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The Minister of State, Department of Health (Andy Burnham): Ministers have regular meetings with MPs and other stakeholders about services in London. We also receive a regular flow of correspondence from across the country, including London.
Mr. Burstow: To balance its books, Epsom and St. Helier University Hospitals NHS Trust is making cuts of £24 million in beds and clinical staff over the coming year. As part of that, it has a programme of cutting one in four beds across the trust. In October this year, it closed one ward at St. Helier hospital and reduced another from 26 to 14 beds, only to decide in December to reverse those decisions and reopen the wards. Surely that is the sort of false economy that undermines and disrupts staff teams, damages morale and puts patient care and safety at risk.
Overspending in the health service must be tackled; if it is not tackled, that will store up problems in the health economy of the hon. Gentlemans constituency, to the detriment of patients who live there. It will also put on hold plans to invest in improving the health of people in the east of London who have contributed top slices to the central fund. I would be the first to agree that overspending should be tackled sensitively, without compromising patient care. Having looked at the trust plan to make savings by
March 2008, however, I am satisfied that it is taking appropriate steps to recover such overspending. It is making progress, and the hon. Gentleman should support it in doing so. Ultimately, that will benefit his constituents, as well as the rest of London.
Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): The City and Hackney Teaching primary care trust was top-sliced because it is a good financial performer, as I have often said in the House. Will my hon. Friend tell the PCT and the people of Hackney when the money that was top-sliced from it will be returned?
Andy Burnham: It is precisely because of the rigour in the system and the requirement that overspending be tackled that we can begin to return money for investment to those parts of London where health is poorest. To put that in context, London PCTs will receive an average 8.3 per cent. uplift in 2007-08, compared with an average of 5 per cent. this year. The top slice will also be returned earlier than expected because of the overall improvement in Londons finances. The picture is therefore more encouraging, although I do not dispute that difficult decisions needed to be taken to get us into that position.
Mr. Charles Walker (Broxbourne) (Con): Will the Secretary of State use her office to ensure that there is joined-up thinking about planning the provision of hospital services? People in Broxbourne face the closure of Chase Farm hospital in Enfield and of the Queen Elizabeth II hospital in Welwyn, which would remove accident and emergency and maternity services from the north and south of the borough. When planning hospital services, will the Secretary of State ensure that such considerations are taken into account, because Hertfordshire and London are very different, although hospital services for the two areas overlap?
Andy Burnham: I admire the hon. Gentlemans opportunism in asking his question during a question on London, but I accept that his constituents do use hospital services in the London area. It is important to get the right model of care in London to ensure that its health economies are stable in the future. Professor Sir Ara Darzi is currently conducting a review across London to develop the right model of care and the right balance between high-quality tertiary and secondary services and good-quality services in every community. He is therefore taking forward precisely the issues that the hon. Gentleman is asking us to take on board, and he will report in due course.
Norman Lamb (North Norfolk) (LD): The Minister will be aware of the challenge from the Commission for Racial Equality to Brent PCT on the impact of cuts in local heath services, particularly on black and minority ethnic communities. Bearing in mind that, under this Labour Government, health inequalities have been increasing rather than reducing, does he find it acceptable that some of the most vulnerable communities are suffering cuts to vital servicessuch as district nurses, school nurses and mental health servicesin order to clear deficits? Does he plan to do anything about that?
Andy Burnham: I am grateful to the hon. Gentleman for that question, because it is important. As I said to the hon. Member for Sutton and Cheam (Mr. Burstow), it is important that when decisions are taken to recover a financial position, that must be done sensitively and not have a disproportionate impact on any particular section of the community. The Department is working closely with the Commission for Racial Equality to ensure that that is the case. However, I take that important point on board. I shall consider it in relation to Brent and write to the hon. Member for North Norfolk (Norman Lamb), giving a fuller answer to the local situation that he raises.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): In many hospitals, voluntary organisations play an important part, and are highly regarded, in providing a range of services to patients, staff and visitors.
Mark Pritchard: Will the Minister join me in recognising the excellent voluntary work and major fundraising efforts of the League of Friends of the Princess Royal hospital in my constituency? Does he share my concern that it recently purchased £27,000 of ophthalmic equipment, donated it to the hospital trust and was told by hospital bosses that they could not accept it, even though it was needed, because they did not have the funds to run it? Does he agree that that farcical situation must be urgently investigated? If so, will he meet a delegation from the League of Friends in the near future?
Mr. Lewis: I pay tribute to the work of the Princess Royal League of Friends. It has done an excellent job within the hospital in raising significant amounts of money and providing services over a number of years.
The specific issue must be resolved by the League of Friends, the hospital itself and the primary care trust to ensure that there is sufficient revenue to support the use of the capital equipment. The problem should be resolved at a local level.
