Community and Voluntary Services: Derbyshire

Creditworthiness Assessment Bill [Lords] – in the House of Commons at 2:28 pm on 8th February 2019.

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Motion made, and Question proposed, That this House do now adjourn.—(Wendy Morton.)

Photo of Ruth George Ruth George Labour, High Peak 2:32 pm, 8th February 2019

I rise to pay tribute to our community and voluntary services across Derbyshire. They are the fabric that holds our rural and often isolated society together. In my own constituency of High Peak, we have four offices—in New Mills, in Whaley Bridge, in Buxton and at the Bureau in Glossop. They organise volunteers, provide services for frail, elderly and isolated people, and give the volunteers a sense of purpose and wellbeing.

One of the volunteers told me that his volunteering

“gives me a purpose, a reason to get up in the morning. It makes me feel like I’m giving something back, rather than being an outcast. I’d lost my wife who died from cancer and my job on the same day. I was her carer for 18 months until she died and I had a breakdown.”

Now, however,

“I can hold my head up high…
I’ve reduced my medication for depression”,

and he feels

“part of a family again and feeling stronger and more confident.”

That is what our voluntary sector can do for us as a society. Another volunteer said:

“While I’m here it takes my mind off what’s happening at home. I care for my wife and my son. My wife has mental health issues and my son has ADHD and neurofibromatosis.”

These are very giving people. They give in their life at home to their family, but they are also prepared to give to others.

A befriender from my constituency said:

“The person I befriend has become so much chattier, less depressed and healthier in general since we have been seeing each other. I honestly believe befriending and regular companionship is the remedy to loneliness, and if this service is cut then it’s going to be devastating for those who rely on their befrienders for social contact, and feeling like someone cares. My ‘friend’
has told me about how it feels to be lonely: they don’t speak for days at a time and they haven’t been touched by another human being for weeks, until they go to the shop and the cashier gives them their change, or until the nurse gives them an injection. It is heartbreaking because these lonely people have so much left to give and no one to give it to, and it is something that is all too common in today’s disconnected society.”

That is why I and communities across Derbyshire are so devastated that our community and voluntary services are facing more than half a million pounds of cuts—part of £51 million of cuts made by Derbyshire clinical commissioning groups, more than £100,000 of which fall on the High Peak and Dales CCG. Those cuts led all affected GP services in High Peak to write and raise their concerns about the decision of the new clinical commissioning group to make cuts of almost £100,000 to the community and to voluntary health and care provision. They say that the cuts will affect many of our patients, in particular the elderly, the frail, and the isolated.

There is a night sitting service—the only one available—and it supports carers when patients come out of hospital. Without it, more patients will wait in hospital when they could have come home. The “home from hospital” service, which also faces cuts, has the same effect wherever it operates. Community transport is facing cuts, even though it is often the only option for patients to attend medical appointments where there is no public transport and they cannot afford a taxi. I have already heard about patients who sent in a sample for bowel screening but were not able to attend the follow-up appointments. They say that the next time they will not bother doing the screening because they cannot get to the follow-up appointment. Community transport drivers offer companionship as well as a driving service, and they keep an eye on frail patients.

As I have set out, the befriending service is appreciated by people who are isolated and lonely. Their regular social contact gives them something to look forward to, and helps to prevent depression, which affects their physical as well as their mental health. GPs say that providing activity and support also helps volunteers, and it gives them a sense of purpose and wellbeing in helping to care for people who value their support and company. That is especially helpful for people who are newly retired, who live on their own, or who are recently bereaved, because it helps them to keep well.

The cuts will impact on GPs and already over-stretched health and care services, yet there has been little to no direct consultation with individual GPs or their practices. The services are extremely cost-effective, and although the cuts bring short-term gain, they will cost the NHS considerably more in the long term. Our GPs believe that the cuts contravene the aims of better care closer to home, and the proposed model of community services that support health and care. If the cuts go ahead and our voluntary services are drastically reduced, it will be extremely hard to set them up again to support localities, as envisaged by the NHS 10-year plan.

Ironically, on the 70th anniversary of the NHS, all voluntary sector organisations across Derbyshire received letters stating that their funding from clinical commissioning groups was to be cut. The voluntary sector provides friendly, personalised local care for far less than any other service could. For example, last year the night sitting service supported 93 people with more than 2,000 hours of care, at a total cost of just £34,000—on average, just £369 per person for three nights of support each. Just one of those nights in a hospital could have cost the CCG more than that.

