Westminster Hall

Thursday 6th September 2018 Westminster Hall

Thursday 6 September 2018

[Dame Cheryl Gillan in the Chair]

Integrated Care

Thursday 6th September 2018 Westminster Hall

00:00

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House has considered the Seventh Report of the Health and Social Care Committee, Integrated care: organisations, partnerships and systems, HC 650, and the Government Response, Cm 9695.

It is a pleasure to serve under your chairmanship, Dame Cheryl. I thank all those who contributed to our inquiry in writing and in person, my fellow Select Committee members, and the Select Committee team, which was ably led by our Clerk, Huw Yardley, with special input from Lewis Pickett. I also thank our special advisers, Professor Sir Chris Ham, Dr Anna Charles and Professor Pauline Allen.

We are all immensely grateful to the South Yorkshire and Bassetlaw sustainability and transformation partnership, the Doncaster Royal Infirmary and the Larwood practice, not only for allowing us to meet them and their teams, but for facilitating the Committee’s meetings with local and national leaders from across the healthcare system, the third sector and many other providers to hear evidence during our inquiry. Without them, the report would not have been possible.

I will start by setting out what we are talking about, and why it matters. It is one of the greatest triumphs of our age that we are living longer but, as that happens, many more of us are living with complex, long-term conditions that require support and input not only from dedicated family and formal carer networks, but from across the health and social care system. If those systems do not join up, if they do not share information, or if they are poorly co-ordinated or inaccessible, patients’ care is poorer and everyone has a worse experience. Don Redding from National Voices said that patients and the public

“want to feel that their care is co-ordinated, that the professionals and services they meet join up around them, that they are known where they go, that they do not have to explain themselves every single time, and…that their records are available and visible.”

That is essentially what we mean by integrated care.

Integrated care can happen at three levels. It can happen directly, in the teams around the patient who deliver care in the patient’s home—for example, through joint assessments. It can happen at the service level—for example, with services brought together in a one-stop clinic. It can happen at an organisational level—for example, in commissioning or the pooling of budgets. We should all be clear, however, that none of that matters unless we keep the patient at the front and centre of those discussions. If the result is not delivering better care for patients and their families, it is not worth doing.

Integration does not save money in the short term or, sometimes, in the medium term, which acts as a key barrier to putting in place integrated systems for the long-term benefit of patients. Unfortunately, particularly with the current financial pressures, we have a system that is sometimes dictated and hampered by short-term pressures to deliver financial savings—I will come on to that later. In essence, we have to keep sight of the fact that integration is about people and families. Although our report focuses on organisations, partnerships and systems, we have tried to relate it back at every stage to why it matters to patients, rather than it being a dry discussion about systems.

[Diana Johnson (Kingston upon Hull North) (Lab)]

We are very ably led by the hon. Lady on the Health and Social Care Committee. The Committee’s approach to the public was the right one, and I hope that, in its future communications with the public, the Department of Health and Social Care might learn that lesson about having the patient at the heart. That is what this is about, because it is so complicated and difficult for the public to understand.

[Dr Wollaston]

I thank the hon. Lady, my fellow Committee member, for her input. We on the Committee heard that there is a complex spaghetti of acronyms—STPs, ICPs, ACOs—and nobody knows what they mean. Even those working in the system struggle to keep pace with them and with the changes. We have to keep bringing it back to plain English and why it matters to people and hold our attention there.

The integration of health and social care has been a long-term goal for successive Governments for decades, so we might ask why it is not happening everywhere if we have been striving for it for so long. We saw and heard about many fantastic examples of good integrated care, but they sometimes felt like oases in a desert of inactivity. It is also possible to have an area that does some things very well but others not so well.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I commend the hon. Lady for the way she is making her remarks on our report, which I welcome. I looked closely at the Government’s response, in which they said that they

“remain keen to consider how to build political consensus on the case for reform and funding as part of the development of the NHS”

10-year plan, but we have heard no reference to exactly how any mechanism for reaching such a consensus might be pursued. We have heard a lot of talk about integrated care for many years, but we now find ourselves at a critical moment. The Government are about to launch their 10-year plan, and it must be front and centre of what they put forward.