Mrs. Madeleine Moon (Bridgend) (Lab): Specialist Parkinsons disease nurses provide clinically effective and cost-effective information, research and specialist care to people on acute wards. Will the Minister use his specialist nurse summit on 1 May to stress to local health boards and trusts that those nurses must not be moved from their specialist role and used in normal duties on general and acute wards? Will he also attend the Parkinsons disease reception on 17 April?
I am always willing to join my hon. Friend at any reception to which she chooses to invite me. I pay tribute to her work on highlighting the important contribution that specialist nurses make within our NHS. It is one reason I decided to host the summit in May. We need to highlight best practice, raise the status of specialist nurses, and make it clear to
the health service at a local level that specialist nurses have an important role to play, especially in long-term and chronic conditions.
Jim Sheridan (Paisley and Renfrewshire, North) (Lab): One of the imponderables of life is the value that the voluntary sector brings to our acute hospitals. Does my hon. Friend agree that that same service is provided in hospices the length and breadth of the country, which do a terrific job, and by other organisations such as Erskine, which provides acute services to our disabled ex-servicemen and women returning from theatres of war?
To secure the best possible health care and social care within local communities, it is crucial that we have a partnership between the NHS, local government and the voluntary sector. The voluntary sector often has a distinct and unique role to play in securing personalised, sensitive services that are close to local communities. We should use this occasion to pay tribute to the hospice movement, which does an amazing job in difficult circumstances. We recently made £25 million available specifically for childrens hospices. We are reviewing the way in which we provide palliative care to children and are, for the first time, about to make a significant announcement on major capital investment in the hospice movement.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): We recently announced the new deal for carers, a package of support including £25 million for short breaks for carers in crisis situations in every council, £3 million towards a national helpline for carers, and £5 million for an expert carers programme. The Chancellor has also announced that we will be holding the most far-reaching national consultation ever on the role of carers. In the months ahead, we will invite carers groups and the voluntary sector to help us to design a modern vision for caring. That will inform the development of a new cross-government national strategy.
Mr. Blizzard: Does my hon. Friend agree that people living in care homes should have good access to dentists, chiropodists and opticians, even when they have mobility problems and cannot go out? As that appears not always to be the case, will he take steps to require care homes to make proper arrangements for such people, and also to require dentists, chiropodists and opticians to be willing to visit them in the homes?
Mr. Lewis: My hon. Friend has made an important point. This is a two-way process. First, there are the responsibilities of care homes. Standard 8 of the national minimum standards states that a registered person
promotes and maintains service users health and ensures access to health care services to meet assessed needs.
specialist medical, nursing, dental, pharmaceutical, chiropody and therapeutic services... access to hearing and sight tests and appropriate aids, according to need.
Care homes must fulfil their responsibilities, but equally the professionals on the front line must acknowledge their responsibility for ensuring that older people, even those living in residential homes, have the same rights to high-quality health care as those who continue to live in the community. Responsibility must rest with both the managers and owners of residential care homes and the professionals who provide those services.
Mr. Stewart Jackson (Peterborough) (Con): Why are the thousands of people who have important family responsibilities as carers in receipt of state pensions, but unable to claim the carers allowance? When will the Minister have a word with his colleagues in the Department for Work and Pensions to sort out that iniquitous, unfair position?
Mr. Lewis: With all due respect, this Government introduced the annual carers grant for every local authority for the first time in 1999; this Government introduced the right for carers to request flexible working from employers; and this Government, through Parliament, are arranging for carers to be able to claim credits towards their pension entitlements. The cross-government review will take account of the fact that millions more people will fulfil caring responsibilities in the future, because as people live longer they also develop more conditions. Of course we will examine the issue that the hon. Gentleman has raised, but I remind him that the shadow Chancellor of the Exchequer recently made very clear
Sarah McCarthy-Fry (Portsmouth, North) (Lab/Co-op): When visiting the Portsmouth carers group, I have been struck by the dedication of our young carers. Will the carers programme provide any specific help and support for those dedicated young people, who are performing such a valuable task?
Mr. Lewis: I entirely agree with my hon. Friend. I can assure her that as part of the development of a new national strategy, we will pay specific attention to the needs of the often hidden young carers. Those young people are heroes, who spend the vast bulk of their lives looking after, usually, a dependent parent. Their caring responsibilities may affect their education, their health and their ability to lead the lives that most young people and children, thankfully, take for granted. We need to consider the specific needs of those children and young people and ensure that we give them the necessary and appropriate levels of support.
