care and NHS integration. While I do not underestimate—I am sure none of my colleagues in the Chamber do—how difficult it will be to find that sum during this Parliament, constructive ideas have been given to the Treasury on how that spending commitment could be achieved without increasing taxation or borrowing more money. Consideration should also be given to removing the upper age limit on national insurance contributions, which could raise £3 billion a year, and to further reform to pension tax relief for higher-rate taxpayers.

[Fiona Bruce]

Should consideration not be given to reviewing the planning regulations when families seek to build extensions to their homes? There are far too few multi-generational homes in this country, yet there are some pedantic planning regulations to which local authorities strictly adhere without recognising the wider value to the community that such extensions can bring.

[Sarah Newton]

That is a good point and it should definitely be considered by those responsible for reforming planning policies.

We all have an important role to play in building momentum for change, contributing constructive proposals and trying to build consensus for vital change. I hope that this debate provides the Minister with a welcome opportunity to hear the concerns and constructive ideas of hon. Members from all parts of the House as he develops his White Paper.

I was particularly pleased when the Backbench Business Committee allotted me this date for my debate. It is the eve of Armistice day, when we remember all those who have served their country and made the ultimate sacrifice. As there are so few survivors remaining from the first world war, our thoughts and prayers naturally turn to those who are serving in conflicts around the world, particularly in Afghanistan. Many of us will also be thinking of the survivors of the second world war. There are some 11.7 million people living in England today who survived the second world war, and they make up 22.5% of the population. We owe a great debt to that generation for our freedom and for the way of life that we enjoy today. Rationing ended in the 1950s, so that generation really understands what an age of austerity means. For those of us who were born after the war, it is our turn to show not only our respect for them but that we have not forgotten their sacrifice. We must take care of them as they grow older.

Over the 50 years in which we have enjoyed peace in most of Europe and a growth in prosperity, we have singularly failed to make preparations for the care of that generation. The welfare state was a great post-war legacy. However, there are gaps in funding in the main provisions—the NHS and pensions—as increases in life expectancy have been consistently underestimated. It is essential that we make lasting reforms to the welfare state so that it can deliver on the promise made to the generation that created it.

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[Sarah Newton]

My hon. Friend has been incredibly generous in giving way, and I am grateful to him. He is making an important point and I would like to underline it. As we have heard, the scale of the challenge facing the Government is so immense that we need short, medium and long-term solutions. At present, the Government face the challenges of deficit reduction and of other huge reforms taking place in our country, but it would be welcome if they set out in the White Paper a direction of travel and suggested proposals that could be achieved in the short term and that addressed some of the issues while not seeking to solve the whole problem all at the same time. We would take a paced, building-block-type approach.

[Tony Baldry]

I agree entirely with my hon. Friend, but I think that we have all slightly lost track of the number of Green Papers, discussion documents and other things that we have had in relation to social care. What will be really important next spring is that we get a White Paper that has a summary that everyone can understand and that makes it very clear what will be the basic system for funding residential social care for the future. I think that that would be greeted in the House by a quick rendering of the “Hallelujah Chorus”.

Following my hon. Friend’s point, if the White Paper can set out the direction of travel for the rest, that would be good news. What we have seen all too often in the past is a discussion paper that concludes that the issue is so huge and so difficult that we have almost lost the will to live. Spring 2012 has to produce a White Paper with a clear commitment to the funding of long-term residential care, and then direction of travel for the rest is important.

Finally, I agree with the need to enhance the status of care workers. In my experience, the model adopted by many residential care homes has often been to recruit people from the Philippines or eastern Europe. The deal was that they came over, got trained, were often paid the minimum wage and, having been trained, worked in the national health service. Because the Government, perfectly understandably and quite rightly, are capping immigration from outside the European Union, it is no longer possible for nursing homes and residential care homes to recruit from the Philippines or outside the European Union, so we have to enhance the status of care workers, both in the NHS and in residential care homes.

On my patch, I have suggested to the chief executive of the Oxford University Hospitals NHS Trust—I am glad that he has responded positively—and others that we should consider setting up in Oxfordshire one of the new Government’s work academies, specifically for care workers. We need to ensure that far more people see care and working in the care sector as a valued profession that makes a real contribution to society. It needs a career path, with a national vocational qualification, training and proper involvement from further education colleges. The issue is of as much interest to the national health service as it is to residential care homes, because if those care homes have sufficient care workers it will be easier for discharges into them to take place. Moreover, we often need to ensure that the NHS has sufficiently well-motivated and well-qualified nursing care assistants. I hope that we will begin to see centres of excellence around the country that will train people as care workers, to ensure that we do not find ourselves in difficulties because nursing homes and residential care homes have to close because they cannot recruit qualified staff.

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[Heidi Alexander (Lewisham East) (Lab)]

I wanted to speak in this debate because I have had two specific personal experiences in the past couple of years that have led me to think that finding a way to fund elderly care in this country is probably one of the biggest challenges that we face. I wish to take a few minutes of Members’ time to share those experiences, which I hope will underline to the Minister the urgency with which the Government need to act.

