Social Care

Toby Perkins Excerpts

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley]

We do not even know what the Chancellor is going to do next week. The hon. Lady has invited me to make a declaration today, and it was a nice try, but we did not hear a word from Ministers about their plans during Health questions yesterday. I will, however, make what I think is an important point to the hon. Lady and to any other Member who raises the same issue. Labour would not have put our councils in this position to start with. If the hon. Lady looks back at our spending plans, or looks at the analysis by the Institute for Fiscal Studies relating to the different parties, she will find that our plans meant that we did not have to make the cuts that her party has made. This Government’s cuts will take £5 billion out of social care. I will send her the link to the IFS analysis if she wants to read it.

[Toby Perkins (Chesterfield) (Lab)]

My hon. Friend is making a powerful case. The scale of the crisis in some areas is very serious, and it will become even worse following the increase in the minimum wage. Although that increase is welcome, if the local authorities do not have the budgets to cover it, the crisis will be exacerbated.

Is my hon. Friend aware that many providers in both the private and the charitable sectors are returning council contracts? They are saying, “We can no longer make this pay; in fact, we will go bankrupt if we carry on servicing the council.” That is adding to the current problems.

[Barbara Keeley]

My hon. Friend has made a key point. I have already mentioned the fragility of the care market. We shall not be able to explore that fully during my speech, but it is a serious factor. If we do not get the funding right, more and more care providers will simply walk away. At the Unison meeting, members of a Leicestershire rehabilitation team spoke of the problems that they experience when care providers walk away from a contract. When the staff are not there any more, they have to plug the gaps.

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[Wes Streeting (Ilford North) (Lab)]

rose—

[Toby Perkins]

rose—

[Mr Hunt]

I will give way to the hon. Member for Ilford North (Wes Streeting) first.

[Mr Hunt]

I acknowledge the financial impact of the national living wage and will talk about the funding of local authorities.

[Toby Perkins]

rose—

[Norman Lamb]

rose—

[Mr Hunt]

I will give way once more now and will then try to give way to everyone during the course of my remarks.

[Toby Perkins]

The Secretary of State is being generous in giving way. He started his peroration by talking about the importance of care for the elderly and he is absolutely right about that. Does he agree that we are also talking about caring for people with learning and physical disabilities? The care debate is often entirely about the elderly, but it is much wider than that.

[Mr Hunt]

The hon. Gentleman is absolutely right to make that point. I want to talk about Winterbourne View a little later, because this is not just about older people.

Community Pharmacy in 2016-17 and Beyond

Toby Perkins Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[David Mowat]

I give the hon. Lady that assurance. She used the word “integration”, which is right at the core of the proposals, as is modernisation. This is a patient-first initiative and we are going to make it happen.

[Toby Perkins (Chesterfield) (Lab)]

It is interesting that the Minister keeps referring to the evils of major chains, because it is impossible to listen to his statement and not realise that he is talking about supporting big pharmacies. Smaller pharmacies, which do not have such a wide patient base and do not offer such a wide range of services, will suffer. Does he acknowledge that small pharmacies will close as a result of the changes? Will he say more about where the savings will come from?

[David Mowat]

The scheme that we are putting into place is blind to ownership, so we will not take into account whether a pharmacy is a Boots, a LloydsPharmacy or something smaller. Given the gross margins that are currently being made by the average pharmacy, including smaller ones, I do not believe that the efficiency savings that we are asking for will cause widespread closures. It is scaremongering to imply that.

Community Pharmacies

Toby Perkins Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

I am always keen to be popular, but I am also keen to do the right thing. Nobody is talking about thousands of pharmacies closing and I do not believe that will happen, but we have talked about hiring 2,000 more pharmacies in the GP sector. That is true, but that is not incoherent; that is the right thing to do.

I just say this to the House: we all need to distinguish at times between the pharmacy profession, which we need and will nurture and help to grow and that can produce all these added values, and those people who own the pharmacy shops, 65% of which are public companies and private equity. The House should just reflect on that.

