Contaminated Blood

Steve McCabe Excerpts

Tuesday 12th April 2016 Commons Chamber

[Nadhim Zahawi]

I have had similar representations from my constituents, and I hope that those on the Treasury Bench take on board the comments of Andy Gunn and of others in my constituency.

The vastness of the loss we are addressing today is such that even the ideal solution cannot do much to address it, but what has been proposed does so much less. The proposals contained in the consultation are far from what the victims of this injustice expected or were led to believe they would receive. I know that many of my colleagues have similar stories to tell. I have had constituents visit my surgeries who have always been so incredibly strong about what has happened to them and hopeful for the potential of a good settlement from the Government, but have now been left in tears. They feel let down and fear that these proposals will make life even harder for them.

Those are people whose lives have turned out to be radically different from what they had planned, through absolutely no fault of their own. They struggle to get insurance or pensions—things we take for granted in this place—and have had their careers curtailed. Even worse, they have been unable to have children, or have seen loved ones die tragically soon. These people should be helped and need to be provided with a full and final settlement that allows them to move on, without being worse off.

There remains much misunderstanding about the medical conditions of the victims and the treatments available. The improvements in care for those with HIV/AIDS have been a blessing for many. However, the disease remains incurable, and haemophiliacs and those with other conditions such as hepatitis C cannot take the medication that could help them. We must also properly consider those infected by more than one disease. Those with both HIV and HCV have a threefold greater risk of progression to cirrhosis or decompensated liver disease than those infected only with HCV. We should not misunderstand, underestimate or underplay the dangers of these diseases.

My constituents, and the constituents of so many of us here today, have suffered a grave injustice. It is an injustice that they never expected to suffer, would never have been able to prepare for, and for which the blame rests entirely elsewhere. They or their loved ones have experienced terrible illness and their lives have been changed or ended. “Unfairness” does not seem strong enough to describe it, but that word is the best we can do.

The Prime Minister was right to apologise, but this consultation does not go far enough. When my constituents only have to look north of the border to see a better deal on the table, with talk about public monuments to those sadly lost, and are then faced with an option here that could leave them in an even worse position, anger and resentment are more than understandable.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Does the hon. Gentleman agree that there is a danger that the consultation will undo the good of the apology? The impact assessment states that the intention of the policy is to safeguard the interests of those who are chronically infected and receive an annual payment, but that annual payment is no longer index-linked, and people have made their assumptions on that basis. My constituent, Norah Tracey, has had to take early retirement because she has hepatitis C, and she based her projections on those financial assumptions. If it is no longer index linked, we are making a mockery of what the impact assessment says and we are undoing the sincerity of the apology.

[Nadhim Zahawi]

I thank the hon. Gentleman for that intervention. I have heard similar representations from my constituents. Indeed, the all-party group found that the representations were very similar across the board. I sincerely hope that those on the Government Front Bench are listening to these interventions today.

The Prime Minister said last year:

“As a wealthy and successful country we should be helping these people more. We will help them more”—[Official Report, 11 March 2015; Vol. 594, C. 289.]

I agree with him and support those words entirely. I hope that the Minister and the Department of Health will ensure that the settlement for the victims will meet the intentions of what the Prime Minister said last year.

Katie Road NHS Walk-in Centre

Steve McCabe Excerpts

Wednesday 24th February 2016 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Tonight I am seeking an opportunity to shed some light on the continuing saga of the Katie Road NHS walk-in centre in my constituency. Its future status has been in doubt ever since its fate was placed in the hands of one of the new clinical commissioning groups. My constituents have had to live with rumours, on-off consultations and continuing threats to the long-term future of an immensely popular and highly valued service that sees about 70,000 patients a year. The origins of the service lie in concerns that the large number of students in the area, as well as vulnerable individuals—often with mental health conditions and in unstable accommodation—were placing a demand on GP services that could not be met by existing provision, which was in turn placing intolerable strains on the local accident and emergency services.

My own fairly extensive consultations with constituents have established that the centre is regularly used by those who cannot easily secure quick appointments with their own GP. That is often a problem for those in work—especially those who work unsocial hours—and for families with elderly relatives or young children who cannot easily gain access to GPs at weekends or in the evenings. The Katie Road centre sees about 300 to 400 patients during an average weekend.

There is now fairly widespread recognition of the value of walk-in centres. The 2014 Monitor review reported rising demand for the service year on year. About 70% of the centres that were surveyed reported that they were seeing an average of 20,000 to 45,000 patients a year, as opposed to anticipated attendances of between 12,000 and 24,000. Yet despite the demand and support for walk-in centres, local commissioners have closed more than 50 since the start of 2010, reduced services at 23 others and reduced overall capacity by about 20%. I am not aware that, other than the Monitor report, there has been any substantial review into the impact of that loss of provision. I wonder whether the Minister is in a position to enlighten me, and whether he might take this opportunity to say what the Government’s position is on urgent care generally and walk-in centres in particular. I noticed that the Department of Health consultation “Refreshing the Mandate” says that

“we want to improve people’s access to primary care through new forms of provision including rapid walk-in access.”