[Dr Wollaston]

I will respond further to the hon. Lady’s remarks when I comment on legislative change and how we can get legislative change through a hung Parliament. I will also comment on the importance of engaging with the service and why that needs to come bottom-up from the service, and the importance of politicians from across the House listening to the service and being focusing on its message and the message from patients and patient representative groups. I thank her for her constructive input. The Committee has been successful in building consensus about how this should go forward. I hope the Minister has heard that intervention and that he will respond specifically to that point in his closing remarks.

[The Minister for Health (Stephen Barclay)]

indicated assent.

[Dr Wollaston]

Coming back to why integrated care does not happen, there are many deeply ingrained structural divides. Since the inception of the NHS 70 years ago, we have had a system that is free at the point of use for the NHS, but means-tested for social care. That presents an extraordinary hurdle when systems are trying to join up. It is not just that; it is different contractual arrangements and working practices. Good integration comes down to individuals and teams being prepared to work together, but it often feels like they are working together to achieve integration despite the systems around them, not because of them.

We need a system where everybody is focused on helping the right kind of integration to take place, and we need to go back and look at that fundamental structural divide between the systems. I ask the Minister to look again at the joint report, “Long-term funding of adult social care”, because that is an important issue that goes to the heart of the barriers to joining up services. It is about contractual differences, different legal accountabilities and payment systems that work against the pooling of budgets, and financial pressures within the NHS.

A certain amount of financial pressure can encourage systems to come together to pool their arrangements and provide a more efficient service, but as the Minister will know, when the elastic is stretched too tight and the financial strain becomes critical, we see the opposite—systems are forced apart. I have seen that happen in my area, where people suddenly feel that they have to retreat to their organisational silos to fulfil their legal obligations. There is no doubt that, for the process to work effectively, we need the right amount of funding—and sufficient funding—and tweaks to the legislative arrangements to allow people to come together, so it does not feel as if they are working together despite the system.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I am grateful to the Chair of the Committee for giving way. Does she agree that when there is an attempt to elicit change through turning off the financial tap, what happens in fact is that people cut what they think is easiest to cut, which is often the most innovative solution, rather than step back with a clear head to consider where they want to get to in the end? Does she also agree that we often find that the result of that kind of cost-cutting is a backward step rather than a forward one?

[Dr Wollaston]

I thank the hon. Member for that intervention and for her own service to the Committee previously—she is very much missed. Her remarks are typical of the constructive input that she has always made to the health debate in emphasising the need to take the long view. Financial pressures so often force us into short-term solutions, not only in the way she set out but through the salami-slicing of services.

One of the points that our Committee feels strongly about and that I was going to make to the Minister is the need to ring-fence transformation funding, because it is so easy for that funding to get lost. I welcome the uplift in funding—a 3.4% increase will be very helpful—alongside a 10-year plan. However, we have to be realistic about what that uplift can achieve, because there are very many demands on that budget, as the Minister will know and as we have seen in the past. We saw it with the sustainability and transformation fund, which tended to get sucked into sustainability and not into transformation. That has been the pattern of recent decades. There is good intention to ring-fence money for transformation, but that money disappears because of other priorities around deficits and, as I have said, the many other calls on the funds available.

That is why we feel that, in order to prevent the continuation of that cycle of past mistakes, it is important that the pattern is recognised and that funding is earmarked for transformation—not only for capital projects but for things such as double-running.

I will give an example from my area. There will be a complete destruction of public trust in new models of care if money is not set aside for double-running. The community was prepared to accept that there would be a new facility—nobody wanted the closure of the local community hospital in Dartmouth, but there was an assurance that there would be a new facility. Unfortunately, despite many of us opposing the closure of the old facility, what happened was that it was closed and then there was a breakdown in the arrangements for the new facility. The community was left with nothing and there has been a huge destruction of public trust in the process, which unfortunately will have ripple effects across other communities. Had we received the money to keep the existing service while the new service was built and got up and running, it would have left us in an entirely different situation. I am afraid that we see that too often across health and social care. There is good intention, but without double-running, which is part of having a ring-fenced transformation fund, I am afraid that the system has broken down too often in the past. I would like the Minister to focus on that when he makes his remarks.

