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Point of Order
3.32 pm
Tim Loughton (East Worthing and Shoreham) (Con): On a point of order, Mr. Speaker. I seek your guidance on correcting the record regarding a reference to me made by the hon. Member for Rhondda (Chris Bryant) during business questions last Thursday.
Mr. Speaker: It is not the purpose of the points of order system to correct the record. If the hon. Gentleman had read Hansard, he would have noted that I stopped the hon. Member for Rhondda (Chris Bryant) in his tracks, to put it mildly.
Chris Bryant (Rhondda) (Lab): I still ran the marathon.
Mr. Speaker: The hon. Gentleman was stopped because he had no right to criticise any hon. Member who had not been notified of such criticism in advance. I said at a later stage that the matter was finished with, and I hope that the hon. Member for East Worthing and Shoreham (Tim Loughton) will leave it at that.
Carers (Identification and Support)
3.33 pm
Barbara Keeley (Worsley) (Lab): I beg to move,
That leave be given to bring in a Bill to require health bodies to identify patients who are carers or who have a carer; to require identified carers to be referred to sources of help and support and to make further provision in relation to such arrangements; to make provision in relation to the responsibilities of local authorities and schools for the needs of young carers and their families; and for connected purposes.
In March 2006, I introduced a Bill with the same aims as the first part of this new one. As I told the House then, 1 million carers in the UK care for more than 50 hours per week. The 2001 census figures show that carers are twice as likely to suffer ill health if they care for 50 or more hours a week. Medical research also suggests increased ill health among those caring for a person suffering from dementia or stroke disease. It is my view that we must intervene to identify and support the most hard-pressed carers, who care for more hours than the hours of any full-time job.
In my Worsley constituency, the highest level of caring commitment is needed in the two wards with the highest levels of people with stroke and heart disease, and with cancer. While the national average is one in five carers caring for more than 50 hours a week, that rises to one in four in Walkden North ward in my constituency, and to one in three in Little Hulton ward.
Those carers play a vital role in health and social care. They are key partners in care for the NHS, but their own health is also threatened and there is a need for recognition of carers’ health needs. In 1999, the Government gave GPs and primary health care teams a five-point checklist for use with carers in their practice population. The first requirement in the list was that GPs should identify those patients who are carers or who have a carer. Eight years on from the launch of that national strategy, research shows that the work done nationwide by GPs and primary care teams to identify carers in their practice population is still inconsistent. Research by the Princess Royal Trust for Carers concludes that only a small proportion of the total number of carers is being identified. Even GP practices with good links to their local carers’ organisations are not doing the work necessary to identify all those carers whose health might be affected by their caring responsibilities.
Two carers known to Carers UK provide examples of how important it is to identify carers. Valerie Low of Carlisle cares for her husband, who was severely brain- damaged in a car accident in 1997. For years, Mrs. Low did not know that advice or respite care were available to help her as a carer. Now that she has been identified, she arranges respite care from Crossroads.
Tracy Barker from the Isle of Wight has cared for her son for 16 years. He has autism, asthma and epilepsy. Like many parent carers, Ms Barker did not see herself as a carer and had no idea of the support available to help her. She struggled to pay bills, yet she had not been told about carer’s allowance. Eventually, she had to move to a different area for financial reasons, and then she suffered depression. Now that she has been identified as a carer, she receives carer’s allowance and has attended a number of courses that have helped her.
If they are not identified, carers will struggle without the help or support that they need. My Bill would require that primary care trusts and local health boards ensure that effective procedures exist within primary care to identify carers, and that carers are referred for advice and given regular health checks.
The Pensions Bill also requires the identification of those carers caring for 20 or more hours per week so that they can earn the carer’s contribution credit. My hon. Friend the Minister for Pensions Reform has made a commitment to use the Government’s review and update of the national carers strategy as an opportunity to explore how that identification can be carried out by health and social care professionals. That is a welcome step forward.
In previous years, hon. Members of all parties have given their support to carers week, which this year runs from 11 to 17 June. Its main objective is to enable new and “hidden” carers to access support and services.
Young carers are perhaps the most hidden of all carers. The 2001 census records some 175,000 young carers, but only 30,000 of them are known to young carers support services such as the Princess Royal Trust for Carers and other children’s charities. Indeed, a survey by NCH and Carers UK showed that fewer than one in five of known young carers have received an assessment of any kind.
The Princess Royal Trust for Carers believes that it is likely that the most vulnerable young carers, including some of the 13,000 who care for more than 50 hours a week, continue their caring role throughout their childhood without any support. Young carers may have parents with substance misuse or alcohol problems, and the extent of that problem is not fully understood. The “Hidden Harm” report estimated that 250,000 to 350,000 children have parents with serious substance misuse problems. The alcohol harm reduction strategy for England states that between 800,000 and 1.3 million children are affected by parental alcohol problems. In the families of alcoholics or problem drug users, children may find themselves responsible for their parents’ safety.
