NHS Care of Older People

Sarah Newton Excerpts

Thursday 27th October 2011 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in the debate when you, Mr Betts, are in the Chair.

The full title of our debate is “NHS Care of Older People”, and the fact that that distinction is made shows that there is an issue in the care of older people by the NHS that needs to be discussed. It is right, therefore, that we are debating this matter today and I congratulate the hon. Member for Stourbridge (Margot James) on securing this debate and on the way in which she opened it.

A number of reports made to Parliament this year on the failings of NHS care of older people have shocked us. The health service ombudsman, Ann Abraham, reported in February on a

“picture of NHS provision that is failing to respond to the needs of older people with care and compassion, and to provide even the most basic standards of care”.

Her report told the stories of 10 people over 65—partners, parents and grandparents: individuals who put up with difficult circumstances and did not like to make a fuss, compared with those who, as we have heard, were difficult—who wanted to be cared for properly and, at the end of their lives, to die peacefully and with dignity. Ann Abraham tells us that what the people involved have in common is their experience of unnecessary pain, indignity and distress while in the care of the NHS.

The second of the 10 stories is that of Mr D, and it particularly focuses on the last five days of his life. He was admitted four weeks earlier with a suspected heart attack but after tests was diagnosed with advanced stomach cancer. He was to be discharged from hospital on the Tuesday after the August bank holiday weekend, but it was brought forward to the Saturday. The summary of the story in the report is harrowing. The discharge of, we must remember, a man with only a few days to live was a shambles. The report goes on:

“On the day of discharge…the family arrived to find Mr D in a distressed condition behind drawn curtains in a chair. He had been waiting for several hours to go home. He was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated he could not speak properly or swallow. His daughter told us that ‘his tongue was like a piece of dried leather’. The emergency button had been placed beyond his reach. His drip had been removed and the bag of fluid had fallen and had leaked all over the floor making his feet wet. When the family asked for help to put Mr D on the commode he had ‘squealed…’ with pain. An ambulance booked to take him home in the morning had not arrived and at 2.30 pm the family decided to take him home in their car. This was achieved with great difficulty and discomfort for Mr D.

On arriving home, his family found that Mr D had not been given enough painkillers for the bank holiday weekend. He had been given two bottles of Oramorph (morphine in an oral solution), insufficient for three days, and not suitable as by this time he was unable to swallow. Consequently, the family spent much of the weekend driving round trying to get prescription forms signed, and permission for District Nurses to administer morphine in injectable form. Mr D died, three days after he was discharged, on the following Tuesday. His daughter described her extreme distress and the stress of trying to get his medication, fearing that he might die before she returned home. She also lost time she had hoped to spend with him over those last few days.”

The summary of this case sounds terrible, but the detail was much worse. The family were my constituents and I supported the family’s complaint after meeting Mr D’s daughter. Every aspect of this case showed the NHS in a very negative light.

Let me give a summary of the detail in Mr D’s case, as reported to the ombudsman. Mr D was not helped to use a commode and fainted, soiling himself in the process. He was not properly cleaned and his clothes were not changed until the family requested that the following day. The ward was dirty, including a squashed insect on the wall throughout his stay and nail clippings under the bed. He was left without access to drinking water or a clean glass. His pain was not controlled and medication was delayed, sometimes by up to one and a half hours. Pressure sores were allowed to develop. No check was made on his nutrition. His medical condition—the fact that his illness was terminal and that he had only a few days left—was never properly explained to his family. He was told of his diagnosis on an open ward, overheard by other patients.

I spoke about this case in a debate about the NHS Redress Bill, and I agree with the comments that the hon. Member for Stourbridge made about accountability. Where was the accountability in this hospital? Where was the ward manager or matron figure who was letting these things happen?

At this point, Mr D’s daughter, a constituent, came to me for help. She desperately needed an answer and an explanation of what had happened. As her MP, I felt the hospital needed to admit its errors and take measures to ensure that what happened to that patient did not happen to anyone else. Regrettably, in the months that followed, the hospital seemed unable to do that. In fact, the dreadful failures in care and communication were made worse by the inadequate way the hospital dealt with my constituent’s complaints, as I reported to the House in that earlier debate.

After raising her complaint with the hospital, my constituent found that responses from it were not sent in keeping with agreed time scales and often took three or four weeks longer than it had promised. Copies of responses from the hospital were never sent to me, and I had to chase every single one of those responses, which were often inadequate. That was the worst thing for this bereaved family, because the delayed answers and prevarication from those investigating the complaints left the family feeling more angry and upset. Their anger was originally due to what they perceived as delays in diagnosing Mr D’s terminal condition and the poor treatment and care he received, but the whole thing became worse because of the way the case was handled.

The complaints the ombudsman’s report details are very serious, and I am talking about just one. In making their complaint, the family know that nothing can bring back their loved one—their father—or change the way he was treated, and families often tell us that. However, the family desperately want explanations and an apology, and they desperately want to ensure that no other parent is treated the same way.

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

The hon. Lady is making an incredibly moving speech. I pay great homage to the work Ann Abraham has done in her role as ombudsman, and yet another fantastic report came out last week about the complaints procedure. Does the hon. Lady agree with the recommendation in that report that there should be far greater partnership working with organisations such as the Care Quality Commission? Does she agree that the Government could take steps in response to the findings of the consultation they have just held on the information revolution? Such measures would really help improve the complaints procedure, which would drive up standards of care.

[Barbara Keeley]

Yes, indeed. We discussed those issues in relation to the NHS Redress Bill. The difficulty we have with the most extreme cases, as I am describing in relation to my constituent, is that the medical establishment seems to close up when facing such complaints, and people become fearful that they will be sued and have problems in their careers. We must remove that way of handling such awful cases, because it is just not acceptable.