The Committee is also looking forward to the 10-year plan—we look forward to working alongside both NHS England and the Department of Health and Social Care to examine how that plan emerges—but is important to draw attention to legislative changes. Our Committee made a recommendation that legislative proposals should come from the service itself rather top-down from the Department, which would immediately run into difficulties. However, as a Committee we also offered to subject such proposals from the service to pre-legislative scrutiny.

As the hon. Member for Kingston upon Hull North (Diana Johnson) pointed out in her intervention, we need to build cross-party consensus at every point. As it has not been covered in the formal response to the Committee’s report, will the Minister say in his closing marks whether the Government would support the Committee conducting pre-legislative scrutiny?

I am pleased to have had a conversation with Simon Stevens, the chief executive of NHS England, who has confirmed that, as it emerges, the NHS assembly will consider that within its remit—NHS England hopes to produce proposals in draft form before Easter 2019. Nevertheless, as I have said, it would be helpful to receive the Minister’s assurance that proposals will come to our Committee for pre-legislative scrutiny as part of the process of building consensus.

[Diana Johnson]

Like me, the hon. Lady was in Parliament when we went through the 2012 reforms. We had to have a period of pause because of the complexity of the legislation. Pre-legislative scrutiny is absolutely essential and I wholeheartedly support what she has said as the Chair of the Committee.

[Dr Wollaston]

Hon. Members know that a lack of proper pre-legislative scrutiny that responded to concerns expressed led to many of the barriers. We have to go back and address them when they could have been addressed in a more collaborative process during the passage of the Health and Social Care Act 2012. I am thinking of the need to reconsider the legal basis for merging NHS England and NHS Improvement, and how we establish a better statutory basis for the process so that provider partnerships do not always have to go back to separate boards to gain their approval. It is about considering how we address issues such as geographical arrangements so that they make more sense to local communities. The Committee could play a constructive role in a host of areas but—I say this to the Minister—unless proposals are subjected to pre-legislative scrutiny and unless a cross-party consensus is established, proposals are likely to fail.

My final point—other Committee colleagues will probably want to develop it further—is this: what will happen around establishing a legal basis for integrated care providers? For two reasons, the Committee welcomes the change of name from “accountable care organisations” to “integrated care partnerships”. First, the original name confused the debate about Americanisation. The “accountable care organisations” proposed were not the same as those organisations in the States, and the original name caused a great deal of unnecessary anxiety. We do not see the process as Americanisation.

A concern raised with the Committee was that the process will be a vehicle for privatisation. We did not agree. In fact, we thought the opposite: we agreed with the witnesses who told us that the process provided an opportunity to row back from the internal market and away from endless contracting rounds, and move towards much more collaborative working. We would like that change to be properly reinforced within the legal status of health bodies, and are disappointed that the Government have not agreed to say categorically that these bodies would be classed as NHS bodies. When the Minister sums up the debate, I would like him to reflect on whether any form of wording can put the matter beyond doubt and ensure that these health bodies will not be taken over by large, too-big-to-fail private sector organisations.

It is not a concern that groups of GPs might want a leading role in the bodies. The Minister will know that the public concern is more about them being taken over by very large too-big-to-fail private sector organisations. It should be possible to come up with a solution. The Committee heard—the Minister knows this—that those working in the service have the view that the bodies are not likely in practice to be taken over by private sector providers. However, that public concern exists and is a barrier to change. If we can put this matter beyond doubt, we should try to do so.

[Luciana Berger]

I would add a bit of clarification on that point about the size of private organisations that might become involved. My concern is that, irrespective of size—whether private organisations are big or small—the threat of a takeover happening within our NHS has distracted the debate. Anything that would categorically rule it out would be very helpful.