[Toby Perkins (Chesterfield) (Lab)]

It really is possible that the centre-ground in British politics is changing. Here we have a Conservative Minister coming to the Chamber to say, “I’m going to put hundreds of small firms out of business, but don’t worry; I’m going to get them all working for the Government.” It is absolutely bizarre, and the Minister is now trying to convince us by saying, “Don’t worry, they’re all hedge funds anyway.” We know it is not the Boots in the centre of Chesterfield that is going to be shutting; it is the community pharmacies in each of our communities. So will the Minister at least give us the commitment that no community will be left without a pharmacy and that no doctors’ surgery will be allowed to have a pharmacy close on its doorstep?

[David Mowat]

I will give the hon. Gentleman the commitment that no community will be left without a pharmacy.

Junior Doctors Contracts

Toby Perkins Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

I wonder whether the hon. Gentleman would have the courage to say that in Wales, but let me answer his question directly. The 15% increase in mortality rates for people admitted at weekends falls to 11% when we take account of the more chronic conditions, so there is a small reduction, but the mortality rate is still significant.

[Toby Perkins (Chesterfield) (Lab)]

May I take the Secretary of State back to the question he did not answer when it was asked by my hon. Friend the shadow Secretary of State? If the Government are now arguing that the Secretary of State does have the power to impose a contract, can he explain why Government solicitors did not argue that case in their letter of 15 April? Can he point to where it is proved that he actually has that power?

[Mr Hunt]

We do have that power by law. The letter we put out in defence against the legal action that has been taken against the Government explains very clearly why and how we have that power. It is all written there for the hon. Gentleman to see. I assure him that, on something as contentious and difficult as this, we take every care to make sure that we are acting within the law.

General Dental Council

Toby Perkins Excerpts

Tuesday 9th December 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone, and a great pleasure to respond to my hon. Friend the Member for Mole Valley (Sir Paul Beresford). I congratulate him on securing the debate and on bringing to bear his front-line experience of working as a dentist, both in this debate and more generally. He has shown his experience today in getting to the heart of some of the issues he raised, as he has done in many debates in the House on issues relating to health care.

The General Dental Council is an important part of the health care regulatory framework that ensures the fitness to practise of health care professionals and the safety of patients. It is right that we should debate the GDC’s performance, particularly in the light of a less than complementary performance review by the Professional Standards Authority, and given the major rise in the fee that dentists will be expected to pay to their regulator.

My hon. Friend will be aware that the General Dental Council is an independent statutory body that is directly accountable to Parliament. However, as he rightly highlighted, I have no legal basis to intervene in matters such as the level of the fee, which are deemed to be part of the body’s operational running. However, in my role as Minister, I have a keen interest in the performance of the professional regulators and have regular contact with them, including the GDC, on a whole range of issues.

The background to today’s debate is that the General Dental Council recently took the decision to increase the annual registration fee for dentists by 55%, from £576 to £890, which is a significant and unprecedented increase. All professional regulators, including the GDC, are aware of the Government’s position, as set out in our 2011 Command Paper, “Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff”: we do not expect registration fees to increase unless there is a clear and strong case that the increase is essential to ensure the exercise of statutory duties.

While the General Dental Council has consulted its registrants on the proposed fee rise, I am aware of, and sympathetic to, a strong body of opinion among its registrants that they are yet to be presented with compelling evidence to justify such an unprecedented fee increase. The proposed fee is more than double the £390 that the General Medical Council requires licensed doctors to pay. That is why, when I met the GDC, I raised concerns about the fee increase and reconfirmed the Government’s position on the need for a strong and transparent case for any such increase.