In early 2013, Birmingham CrossCity clinical commissioning group announced plans to consult on the future of the Katie Road walk-in centre. That was apparently based on a report commissioned by the former South Birmingham primary care trust, a report that remains secret to this day. I first asked to see a copy of it in March 2013. In June 2013, the CCG called off its plans for walk-in centres and it was announced that they had been saved, only for the chair of the clinical commissioning group to reveal later that it planned to renew the contract temporarily and that Katie Road had been saved for 12 to 18 months. Later, the CCG announced that it planned a two-stage consultation, with a pre-consultation phase and then a main consultation with the public.

Naturally, I wanted to ensure that my constituents had their say on the matter. When I consulted them, I discovered that more than 72% had experience of using the centre and were firmly opposed to any plans to close it.

[Craig Whittaker (Calder Valley) (Con)]

I agree that walk-in centres have the ability to take pressure off overworked A&Es, but does the hon. Gentleman agree that the best way to take pressure not just off A&Es but walk-in centres is to have GP surgeries open seven days a week, so that people can access services overall?

[Steve McCabe]

I might agree with that, but one of the problems in my area is that GP surgeries have been cut as well, so that is not the answer.

As I said, more than 72% of the people I consulted had experience of using the centre and were firmly opposed to any plans to close it. I also found that 56% of people had used the centre for out-of-hours emergency treatment, and 55% expressed serious concern about any plans to move the service to or near the A&E unit. My findings are consistent with that of the survey conducted on behalf of the NHS central midlands commissioning support unit in 2012, which found that more than two thirds of patients surveyed at eight walk-in centres and urgent care centres across Birmingham and Solihull indicated that they had attended because of an access-related issue—for example, they could not get an appointment with their GP or had to wait a considerable time to be seen.

There were major objections from my constituents to relocating their walk-in centre to the main hospital. They referred, for example, to the distance, waiting times, parking and accessibility. During a visit to Katie Road, I witnessed an ambulance crew bring into the walk-in centre an elderly lady in need of stitches to a leg injury. They did that rather than take her to the A&E unit because of their concerns over the likely delays. The CCG’s own figures suggest that an average visit to the walk-in centre costs around £45, as opposed to £75 to £100 for an A&E visit.

I am aware that there are many examples of walk-in centres being co-located with other health or social care services, and that some have a pharmacy on site or are co-located with diagnostic services such as X-ray services, dental facilities or family planning, but I should like to ask the Minister whether there is any evidence that shows an obvious advantage in co-locating an urgent care or walk-in centre alongside an A&E unit, especially evidence that would outweigh such negatives as distance, waiting times, parking and accessibility. In fact, is it not the case that most walk-in centres have a limited ability to refer patients on to secondary care services, as patients needing a referral to secondary care are normally referred by GPs, who are the traditional gatekeepers—a role that has, if anything, been strengthened as a result of the reorganisation of the NHS?

In autumn 2013 the CCG commenced its pre-consultation. The chair of the CCG met with a number of my constituents in February 2014, when he heard clearly their desire to retain Katie Road and their objections to a plan being pushed by the CCG to relocate the walk-in centre to a site at the University Hospitals Birmingham NHS Trust site, adjacent to the hospital’s A&E unit. In July 2014 I invited the chair of the CCG and a number of his staff to take part in a second meeting attended by more than 80 constituents—we were limited by the size of the room, or it would have been many more. At that meeting they heard clearly once again that there was total opposition to the closure of the walk-in centre and the plans to relocate to the hospital. That review or consultation eventually fizzled out, with the promise of a bigger and better consultation later in 2014.

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

The issue of such walk-in centres closing down is difficult for all of us in our constituencies. It is no good Conservative Members saying that we will have a seven-day a week GP service, because what they have done already with regard to the junior doctors dispute shows that they are not capable of doing that. That means that our constituents will continue to suffer. In particular, those at work cannot access services and are therefore put at greater risk through further misdiagnosis or non-diagnosis.

[Steve McCabe]

My hon. Friend will know very well that there is a problem with GP provision in his part of Birmingham as well as my own, so it is difficult to see how it could be stretched further.

As I said, we were promised a bigger and better consultation for later in 2014, but that was abandoned in light of the impending general election, the date of which had, obviously, been known since the Fixed-term Parliaments Act 2011.

No satisfactory explanation for the proposed change has ever been provided, but now, once again, the CCG wants to consult on the future of the walk-in service. This time it apparently wants to consult on a new model of service, the details of which are known only to itself but which has apparently not been clinically tested. It appears that, once again, it involves plans to relocate the walk-in centre to a site adjacent to the A&E unit.