The CCGs have themselves calculated that for every £1 spent on voluntary services, they save £8. On that basis, the £500,000 saved this year will cost £4 million in extra care next year, and every year thereafter. That comes on top of all the other cuts to health and social care in Derbyshire. We have seen our county council lose more than half its revenue support grant since 2010, so in large swathes of High Peak it is impossible to get a care package and the only help is from the voluntary sector.

My constituent Debbie has a son with autism who wanted to live independently but needed the support of a care package. The package could be provided only by the voluntary sector, but the CCG cuts meant that it could no longer be afforded, so they were facing the prospect of residential supported care, which would have cost far more, until I intervened.

The lack of care packages means that people are stuck in rehabilitation beds, such as an 82-year-old constituent of mine with a muscle-wasting disease. She could not walk unaided and could not get a company to bid for her care package, but she received four letters from the CCG and her social worker, telling her that she was no longer able to stay in the rehab ward. They reduced her to tears. That ward is the only one of its kind in my constituency—Fenton ward in Buxton—but it is due to lose more than half its beds, despite a waiting list of patients in our acute hospitals needing those beds, even during the summer months.

We have seen the loss of our local dementia assessment and support ward in Buxton, a gold-standard service that took the most difficult patients with dementia and helped them back into care in their own home in an average of less than six weeks. We are seeing community hospitals across Derbyshire facing the loss of 84 beds. Anyone would think that we are seeing a reduction in the number of patients with dementia, or elderly and frail people who need rehabilitation to get them home from hospital. Of course, we are not. Instead, there has been an explosion in need for those services, at a time when our NHS is being forced to make short-term cuts, by the end of March, that will have long-term implications for the care of our patients and for the skilled staff we need to keep in the NHS. At the same time, we are seeing cuts to our voluntary sector services, which provide care much more cost-effectively.

Given all the rhetoric from the Department of Health and Social Care about sustainability, why is that happening? Why are short-term financial decisions impacting so hard on frontline health services and on voluntary services, which are vital for that long-term sustainable service, and for the frail and vulnerable people who need them?

What is happening in North Derbyshire is in stark contrast to what is happening in the other part of my constituency, in Glossop, which is part of the devolution of health in Tameside and Greater Manchester, where the Bureau is providing a fantastic social prescribing service that is assisting people across the area. That is in stark contrast to what is happening in North Derbyshire, which has not seen the devolution of healthcare or a Labour council supporting local services to deliver much more cost-effectively. We are seeing our healthcare needs rise at 3.5% a year, but our CCG says that it will have to cut costs by 5% a year, and not just this year but for the foreseeable future, despite the long-term plan for the NHS. That will have a devastating impact on our health services. Without our voluntary services, they will be even harder hit.

In my debate in September, the Minister told me:

“It is unhelpful to scare local people ahead of those consultations, because those decisions have not been taken.”—[Official Report, 4 September 2018;
Vol. 646, c. 62WH.]

She said that there would be full consultation with patients, GPs and other stakeholders, but, as GPs have made clear to me, that consultation has not happened. The decision to cut £500,000 of voluntary sector funding was made just before Christmas.

How can our NHS deliver a low-cost model without our voluntary sector? As one of my constituents asked me:

“Please put up a good fight for these services! I doubt any of the people making the decisions have ever been as lonely as my friend has been, it takes only a smidge of empathy to understand why these services are vital. I am really passionate about combating isolation and loneliness …
however, this latest news feels like a big step backwards.”

That is why I am asking if the Minister is prepared to meet me and local GPs in High Peak to discuss all the cuts that are being made across health, social care and the voluntary sector in High Peak and across Derbyshire to make sure that we can get a sustainable service that delivers for local people on the ground without the sort of suffering that the cuts will create. Thank you.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care 2:45 pm, 8th February 2019

I thank Ruth George for bringing forward this important matter for debate.

First and foremost, I would like to reiterate the vital role that the voluntary sector plays in ensuring that people have access to the services that they need in the places where they live. Indeed, I go much further: I am an extremely firm advocate of encouraging NHS commissioners to commission services from the voluntary sector to get much better coverage nearer people’s homes and achieve better outcomes for patients at good value for money. I defer to no one in my support for the voluntary sector. The principle of making use of and commissioning services from the voluntary sector is a key theme in the long-term plan, and we will be investing at least an extra £4.5 billion a year in primary care and community health services.

This is the first time in the history of the NHS that real-terms funding for primary and community health services is guaranteed to grow faster than the rising NHS budget overall. Clearly, that is not reflected in the comments that the hon. Lady has just made. I understand her concerns about the cuts in funding for services in Derbyshire. I am advised by the CCT that it has confined the cuts to those services that are not associated with delivery of their statutory services, and that of a potential £1.25 million that was earmarked as meeting those criteria, only £300,000 has been cut. It is worth putting into context why that is.

