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8.45 pm
Ms Julia Drown (South Swindon): In an intervention on the hon. Member for Southend, West (Mr. Amess), I quoted support for the measure in a briefing from Help the Aged. However, I inadvertently referred to that briefing as being from Age Concern. I apologise, but I saw the same briefing in the hands of the hon. Member for Southend, West, so my point remains valid.
I welcome the Bill, which comes from a Government committed to improving the NHS, increasing investment in it, and improving its quality. I see that in my South Swindon constituency, where a new hospital is being built, and where we have an NHS walk-in clinic, access to NHS Direct, a refurbished accident and emergency service, a new mobile breast cancer screening service and additional ear, nose and throat facilities and cataract services. That is all happening on the ground in my constituency. By contrast, the Opposition divided up the NHS, made one hospital compete against another and failed to fund the health service. Their management of the NHS led to an increase of 400,000 people on waiting lists from 1979 to 1997.
In looking at the Bill, I should like to start with the issue of long-term care. The House should note that the royal commission did not produce a unanimous report. There was a significant minority report, which made recommendations similar to those in the Government's proposals. The commission addressed difficult issues, and the Select Committee on Health dealt with the same difficulties when it considered long-term care. I share the Government's view and that of the minority report on the need to distinguish between personal and nursing care: that was a persuasive viewpoint. However, I would be the first to welcome personal care being free, if money for that could be found. However, I accept that a balance must be struck.
On one hand, we all know about the concern in our constituencies that those who go into residential nursing care are sad to leave their own homes, and feel additional sadness when their finances disappear to pay for care. They are disappointed that they have less inheritance to pass on to the next generation than they had planned. On the other, we all see nursing and residential care homes in our constituencies which, with more funding, could provide better care. We see how the quality of life for residents could be greatly improved by the provision of more therapists, more staff, who should be better paid, and more staff training.
All Governments have to think about the funds that they have and must strike a balance between those two concerns. The majority report of the commission on long-term care argued for more support for individuals' personal finances, saying that all personal and nursing care should be paid for. However, the minority report called for more of a balance in provision, which the Government have been correct in striking. Individuals' finances have been supported, and free nursing care will help 35,000 people. The three-month disregard will help families financially, and will allow our constituents to keep more of the funds that they have earned in their lifetime.
It is right to balance that financial help with improving quality of life. It is not only about improving the quality of life for those in nursing and residential homes, but about supporting the quality of life for people at home. I want to see an expanded home help service and go back to the days when one could get individual help, such as a home help service to help with cleaning around the house. Such help is not provided by most local authorities, but it is good preventive care and would pay for itself in the long run. To get those finances, have that good preventive care and get more aid more quickly to our constituents, we must look to the Government to strike those balances. I therefore support the Government's decision to create a balance between supporting people's personal finances and the care that we give our constituents.
I also welcome some of the Bill's specific proposals. Clause 53 allows residents to pay a top-up towards more expensive accommodation. There must be good quality nursing and residential care for everyone, but I also welcome the freedom that this measure will give to my constituents to buy into more expensive homes, just as younger people can choose to spend their money on more expensive houses or services. I know that my constituents will welcome that.
I have a concern--which has also been raised by the citizens advice bureaux--relating to disregarding the value of people's homes. Local authorities currently have
the power to disregard the value of a property when other family members live there. That is an important disregard. A person's moving into a residential or nursing home should not make another family homeless.The CABs have made a sensible suggestion, which I hope the Government will consider. It is that there should be mandatory property disregards, and that they should be extended to all cases in which the property continues to be occupied by a relative, a same-sex partner or a carer who received or met the conditions for invalid care allowance during the 12-month period before the resident entered residential care.
I particularly welcome the ability to provide health and social services care in an integrated way. This will be welcomed throughout the country. I am sure that most hon. Members have come across instances in which one of their constituents needed care but was faced with the health service and social services arguing about who should provide it. The more we can push people to work together, allow people to work together, and establish pooled budgets, the better we shall be able to achieve what our constituents want: a good quality service. Many people do not understand the distinction between health and social services. The more we can create a seamless service, the better the care we shall be able to provide for our constituents.
I also welcome the setting up of the local investment finance trust, providing up to £1 billion of investment so that GP practices can be improved. I should like to bid, right now, on behalf of a number of practices in my constituency that have been waiting for some time for development funds such as these, so that they can update their premises and give their patients the care that they want to give.
Pharmacists in my constituency will welcome the proposals for expanding their role. They have frequently talked to me about the greater help that they could provide to GPs and to the wider NHS. The Bill allows some of those developments to take place. It is absolutely right that we should extend prescribing rights to pharmacists and other health professionals, and I am glad that we have support across the House for that measure, which is most welcome.