Like every MP, I understand that the Government cannot manage every consultant and every ward to make sure such things do not happen. However, they do happen, and there are many more cases than the 10 the ombudsman reports on. We must bring about a change of culture to allow for an acknowledgement of the fact that there must be better redress than there was in this case when a whole system of care and treatment fails a patient and his family, and when standards of professional practice and communication fall. The MP and the family should not have to battle the complaints system and eventually take their case to the ombudsman because only the ombudsman can ever make a hospital do what it should have done in the first place.

The family were looking for an acknowledgement, an explanation and an apology, and they wanted to make sure that these things did not happen again. It is very reasonable that they should expect that.

[Sarah Newton]

The hon. Lady is making an incredibly important point about how complaints are handled in the NHS. In highly effective organisations, complaints are considered to be gold dust, because they are part of how those organisations drive up standards and improve services. That benefits not only the patients, but staff. It is so demotivating if staff working on poorly managed wards, or in the NHS more generally, raise complaints, even through protected disclosures, and nothing happens. That can cause them stress and great personal harm.

[Barbara Keeley]

Indeed. I do not distance myself in any way from the excellent point the hon. Member for Stourbridge made in opening the debate: this is about leadership, management, training and accountability, all of which failed in the case I have outlined.

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

It is a pleasure to serve under your chairmanship, Mrs Brooke. I am particularly grateful that you have allowed me to speak. I missed the beginning of the debate because my watch broke. It was immensely frustrating, so I appreciate you making an exception to the rule and allowing me to speak.

We have heard so many excellent speeches this afternoon and I agree with the contributions of all my colleagues. It is so refreshing to be part of this debate, which provides a contrast with yesterday’s debate on the NHS in the main Chamber. We are working together to highlight considerable concerns. I am sure that, considering the great passion that has been in evidence today, we can make a difference.

Other colleagues want to speak, so I will touch on only two areas that could be improved in the NHS. If they were improved, it could make a real difference in driving up the standard of care for elderly people. The first relates to improvements to the complaints process, and the second to a particular training need for people, whether they be doctors or clinicians, who come from overseas to work in the health service.

On the complaints procedure, highly effective organisations appreciate that every complaint is an opportunity to learn and improve. Such organisations have virtuous circles of continuous improvement, from complaint through to monitoring the improvements that they agree to make, to make sure that improvements result from every complaint that is investigated.

I have read with interest the recently published report of the parliamentary and health service ombudsman, Ann Abraham, “Listening and Learning”. It is a review of NHS complaints handled in England from 2010 to 2011. It is a hard-hitting and informative read. Ann says:

“In last year’s report…I concluded that the NHS needed to ‘listen harder and learn more’ from complaints. The volume and types of complaints we have received in the last twelve months reveal that progress towards achieving this across the NHS in England is patchy and slow.

This report shows how, at a local level, the NHS is still not dealing adequately with the most straightforward matters.”

We have heard that today. She goes on to say that two particular themes emerged. First, the most prevalent reason for complaints was a lack of effective communication, as every speaker today has highlighted. Poor communication can have a serious, direct impact on patients’ care and can unnecessarily exclude their families from a full awareness of the patient’s condition or prognosis. Secondly, in an increasing number of cases, a failure to resolve disagreements between patients and their GPs has led to their removal from the GP list. Her report cites a particularly harrowing example of somebody—a very vulnerable and elderly person—being excluded from the GP list in the last few days of their life.

More positively, Ann Abraham notes that there have been improvements in the attitudes of NHS senior management when tackling the issue of complaints handling and that there has been more partnership working with other parts of the NHS, such as the Care Quality Commission. However, clearly, much more effort needs to be put into showing NHS staff how complaints can drive up standards of patient care. The majority of doctors, nurses and other clinicians in the NHS in Cornwall, and I am sure around the country, get job satisfaction from delivering high-quality care to their patients. I have listened to nurses who suffer when they work in wards that are poorly led and monitored, and where bad practice is ignored. Worse still, when they try to tackle the situation by reporting their concerns and even making protected disclosures, nothing happens.

In remote and peripheral parts of the country, such as Cornwall, there is only one acute hospital, so staff are very reluctant to complain because there is nowhere else for them to go. That is stressful for staff and, obviously, far from good news for the patients on their wards and under their care. I am pleased and encouraged by the Care Quality Commission’s work in Cornwall. When all parts of the NHS and other care providers are registered, so long as they have the necessary resource, they will be highly effective in driving up standards of treatment and care. I would like the Care Quality Commission to have a far greater role in the NHS complaints process—for example, it should be given copies of all complaints, all protected disclosures and all death reviews in hospitals. That information is vital to helping the CQC to assess risks and manage improvements.

Where a complaint has led to an improvement being agreed, the CQC should have the opportunity to visit and spot-check to ensure it has been implemented. If the CQC were more involved in the complaints process, the quality of care and services, as well as job satisfaction for NHS staff, would be improved. The poor quality of care an elderly person might have experienced, either at home or in residential care, should also be dealt with by complaints processes that involve the CQC.

A more public communication of complaints data will also help to drive up standards of care and will give patients more important data upon which to make a choice. I am pleased that, from this month, the Department of Health has committed to publish complaints data by hospital, and that foundation trusts will also shortly be required to provide information on complaints. Like Ann Abraham, I hope that, following the Government’s consultation “An Information Revolution”, a framework for making that information available will be published. It is important to have standardised indicators and measures for both complaints and lessons learned, so that patients and staff can compare like with like. I hope that the Minister might be able to comment on that today.