As the Minister will know, sections 75 to 77 of the Health and Social Care Act 2012 specifically state that commissioners are required to act in a transparent way when procuring services:

“Transparency is important in ensuring that commissioners are accountable for their decisions. As noted, commissioners also have a duty to involve the public in commissioning decisions.”

It is not clear to me where in that part of the Act there is support for a series of bungled and inadequate on-off reviews and a constant determination to impose one outcome irrespective of the arguments to the contrary. I would welcome the Minister’s view on that. I am deeply concerned at the continuing threats to the service, which plays such a vital part in the delivery of healthcare for my constituents. I cannot see how the loss of a provision such as Katie Road is consistent with the Government’s ambitions for a seven-day NHS—perhaps the Minister can advise me on that.

Ironically, I have recently discovered that the opening hours of the Katie Road centre are to be extended to help cope with winter pressures. Dr Lumley, who works with the neighbouring CCG, which also serves south Birmingham, is quoted in the press as saying, in response to that announcement, that

‘this is great news for patients in Birmingham and means they can access the Walk in Centre until late, seven days a week.”

Such a pity her views are not shared by her colleagues in CrossCity CCG, who assumed responsibility for Katie Road in the carve-up following the introduction of the Lansley reforms.

It seems to me that the CCG is clearly out of its depth in handling a public consultation, or certainly one that can command any public confidence. What advice and support, if any, do the Government offer to CCGs on conducting consultations with the public? I am curious to know how much public money—money that could obviously have been spent on patient care—the CCG has spent on its on-off reviews and consultations so far. Is there any limit to how much public money a CCG is entitled to spend on a review or consultation on a single issue? If so, how much is it? Who is ultimately responsible for making a decision on the future of urgent care provision in south Birmingham? Do the Government accept any responsibility for this unsatisfactory state of affairs, and is there anything the Minister can do to help me and my constituents secure the future of this popular and well used health resource in south Birmingham, which is clearly needed and highly valued?

At the very least, I urge the Minister to write to the chair of the CCG following this Adjournment debate, urging him to communicate properly with my constituents and their elected representatives, to stop repeatedly trying to impose plans that have already been rejected and to bring this whole sorry state of affairs to a satisfactory conclusion.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the hon. Member for Birmingham, Selly Oak (Steve McCabe) for his clear outlining of the case for his constituents and for Katie Road walk-in centre, and I congratulate him on securing this debate. He touches on an interesting issue for the NHS as a whole, one with which clinicians have been grappling in the past few years: what is the nature of urgent and emergency care in a world where demography is changing rapidly, where demands on the service are changing and where there are incredibly different and disparate populations? He rightly points out that he represents a constituency that has a high student population, that has areas with high levels of deprivation and that has a wide mix of ethnic diversity. Other parts of the country have a significantly ageing profile and do not have the ethnic mix that he is able to enjoy in his part of Birmingham; they have a different socio-economic profile.

What is clear for commissioners and for clinicians is that the answer for urgent and emergency care in one area is different from that in another. I know that might be stating the bleedingly obvious, but it was something that was not observed by the NHS before Professor Sir Bruce Keogh initiated his review of urgent and emergency care in 2013. The result of that was a holistic, sensible and coherent plan for how urgent and emergency care should be delivered across the country. The variation in care, from Northumbria down to Cornwall, is extensive at the moment; there are considerable differences. The hon. Gentleman has highlighted the fact that there are differences even within the city of Birmingham. At the very least, we have made progress in the past few years in having a vision of what urgent and emergency care should look like. The challenge is to try to implement that across the service, which is why, over the past two years, considerable work has been done by clinicians and commissioners to try to understand how the principles of the Keogh review can inform the reshaping of emergency and urgent care in their patches.

As the hon. Gentleman has identified with the issue of one walk-in centre—he can imagine how such local controversies become all the greater when they involve accident and emergency centres and trauma centres—these are matters that are very close to the hearts of constituents, who rely on those services. Those services are there in their moment of need, and they are, in a very real sense, the single greatest embodiment of the NHS and its values. We must treat urgent and emergency care with the utmost care.

The plans that are being worked up across the country are being done carefully with commissioners in co-ordination with NHS England and, ultimately, with Professor Sir Bruce Keogh. Let me give the hon. Gentleman an idea of why that has been so carefully done and the extent of care that has been taken: it was only in the autumn that the route map for the whole country was published. I hope he will therefore understand why his local CCGs have had to revise the timetables by which they have been looking at urgent and emergency care. As he pointed out, they began their own study of this in Birmingham before Professor Sir Bruce Keogh undertook his review. They have had to revise their thinking in the light of that, and I know that they are taking forward their current consultation on the basis of the route maps that have been designed by NHS England with commissioners around the country.