[Dr Wollaston]

I thank the hon. Lady for her helpful clarification. I was trying to distinguish GPs, who are private contractors to the NHS. Sometimes that status is used as a reason why integration cannot be done. I do not think there is concern about that level of leadership involvement but, as she rightly points out, there is concern about other aspects of the private sector. It is acting as an unhelpful distraction when there should be a consensual approach to ensure, as I said at the beginning, that we keep focused on the purpose, which is to provide better services for patients. Anything we can do to facilitate making it easier for that to happen—rather than feeling like we are wading through treacle—will be a positive way forward.

I thank my colleagues and all who helped with the inquiry.

13:50

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Cheryl.

I thank the hon. Member for Totnes (Dr Wollaston) for securing this debate and for her outstanding leadership of the Health and Social Care Committee. As a GP and a public health doctor, I have a lot of experience of care that has not been adequately integrated. Too many times, I have seen patients repeat their story again and again to different health and care professionals. Too many times, I have seen doctors, nurses, managers and secretaries waste time searching for information that has not been passed from one part of the system to another. Too many times, I have seen dedicated community nurses, social workers, GPs and therapists all providing care that either overlaps with or contradicts care provided by other health workers.

Integrated care, as the Committee has acknowledged, is a very laudable aim, and the Government have some credible plans on delivering more integrated care. I will use my speech to focus on where those plans need to be strengthened. I will talk about resource, about what success should look like, a little bit about legislation and governance, about keeping the NHS as a public sector organisation, and about leadership.

First, integrated care needs to be properly resourced. The new care models pilots have had significant resource to facilitate change, as the hon. Lady indicated, and that may be a key factor in any reported success. Greater Manchester has also had significant investment of extra funding. Can the Minster assure us that, as other areas move towards integration, we will not see what usually happens: the pilots get extra resources and then the roll-out fails because of a lack of extra resource?

[Dr Whitford]

I am glad that the hon. Gentleman has highlighted that problem, which we have been seeing for literally decades. Early adopters are well resourced and well supported and have the ear of the health board or the Government, but during roll-out, all the people who did not have that experience are told to do it out of existing budgets, and it fails.

[Dr Williams]

I thank the hon. Lady for emphasising that point.

My second point is on what the broader health goals of an integrated system should be. The NHS is focused on reducing unplanned hospital admissions. Although that is important—it is especially important because of the financial costs to the service of unplanned hospital admissions—I want to see integrated care providers trying to achieve broader health goals. Success should not be measured by a reduction in secondary care activity alone, although I agree that in many cases the use of unplanned secondary care is a failure of prevention. ICPs will provide healthcare for a population of people. They need to take a population needs-based approach to healthcare, and they need to be prepared to invest outside the traditional medical model of care, including investing in the voluntary and community sector. We know that loneliness, social isolation and bereavement can have a huge impact on health, and we need integrated care not to be integrated medical care, but integrated holistic healthcare. I consider that integrated care providers will have succeeded if resources are focused on improving the health of the members of our population who have the greatest health needs.

Health needs are often not expressed. The inverse care law tells us that those with the greatest needs often have the least access to healthcare. A clever healthcare system does not just react to the people who turn up; it works with communities to identify and address needs within communities. For example, many people with mental health problems simply do not access healthcare, and it is not only their mental health that suffers as a result; their physical and social health suffer, too. On average, people with learning disabilities die 15 years younger than those without. They do not die because of those learning disabilities; they die because they are not accessing healthcare, both preventive and curative. We know about the health issues suffered by people living in poverty and other vulnerable people, including those with substance misuse problems, homeless people, veterans and vulnerable migrants.

Overall, I will consider integrated care to be a success if the share of healthcare expenditure that goes to preventive care, community care and mental health care increases year on year. Also, prevention must be prioritised, and I am pleased it is one of the three named priorities of the new Secretary of State for Health and Social Care. We need prevention at all its levels: better early detection, better immunisation and screening coverage, better prevention of falls, and better prevention of mental health problems, including investment in prevention right at the beginning of life—the first 1,000 days—where it has the greatest impact.

My third test for success is that performance, quality and safety are all maintained within a system that is taking out competition. There is a genuine risk that taking away some of those internal market forces might take away some of the incentives to keep waiting lists and waiting times down and to improve quality. As we integrate care, we need to ensure that we maintain those things.

