Saturday, 22 March 2014

Care Bill passes the Commons - its key measures outlined

I am a huge supporter of our NHS, both locally and nationally. We are lucky to receive such fantastic care in our region, and I am determined that this should continue. My grandmother was a matron in an NHS hospital, and I have spent more time in hospitals than most MP’s, due to my previous profession, and bone-breaking falls, as a jockey, and through the many visits and meetings I regularly hold both in hospitals and with nurses and doctors in our area. I am very clear that this Care Bill, in all its parts, is a vital reform of social and other health care in our country. We have ignored the need for this reform for many years and I am very pleased that we have changed this. I have recently written in detail about the cpontents of the Bill to constituents and set out below a shortened version of that letter:

The Care Bill was debated in the House of Commons at length on 10th and 11th March.
It is over six decades since the foundations of social care law were put in place, based on principles that are no longer relevant in today’s society. All parties agreed that we needed new laws that reflect modern standards, practices and expectations. There are several key steps to the Care Bill.
- reforming care and support. For the first time, we have introduced a cap on the costs that people will have to pay for care in their lifetime. It is intended that this cap will be £72,000 and put people more in control of their care and support.
- takes forward elements of the Department’s response to the unacceptable failings in care at Stafford Hospital, which saw literally hundreds of avoidable deaths in an NHS hospital over several years. It will allow for Ofsted-style ratings for hospitals and care homes that will allow patients and the public to compare organisations or services in a fair and balanced way, so they can see which they prefer and where they want to go. The Bill gives the new Chief Inspector of Hospitals the power to tackle unresolved problems with the quality of care more effectively than before.
- establishes Health Education England as a statutory body which will assist local healthcare providers and professionals to take responsibility for educating and training their staff. It also establishes the Health Research Authority, which promotes research and strengthens patients’ interests in health and social care research.

Several constituents wrote to me about Clause 119. In short, the Clause:
• extends the public consultation period from six to eight weeks so that the public and others in the wider health economy can give their views and improve the recommendations;
• gives the administrator more time to produce draft recommendations, from 45 – 65 working days;
• allows a more holistic view to be taken of the wider local health system by allowing an administrator to make wider recommendations;
• widens consultation to affected trusts, their staff and commissioners.

In extreme circumstances, when a Trust goes into administration, it is necessary to give the administrator enough power to take the difficult decisions necessary to ensure patients get safe care. Clause 119 makes vital changes to the Trust Special Administrator regime (TSA) that will help protect hospital services and save patients’ lives.

The TSA regime, introduced by the previous Government in 2009, provides a time-limited, clear and transparent way of dealing with local health services which are badly failing. This process is used only as a last resort, in the most urgent cases when all other efforts to ensure safe and effective local services have been unsuccessful and lives are potentially being put at risk. It has only ever been used twice. The problem with the current legislation is that it only covers financial failure of a Trust, not a failure in care. The Care Bill introduces a new role for the Care Quality Commission for triggering the regime when there has been a serious failure of quality. The emphasis will now be on quality, rather than merely on financial failure. This clause will ensure that swift action can be taken against Trusts that are significantly failing their patients, like we saw with Mid-Staffs.

As the Health Minister, Dr Dan Poulter MP, made clear to the House of Commons on 11th March:
“I stress at the outset that the TSA regime will not be used routinely, and will only be used when all other processes at a local level to deal with the challenges of hospitals have been exhausted. The usual approach for locally led reconfigurations will remain. TSAs are for rare and extreme cases of failure. This is not a power to be used to reconfigure services routinely—we need to get that right at the outset. This is a system of last resort, and other actions will of course be taken first to address the problems of trusts in difficulty.”

Claims that hospitals will be closed without consultation are nothing more than irresponsible and opportunistic scaremongering. The NHS is currently turning round a number of hospitals in special measures, like Carlisle / North Cumbria, many of which have had deep seated problems for years. Clause 119 ensures that commissioners of affected trusts would have every opportunity to make their views known. It also lengthens the time the administrator has to produce their draft report and extends the formal consultation on the recommendations, crucially giving more time for involvement of the public and all key stakeholders.

We need to have a regime of last resort that is able to address these problems in the interests of the patients and the public, rather than simply ignoring problems, amnd suffering unavoidable deaths, or bailing out failed and unsafe services.
New Clause 16
NC 16 was tabled by Paul Burstow MP. To say that this new clause would stop “the hospital closure clause”, as some have sought to suggest is simply misleading, and Paul Burstow MP would agree.
Parliamentary debate and agreement
After much debate, the Government agreed to update the guidance to make it clear that the agreement of commissioners to the TSA report should include their agreement that essential services have been protected at other trusts, as well as at the failing trust, so that all local commissioners have an equal say, with NHS England arbitrating in the event of disagreement.
It is important to note that Paul Burstow MP, the MP who tabled the amendment, later thanked the Health Minister for his clarification and reassurances, and did not wish to call for a vote on his amendment as he was satisfied. Mr Burstow said in the House:

“I have heard the Minister tell us that there will be an equivalency between commissioners whereby they will all have to agree to changes being led by a trust special administrator, that there will be further examination of the consultation issues, and that we will make sure that the process is used rarely and exceptionally. Given his confirmation of those things, I want him to know that I am satisfied that my concerns are being addressed. On that basis, I do not intend to press my new clause, and I urge colleagues to do likewise.” Hansard reference: (Citation: HC Deb, 11 March 2014, c268)

I would make the final point that the hospital closure clause was introduced by the Labour Government in 2009. This Government has merely taken steps to give powers to ensure no new Stafford Hospital disaster ever occurs again. This Care Bill is long overdue and is a much needed reform to the Care system that we so rely upon.