The second point is about staff who come into the NHS from overseas and who have been trained overseas. Much has been reported in the media recently about the poor language skills of some of the doctors, nurses, clinicians and care workers who come into the NHS, and the problems that that causes. That is an important issue but the attitude of such staff, especially towards older people, is as significant.

Although I appreciate that the training of doctors is not the responsibility of the Department of Health, it could be part of the commissioning of services. Guidelines could be given to commissioners not only on training, but on ensuring that people coming from overseas had effective training on how to treat people with respect and dignity. The value assigned to elderly people is different in different cultures around the world, and that needs to be addressed when employing people in the NHS. I am aware that many colleagues want to contribute, so I shall conclude my comments there.

National Health Service

Sarah Newton Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

My right hon. Friend makes an important point. When we were in government, we said that there had to be a clinical case for change, if changes to hospital services were to be made. I mentioned Greater Manchester a moment ago. There was a clinical case to support those reforms. The experts, to which she rightly pointed, said that about 50 babies’ lives would be saved every year by specialising care in fewer locations. In such circumstances, politicians have a moral obligation to listen to those experts and to make changes, no matter how politically difficult they are. That is why I say that it was sheer opportunism of the worst kind for the Government, when in opposition, to say that they would have a moratorium on any changes and to tour those marginal constituencies promising to overturn decisions, when in fact they had no intention of doing so. I put it to the House that the people of Bury, Burnley and Enfield have now clearly discovered what opportunism there is from those on the Conservative Front Bench.

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

Does the right hon. Gentleman therefore welcome one of the Government’s first actions, which was to change the NHS operating guidelines for reconfigurations to ensure categorically that clinicians and the communities they serve were in the driving seat for future reconfiguration of the NHS?

[Andy Burnham]

If that is the case and the people of Enfield are in control of the decision, would Chase Farm A and E be closing? What the hon. Lady describes is a complete and utter reinvention of the moratorium policy. She stood on an election manifesto that promised a moratorium. Where is it? It has not materialised. It is a mythical policy that was designed to win votes; it had nothing to do with the good stewardship of the national health service.

--- Later in debate ---

[Sarah Newton]

The image that the right hon. Gentleman has just painted is totally inaccurate. The Royal Cornwall Hospitals NHS Trust is struggling with an enormous debt, which it incurred as a result of enormous reorganisations under Labour and a ridiculous accountancy measure that doubles the debt every year. I will not take comments like that from the right hon. Gentleman, because Cornwall has been left in a very difficult situation that this Government have been left to sort out.

[Andy Burnham]

I did not say that everything was perfect, but I said a moment ago that we took a grip on those problems and dealt with them from the centre. In the hon. Lady’s Government’s NHS, there will be—what are the words?—no bail-outs. Everyone will be left to fend for themselves. Does that mean that her hospital will be allowed to go bust? I do not know, but that is the implication of the Secretary of State’s White Paper and Bill, and she needs to direct her questions to him.

The fact is that we are now looking at a national postcode lottery, in which GPs are free to send letters to patients telling them that minor operations must now be paid for, and in which hospitals no longer have maximum waiting times for NHS patients and can devote the freed-up theatre time to private patients as there is no longer any cap on private work. The Government have placed the NHS in the danger zone. It has been placed there by a Prime Minister who said “Trust me” and has gone back on his word. He wrote cheques for the NHS in opposition that he knew he would not be able to cash when in government. He made promises that he knew he would be unable to keep, in order to win votes. This is the Prime Minister’s very own great NHS betrayal, and, far from detoxifying his party, he has proved once and for all that we really cannot trust the Tories with our NHS.

--- Later in debate ---

[Sarah Newton]

I agree with much of what my hon. Friend says. Does he agree that on such an important subject as the NHS, the people we represent and who sent us here would expect us to be thinking about how we can improve the NHS for patients and for the people who work in it, rather than engaging in this ridiculous tit-for-tat party political scrap that we are seeing this afternoon?

[Chris Skidmore]

I entirely agree. A constituent, a lady who sadly lost her foot through a rare cancer, came to my surgery recently. She is allowed only one type of plastic foot from the NHS and the PCT. She wants what is called an Echelon foot which will allow her to walk up a hill—she is a hill walker—but under the current model she cannot get that alternative foot. By bringing in any qualified provider, we will allow patients and clinicians the freedom to choose for the first time—a choice that was denied under the “any preferred provider” model that the shadow Secretary of State still clings to vainly. We need to ensure that our NHS operates for the 21st century and I hope the reforms will deliver that.

To sum up, I will oppose the motion. It is juvenile—the text could have been written by Adrian Mole. This is about getting away from the politics of debate in the Chamber and giving the NHS back to the professionals and the patients. It is not our NHS; it is their NHS, and we need to ensure that we achieve that aim.

--- Later in debate ---

[Dr Poulter]

I thank the hon. Lady for her intervention. Any period of transition will be difficult, and must be managed. Will the mechanisms and bodies that the Health and Social Care Bill will put in place be better able to deliver community-focused, integrated care than the existing system? I want to consider two matters that we will come to later: health and wellbeing boards, and basing commissioning fundamentally in the community. Both are good mechanisms for delivering better integrated care, and I will return to that.

We have too many silos in the NHS. The primary care sector often does not integrate with the secondary care sector as well as we would like. For example, hospitals are paid by results, but they have no financial incentive to ensure that they prevent inappropriate hospital admissions. We talk about better looking after the frail elderly and about ensuring that we prevent people with mental health problems from reaching crisis point and having to be admitted, but there are no financial incentives and drivers in the system to ensure that that is achieved to the extent we would like. A and E admissions in many hospitals are rising year on year—in rural areas that is partly because we do not have an adequate out-of-hours GP service—and far too often the frail elderly are not properly supported in the community.