I have also strongly suggested to the GDC that it considers a differential rate for newly qualified dentists. Newly qualified doctors are required to pay £185 for their registration with the GMC, while newly qualified dentists pay the same as established dentists. The GDC stated to me as justification for its fee rise that there has been a 110% increase in the number of complaints from patients, employers, other registrants and the police about the dental profession, and that the cost of handling such complaints has been the key driver of the increase. However, I have not been presented with what I consider to be compelling evidence that a fee rise of that magnitude is justified by a 110% increase in the number of complaints.

It is worth noting that other health care regulators, as my hon. Friend suggested, have experienced increases in complaints but have not felt compelled to raise their fees to the same extent. I therefore understand why the British Dental Association has chosen to test this decision and issued judicial review proceedings challenging the setting of the fee. The hearing is set to take place next week, so I am sure that hon. Members will understand that it is inappropriate for me to comment further on those proceedings.

[Toby Perkins (Chesterfield) (Lab)]

I am grateful to the Minister for giving way, and I congratulate the hon. Member for Mole Valley (Sir Paul Beresford) on securing this debate. I have been written to by Derbyshire county local dental committee, which is concerned that the General Dental Council, under the leadership of its current chair, is investigating much more minor concerns than it did previously. That expansion in its role is one of the reasons why it is now asking dentists for more fees. Will the Minister let us know whether he thinks that the direction that the General Dental Council is taking is the wrong one, as my constituents clearly do?

[Dr Poulter]

As I said, under legislation, I am unfortunately powerless to intervene directly on fee setting. We recognise the independence of health care regulators and would not want them to be micro-managed by Government; that would be wrong. However, my view is very clearly, as I have outlined, that a strong evidence base is needed to justify a fee rise. Given that other health care regulators faced with similar challenges have not raised their fees to the same unprecedented degree, I have not myself been convinced that the evidence base is strong enough to justify this fee rise. I hope that that answers the hon. Gentleman’s question.

In that context, it is worth drawing attention to the section 60 order currently in progress in the House, and to the consultation process that has been taking place. The fee rise is perhaps all the more surprising as we are making good progress with the GDC on bringing in the legislative changes that will reform the way that it operates. Those changes, in the form of a section 60 order, will assist with reducing its operational costs by an estimated £2 million a year through potential efficiency savings. My hon. Friend the Member for Mole Valley made the point that all regulators need to look at better ways of working and efficiency savings in their own practice. Of course, that, as well as patient protection, is a benefit of introducing a section 60 order: it will help to reduce the running costs, potentially, of the GDC and streamline processes.

The public consultation on the GDC-related section 60 order recently closed, and the vast majority of respondents were supportive of the proposals. We therefore intend to proceed with the measures and will publish our response to the consultation in due course. My hon. Friend may be surprised to learn, as I was, that the GDC did not wait for the outcome of the section 60 order consultation before announcing the fee rise.

The changes proposed in the section 60 order will: enable the GDC to delegate the decision-making functions currently exercised by its investigating committee to officers of the GDC, known as case examiners; enable both case examiners and the investigating committee to address concerns about a registrant’s practice by agreeing undertakings with that registrant, which have the same effect as conditions on practice, without the need for a practice committee hearing; introduce a power to review cases closed following an investigation—rules to be made under that power will provide that a review can be undertaken by the registrar if she considers that the decision is materially flawed, or new information has come to light that might have altered the decision and a review is in the public interest—introduce a power to allow the registrar to decide that a complaint or information received did not amount to an allegation of impairment of fitness to practise; introduce a power to enable the investigating committee and the case examiners to review their determination to issue a warning; and ensure that registrants can be referred to the interim orders committee at any time during the fitness to practise process.

Very similar section 60 orders have been laid before Parliament in conjunction and consultation with other regulators, and a great benefit of those orders is that they are about not just protecting the public but supporting the regulators to have more streamlined processes and reducing costs. Of course, when costs are reduced, we would always expect the savings to be passed on to the people who pay the annual fee.

National Health Service (Amended Duties and Powers) Bill

Toby Perkins Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

And then led a campaign to stop his local accident and emergency department closing, having done that for the Government.