My Bill would place duties on social services authorities to consider what support services are needed to sustain the parenting role in such families. When a parent is assessed for community care services, support services should be offered if it is found that the adult relies for support on the caring role of his or her child. In that way we can ensure that the health, education and well-being of the child or young person are not impaired by caring responsibilities.
Young carers may have a parent with an illness such as multiple sclerosis, or with a learning or physical disability. The parent may rely on the care from their child, as a case known to the Princess Royal Trust for Carers illustrates. A single parent was diagnosed with multiple sclerosis and loss of mobility, which affects not only her but her children, aged 8 and 12, who have to provide her with the round-the-clock support she needs.
Such children are missing out on their education and, like other young carers, they find themselves misunderstood at school, treated as truants and bullied by other children. Schools need written policies stating the support that they will offer young carers. My Bill would require that both schools and local authority children’s services have policies in place to support such young carers.
Many health and social care professionals are frustrated by the difficulties they experience due to different thresholds for service provision for different client groups. An adult mental health worker may be aware of several children affected by their parent’s mental health condition. However, unless the children are at risk of serious harm the health professional will probably not be able to help them. The general duties to young carers and their families outlined in my Bill would help. A simple joint working protocol between children’s and adult services, combined with a training programme for staff, would help to solve the problem.
Census figures tell us that a minimum of 2 per cent. of all children in the UK are young carers. However, work by Professor Saul Becker of Nottingham university and others suggests that the true number of young carers could be much higher—possibly 1 million of the 3 million children and young people who live in families where there is serious illness or disability. Whichever figure we use, we need now to bring in measures so that schools and local authorities recognise the issues faced by young carers.
I have outlined how the measures in my Bill would ensure that health professionals identify carers and refer them to much needed help and support. As we move towards the Government’s review of the national strategy for carers, I hope the measures outlined in the Bill will offer a sturdy framework for improved services and support to carers. My Bill is supported by Carers UK, Contact a Family and the Princess Royal Trust for Carers. I thank Carers UK and Luke Clements for helping me to draft the Bill and Alex Fox of the Princess Royal Trust for Carers for his input on young carers. I also thank the House for giving me the opportunity to present it today.
Bill ordered to be brought in by Barbara Keeley, Tony Baldry, John Bercow, Mr. Paul Burstow, Annette Brooke, Dr. Hywel Francis, Helen Goodman, Lady Hermon, Mrs. Sharon Hodgson, Ms Diana R. Johnson, Ms Sally Keeble and Lynda Waltho.
Carers (Identification and Support)
Barbara Keeley accordingly presented a Bill to require health bodies to identify patients who are carers or who have a carer; to require identified carers to be referred to sources of help and support and to make further provision in relation to such arrangements; to make provision in relation to the responsibilities of local authorities and schools for the needs of young carers and their families; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed [Bill 92].
Opposition Day
Modernising Medical Careers
Mr. Speaker: I have selected the amendment in the name of the Prime Minister.
3.43 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,
That this House acknowledges the UK’s exceptional history of medical training which has produced some of the best medical professionals in the world; supports medical training designed to improve patient care which is well implemented, flexible and applied in a way which ensures the necessary level of clinical experience; believes that these objectives have been undermined by poor planning, inadequate consultation and lamentable implementation; notes with particular concern the flawed electronic application process (MTAS) which has breached legitimate expectations that selection for entry to programmes must be open, fair and effective; regrets the lack of ministerial leadership for MTAS and the failure of the Government’s review to deliver strategic solutions; accepts that training posts are competitive but believes that insufficient allowance has been made for the number of trainees coming through the Foundation years in addition to the Senior House Officer (SHO) route; calls on the Government to create additional training posts to allow transition for SHOs into specialty training in 2007, 2008 and 2009; deeply regrets the distress and loss of goodwill among junior doctors in training; and further calls on the Review Group led by Sir John Tooke to listen to the medical profession in reviewing the structure of Modernising Medical Careers to ensure that the original principles, including flexibility, are sustained and command the confidence of the medical profession.
The reason why we have called this debate and given up Opposition time to such an important subject is that time and again we have sought answers from the Secretary of State for Health and Ministers about what has happened to the modernising medical careers programme, in particular the recruitment and selection process. With your consent, Mr. Speaker, we put an urgent question that the Secretary of State had to answer, because previously she had provided no good answers. Last Monday, she came to the House to apologise unreservedly—about time—but also to announce a further review and the conclusions of the first review group she had instituted. Serious questions and issues remain, however, and many junior doctors across the country and the consultants responsible for the interviewing process feel they have not been answered.