If we put the majority of commissioning into the community with local commissioning boards, that will provide a more integrated and joined-up approach to local commissioning, which will undoubtedly help to prevent inappropriate admissions. We no longer want an NHS in which people with mental health problems or the elderly present in crisis because they have not been supported in the community. That must be the focus of care, and the focus of delivery of services.

[Sarah Newton]

I wholeheartedly agree with my hon. Friend about the importance of integrating social care and the NHS. I want to share with him the good, concrete steps that are being taken in Cornwall, where we have a pilot health and wellbeing board, and the beginning of integration. That has not happened before in Cornwall, and we are about to have the first joint commissioning of services. That is the way forward to improve patient experience in the NHS.

[Dr Poulter]

I thank my hon. Friend for a helpful intervention, which makes the point very well that we need integration through community-based commissioning.

The other key factor is how better to integrate adult social care—the right hon. Member for Leigh made the point, as did the Secretary of State—into the current NHS system. At the moment, integration of services is sometimes variable. There is a good example in Torbay of a more integrated system, but what are the Government proposing that will at least facilitate the integration of services? Local health and wellbeing boards are definitely a step in the right direction because for the first time they will bring together adult social care from local authorities with housing providers, the NHS, and primary and secondary care. That must be a step in the right direction for delivering the integrated care that we all want. It will help to provide more community-focused care.

I referred to the concern about inappropriate admissions, and the fact that elderly people are not supported in their own homes. The savings in adult social care from doing things well are NHS savings, but at the moment there are different cultures in two different organisations, which do not always talk to each other in different parts of the country, and that will not benefit patients. Bringing people together on a health and wellbeing board must be good for patients and integrated care.

For all those reasons, I hope that we will have more positive Opposition day debates on the NHS, and I hope that the Opposition will at least concede that some good things are happening as a result of health care reform.

Health and Social Care (Re-committed) Bill

Sarah Newton Excerpts

Wednesday 7th September 2011 Commons Chamber

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

Will my hon. Friend give way?

[Margot James]

I would love to but I am aware that others are waiting and I am trying to curtail my comments. [Hon. Members: “Hear, hear!] I will take that as a prompt to get a move on.

I want to address a point that was made earlier about where the director of public health should sit in a local authority. I think it is important that the public health director should report to the chief executive because the public health function will cover so much that is part of children’s services, adult and social care and housing that it is hard to see how they will fit in unless they report at the top level.

In conclusion, I believe that the elevation of public health will enable public health to be placed at the centre of commissioning and that the link between the wellbeing boards and the primary care commissioning groups will enable public health to be instrumental within commissioning. That is where we will see the long-term benefits outrunning the short-term imperatives.

Oral Answers to Questions

Sarah Newton Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

That is an important point. One of the factors that will change those assumptions is the extent of our effectiveness in preventing and postponing the need for such services. “A vision for adult social care”, which we published last year, emphasised the need for more investment in preventive measures. That is why we have provided, and continue to provide, additional resources for reablement, which not only does the individuals concerned a great deal of good but saves money for social services authorities.

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

Does my hon. Friend agree that in the months before the White Paper is published it will be important to take time to build the necessary all-party cross-House support for long-lasting reform?

[Paul Burstow]

My hon. Friend is absolutely right, and the exchanges on the Secretary of State’s statement last week made it plain that we are committed to having those discussions and working to secure a long-lasting reform. That is the only way in which such a reform can secure the necessary changes, both in law and funding, for this country.

Reform of Social Care

Sarah Newton Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

I am grateful to the right hon. Gentleman for the welcome that he gives to the report by Andrew Dilnot and his colleagues, and indeed to the report that Tom Hughes-Hallett and Alan Craft produced on palliative care. They are both immensely valuable.

The right hon. Gentleman rightly says that it is important for us to move beyond many of the suggestions that have been made in the past. One of the essential purposes of the Dilnot commission was to seek something that was affordable and sustainable, that met tests of choice, fairness, value for money and ease of understanding, and that would be sustainable for the longer term. Dilnot has responded immensely well to the issues that we put to him, but that is part of a broader process of reform. In that sense we have not waited for Dilnot, because we have made progress on the wider aspects of reform. Now we have to ensure that we bring them together in a way that is coherent and works to deliver long-term, sustainable reform across the whole social care sphere.

The right hon. Gentleman rightly points to the fact that we inherited a fragile system in which there had already been a substantial tightening of eligibility and loss of care and support, with increasing levels of unmet need. That was precisely why, in an interim report last year, Andrew Dilnot and his colleagues asked us to make additional resources available in the spending review. I set out in my statement precisely how we have done so.

The concerns in relation to Southern Cross are particular to that company, and the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has made clear to the House how we are interacting with those who are involved with the company. We are making it very clear to the public—I reiterate it today—that we are prepared to act to secure the interests of individuals if there were any threat to their position in care homes. We are working with the Association of Directors of Adult Social Services and local authorities to ensure that those contingencies are in place. What I said today in the statement, and which people have not previously recognised, is that as early as last year we set out in the Health and Social Care Bill that we were prepared for regulatory powers to be available to ensure the future viability of social care providers, as we intend to do in relation to health care providers.

Let me may make one final point. I believe that my statement makes it absolutely clear that we will engage on the basis of the Commission on Funding of Care and Support, and that we will do so on a timetable that will work and that gives stakeholders and the public, and indeed the Government and the Opposition, an opportunity to come forward with a consensus. I discussed that timetable with Andrew Dilnot, and he is clear that he supports it. It will lead to a White Paper in the spring and an associated progress report on funding reform. I am clear that that assures stakeholders that we will take this forward as a priority.