Before I became a Member of Parliament, I was a councillor in the London borough of Lewisham and can honestly say that the worst meeting I ever had to attend was when the council was reviewing the eligibility criteria for adult social care. At the time, we were looking at whether we could sub-divide the category of “substantial care needs”, which are really serious needs for which people need help. It is about basic human dignity, so it was a difficult thing to consult on at the time. Hundreds of people attended the council meeting and I remember being almost moved to tears by some of the testimony that people gave about the support that they received. I am pleased that, that year, my local authority of Lewisham chose not to do away with funding substantial care needs. It still funds such needs, although in the current economic and financial climate, Lewisham has had to increase considerably the charges for care packages.

I realised at that time that adult social care in this country is woefully underfunded. It constitutes such a large proportion of local authority budgets that, in the present climate of huge cuts to local councils, they are faced with very difficult decisions about how they can fund care provision, while setting a balanced budget elsewhere. I am concerned, as I said in my intervention, that the so-called extra money being diverted from NHS budgets into adult social care is not really extra money at all. When the large cuts to the budgets of local authorities are taken into account, that money is merely being used to prop up what was already being done. For example, from my local authority experience, I know that out of a £270,000 million revenue budget, Lewisham council spends approximately £100 million every year on adult social care. If it has to find £80 million worth of cuts in the next three years, it has to take some very difficult decisions about how to make all that work.

My experience in Lewisham also told me that in this country we do not fund the sort of preventative care that is necessary to avoid having higher care needs later on in life. I urge the Government to consider how we can provide more preventative support, so that we do not have huge outlays further down the line. As people get older, their care needs become a lot more complex. If we can intervene earlier and provide the right sort of support, perhaps we will not have such high expenditure further down the line.

I said that I had two personal experiences that led me to take part in the debate. My other experience is very personal. Last year my nan passed away, after suffering with Alzheimer’s for a number of years. She spent the last years of her life in a care home. My hon. Friend the Member for Luton North (Kelvin Hopkins) spoke earlier about the experience of working-class people and what it means for them to pay for their care. My nan was a working-class woman. She worked very hard all her life and saved hard to buy her own home. She never went on a foreign holiday. She was very frugal with her money. She ended up having to sell her home, which was worth about £140,000, and using the small amount of savings that she had to pay for her care. There is obviously a limit on how much money one has to pay for such services. Her estate was worth in the region of £23,000 at the end of that process, but my family paid more than £100,000 for her care. The local authority picked up the costs of that care towards the end, because all her savings had been used. I think it would break her heart to think that what she had worked hard for all of her life did not get passed on in any significant way to my father, to my aunt, or to her grandchildren.

[Sarah Newton]

The hon. Lady has highlighted another illusion in the system: the illusion of the separation between the so-called self-funders and others. There are very, very few people who end up fully self-funding their care. Most people deplete their resources and end up having to be funded by local authorities. We must not always see the issue in black and white. Of those who self-fund, about half go on to require support from local authorities.

[Heidi Alexander]

The hon. Lady makes a very good point and I agree completely that there is not a clear distinction between self-funders and local authority-funded clients. I reiterate the point made by my hon. Friend the Member for Luton North about how wealth is inherited in our society. My family, perhaps unwisely, have not planned greatly for their retirement. My dad is a self-employed electrician. I think that he was planning to use some of the money that came from the sale of his mother’s house to fund his retirement. He does not in any way begrudge the money that he spent on my nan’s care towards the end of her life. I do not begrudge it. She had fantastic care in a fantastic care home, and that is completely right. However, I know that he feels that the system is perhaps not really fair. He asked me questions about people who play the system, and whether people transfer homes into somebody else’s ownership so that they do not have to pay.

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[George Hollingbery (Meon Valley) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bone, and I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this important debate. Had I not come last in the roster this afternoon, I would—of course—have made a philosophical, wide-ranging and sparkling speech on the philosophical implications of the Dilnot report. Hon. Members will be glad to hear that I am not going to do that, and I will restrict myself, if I can, to a few small points that have not yet been covered in any great depth. I apologise for being absent from the debate for an hour, but next door to the Chamber the Surviving Winter appeal was being launched. The appeal transfers the winter fuel allowance from those who do not need it to those who do and, if I may make a quick plug, anybody who would like more details about it should speak to me after the debate.

Some difficulties over the local funding of care for the elderly need to be pointed out, and I know that the Minister will have seen the submission to the process by Hampshire county council. My hon. Friend the Member for Stourbridge (Margot James)—who unfortunately is now leaving the Chamber—talked about private citizens having to pay more than the county council for care, and that view is supported in a letter that I received recently from Mr Winterton-Smith, who wrote to me at great length about the difficulties he faces in financing care for his mother.

I looked up some statistics. Market research by Laing and Buisson in “Care of Elderly People UK Market Survey 2010-11” estimates the average weekly cost of nursing care in the southern home counties, which includes Hampshire, as £787. On average, Hampshire county council’s nursing care beds cost £650 a week. That is a difference of over £5,000 a year for the private carer, and it is a substantial gap that needs to be looked at.