The hon. Gentleman makes a fair point about process. I know why he is frustrated, and I completely understand his frustration. I also understand his irritation at the bureaucratese that can fly in his face as a representative of local people. I cannot specifically talk about the consultation of which he speaks because I do not have a detailed knowledge of it. All I can say is that in the NHS there are good and bad consultations. What we have tried to do over the past five years—and I am trying to do this in my current position—is to ensure that we bring the worst consultations up to the best, that we learn from where they have gone wrong and that they go better. I can of course commit to write to the chairman of his CCG, perhaps highlighting the work that has been done around producing very good consultations, reiterating the points that he has made in his speech, and asking for a clarification around each and every point that he has raised, so that he feels satisfied that he has raised his issues in the Chamber and that he can provide answers to his constituents. Clearly, he feels that, at the moment, there is much confusion and not too much clarity.

I spoke to senior commissioners in the CCG today in advance of this debate to ensure that I was availed of the facts of the situation. They assured me that there is a full intention to continue services at Katie Road. The centre’s value is understood and well known, which is precisely why there was a temporary extension of the hours till 10 pm to deal with the winter pressures that are felt across the service. The commissioners also made it clear that there has not been a predetermination about the location of a further urgent care centre. It will be in Selly Oak, and it will be considerably larger than Katie Road so it will be able to accommodate more services and will be of greater use to the hon. Gentleman’s constituents. The commissioners have not come to a decision yet about where it should be located. I know that they will want to engage fully with him and with the community in order to ensure that it goes to the right place.

[Steve McCabe]

When the Minister was given an assurance that Katie Road would continue, he was presumably told that the contract was due to come to an end. Was there any indication that there was an intention to have yet another roll-over contract, or whether there is a timescale attached to the consultation—yet another one?

[Ben Gummer]

No, I was not assured in that level of detail—I can ask for that information in my letter to the chairman of the CCG—but I think that the intentions were clear, and they seemed entirely honourable. They understood the purpose of the centre, and they clearly saw the disadvantage of those services discontinuing before a new urgent care centre opens. I think that they understand the hon. Gentleman’s perfectly reasonable point that there needs to be some sort of continuity of service so that local people know where to go and can feel confident about local service provision.

On the important point about location and co-location, it will be different for different areas. The hon. Gentleman might have local pressures at University Hospitals Birmingham that do not pertain elsewhere in the country. It might be right—we are having exactly the same discussion in my constituency at the moment—to make use of an A&E brand and say, “Right, you have one simple place to go,” or it might be right to locate services on a different site. That will be different for different places. That is why it was decided in 2009, under the previous Labour Government, to give commissioners a greater role in local decisions on urgent and emergency care, because they are the ones who know their patches best, and what I write in Whitehall might not be right for local conditions in Selly Oak, or anywhere else for that matter.

I cannot therefore give the hon. Gentleman an answer on co-location because it will be different in different parts of the country, but what I can tell him is that my letter to the chairman of the CCG will include a particular reference to the fact that he and his constituents wish to be consulted and that there needs to be a clear rationale behind the location so that people feel that it is done not for the ease of NHS-land, but for the betterment of patient service.

The hon. Gentleman asked about consistency with seven-day services. I would like to reassure him that we are building seven-day services on the basis of the urgent and emergency care networks that were outlined by Professor Sir Bruce Keogh in his 2013 review and the consequent work. Contrary to the suggestion of his hon. Friend the Member for Birmingham, Perry Barr (Mr Mahmood), the seven-day services programme is entirely clinically led. It draws on the work that the Academy of Medical Royal Colleges undertook in 2013 to develop 10 clinical standards. That is the basis of the work we are taking forward. The contract reform that we have undertaken, both for junior doctors and for consultants, is based in part on the recommendations of those 10 clinical standards, so it is routed entirely in the need to respond to the top clinicians’ advice on how we achieve consistency of service across seven days of the week.

I would therefore expect the results of any consultation into urgent and emergency care in Birmingham to match precisely the overall work that we are doing to ensure consistency of standards across seven days of the week, good access for patients and a clear and transparent approach to urgent and emergency care, which in parts of the country, as the hon. Gentleman has identified, can at times be both patchy and confusing.

Finally, the hon. Gentleman asked whether there is a threat to walk-in centres. Under this Government he will see continued investment in urgent and emergency care. We will seek to find greater clarity around urgent and emergency care so that there is a clearer brand and more easily recognisable services for local people, so that we eliminate inconsistencies across the service and so that we fulfil the best clinical advice on how to achieve better services in urgent and emergency care by following the recommendations of Professor Sir Bruce Keogh and the work that has been done by local clinicians since. I do not believe therefore that there is a threat to urgent and emergency care services, and I believe they will improve over the next four years.

That is why I am happy to promise the hon. Gentleman that I will continue to answer questions on Katie Road. Should he have any further concerns, I would be delighted if he came to me so that we could talk about them. I will do what I can to allay those concerns and to make representations on his behalf to his clinical commissioning group so that he can get the answers he seeks.

Question put and agreed to.