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

I very much welcome the report and the Secretary of State’s statement. It was the previous Government who kicked the fixing of our broken care system into the political long grass. Will my right hon. Friend reassure me that we will work with all parties in both Houses to find a lasting solution?

[Mr Lansley]

Yes, I agree with my hon. Friend. That is indeed what we will set out to do. There have been many false starts, and not just under the previous Government. It is important for us to make progress, and for us to do so on a basis that is sustainable for the longer term.

NHS Reform

Sarah Newton Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

As we have demonstrated, NHS performance is continuing to improve, and it will improve further with clinical leadership, but we can achieve that effectively only if we achieve a £1.9 billion a year reduction in administration costs in the NHS. We have started that process: since the election, we have reduced the number of managers in the NHS by 3,000 and increased the number of doctors by 2,500.

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

I very much welcome the Secretary of State’s continued support for the NHS in Cornwall, with the cash increases this year, the long overdue integration of adult social care with the NHS, and the real opportunity of giving power to local people through the health and well-being boards. Will he ensure that the central changes he wants to introduce to achieve the aim of “no decision about me without me” are kept absolutely at the heart of what he does?

[Mr Lansley]

I will indeed do that, and I am very grateful to my hon. Friend for her comments. She represents a Cornwall seat, and she and I know that over the years many people in Cornwall have felt they wanted a greater sense of ownership of the decisions made in the health service, not only for individuals but for the health service in Cornwall itself. That is precisely what we are going to make available through both local commissioning and local authorities.

Hospice Care

Sarah Newton Excerpts

Wednesday 2nd February 2011 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right. He talks about a children’s hospice, but hospice care, and the valuable service that it provides to people with terminal and progressive illnesses, is particularly pertinent to adults. It is also important to children, however, because there is nothing more distressing than a very sick child whom we know is going to die.

I shall explain why we need to invest in hospices and palliative care. The UK population is ageing significantly, and we will have to look after a lot more people with more than one terminal and progressive illness. By 2033, the number of people aged 85 and over is projected to more than double to 3.3 million, and it is predicted that 8.7 million people will be 75 years or older. There is an ever-increasing strain on the palliative services that help to support people with co-morbidities, or several illnesses, and we need to recognise that and invest properly in those services. It is often through the hospice movement that such people are properly looked after and their families properly supported during the terminal illness.

Hospice charities have many concerns, because in the past the top level of government paid insufficient attention to the role that hospices play in easing the burden on the NHS, as well as in providing a vital service for local communities. We are of course in a time of economic belt-tightening, but given the Government’s investment in the big society, there is a unique case for supporting hospices and the valuable services that they provide, alongside their role as a provider of NHS services and a key provider of support for families in the community.

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

On the point about invaluable support services, does my hon. Friend agree that hospices, such as Children’s Hospice South West, which aims to build a new hospice in Cornwall to add to those it has in Devon, offer vital support to families through respite care for the children whom they look after who, sadly, have terminal illnesses?

[Dr Poulter]

My hon. Friend is absolutely right, and I am delighted to hear that a new hospice is emerging in her part of the country. I am sure that it will provide a valuable service. I shall focus most of my comments on the provision of adult care, but she is absolutely right to talk about children’s hospices, because a sick child—especially one with a terminal illness—needs a lot of support and care, as do their families in particular, during their illness. I am delighted that the communities in her part of the world are investing in that service.

I shall now discuss the hospice movement’s background, because it teases out the key areas of support that hospices provide. We all probably know that St Christopher’s hospice in Penge, south London, is likely to be identified as the first modern hospice, and I am delighted that in my constituency we have a hospice, St Elizabeth’s hospice, which provides a key service, supporting most of central and eastern Suffolk. St Elizabeth hospice delivers a number of services. It has 18 in-patient beds, some of which are for respite care, to which my hon. Friend the Member for Truro and Falmouth (Sarah Newton) alluded. These provide care to give families time off when dealing with a relative who has a terminal illness, and look after people in the very last days of their life.

However, hospices do more than that. One thing that is often forgotten when we talk about the hospice movement is the very valuable outreach service that they provide to their communities. People will want to have as good a death as possible, and part of that is about supporting them in being able to die, where possible, in their own homes in as comfortable an environment as possible. What St Elizabeth hospice does very well, as do many others, is invest in those outreach services to ensure that people can die comfortably at home.

Health and Social Care Bill

Sarah Newton Excerpts

Monday 31st January 2011 Commons Chamber

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

Thank you, Madam Deputy Speaker, for calling me to speak in this most important debate. The scope of the Bill is far reaching and other Members have covered many aspects in their contributions, so I want to focus on one area—that of the future governance of the NHS.

The Secretary of State has identified a powerful and simple concept that resonates with people across the country—that “No decisions taken about me should be taken without me.” While this concept is usually applied to the individual relationship between the patient and clinician, I believe it is just as applicable to the communities that the NHS serves in any particular area.

As we have seen from campaigns across the country, people do not want decisions about the health and care services available to them in their community to be taken without the opportunity to get involved in the decision: “No decisions about us without us.” Over the last few years, I have seen the lack of openness, the lack of transparency, the lack of consultation and the consequent fear and suspicion that that brings.

I realise that not everyone will want to become involved in local decision-making and that many are happy to leave it to others, but I believe that we are right to enable more resilient and empowered communities to shape their own futures. Giving more power to the people is as important in the context of decisions about health and well-being as it is in the context of decisions about planning, homes and the environment.