The Bill also allows for prescriptions by e-mail. Some of my constituents have asked me why we cannot use new technology to make things easier for them. The proposal is all part of creating a flexible and modernised NHS for this new century.
The powers to extend NHS dentistry will also be widely welcomed. I am delighted that this Government have restored NHS dentistry to Swindon, where none was available to adults under the Tories. The more that that can be made available across the country, the better.
I am also pleased that the Government will look at patient involvement. That is important. There are undoubtedly good proposals on patient involvement in the Bill, and they will have a positive impact on health. NHS care should not be something that is done to people; it should be a partnership between an individual and the clinicians and, ultimately, patients should take charge of their treatment. Taking charge in that way has a positive mental and physical impact on many illnesses. Better physical and mental outcomes will result if patients are seen to be the centrepiece of their care and their care plan.
I welcome all the new developments, particularly the involvement of local authorities. In the history of consultation, local authorities have been better at genuinely consulting than the NHS has been. The NHS has traditionally been very good at making announcements to the local population, then going on and doing exactly what it said it was going to do. Local authorities, however, have a history of listening and changing as they go through a consultation process.
Mr. Bercow: I was somewhat provoked by the hon. Lady's elliptical reference to patient involvement. Will she tell the House whether, pursuant to her signature of the early-day motion on community health councils--we are keeping a tally of those involved--she continues to support those councils, or whether she now supports the PALS that are to be employed by the trusts that they are somehow expected to scrutinise?
Ms Drown: I was just about to explain my position. Perhaps the hon. Gentleman could wait a little longer.
It is important to have more patient involvement, but there should be independent support for people making complaints in the NHS. People should receive help from the trusts so that their complaint can be dealt with straight away. The Select Committee on Health found that the earlier a complaint is dealt with, the more likely it is to be dealt with constructively.
In that sense, these proposals are an improvement. However, why not allow more of the proposed structures to be linked to the Commission for Health Improvement? Including independent people in the process could lead to better logging of complaints across the country. Patterns might be created across the country in a way that cannot happen at present under community health councils. The movement of locums across the country could be logged and complaints picked up more easily. I hope that the Government will consider that.
There are three points on patients forums on which I would like clarification. The first is the right to inspect in all settings. That will impose on all members of those forums a need for patient confidentiality. I hope that Ministers can reassure us about that.
Clause 12 refers to the annual reports to be produced by patients forums. They do not have to be the type of mammoth, glossy exercises, of questionable benefit, that are produced by many trusts across the country. One page of A4 paper will do, if it gets across the key points. That will enable patients forums to concentrate on their important work.
Age Concern has reported how elderly people find it hard to have their complaints about the NHS listened to. The views of women and children are also often not heard. One reason why women are still sometimes invisible in our society is the sexism in our language and in the wider society. Sexist language reinforces the male dominance that we still see. The explanatory notes to the Bill refer to "manpower" when "staffing" could be used, and the Bill provides that forums should be chaired by a chairman. People tend to think of men when they hear "chairman", so I would encourage the use of "chair" or another alternative.
I urge Ministers and right hon. and hon. Members on both sides of the House not to be too prescriptive or bureaucratic in the way that we develop the NHS. We are, quite rightly, being asked for more details about the Bill. Organisations are also pushing for matters such as membership of patients forums to be subject to primary legislation rather than regulation and for the Bill to state the system of accountability to be exercised by local authorities over their own scrutiny committees.
We do not want over-regulation in the NHS. It has a tendency to bury itself in paperwork and it needs the freedom to allow pilot schemes to start, to create flexibility and to see what works for various areas. Of course we need to regulate for safety, but apart from that we should limit regulation to allow NHS and social services staff to get on with caring for people, as they do so well--staff on the front line and behind the scenes too. The more regulations and paperwork that exist, the more we limit their flexibility. I am glad that the Government support managers all the way down the line--or perhaps that should be up the line--to patients so as to limit regulations and allow people the freedom to get on with caring for patients.
The Bill contains powers to extend the direct payment scheme. That is welcome in terms of giving people more control over their care. However, direct payments can lead to extra bureaucracy and there can be dangers when the care plan breaks down, for example. We must ensure that there is a choice and that it is monitored carefully.
Clause 59 is entitled "Control of patient information". Again, I hope that we can avoid the mistake made by the Tories, which was to create too many regulations to protect patient confidentiality when NHS staff should be trusted. They recognise the need for confidentiality. We need to ensure that information flows throughout the NHS, which will help to support research and patient care. That is important too.
I have dealt with parts of the Bill in detail. It is a good measure and I welcome it. It will be a leap forward for patient care--I should say people care, as much of it is social care and we must think of people as individuals, rather than patients. My constituents will welcome the Bill. I apologise to you, Mr. Deputy Speaker, and to both sides of the House, as I cannot be here for the replies, but I will read them with great interest. I am pleased to be here, however, to support this Second Reading.
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