Sugary Drinks Tax

Steve McCabe Excerpts

Monday 30th November 2015 Westminster Hall

[Dr Huq]

No, but alcopops and such things have always been popular with young people, because they look harmless, but some of them have a high alcohol content. We have a golden opportunity, because the Government are working on a childhood obesity strategy, and we must not waste that opportunity We must think long-term and heed the BDA chief’s words:

“Public health policy must be guided by evidence, not by personal prejudice or commercial interests.”

So happy Sugar Awareness Week, one and all. I will be interested to hear the summing-up speeches.

[Steve McCabe (in the Chair)]

We have just over an hour, but I remind Members that we do not have to fill the entire time. I would, however, like enough time to be left for Helen Jones to reply to the debate. I call Philippa Whiteford.

--- Later in debate ---

[Geraint Davies]

On a point of order, Mr McCabe. Like you, I sit on the Panel of Chairs. I was here for the first one and a half hours of the debate, and I had to leave the room for 20 minutes. I have introduced a Bill on sugar, and I was wondering whether I could crave your indulgence and make a small contribution, given that the debate is meant to go on until 7.30 pm.

[Steve McCabe (in the Chair)]

You are welcome to intervene in the debate, Mr Davies, but we have moved on to the winding-up speeches.

[Geraint Davies]

I appreciate that, but I was wondering whether you might exercise some discretion.

[Steve McCabe (in the Chair)]

No, we are going to continue with the winding-up speeches.

[Barbara Keeley]

I was saying that I have concerns about how children and their families manage in the school holidays. For anyone who has not heard about it, I want to commend the Feeding Birkenhead project, and the work done on it by my right hon. Friend the Member for Birkenhead (Frank Field). The project makes sure that children have healthy food in the school holidays. It is sad that we need to think about that issue, but we do.

Between April and September 2015, Trussell Trust food banks in Greater Manchester gave more than 22,000 lots of three-day emergency food supplies to people in crisis. Of those, nearly 9,000 were directed to children. We have talked about choice, but if we think this through, we realise that, if families rely on food banks to feed their children, that will limit the number of healthy meals they can make with fresh food. Clearly, for people in the upsetting circumstances of not managing financially, feeding their child with something is better than seeing them go hungry.

At the start of the debate, we heard about people who do not have local shops that sell healthy food, and we have to take that into account, too. Some people are also fuel-poor, while others work a number of jobs, which leaves them with little time to cook. We must not, therefore, jump to conclusions about why people are in this situation.

We should look at the wider issues around poverty, which must be addressed to ensure that people can access a good-quality diet. There is an awful lot more to achieving a good-quality diet than just wanting to do that. How, therefore, does the Minister plan to help families that have to rely on food banks? Next weekend, I will be helping the Trussell Trust food bank to collect food in my local supermarkets. On a previous occasion, one donor gave me lots of vegetables—onions and things like that. I thought they were part of her shopping, so I ran after her to give them back. However, she said, “That is just to liven the donations up. All the packet food seems a bit dull.” However, that is not the way Trussell Trust food banks operate—they have to have packet and tinned food. We have to think through what is happening in families where there is a reliance on donated food, which will not always contribute to a good enough diet.

Education must play a significant role. We want to provide children and adults with information about how they can achieve a healthy diet. One of the most interesting things Jamie Oliver has done—it was not his recent interventions here in the House—was his programme showing people how to cook. There were families that existed entirely on one or two sorts of takeaway.

Junior Doctors’ Contracts

Steve McCabe Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

I am not saying that the existing contract is perfect—I do not think that the British Medical Association would say that either. A few months ago, an alternative contract was being discussed, the work on which was led by the former Health Minister, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). The answer is not the contract that is on the table at the moment.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State may say that the overall pay envelope remains the same, but, as far as I am aware, it has been really hard to fathom how the difference between the local education training board contribution and the individual trusts will work. It may not be the same, but even if it is, is this not an example of further administrative and organisational costs being imposed on the health service by a Tory Secretary of State?

[Heidi Alexander]

My hon. Friend is completely right. The lack of clarity in all these negotiations is something that I will come on to later.

The truth is that if the Secretary of State wanted to persuade junior doctors that industrial action is not the answer, he has the power to do so; it is his political choice.

Junior doctors are the lifeblood of the NHS. Two weeks ago, I spent a morning shadowing a junior doctor at Lewisham hospital. It was the single most powerful thing I have done since taking on this role. I was blown away by the skills, knowledge, humanity and professionalism I saw. The junior doctor I shadowed was working a gruelling 11-hour night shift and regularly works 60-hour weeks. I left the hospital asking myself how it could possibly be right to say to that individual, “You might be paid less for the work that you do.”

Children’s Palliative Care

Steve McCabe Excerpts

Tuesday 3rd March 2015 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I am grateful to have secured this debate and glad to have the opportunity to serve under your chairmanship, Mrs Main. I first became interested in this area through the work of Acorns children’s hospice in my constituency, which provides a valuable service to children and families from all over Birmingham. I cannot praise its work too highly.