[Luciana Berger]

I am listening closely to my hon. Friend’s remarkably informed remarks. Taking him back to his second priority, prevention, does he agree that the Minister should be thinking about what he should be doing beyond his own Department? The Minister and his colleagues in the Department of Health will not on their own be able to do what is needed on prevention as well as tackle this country’s mental health crisis and increasing lifestyle-related disease. If we are to address those challenges seriously, it will also be about what happens in our communities, our schools and our workplaces. That comes from local government and is what will ultimately make the difference.

[Dame Cheryl Gillan (in the Chair)]

I remind colleagues that interventions are meant to be short. I hope Members will be able to keep them a little briefer.

[Dr Williams]

I thank my hon. Friend for her informed comments. I agree with her. We need a cross-governmental approach, particularly for children. There is a glaring absence of a cross-governmental strategy that would enable us to focus on all the things that have an impact on children.

The third area I want to mention is legislation. Under current rules, clinical commissioning groups will remain the statutory accountable bodies, even as the relationship between commissioners and providers starts to evaporate. At the moment, STPs, where the providers and commissioners are getting together, are making decisions—often behind closed doors—which are then rubber-stamped by the accountable bodies, which are the CCGs. That does not feel to me like particularly good governance. Legislation needs to follow the new provision arrangements.

We might also need to consider legislation to improve information sharing. The duty to share information—the eighth Caldicott principle—is often forgotten. In my experience the biggest barrier to integration is the fear that NHS providers have about sharing information with other parts of the system, and their resistance to do so. We are not necessarily doing enough in legislation to protect that duty to share information in the interests of providing good-quality clinical care.

The current situation on procurement is very difficult for CCGs. The law says that many services have to be procured if they are over a certain value. CCGs, as small organisations with accountability for their local pot of NHS funds, genuinely fear legal challenge. When they ask lawyers they are, unsurprisingly, advised that they have to follow the law, but the political and NHS England leadership strategy is to integrate care, which often cannot be achieved when care is fragmented by putting services out to tender, and provided by numerous different organisations. Many CCG governing bodies want and need to be cautious. They are just not going to take the risk given the current legislative framework.

Quite simply, if we, as elected politicians, want the NHS to collaborate, we should legislate for collaboration. In my view, the Health and Social Care Committee should be an enabler of that process. We would like to provide pre-legislative scrutiny, but we would like first to ask the health and care community what changes in the law would enable them to achieve their goal of providing integrated care to patients. I would like to know whether the Minister agrees with that proposition.

My fourth point is that integrated care providers should be NHS organisations—a recommendation the Committee made in its report. There is a well-founded concern in the health and care community that, under current legislation, private companies might bid to win contracts to provide significant chunks of our health services. That concern could be alleviated if it were made clear that integrated care partnerships need to be NHS bodies. In their response to our report, the Government did not accept that recommendation, arguing that ICP contracts could be held by GP-led organisations. It would be a very good thing to have GP-led organisations running primary and community care and other parts of the health service, but I see no reason why those GP-led organisations cannot be NHS organisations.

It is a barrier to progress in the NHS that there are not community-based NHS organisations that GPs can lead and work for. I urge the Government to look seriously at the recommendations in the Institute for Public Policy Research report “Better health and care for all”, published in June, which suggests the creation of integrated care trusts in communities and a right to NHS employment within such organisations, which would provide all non-hospital care in an area.

My final point is about leadership. My hon. Friend the Member for West Lancashire (Rosie Cooper), who is a member of the Health and Social Care Committee but cannot be here today, has done significant work shining a light on leadership failures within the NHS. Integrated care is possible only if we have the best and most talented managers in the NHS. As was evident in the failure of management in Liverpool Community Health NHS Trust highlighted by Dr Bill Kirkup, we are far from achieving excellence and need to be certain we have the right mechanisms in place to ensure that we have only the best and the brightest. Will the Minister assure us that the Kark review will be expansive in its remit and that those NHS leaders charged with fixing the mess in Liverpool have been consulted for their expert views?