Clearly, the Derbyshire CCGs have a duty to ensure the long-term sustainability of health services in the area. In the light of well-known financial challenges, that CCG has had to make difficult decisions on where to prioritise funding. As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that local areas are not running at a deficit. This is absolutely essential if we are to have an NHS that is financially sound and sustainable in the long term. Owing to their financial position, all Derbyshire CCGs are required to scrutinise their financial spend to ensure the best outcomes for patients for the investment made and to deliver financial balance. They have been working on that in close collaboration with NHS England. The joint saving plan agreed with NHS England states that if the CCGs make savings of £51 million, the remaining £44 million will be absorbed by NHS England. It is very much a joint approach to tackling the financial position in which the Derbyshire CCGs find themselves. None the less, they need to live within their means, and that is why they have had to review the overall spend and identify where savings can be made. It is challenging, but I have been assured that the absolute top priority of the CCGs is to minimise the impact that cuts have on patients.

I listened with sympathy to some of the points the hon. Lady made about spending on services provided by the voluntary sector that keep patients out of hospital and support them to live independently, and clearly I want to encourage all CCGs to commission exactly those services. I am reassured that those services that continue to be funded by CCGs, rather than remaining with grants, have been issued with NHS commissioned contracts—that has been done for stroke support, eating disorder and bereavement services—and I am satisfied with the efforts of CCGs in that area.

Photo of Ruth George Ruth George Labour, High Peak

The Minister says that the cuts are to services that do not deliver such good statutory support. How does she think that community transport does not deliver for patients struggling to get to, say, follow-up appointments for bowel screening?

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

The advice I received from the CCGs was that they had reduced grants only for services not part of their statutory functions, which fall to other agencies, particularly local authorities, with which they are working closely to make alternative funding available for some of the organisations that have been cut. I cannot answer the hon. Lady’s specific question about transport, but I understand that the total cut to transport amounts to £24,000 out of £300,000, so we are talking about quite a small part of what have been significant savings of £44 million that the CCGs have had to find. Support for local transport and accessibility normally falls to local authorities.

The voluntary and community sector has been an important part of the health system for many years, and partnership working between the voluntary sector, local government and the NHS is crucial to improving care for people in their communities. I expect all local CCGs to build much stronger relationships with local authorities to better join up all support services for patients. I welcome the scrutiny of this process by the health overview and scrutiny committees. I appreciate that it has been extremely political, but it is important that those decisions be taken transparently.

We also recognise the important role the community can play in helping people to maintain their health and wellbeing. Social prescribing is crucial. We are encouraging CCGs to look much more at such solutions, and not just at the medicalised solutions, and we will be using part of the £4.5 billion investment set out in the long-term plan to recruit more than 1,000 social prescribing link workers. I hope they will be able to work with the voluntary sector in the hon. Lady’s constituency.

We will also be looking at funding expanded community multi-disciplinary teams, meaning that in five years all parts of the country will have improved the responsiveness of their community health response services to deliver crisis services within two hours and reablement care within two days.

I appreciate that it will always be difficult to tackle a financial deficit of the size of that of the Derbyshire CCGs, and I welcome hon. Lady’s engagement in that process and the public scrutiny. I also pay tribute to the work of my hon. Friend Maggie Throup, who has been representing the concerns of her constituents in this respect. I am assured and satisfied, however, that the Derbyshire CCGs have done the best they can to support funding for the voluntary sector where it has been delivering a valuable service to the rest of the health sector. Indeed, one of the overriding criteria for making decisions regarding these cuts was that it would not lead to additional demand on health services and additional spending elsewhere, and I am satisfied that the decisions have been taken on that basis.

Photo of Ruth George Ruth George Labour, High Peak

The GPs on the CCG themselves stood up in the meeting and said there was a recognised risk that these service cuts would create cost pressures on other areas of services, so I am sorry, Minister, but it is simply not guaranteed at best, very likely at worst.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

I say respectfully that we expect the CCGs working with NHS England to properly interrogate the implications of their decisions, and they have done that; I have been given that advice, and I stand by the advice I have received from them on that.

I recognise, however, that those local commissioners in Derbyshire have had to make very difficult decisions, and we do believe that they are best placed to make those decisions. They have access to the local expertise and clinical knowledge needed to make an informed decision.

While I recognise the hon. Lady’s concerns, I hope she can reassure her constituents that the local CCGs are working to provide sustainable services that meet the needs of the people living in Derbyshire. The Government will continue to work with the local CCGs and NHS England to help progress with ongoing work and to help create those sustainable services for the future.

Question put and agreed to.

House adjourned.