I begin by acknowledging that I believe the Government are genuine in trying to establish a clear funding path for children’s palliative care and hospice services. I understand that the major change envisaged by the Government is the new per-patient funding system. It would be helpful if the Minister said more about how it will work and how he plans to ensure that it is properly monitored and reviewed. I also want to raise the issue of short breaks and bereavement care, as these elements are not included in the per-patient funding strategy.

The children’s hospice movement supports the principle of per-patient funding for children’s palliative care as a means of providing more sustainable, transparent funding through an NHS currency, commissioned by clinical commissioning groups and designed to complement NHS England’s commissioning of specialised children’s palliative care services.

I understand that the third strand of Government thinking is that local authorities should continue to be responsible for commissioning necessary elements of social care and that together this should create an overarching system where all elements of the care—clinical and non-clinical aspects, short breaks and bereavement support—are all provided for.

My purpose in seeking this debate is to address a genuine fear that the impending general election and uncertainty over the new system could lead to a funding hiatus that could have a damaging effect on the children’s hospice movement. If I have understood it correctly, the per-patient system is designed to reimburse providers according to the activity they undertake, and to incentivise both commissioners and providers to deliver palliative care in a child’s home, community or hospice setting, if that is consistent with the wishes of the child and the family, and clinically appropriate.

The idea of the currency is set out in NHS England’s 2014 document, “Developing a new approach to palliative care funding: A revised draft for discussion”, in which it is argued that the currency should make it easy for clinical commissioning groups to understand the specific needs of children with life-limiting conditions. It should also be possible for clinical commissioning groups to have a better understanding of what constitutes palliative care and of the potential cost drivers for commissioning.

What steps have the Government planned to ensure that those elements of palliative care not covered by the new per-patient funding system will be properly funded by local authorities and clinical commissioning groups? This new system is the product of hard work and, as I have indicated, the sector is generally favourable towards it, but it is worried about a number of aspects. For example, how will the costs incurred by providers during the transition be met, including costs of setting up new systems to record activity and of ongoing data collection demands?

The Government-commissioned palliative care funding review by Hughes-Hallett, Craft and Davies in 2011, was clear that introducing and implementing the new system should be cost-neutral to the sector. What support does the Minister envisage for the voluntary sector providers to enable them to implement this new approach?

It would be useful if the Minister outlined any plans to provide models of practice that show how the currency will work, especially in situations for children and young people subject to continuing care packages and personal budgets, as introduced by the Children and Families Act 2014. It would also be useful to understand how the data quality will be monitored and how comparisons of models of care and outcomes will be assessed.

It is not clear to me how the new system will deal with the issue of transition from child to teenager to young adult.

[Mr Robin Walker (Worcester) (Con)]

I congratulate the hon. Gentleman on securing this important debate. Acorns children’s hospice serves my constituency as it serves his. It has a fantastic hospice in Worcester. It has done some important work on transition space and supporting the many people who, because of advances in medicine, are living longer. Does he agree that it is vital that the Government engage with it on this work, to make sure that transition is properly supported by the future funding system?

[Steve McCabe]

Yes, I agree. That is exactly the point. It is fantastic that so many children now survive for so much longer. That creates new demands and service needs that have to be considered. I should be grateful if the Minister said what work is being undertaken, both within Government and the NHS, to ensure that these transition issues are being considered in any new funding plans. I concur with the hon. Gentleman on that. The Care Quality Commission report, “From the pond into the sea: children’s transition to adult health services”—that is its title, I kid you not—also indicated that this focus is important.

We are moving towards the election, so it would help if the Minister clarified where we are with all these plans. As I have said, I acknowledge that the intention is to create a fair and sustainable framework, but we are now in March—the projected launch date for the introduction of the new non-mandatory currency is March—and as yet, unless I have missed something, we do not know the Government’s intention. What I would really like to know, and what I think the hospices would like to know, is what is going to happen with the hospice grant? Is the intention that it should continue during 2015-16 and beyond? I am sure that the Minister appreciates that not knowing is a real source of anxiety and a blow to any attempts at long-term planning.

Almost 96% of children’s hospice organisations are worried, according to the Together for Short Lives survey, that CCG funding will be less than their existing grant and harder to access. That grant covered about 13% of the care costs incurred by children’s hospices and existing clinical commissioning group funding represents about another 12%. Uncertainty over almost 25% of previously guaranteed funding is a difficult basis from which to operate.

I am sure the Minister knows that these bodies rely massively on public generosity and fund-raising efforts, but they also need some core guaranteed funding. If the grant ceases and is not matched by equal funding elsewhere, 89% of children’s hospice organisations could be forced to reduce their services. Areas at risk include short-break services for 60% of users.

[Stuart Andrew (Pudsey) (Con)]

As someone who has spent 14 years working for the children’s hospice movement as a fundraiser, I am completely aware of the point that the hon. Gentleman is making. Short breaks are incredibly important, because they are not only a break for the child, but for the whole family. Often people arrive on a Friday looking utterly exhausted. Just being able to have some normal family time until Monday is a great relief for them. Is that not the importance of these short breaks?