The Bill is nothing short of a revolution in terms of the devolution of decision-making power to people in their communities, accountability, and the governance of health and care services. First, it links two crucial services. For too long the separation of those services, and the silo mentality governing the care delivered by local authorities and health services commissioned by primary care trusts, have prevented care pathways from being developed effectively in a way that works for the patient, which has often closed off the vital role played by families, carers and volunteers in supporting people. There cannot be a Member in the House who has not had personal experience of that, or shared the experiences of elderly constituents who have been bundled around the system, described as bed-blockers and made to feel a burden.

Of course, in some parts of the country health and care services have been integrated, but they are in the minority. The Bill, and the money that the Government are making available to help fund the integration, will enable all parts of the country to develop the high-quality, joined-up services that are currently available only to a few.

[Stephen Lloyd]

I agree with much that my hon. Friend is saying about integration and the need to work with the community, and I applaud many of the changes made by the Bill. For years we have all talked of using pharmacists in a smarter way. Does not the Bill provide an opportunity for much more integration of community pharmacy with the consortia, and for the Government to support the consortia in that endeavour?

[Sarah Newton]

As someone who represents a rural area of Cornwall where GPs’ delivery of pharmaceutical services is vital, I think that that is an extremely good idea.

Secondly, the new responsibilities of Monitor and the Care Quality Commission will make possible independent regulation of both quality and safety of care and value for money. I have observed the problems that have occurred in recent years when managers have evaluated their own compliance with standards. Good decisions can be made only with sound evidence. The powers of the National Institute for Health and Clinical Excellence and the Information Centre will be enshrined in legislation for the first time, and their independence from Government will thus be guaranteed.

Thirdly, the Bill creates a new role for local authorities in public health. Directors of public health, jointly appointed by Public Health England and local authorities, will play a leading role in the discharging of authorities’ public health functions. Arguably, it was the initiatives of local authorities in past centuries—such as the introduction of fresh water, drains, sewage management and the controlling of vermin—that led to some of the most significant improvements in life expectancy.

[Anne Marie Morris]

Is not one of the real strengths of making public health part of the role of local government the fact that housing, which is a critical issue to public health, can be viewed in the round?

[Sarah Newton]

I entirely agree with my hon. Friend, who has anticipated a point that I was about to make.

The returning of more responsibility to local authorities—along with the considerable social determinants of health for which they are already responsible, such as the availability of good-quality housing and the regulation of places of work, environmental health and leisure services—has the potential to improve health outcomes, and to close the ever-widening gaps in health equalities in this country.

The Bill will ensure that every upper-tier authority establishes a health and wellbeing board consisting of the director of public health, GP consortia, children’s services, adult services, care providers from all sectors, and local health watch organisations. Such boards should provide local leadership and a strategic framework for the co-ordination of health improvement and the addressing of health inequalities in their areas. The joint strategic needs assessment will be integral to the process, and will influence the commissioning of services. The local health and wellbeing boards will, in effect, hold the ring when it comes to the health and care services provided in their communities. Local authorities will maintain and extend their role as scrutineers of all services, whether they are commissioned locally or nationally and whether they involve health or social care. They will also be able to commission complaints and advocacy services from any provider, rather than just from the local or national health watch.

The Local Government Association has warmly welcomed the proposed changes. The best local authorities have good experience of working with public, private and not-for-profit organisations as well as the charity sector in delivering integrated care. They are used to planning person-centred and personalised care.

I believe that—along with the changes that the Secretary of State has already made to the operating framework of the NHS in relation to the reconfiguration of services—the Bill, when effectively implemented in communities across the country, will lead to greater openness, greater accountability, and greater confidence for all those working in health and care, as well as for the ordinary people up and down the land who have lost so much confidence in the way in which decisions are made. These changes will take time, but I am confident that within the next four years, when we ask the people of this country, “Do you feel that decisions are being taken about you and with you?”, many more people will say “Yes” than would do so if asked that question today. That is a result that I shall be proud to have played my part in achieving.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

It is easy to see why politicians continuously want to fix the NHS. The perspective from the green Benches is very different from the perspective one gets as a GP—I say that having worked in the health service for 24 years. My surgeries and postbag, and I am sure those of other Members, are full of stories of delays, frustrations and sometimes really poor practice. The trouble is that not enough people write to their MP to tell them how sensitively or compassionately they have been treated, or how the NHS saved their life. They do feel those things, however, and they do appreciate the NHS. That is why they are understandably wary of any changes, proposed by whatever Government.

Here are the things in the Bill that I welcome. I really welcome clinical leadership. We should be in no doubt about this: there is clear evidence that commissioning works best when there is clinical leadership backed up by excellent management. The Bill will go some way to pushing us towards true clinical leadership in all parts of the NHS.

The provisions will also result in an information revolution. That will involve information about not only whether someone’s treatment worked but what the experience was like—a kind of TripAdvisor for the NHS. We all know that, with information, daylight is the best disinfectant. If people know that their performance is going to be compared with that of others, that is likely to drive up performance in the NHS.

The provisions will allow for that early scan that can make all the difference in an early diagnosis of cancer. When GPs can commission very good early diagnostics much more quickly, we will see a difference. The changes will also give GPs much greater flexibility to respond to their own area. In Devon, for example, community hospitals are really important, but they might not be so important in inner cities. The provisions should also give better choice to services such as mental health, and bring in opportunities for the voluntary sector. I recently met a group of carers for patients suffering from mental health difficulties, and they told me that they wanted better access to talking therapies. Rather than the support that has traditionally been supplied to them, they want better access to other kinds of support. I also really welcome putting public health back where it belongs, with local authorities.

Our spending now matches the European average, and I genuinely congratulate the Labour party on that, but I am afraid that that has also been a wasted opportunity. It is unforgivable that so much of that money was squandered, and that we have seen flat-line productivity. For that level of spending, patients should be able to expect the kind of services that people receive in France or Germany. I am sure that we have all heard instances of people coming back from a holiday on the continent with a minor condition, having had a scan and treatment within a week. We should be able to deliver that here. Health care workers should not have to spend three weeks chasing down a patient’s results. I am sure that we have all heard instances of that, as well.