Hampshire county council’s submission shines a spotlight on the number of self-funders in the southern counties, and in Hampshire, nearly 60% of those who receive elder care are self-funders. One imagines that the funding pattern could become enormously complicated if some parts of the country need massive cash inputs to deal with people converting from self-funding to being funded by the state. I point that out in passing because I was asked to do so by Hampshire county council, which I am partially representing today.

I was always attracted to the insurance model; it seemed to be a way of providing for future care in a proper way. Unfortunately, however, it looks as if that model is too complicated for institutions to price properly, and even the guarantee provided by Dilnot does not provide sufficient certainty for insurers to enter the market in any real number. The Joseph Rowntree Foundation and the International Longevity Centre have pushed forward insurance models, but Dilnot speaks about the market and explicitly rejects such models as stand-alone solutions. He believes that insurance models can be part of a solution and that some schemes will help, but the overall model is rejected.

Policy Exchange—not the favourite think-tank of Opposition Members, I know—published a report last year entitled “Careless.” I have spoken widely about countries such as Germany and Japan that have partially insurance-funded models of care, but are beginning to struggle with the implications of rising costs, and such models are beginning to look unsustainable. The Policy Exchange report gives a figure of £106 billion for the full cost of replacing care that is provided throughout the community, both privately and publicly, to those who need elder care. All sorts of perverse incentives might arise in a system that provided universal care. People who now provide care for nothing would, quite understandably, not provide it in the same way as they used to. The sum of £106 billion is a frightening figure to consider. I have no particular basis on which to back up that number, however, but I merely cite it from that report.

We have talked a little about the link between adult social care and health spending, and cross-departmental spending. When I was reviewing the literature, I noticed a reference to a spat that occurred in County Durham when the local PCT spent money on gritting the roads. It did so because it felt that it was a good way to prevent accidents and stop people needing adult social care. To me, that made a great deal of sense. The council, however, got into the most terrible trouble; all sorts of newspaper articles said that it was foolish or idiotic and did not know what it was doing. The harsh reality is that trips and falls cost the health service money, and they cost many elderly people their independence, and later their freedom.

The council’s decision is exactly the sort of thinking that led to what I will happily call the excellent Total Place initiative launched by the previous Government. That agenda has real potential to provide some of the funding that we require to solve the problem of care for the elderly in the long term. Breaking down the barriers between Departments, and pooling spending to deal with complex objectives, are ideas that the coalition must pursue if we are to make real inroads into solving problems such as the care of older people in times of increasing complexity and tighter spending.

[Sarah Newton]

My hon. Friend makes an incredibly important point. Does he agree that we have huge unmet housing needs for the ageing population, and that we have not thought about the types of homes that would most appropriately enable people to live comfortably at home? By planning services in a particular location, all the aspects that impact on whether people live healthier and longer lives could be better developed and delivered.

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[Sarah Newton]

Thank you very much indeed for calling me to speak, Mr Bone.

This has been a really interesting debate and I am very grateful to the hon. Member for Lewisham East (Heidi Alexander), my hon. Friends the Members for Stourbridge (Margot James), for Banbury (Tony Baldry) and for Stroud (Neil Carmichael), the hon. Members for Luton North (Kelvin Hopkins) and for Worsley and Eccles South (Barbara Keeley), my hon. Friend the Member for Meon Valley (George Hollingbery), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Southport (John Pugh) for their contributions. There were numerous very helpful and constructive interventions from colleagues who had to join the debate in the main Chamber or go back to their constituencies.

I think I speak on behalf of us all when I say how much I welcome the tone of the Minister’s response, the commitment to producing the White Paper in April and his clear desire to wrestle with this issue to ensure that it does not disappear into the “too-difficult-to-do” category. He also showed a clear desire to work with all parties and to continue to listen to the concerns of the chairs of the all-party groups, who come from all parties represented in the House, in further dialogue and debate while he and the Government develop their White Paper.

Although we cannot do it in the format of today’s debate, it would be very helpful to hear the Minister’s response to the specific request made by the hon. Member for Leicester West about the nature of the cross-party negotiations that were proposed. That would give us all a great deal of confidence that there was a proper process in place to achieve cross-party support before the White Paper is produced, because that cross-party support would indeed enable the White Paper to have the best possible chance of becoming legislation at the first opportunity, which would allow the Government to start to address these issues.

I thank the Minister for his words of encouragement and I thank everybody who has participated in the debate. And Mr Bone, it will not surprise you that I am sure that as a result of this debate, and because of the number of Members who were not able to get to Westminster Hall to speak in the debate that they really wanted to speak in, you and the rest of the Backbench Business Committee will receive another request to have a further debate on this vital issue in the main Chamber, probably in January, when the work of the Health Committee, which is examining the area of social care funding, is completed and when the Minister has had opportunities to have further cross-party discussions. Thank you, Mr Bone.

Question put and agreed to.