[Steve McCabe]

I do not think we can in any way overestimate the importance of short breaks to families and to children. Both need space at times, and the hon. Gentleman is absolutely right. The survey suggests that more than 60% of users could lose that service. There is also a risk of a 35% reduction in family support work, which is connected with short breaks and enables many families to keep going in stressful situations. There is also a risk of a 23% reduction in the amount of end-of-life care support provided.

Short breaks provide respite for carers and families and should be funded by local authorities and the NHS under their respective legal short-break duties. Despite being key providers of short breaks, a third of children’s hospices are not recognised by local authorities as being short-break providers. Some 42% of children’s hospice organisations receive no funding from local authorities. Page 56 of the palliative care funding review report states that

“pre-bereavement support is an absolutely essential part of palliative care and should be fully funded by the state.”

The review goes on to state, however, that far from being universal, only 65% to 70% of local authorities have open access services. Without the children’s hospice movement, there will be a gaping hole in end-of-life care.

I am not here to criticise the Government’s intentions, but the combination of the election and a new system with many unanswered questions risks significant funding problems. As organisations try to tighten their belts and take on new responsibilities, there is a danger that they will fall back on what they know or believe they know. It will not help the children or families of children with life-limiting conditions if clinical commissioning groups fall back on a narrow, clinical model that focuses on the child’s health needs as defined by doctors. The currency should not be used as a top-up for the acute sector providers, who can access other tariffs to fund care for children with life-limiting conditions.

Palliative care for children with a life-limiting or life-threatening condition is an active and total approach to care, from the point of recognition or diagnosis through the child’s life to death. It embraces emotional, social and spiritual elements and focuses on enhancing quality of life. It also supports the family and includes managing distressing symptoms, providing short breaks and care right through to the point of death and bereavement. That more holistic understanding of palliative care is reflected in national policy documents such as NHS England’s “Actions for End of Life Care: 2014-16” and the 2014 Care Quality Commission handbook. I welcome the interest that the Government have shown in an often neglected area, but we now need some clear messages, actions and signals to ensure that valuable work is not wasted and that an easily avoidable funding crisis is not allowed to develop. Local authorities under significant financial pressures are highly unlikely to fund what they might see as additional services unless required to do so. NHS England’s draft currency for children’s palliative care should be accompanied by clear guidance to local authorities on funding short breaks and bereavement care.

I would like the Minister to give an assurance that the structure is clear and that the intention is to have a three-source funding arrangement, with NHS England commissioning specialised children’s palliative care and utilising the experience of the children’s hospice movement, with CCGs commissioning general children’s palliative care using the new per-patient funding system and working closely with children’s hospices and with local authorities required to commission social elements of palliative care, such as short breaks, bereavement care and support for siblings and other family members, and seeing it as their duty to work with children’s hospices. It is vital that all three funding sources complement one another. If not, there is a risk that local authorities will regard those services included within per-patient funding as the entirety of palliative care and avoid playing their part. NHS England’s specialised care could fall prey to a narrow medical model and never leave the acute hospitals.

The Government need to provide some specific distinctions between specialised and general palliative care, so that one side is not tempted to avoid its responsibilities by relying on the funding of the other. We also need to know that NHS and local authorities are clear about their duties under the Children and Families Act 2014. It places a duty on them to jointly commission care for children and young people with special educational needs and disabilities up to the age of 25. I urge the Minister to provide what answers he can today to a valuable sector, which eagerly awaits his response.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

This Government have absolutely not made any decision to cut children’s mental health services, and the hon. Lady knows it is misleading to suggest otherwise. These decisions are taken by local commissioners in local authorities and CCGs. Indeed, we have legislated for parity of esteem for mental health. I urge her to look at the outcome of the work of the children and young people’s mental health and well-being taskforce, which I think gives us a real opportunity to improve the way in which services operate.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

11. How many nurses per million population were working in the NHS in each of the last five years.

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

The full-time equivalent number of nurses, midwives and health visitors working in the hospital and community health services in England per million population from September 2010 to September 2014 inclusive has remained broadly constant at 5,872, 5,768, 5,703, 5,712 and 5,781 respectively.

[Steve McCabe]

In response to 11 parliamentary questions that I submitted in the past year, the Minister has admitted that he does not know how many part-time, agency and locum GPs are in the health service, the number of agency and part-time nurses, the number of part-time doctors in our hospitals, or how many working nurses and midwives are also drawing their pensions. Given that he has so little detail on staffing, where did today’s figures come from, and what faith can anyone have in them?

[Dr Poulter]

They are in the monthly staff statistics survey. As the hon. Gentleman would like some detailed information, I am sure he will be pleased to hear that in his constituency there are now 386 more nurses than there were in 2010 under the previous Government, and nationally there are 7,500 more nurses, midwives and health visitors working in the NHS.