The challenge is to improve aspects of the NHS, to look at the detail, to listen to patients and professionals and to ensure that we get this right. In Torbay, they have been getting it right for some time. It has been part of a national pilot of integrated care. Baywide, a not-for-profit company of local GPs, commissions health and social care from a pooled budget.

[Sarah Newton]

My hon. Friend mentions GPs working together on a not-for-profit basis. Does she share my huge disappointment at some of the terribly derogatory comments made by Opposition colleagues about GPs’ motivation, comparing them to the worst kind of bankers in the City? Is it not disappointing that they are so disrespectful to GPs?

[Dr Wollaston]

I agree with my hon. Friend. We have heard some terrible slurs about GPs profiteering and lining their own pockets. I am absolutely confident that that is not what we are going to see.

Torbay has been highly successful because it has pooled budgets and it can design integrated care. That saves lives and money. No one should be in any doubt that improving the quality of care, and thereby the quality of life, for those with complex, long-term conditions is the key to improving health care and cutting costs.

NHS Reorganisation

Sarah Newton Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

We still have a lot further to go. There have been big improvements in international comparisons, but we must go further. It beggars belief that the Government have decided not to press ahead with plans to give patients a guarantee of, for example, receiving test results within one week, especially as hon. Members on both sides of the House recognise the importance of early diagnosis for cancer, and the cancer specialist, Mike Richards, said that this contribution to early diagnosis could save 10,000 lives a year.

Instead of building on those great gains, I fear that the NHS will again go backwards under this Tory-led Government. It is already showing signs of strain. The number of patients waiting more than 13 weeks for diagnostic tests has trebled since last year, 27,000 front-line staff jobs are being cut, and two thirds of maternity wards are so short-staffed that the Royal College of Midwives says that mothers and babies cannot be properly cared for.

This is not what people expected when they heard the Prime Minister say that he would protect NHS funding. In fairness, a proper, long-term perspective is needed on NHS financing. Year-on-year funding just below or even 0.1% above inflation is way short of the 4% average increase that the NHS has had over its 60 years. During the last Labour decade, it averaged 7% in real terms.

There are, and have been for many years, built-in pressures on the NHS: the cost of staff, drugs and equipment rises by about 1.5% above general inflation, and the demands of our growing and ageing population adds £1 billion to the bill each year just to deliver the same services.

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

It is interesting that the right hon. Gentleman omitted from his list any mention of the escalating costs of administration in the NHS. Does he agree with us that what is really important is to reduce the cost of administration?

[John Healey]

The hon. Lady is right, and there is plenty of scope to do that. We recognised that, and we had plans to take out many of the managerial costs. I will come to that later, but it is hard to understand how creating three or even four times as many GP consortiums doing the same job as primary care trusts is likely to reduce rather than increase bureaucracy in the NHS. My right hon. Friend the Member for Leigh says that in Wigan there is one PCT, but it is set to have six GP consortiums. The same job will be done six times over in the same area. How is that a cut, or an improvement in the bureaucratic overheads and costs of the NHS?

In the spending review, the NHS is set for the biggest efficiency squeeze ever. On 12 October, the NHS chief executive, David Nicholson, told the Health Committee:

“It is huge. You don’t need me to tell you that it has never been done before in the NHS context and we don’t think, when you look at health systems across the world, that anyone has quite done it on this scale before.”

Money is tight, and something must happen, but that can be done by building on Labour’s big improvements in the NHS over the last decade. It will be tough, but I will back the Government, as long as all savings are reused for better front-line services to patients.

NHS (Cornwall)

Sarah Newton Excerpts

Monday 12th July 2010 Commons Chamber

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

I am delighted to have this opportunity of welcoming the publication today of the coalition Government’s health White Paper, “Liberating the NHS”. It received a warm welcome in Cornwall this evening during the evening news on the BBC, with support from patient groups and GPs. I believe that making the NHS more accountable to patients and freeing staff from excessive bureaucracy and top-down control will drive up quality of care and outcomes for patients. I also welcome the measured pace of change and the Government’s desire to engage in a wide range of consultations to get the detail of the proposals working for the benefit of patients.

This evening, I would like to describe the current situation and direction of travel of the NHS in Cornwall, and to raise one important aspect outlined in “Liberating the NHS” today: assuring the continued improvement in quality of care in Cornwall. In addition to the ambulance service, we have three organisations that commission or provide care for people in Cornwall: the Royal Cornwall Hospitals NHS Trust, the Cornwall Partnership NHS Foundation Trust, and the Cornwall and Isles of Scilly primary care trust. There have been significant problems with some aspects of the quality of care provided by those organisations, but over the past three to four years improvements have been made. Significant challenges remain, and it is essential that momentum be maintained in the further improvement from ratings of “adequate” and “fair” to “good”, and then sustained at that level.

The Royal Cornwall Hospitals NHS Trust annual health check ratings demonstrate some steady improvement. Areas that needed work were governance, financial management, infection control and elderly care. The quality of service was rated “weak”, and remained weak until 2008-09. However, more recently the trust has demonstrated overall improvement through the interim core standards declaration in October 2009. The trust was registered under the Health and Social Care Act 2008 in April 2010 without conditions and with only minor concerns. The overall annual health check ratings of the Cornwall Partnership NHS Foundation Trust demonstrate improvement in performance, particularly since the high-profile investigation of services for people with a learning disability. In 2005-06, the trust’s quality of service was rated weak, improving to good in 2007-08, and that improvement was sustained into 2008-09. Its quality of financial management similarly improved. The trust was registered without conditions under the 2008 Act in April 2010, and achieved foundation status on 1 March 2010.