Our purpose today is therefore threefold. First, we want to secure some answers; secondly, through our motion, we want to make clear the necessary steps that the Government should accept to regain the confidence and support of the medical profession; and thirdly and not least, we want to demonstrate to the many junior doctors who have come to Westminster today to tell their Members of Parliament of their personal experiences, their disillusionment and, in many cases, their anger at what has happened to them that Conservative Members at least understand and accept their views. I suspect that many Labour Members, on the Back Benches at least, understand the problem. We will see later whether they are willing to come to the House to express to Ministers the sentiments that they have no doubt expressed to their constituents in private.
Dr. Nick Palmer (Broxtowe) (Lab): Does the hon. Gentleman agree that whatever the flaws or otherwise of the electronic system, the underlying problem is the surplus of applicants compared with places? Will he commit his party to increasing funding to the health service by the same level as we are committed to doing so that these doctors have a real prospect of a future in the NHS in the years to come?
Mr. Lansley: The hon. Gentleman must know that, in the general election the year before last, we committed ourselves to exactly the same level of funding as applies now. However, we are talking not about the next election, but about what is happening now. We are committed to the same level of funding, but we are also committed to a far more efficient use of that funding.
The hon. Gentleman could have said, “By the way, the Government spent £72 million on the NHS university,” but that turned out to be completely wasted. What was their response to that waste of money? It was to try to suppress the report by Sir William Wells that was designed to examine where all that money had gone. Let us first be concerned with spending money effectively before we start debating how much money there will be beyond the comprehensive spending review.
The Secretary of State is sometimes at pains to challenge us on whether we agree with the principles behind modernising medical careers. Yes, we agree that modernising medical careers is a necessary process. To put it at its simplest, let us consider whether services in the NHS should be provided in the long run by specialist doctors or by doctors in training. Patients and the public would expect the services to be delivered by specialists and that it would be a consultant-led and increasingly a consultant-delivered service. When one looks across the world, one sees that this country has been unusual in the extent to which services in NHS hospitals, in particular, have been delivered by doctors in training rather by doctors who have their specialist certificates.
The principle of modernising medical careers is accepted and we also accept many of the principles in the documents of 2002 and 2004 that led to it. We should not rely on doctors in training for service delivery and training must be limited in time. It cannot be open-ended. As Sir Liam Donaldson said in his report about the “lost tribe” of senior house officers, we cannot have junior doctors who drift from one SHO job to another for years without ever making progress in specialist training.
Let us remember that one of the principles of MMC was that it was intended to be flexible and widen career choice. Where did that one go in the translation of principles into practice? The way in which MMC has been implemented is lamentable. When people look at the political gravestones of the figures in the Government, they will see carved on them, “It should have worked in principle, but it didn’t work in practice.” The Government started out with good intentions, but time and again they have failed to deliver. Here is another lamentable and shocking example of how they have failed to turn what, five years ago, was a straightforward set of principles into something that works in practice for those in the NHS today.
Mr. Henry Bellingham (North-West Norfolk) (Con): My hon. Friend is putting forward an excellent case. Like many hon. Members, I have been meeting young doctors, including some who are now going to go abroad. Those doctors are worried that they will not receive sufficient training under MMC. For example, orthopaedic surgeons received 22,000 hours of training under the old system, but they will receive only 6,000 hours of training under MMC. There might well be a happy medium, but the Government have certainly not got this right.
Mr. Lansley: I understand exactly the point that my hon. Friend makes. I have had exactly the same conversations. I think that most junior doctors would acknowledge that it would be difficult to sustain the degree of clinical experience that used to obtain and that that would probably not be consistent with the delivery of services by specialists. However, my hon. Friend is right that there is a balance to be struck. Surgical specialties, especially, are, in effect, crafts as well as academic disciplines. While the structure of MMC and its focus on specific competencies address important issues, the programme has significantly failed to reflect accurately the importance of clinical experience and academic achievement, which should be involved in the selection of candidates.
Mr. Lansley: I give way to my hon. Friend the Member for Worthing, West (Peter Bottomley), who has done an enormous amount to represent the views of junior doctors on this subject.
Peter Bottomley (Worthing, West) (Con): I, like Ministers, care about what is happening, but perhaps Opposition Members have been more open about some of the problems. Locally, we have discovered that filling out 150 words is worth the same as a PhD, which involves three years or more of hard work. An explanation of that is needed. On the first day the system opened, it was apparently not possible to apply for a job within 50 miles of Worthing or for one in genito-urinary medicine. The problem is not the computer or the method of consulting the people who put the thing together. The problem was caused because the system was not run as a trial in at least one region to evaluate the experience. Will my hon. Friend commit us to go on working not only for senior and junior doctors, but for those in the MMC system who resigned because of a loss of confidence, by backing the doctors and, if necessary, saying to the Government, “Why don’t you drop your defences and join in working out the problems and solving them?”
Mr. Lansley: My hon. Friend has captured exactly what we are trying to achieve through this debate. If hon. Members read the motion, they will see that its objective is not to engage in the easy task of saying, “It’s all gone wrong and the Government are to blame.” The motion engages with the question of what needs to happen now, although I note that the Government amendment says nothing at all about that.
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