Ann Winterton (Congleton) (Con): Is the Minister aware that one of the most vulnerable groups of carers consists of elderly people, often parents whose adult children have mental health problems? As part of his review, will the Minister ensure that mental health trusts provide a service to deal with crises? A telephone line may be useful, but it is no use unless there is a dedicated team of people who can go to the home or other place where the crisis is taking place. Will the Minister take action to ensure that vulnerable elderly parents are not disadvantaged further?
Mr. Lewis: I entirely agree with the hon. Lady. Ironically, as people live longer the age of carers increases, and the responsibilities that relatively older and frail people fulfil become more important. We will look into that as part of the review. However, it is also fair to say that in the announcement we made a couple of weeks ago on the new deal for carers, we specifically addressed the question of emergency respite. It has been suggested that that is not what people need, but many carers tell us that on occasions it is the emergency respite that is lacking. I should also mention the investment that we have put into telecare, which ensures that we can make the best use of the most advanced technology in peoples homes. That is another support mechanism that is making a real difference to the lives of carers.
Barbara Keeley (Worsley) (Lab): The new deal for carers is very welcome. My hon. Friend mentioned hidden carers, and it is true that many carers do not identify themselves as such and that they do not know to look for the advice and support that is already available and that which will become available. Health professionals can help with that, as they are the people with whom carers have to be in contact. Will the Department of Health make a special effort in the coming months to inform GPs and their teams of that task and to make sure that they perform it?
Mr. Lewis: First, I pay tribute to my hon. Friend for the work that she has done over many years in highlighting the needs of carers with regard to public policyshe has done a tremendous amount. I do not want to upset the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), who is responsible for negotiations with GPs on their annual contracts, but if I am allowed to express a personal opinion I would say that one of the things that we want GPs to do in a modern health care system is to identify those of their patients who are carersas GPs are frequently the health care professionals whom carers have the most contact with and confidence inand then, having identified them, make sure that they get signposted to whatever services they need to support them to fulfil their caring responsibilities.
Sir Patrick Cormack (South Staffordshire) (Con): Is the Minister aware that there is real consternation throughout Staffordshire among carers and others at the decision of the county council to close all its care homes within a year? Will he summon leaders of the county council to discuss the implications of that decision and to satisfy himself that adequate provisions are being made for all the vulnerable people who are currently very anxious?
I understand the anxiety and insecurity felt by the older people affected by that decision, and also by their families and the staff who work in those homes. The local authority must make decisions in consultation with the affected parties. I have previously told my hon. Friend the Member for Stafford (Mr. Kidney) that if it would be helpful I would be willing to meet those who are most affected. However, it is only fair to say that we cannot any longer make decisions about the best way to provide local services from offices in Westminster and Whitehall. What we can do is support that local
decision-making process and make sure that the people who are most affected feel that they are listened to and respected.
John Robertson (Glasgow, North-West) (Lab): My hon. Friend will be aware that many carers are unpaid and need training. What is he doing to ensure that they get the training they need to support their family members and to look after them in a proper manner?
Mr. Lewis: My hon. Friend makes a very important point. As part of the new deal for carers, we announced two weeks ago the creation of an expert carers programme. That will specifically do two things: first, provide training to carers on the practical issues that they need to feel comfortable with and confident about in terms of lifting, handling and supporting whoever they are caring for in their own home; and, secondly, boost the confidence, knowledge and expertise of carers so that they feel that they can fight for the rights of the person whom they are caring for and relate on a more equal basis with professionals. Those will be the two objectives of our expert carers programme. I agree with my hon. Friend that the issue we are debating will become increasingly important, especially given the demographic changes that are taking place in our society.
Sir Nicholas Winterton (Macclesfield) (Con): May I make a plea to the Minister for there to be an entirely cross-party approach to those who have caring responsibilities? The biggest sector comprises those who provide it freethe volunteers. Does the Minister agree that although the Government have done quite a lot to assist them, those who voluntarily undertake caring responsibilities for the young, the old and those who are disabled genuinely deserve a better and fairer deal?
Mr. Lewis: I agree with the hon. Gentleman. We introduced the annual carers grant, we announced the new deal for carers a couple of weeks ago, and we are also giving new rights and a new pension entitlement to carers, but there is a lot more that we have to do. The reality is that our society is changing. People are living longer and in doing so are developing an increasing number of frail conditions, which is asking new questions not only of the Government and the state, but of families. Disabled people, thankfully, are now having fuller and longer lives. The current review, led by the Treasury, on the needs of children with disabilities and their families and carers, is incredibly important. Wherever possible, these issues should of course be of a non-party political nature, but in the end it comes down to hard choices about the level of investment that the Government are willing to make in these services, and whether we are willing to prioritise families and carers in the context of the changing demographics to which I have referred.
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