To conclude, the purchaser-provider split has not always achieved the best NHS care for patients. I welcome the step towards integrated care, but I do not think it will succeed when the legislation promotes, and sometimes mandates, competition. There is political will—certainly from the cross-party Committee—to work with the NHS and care system, including the NHS assembly, on proposals to change legislation, keep integrated care providers within the NHS, improve governance and remove mandatory competition. I hope the Minister will respond positively to those concerns. Integrated care has the potential to transform the lives of millions of patients in our health service. I commend the Committee’s report, and I thank the Government for the changes they are making.

14:04

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak on this matter. I commend the hon. Member for Totnes (Dr Wollaston) for setting the scene, and the hon. Member for Stockton South (Dr Williams) for making such a valuable contribution. I do not have the expertise of those two hon. Members—far from it—but I have a deep interest in the health service, and the treatment and service that is provided, which is why I am here. I thank the hon. Member for Totnes and all those who made a contribution to the Health and Social Care Committee’s seventh report, “Integrated care: organisations, partnerships and systems”.

We are ever-mindful of the anniversary of our own NHS. A lot of minds have looked back over the past 70 years, and we have all looked back over the years that we have been here, and we are thankful for the institution, which has been a beacon of the best of British by far. Just last weekend, I was present as my local council, Ards and North Down Borough Council, conferred the freedom of the borough on the NHS as a gesture of good will and a vote of thanks to those who work so hard in adverse conditions to provide care to those we love. As an active representative, I speak to those who work in the NHS and are recipients of NHS services every week. The hon. Member for Totnes made many telling comments, but one that I took from the very beginning of her contribution was that the purpose is to deliver a better service for patients. That really is the core of what we are about in the NHS, and at the core of the report’s recommendations.

Until recent years I had little cause to visit doctors or use the NHS but, as often happens, with age came complications, and diabetes was one of those. The doctor then said, “You need a wee tablet for your blood pressure. Well, you don’t really need one, but we’ll give you one anyway, just to keep you right.” Along with that, last year I was in hospital on three occasions for surgical operations. Not having been there for more than 40 years, suddenly finding that I was almost a regular visitor to the hospital gave me a really good idea of what our NHS is like today. I put on record my thanks to all those who made valuable contributions to those operations. I know it was down to the skills of the doctors and surgeons, but it was also down to people’s prayers.

We all know that the NHS is hanging on by a thread in many cases. It sometimes seems like that, but when I hung in the balance the NHS rose to the challenge. Sometimes we think that the NHS cannot deliver, but very often it does, and it delivers well. Any discussion about the NHS must begin with thanks to those who make it work against all the odds and who make what should be impossible possible. All of us here—myself in particular—say, “Thank you.”

I thank every person involved in the report, and I thank the Minister who is here to respond to it; I know he will do so very positively. As I began to read the report, the massive amount of work that went into it became abundantly clear. We need to bring on board the people with the vision for the NHS, as put forward in the report. I can see the vision for the NHS—I can read it on paper anyway, and then picture it. I understand the rationale behind the vision, but I also see the fear of secret privatisation, which people believe to be taking place. Some of the hon. Members who intervened referred to that.

We have all seen what happens when things move from public to private, and people fear a lack of services. That is easy to understand when talking about the loss of a rural bus link, but not when discussing whether a mother who is 72 years of age and has cancer will get treatment on the NHS. There is a fear among the general public that risk assessments will mean that we do not give such people a chance. I know that that is not the case, but we have to consider public opinion, and how people assess and see the situation. People see things quite simply at times. It is good to see things simply, because it makes it easy to follow through with the solution—those are my feelings anyway.

My feeling is that something has to change in the NHS. We all understand that bandages are not enough—it needs clinical surgery and massive intervention, some elements of which are in the recommendations. However, in order to be able to do that, we need to first prep the patients—the general public. We need to convince them that the proposed changes are for the better. We need to do a better job of preparing the public and explaining exactly what the plans are.