GP Services

Steve McCabe Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

The hon. Gentleman raises an important point and he is absolutely correct. I will refer to that later in my speech.

There can be no doubt that GP recruitment has not kept up with the demands of our population. That is the key problem today. In addition, the pressure on hospitals has increased massively because if people cannot see their GP they often go to A and E. That has been a problem in areas such as mine. There is also the inability of hospitals to discharge frail, elderly people from wards into the community because of the shortage of care in the community. Councils face massive budget cuts, so there are pressures all round. There are pressures on GPs in relation to access and there are pressures on hospitals and elsewhere.

I want to raise a particularly important point with the Minister that I have raised before. The Government are proposing to demand a 3.8% efficiency saving in the national tariff for 2015-16. That will push many hospitals to breaking point and possibly endanger patient safety. I hope that the Minister will look at that again. Members should read the briefing on that from NHS Providers.

There is clearly a view among many that general practice is heading for some sort of crisis. One GP in Halton told me recently:

“The overwhelming problem is the manpower crisis and the rock bottom morale of the Profession, which are interlinked. We are unable to recruit new GPs into practice or medical students into our specialty, training places are left unfilled and there are vacancies all over the country with very few applicants.”

It is hardly surprising we have that problem when we consider what the RCGP has said:

“Funding for general practice has fallen to an all-time low of only 8.3% of the overall NHS budget…GP surgeries are now seeing 372 million patients a day, compared to 300 million a day in 2008.”

Some family doctors are seeing 40 to 60 patients a day. That is unsustainable in the long term. Some 49% of GPs say that they can no longer guarantee safe care to their patients.

The RCGP tells me that the average coverage is 6.9 GPs per 10,000 of population. That is the lowest level of coverage since 2011. The RCGP estimates that up to 543 practices in England could face closure due to the fact that 90% of GPs working in those practices are 60 or over or are likely to retire soon. The hon. Member for Kettering (Mr Hollobone) made that point.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I certainly agree with my hon. Friend’s point, but does he also agree that the constant stop-go policies and the changes in contracts and the confusion over NHS England and clinical commissioning groups is adding to that problem? In my constituency we have the Bournbrook Varsity practice. It expanded and did everything that was asked of it by the primary care trust to create a broader health service. It now finds itself about to be penalised, have its funding cut and have to reduce staff in an area where there is a huge student population. Those students will inevitably gravitate to A and E if this service goes.

NHS Major Incidents

Steve McCabe Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

That is absolutely right, but Members on the two sides of the House hold different views. We believe in devolving power locally and we want local decision-making. We accept that that might mean that sometimes services are slightly different in one part of the country compared with another, but the benefit is that we do get that local knowledge. In the past few weeks, I have spoken to South Western ambulance service, which had particular pressures over Christmas, to ask whether there is anything we can do from the centre. What I want to ensure is that the decisions that keep my hon. Friend’s constituents safe are made locally, because they are likely to be better than any that I could make in Whitehall.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State is very reassuring when he says that, under him, the NHS is free from political news management. If that is the case, why does he not free it from the constraints of election purdah, and allow these officials to get on with their jobs without having to second-guess the consequences of some of the decisions?

[Mr Hunt]

We are not in election purdah. The point is that during election purdah we will continue to publish the weekly A and E performances and other figures from the Office for National Statistics, and that has always been the system. But there is a difference between what is happening in the run-up to this election and what happened in the run-up to the previous election. This time, the CQC is free to speak up, without fear or favour, about the quality of care in every single hospital in this country, and it will continue to do so.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I have met the doctors in Chippenham and been personally lobbied on that plan. I thought it sounded very promising, so I am happy to take it away and look at it again, and hopefully at some stage they can get some of the funding.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T4. The Bournbrook Varsity medical centre is about to face a double-whammy financial crisis, as NHS England scraps its minimum practice income guarantee and forces it to switch from a personal medical services contract to a general medical services contract. Why should that excellent practice, which has done all that could be asked of it, and its patients be victimised because a high proportion of the patients are young students? Will the Secretary of State agree to look at this disaster immediately?

[Mr Hunt]

I am very happy to look at that issue.

NHS Investigations (Jimmy Savile)

Steve McCabe Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. Today’s report is about the NHS and the BBC report is ongoing, as is the report being done by the Department for Education and the work being done by other Departments. We have to wait for the BBC to make its own statement on the matter, but my priority now is NHS patients, and the reason that I wanted to go at speed on this was to make sure that any changes we need to make now, we do so.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State says, quite understandably, that we cannot undo the past, but there are several people culpable in this affair who are still drawing substantial NHS pensions. Why does he not consider docking their pensions, as a consequence for their behaviour and as a clear warning to others?

[Mr Hunt]

I do not rule that out at all. If someone has behaved in a way that is in breach of either the law or the regulations that were in place at the hospital in which they worked, and there is a way to have legal redress such that things like pensions can be docked, I think that they should face the full consequences of that.