[Toby Perkins (Chesterfield) (Lab)]

I, too, congratulate my hon. Friend on his Bill. He also carries the congratulations of 1,924 people from across Chesterfield who have signed a petition asking me to be here to support it. He is not just speaking with people behind him here; people right across the country are saying, “Thank you very much for what you are doing.”

[Clive Efford]

I am grateful for my hon. Friend’s kind words and for the support of all the thousands of people, particularly health service staff, who have supported the Bill.

Accident and Emergency

Toby Perkins Excerpts

Wednesday 18th December 2013 Commons Chamber

[Toby Perkins (Chesterfield) (Lab)]

Hon. Members will remember that when the Prime Minister wanted to detoxify the Tory brand, he said that he could spell out his priorities in three letters—NHS—but people in Chesterfield have seen through that cruel joke. Opinion polls show us that the importance of the national health service is going up as the Government’s record is so terribly exposed.

I did a survey across Chesterfield this summer and spoke to people about a range of issues, as I did back in 2009. Back then, satisfaction with the NHS was clear, but now 37% say that GP services have got worse, and just 12% say they have got better. Only 8% say that they think the NHS has got better since 2010; almost 50% think it is getting worse.

I want to focus on the part of the motion that deals with the difficulty of accessing GP services, which is one of the primary causes of those figures. Some 42% of people who appear in A and E have previously attempted to contact GP services. Hon. Members might remember my raising the case of Jemma Hill on 22 October with the Secretary of State. Her GP referred her to a specialist, who recommended hip arthroscopy surgery. She was then told that her clinical commissioning group would not fund the surgery. The Secretary of State promised to look into the matter if I wrote to him. I wrote to him on 23 October but still there is no response. Jemma Hill is still in agony. She sees a fragmented national health service leaving her behind.

The problems in the NHS, and in GP services in particular, are acute in the Staveley area. A recent Care Quality Commission report found that the Rectory Road and Grange health centres failed on five different criteria. I surveyed almost every house in Middlecroft and Inkersall, which are parts of Staveley, and had hundreds of responses. Eighty-six per cent. said that services were unsatisfactory or very poor.

I have here some of the comments of the people who responded. One says, “I don’t bother going to the doctors anymore. I could never get an appointment. I simply self-diagnose on Google.” Someone else said that they are entirely dependent on locums, meaning that when their scans or results come back, the GP is not there. One patient said that a GP broke down in tears in front of them. Another patient said that no one had contacted them after their blood test results. In fact, they should have been urgently sent to hospital—subsequently, they discovered they had cancer.

One person said that they waited eight weeks for a GP appointment. When they eventually got one, they were told that they had a hernia and were sent straight to hospital. Another person waited two weeks for an appointment for a repeat prescription, meaning that they did not have their prescription for more than a week. One 90-year-old said that they had to get a taxi to the surgery and had to queue outside at 8 o’clock in the morning.

I met a partner at that GP surgery and we discussed how it is desperately struggling to recruit people. There is a widespread GP recruitment crisis. I was told that a huge number of GPs have retired, either because they are disillusioned or simply because they want to get out of the service. Forty-three per cent. of GPs told a Pulse survey that they will retire earlier than they had intended because of how disillusioned they are.

My hon. Friend the Member for Wigan (Lisa Nandy) spoke about the massive impact the Government’s cuts to care services have had on A and E, but there is also a huge crisis in general practice. The people of Staveley, and people across the country, do not have proper access to a GP service. The problem is getting worse and it is exacerbating the problem in A and E. The people suffering are not only the brave heroes who work so hard in the national health service, but those in the most deprived communities in our constituencies. It is a disgrace.

Oral Answers to Questions

Toby Perkins Excerpts

Tuesday 22nd October 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am always happy to meet colleagues for discussions, particularly when they are championing important health care facilities in their local area. I can confirm that the Secretary of State has received a formal referral from South Gloucestershire council in relation to these proposals, and has referred them to the Independent Reconfiguration Panel. He will of course consider the panel’s recommendations before making a final decision, and I am sure that my hon. Friend would agree that it would be inappropriate to pre-empt those deliberations.