The Cornwall and Isles of Scilly PCT has also seen some improvement in performance. In 2006-07, its quality of commissioning was rated fair, improving to good in 2007-08 and then returning to fair in 2008-09, and its quality of financial management is improving to good. The trust was also registered without condition, however this was with a moderate level of concern.

Also of relevance to all three Cornwall NHS trusts is the report on the inspection of safeguarding and looked-after children’s services published by Ofsted on 23 October 2009. Out of 16 outcomes, Cornwall council was awarded only one score of “good”—there were six of “adequate” and nine of “inadequate”. Although most issues for action are for the local authority, there were also issues for the health community to address, which involve all three NHS trusts to a greater or lesser degree. Action plans are in place, and oversight and scrutiny of the health element is provided by the South West Strategic Health Authority. It is performance-managing progress on delivery of the action plan weekly and bi-monthly, alongside an improvement board, which has been established.

At such an important time, when Cornwall’s NHS trusts are working hard to improve the quality of care, which they need to deliver for Cornwall, it is essential that momentum is not lost. The regulation of the quality of care is vital to patient confidence. The ability of patients and clinicians to access information about the quality of services provided, as well as their being able to feed in information to the inspection and regulation regime, is very important. With the abolition of many centrally imposed targets and more devolved target setting and commissioning, the regulation and inspection of the quality of commissioning will need to adapt to this new environment. Many local factors are important to health outcomes in Cornwall, such as access to services, and those will be able to be taken into consideration. There is also an opportunity to invite the greater involvement of patient and clinical experience of services into the regulation and inspection regime.

The information provided to patients must embrace all that goes on to make up quality, including access, waiting times, cleanliness, infection rates, quality of clinical care, results for patients, access to same-sex accommodation and single rooms, cancelled operations, emergency readmissions, discharge arrangements, numbers of complaints, patient experience and patient-reported outcomes. Most of those data already exist, but they are difficult to access for many people. An open attitude to acknowledging and acting upon criticism is also needed to drive up the quality of care. If we had an open information culture, the scandalous failings that took place in Maidstone and Tunbridge Wells and then at Stafford hospital would not have gone unchallenged.

I am concerned by the number of clinicians in the NHS in Cornwall who tell me that when they challenge their manager and try to improve a service for patients they are told, “Nothing can be done”, “There’s no point saying anything as nothing will change” and, “Don’t ask, don’t tell, don’t complain”. At Mid Staffs there was clearly a sense among some of the professionals, and indeed the public, that the hospital had problems, but that was just the way things were done. That is just not good enough. We should never allow that sort of thing to happen again.

[Andrew George (St Ives) (LD)]

My hon. Friend is making a good point, particularly about whistleblowers in the NHS. It is vital that they are treated seriously and not threatened or bullied as a result of their whistleblowing.

Within the coalition agreement, to return to the role of patients and the local community, there was a commitment to a strong voice for patients locally through directly elected individuals on the boards of local primary care trusts, with the other members being representatives from the local authorities. However, those PCTs will be abolished. Does my hon. Friend agree that in Cornwall we need to ensure that there is some democratic accountability and community representation in the overview, scrutiny and management of the local NHS?

[Sarah Newton]

I thank my hon. Friend for that comment and I am sure that when the Minister replies he will describe some of the proposals in the White Paper to give local authorities and representatives far greater involvement in the overview and scrutiny of health services.

Instead of whistleblowing being seen as going outside the organisation, we should see such challenges as integral to safety and improvement within the organisation. In April 2009, John Watkinson was dismissed from his role as chief executive of the Royal Cornwall Hospitals NHS Trust. He took his case to an employment tribunal, which has published its judgment that he was unfairly dismissed. In the opinion of the tribunal, he was unfairly dismissed because he made a “protected disclosure” covered by the Public Interest Disclosure Act 1998. The disclosure was linked to the reconfiguration of upper gastro-intestinal services in Cornwall. The tribunal also found that the trust acted as it did as a result of pressure from the South West strategic health authority. Verita, a specialist company that conducts independent investigations, reviews and inquiries, has been commissioned to undertake a review and will report later this year. With a different culture in the NHS, this difficult situation might well have been avoided.

In the same way, instead of seeing complaints as a burden, distraction or something to be dealt with outside mainstream service provision, we must see them as integral to the improvement of the service that we provide. Learning from our mistakes, listening to complaints, comparing what we do, evaluating our performance and constantly seeking to improve quality are the features of the best performing organisations in every sector, and they can be already found in the best performing NHS trusts.

Listening to patients—asking, reporting and learning from patient experience—will be of great importance in designing and improving services, including achieving greater efficiency. However, the NHS too often asks insufficiently penetrating questions, insufficiently frequently, of too few patients. The NHS patient survey, which asks whether patients are satisfied with the care they received, is too much like asking patients if they are grateful.

I have read with interest the section in the White Paper entitled, “Autonomy, accountability and democratic legitimacy”. It sets out the outline of the proposed registration, evaluation and inspection regime. The Care Quality Commission process is new and generally thought to have made a good start in Cornwall, and I am pleased to see that it has an extended role in regulating quality of care.

Given the important stage that the NHS trusts have reached in Cornwall, assistance from those aiding the improvements that have already been identified in action plans needs to continue. As a result, I want to understand what plans the Minister has to develop the regulation and inspection of care providers and commissioners to ensure that standards of health care and the confidence of clinicians and patients in that care are improved. What is the time frame for migrating from the current regime to the new one and who will be involved in the consultation process for the creation of the new regime?