[Toby Perkins (Chesterfield) (Lab)]

T4. My constituent Jemma Hill is 25 and suffers from chronic hip pain, for which a specialist has recommended hip arthroscopy surgery. However, she has now been told that her local clinical commissioning group does not fund such treatment. Does it not make a mockery of GP-led commissioning when a CCG will not fund the treatment recommended by a specialist to whom the GP referred my constituent in the first place?

[Mr Hunt]

I am very happy to look into that matter, because it sounds like a very deserving case. I will look into the details carefully if the hon. Gentleman gives me the relevant information.

Health and Social Care

Toby Perkins Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I am pleased that we hit our A and E target in the NHS last year, but disappointed that in Wales, which is controlled by the Labour party, the A and E target has been missed since 2009. Those on the Opposition Front Bench still refuse to condemn that.

[Toby Perkins (Chesterfield) (Lab)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I will make some progress.

Even worse, when signs of how the targets policy was going wrong became clear, Labour’s response was to ignore or cover up the findings.

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[Andy Burnham]

I thought the new compassionate Conservative party was meant to have stopped “banging on about Europe”—that was the phrase, was it not?—but now its Members are all dancing to UKIP’s tune and reading out what Mr Crosby gives them. It will not wash. The country can see that this is a shambles of a Government who look ridiculous to the country they purport to govern. When Britain needed leadership, it got the farce of this coalition. There is no need to send in the clowns; they are already here.

[Toby Perkins]

Does my right hon. Friend think, like me, that perhaps the Government feel more comfortable exposing their divisions on Europe than facing up to their record on the NHS, which, as many people across the health service recognise, is an absolute disgrace?

[Andy Burnham]

I shall come to that point directly, because the Queen’s Speech is a diversion from the real issues, an attempt to say, “Look over here at this other issue” and divert people’s attention from the chaos the Government have visited on the NHS.

On health and care, our objection is not to the modest measures the Government are proposing. We will of course wait to see the detail, but it sounds as though we will be able to give our support to many of them. Our objection to the Gracious Speech is not to what is in it, but to what is not in it and to the unpleasant political strategy that lies behind it. As a response to the developing crisis in our health and care system, it is inadequate. Worse, however, it tries to disguise that fact by pointing the finger at others. Forget compassionate Conservatism; this is straight back to the dog-whistle tactics—failed tactics, I might add—of the 2005 general election. This is the coded message the Government want the Queen’s Speech to send: “You see all those problems with accident and emergency departments? Well it’s all down to immigration. It’s nothing to do with us.” It is a Crosby-fied Queen’s Speech that is more about positioning and politics than a serious programme for government.

--- Later in debate ---

[Toby Perkins]

The link between health and unemployment was addressed very well, under the previous model of the NHS, by Derbyshire primary care trust, which supported and funded programmes to get the long-term unemployed into work. This does not seem to be happening as much in the restructured NHS. Will my hon. Friend expand on the importance of getting the long-term unemployed into work and the impact that joblessness has on their health?

[Mark Lazarowicz]

My hon. Friend makes an important point. Measures to address long-term unemployment and child poverty, to tackle housing inequality and poor housing provision, and to provide more security in jobs and housing and in other ways are some of the biggest things that could have been done to promote health throughout our country.

I wish that Conservative Members who have spoken in the debate on the Queen’s Speech and the debates leading up to it had shown as much concern and passion about these issues as they have with the in-fighting on European issues that has taken up so much of the internal debate within their party. I accept that in the past few hours we have heard mainly constructive and thoughtful speeches on health issues by Conservative Members, but I suspect that that is simply because the ones who are doing the plotting and the in-fighting are doing it elsewhere. It is a pity that more Conservative Members have not paid attention to the issues that the people in our country want addressed—health, employment and housing. In those areas we need a significant change in direction from the Government which the Queen’s Speech did not give us.

East Midlands Ambulance Service

Toby Perkins Excerpts

Monday 21st January 2013 Commons Chamber

[John Mann]

The figures I have presented to the House show this in-built bias against rural and semi-rural areas, and, not least, former mining communities. We have the proposals to close Worksop and Retford ambulance stations and to have one hub in Ashfield’s King’s Mill hospital to serve my population. The population of Bassetlaw will have a parking lot with a potential portakabin under the original proposals.

[Toby Perkins (Chesterfield) (Lab)]

Was my hon. Friend as surprised as I was to hear that the initial consultation has been replaced by a subsequent one which is suggesting doubling the number of hubs? I welcome the fact that there was some element of listening, but it suggests that the original plans were miles away from what was safe for the people in the east midlands.

[John Mann]

As you might imagine Mr Deputy Speaker, in Bassetlaw we had the biggest response to the consultation, with more than 19,000 people involved directly in the consultation, and we had the largest public meetings. We found one person—I will not name his political party, but he was the campaign organiser for a small party—in favour. All the other 19,000 who signed up were against it—every single person in the public meetings was against it. All the staff were against it—every single one of them. They were all against it because, if the ambulances and the base are shifted out of the area and we have just a parking lot with a portakabin, we will have an even worse second-rate, service in Bassetlaw. The averages will be maintained as the cities get our ambulances and we will not have them, and we will become the bit of the response time that is not met. My constituents will continue to die unnecessarily.

What I want from the East Midlands ambulance service, therefore, is a proper rethink. It is clearly rethinking, but I want to ensure that Worksop and Retford ambulance stations stay open. If they want to juggle the minutiae of where the management is based, I am not worried about that and neither are my constituents, but we want two proper bases. We want the Gainsborough ambulance service maintained to keep accessibility in the north-east part, the rural part, over the border in Lincolnshire. That is what we need if we are to maintain the kind of service that my constituents expect. They pay their taxes. We have our illnesses like everybody else. What is unacceptable to all of my constituents and to me is that former mining areas and rural areas have a worse ambulance provision than the rest of the country. We are not prepared to accept that. East Midlands ambulance service must come back with a proper proposal. In that proposal, Worksop and Retford ambulance stations will need to stay open so that there is a proper base to allow the staff to continue to do their excellent job. I thank the people of Bassetlaw for the way they have responded. They will continue to do so to ensure that we get the service that they deserve.

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[Anna Soubry]

No, the Minister is not saying that she is going to get rid of them; what I am saying is that I take the view—as the hon. Gentleman does—that targets are not particularly improving services. I think there is a case for re-examining targets, and I hope he would join me in saying to the ambulance service, “Let’s look again at these targets in the NHS to see whether they’re doing the job we want them to do,” because it is precisely because of these targets that elderly people in my constituency have been lying on floors for up to four hours while ambulances have to go to meet a target.

[Toby Perkins]

The hon. Lady seems to be saying that the ambulance service is so focused on targets that it is incapable of recognising that leaving an old lady lying on the floor for four hours is reprehensible and appalling. She is letting the ambulance service off tremendously lightly to suggest that that is reasonable.

[Anna Soubry]

I am not saying that it is reasonable at all. What I am saying is that this was the system introduced under the last Labour Administration— a Government whom the hon. Gentleman supported. These are the precise consequences of that system; it is the perversion of that system that has led us to a situation in which targets have to be hit. I can assure hon. Members that I explored this matter with Mr Milligan, and an elderly lady lying on the floor with a suspected fractured hip does not fall into the category of an emergency life-threatening situation. These are not definitions imposed by this Government; these are the consequences of the 13 years of the previous Administration. I take the view that the situation needs urgent review, and I will certainly be making that recommendation in the Department that we need to look again at the ambulance service.