As the report was at pains to show, people do not fully understand how the NHS works. Information is not shared between emergency services and GPs in the detail and with the connections that it should be, and healthcare is provided from different sections who are not working together as well as they should. The integration referred to in the report can only work through partnerships that are truly trying to work together. When there is no understanding there is fear, and while people may not understand the current system, by and large they trust it. They trust that when they dial 999, an ambulance will arrive and bring them for care to their local emergency unit. When we tell them things are changing and we abbreviate terms using initials that save time but increase complexity, they fear that the very thing that they can trust no longer exists, because it is different from what it was five or 10 years ago, and they do not quite understand what is being said. That is why it is important to keep it simple. Of course, however we change the NHS, an ambulance will always be sent in response to a 999 call, but the simple fact is that people do not trust to that, so they will be unsure about what will unfold.

As a lay person, without the expertise that many on the Committee have—I bow to their knowledge and expertise—it is my humble opinion that we must do better in informing people how things are working now and how they can improve with changes, but understanding takes time and it is better to bring the public along, clarify uncertainties and address the issues at an early stage. Such corrective surgery has to take place, but the theatre must be prepped. People must be allowed to understand and that has to come with co-ordination and better working relationships with the press, as well as one-on-one discussions with patients when possible. It must happen with easy-to-understand information and it must happen before the changes are implemented.

I congratulate the hon. Members involved in preparing the report. I look forward to the Minister’s response, as well as the contribution of the shadow Minister.

14:12

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to contribute to this important short debate this afternoon. As has been said, for most of our constituents, this world of ICPs and various other acronyms is a bit of an enchanted forest or secret garden that they do not really understand—they just want their healthcare to go on being delivered properly and professionally—but it does of course matter. I completely agree with the Chair of the Health and Social Care Committee, my hon. Friend the Member for Totnes (Dr Wollaston); we need to keep seeing this from the patient’s perspective.

Like many others, I was struck by the clarity with which Don Redding, the director of policy at National Voices, explained how this should look from the patient’s perspective. He said that patients

“want to feel that their care is co-ordinated, that the professionals and services they meet join up around them, that they are known where they go, that they do not have to explain themselves every single time, and, therefore, that their records are available and visible.”

That is a succinct, powerful way that encapsulates what we are all trying to achieve—what the Government are doing and the purposes in this debate this afternoon. The last part of that sentence—making sure that their records are available and visible—is highly topical, given what the new Secretary of State for Health and Social Care said this morning. He is absolutely right to make sure that the NHS has the technology so that its brilliant workforce get the information they need to give first-class patient care, and that patients can use that technology to their own benefit and to the benefit of the health service generally.

I remember a Department for Work and Pensions initiative from some time ago that was called “Tell us once”. In terms of benefit claims, all of us as Members of Parliament will have had constituents who come in and recount giving their details, endlessly, to different parts of the Department for Work and Pensions. The principle should be the same in health. Our constituents’ time is precious. It is not just Members of Parliament who are busy people; our constituents lead highly busy, demanding lives, juggling work, family and everything else. The more we can make it simpler to capture what they say once, the better for them and the better for hard-pressed NHS staff, and it has to lead to a better outcome. I hope that is part of what our excellent new Secretary of State, who follows the last excellent Secretary of State, is looking to achieve, in light of his speech in Manchester this morning.

There were various highlights in the Committee’s inquiry. The one that stood out for me above all others was our visit to the Larwood practice in Worksop. I have spent a large part of the summer speaking to every single general practice in my constituency. I asked them to tell me about the pressures they face and what the NHS and the clinical commissioning group can do to help them, because I am very aware that general practice is under a lot of pressure. I know the Government are recruiting 25% more doctors, which is brilliant, and last year 3,157 of those doctors went into general practice, which is also brilliant, but we have to retain them as well and some of the workload pressures are challenging.

When the Committee arrived at the Larwood practice, it was incredibly exciting and invigorating, because we saw a practice that was joining up primary care, secondary care, social care and the voluntary sector. It was using paramedics and had its own pharmacy on site, so that people are not sent down the road in the rain to get their prescriptions. There was a buzz about the place. The GPs who worked there were bright-eyed and bushy-tailed, because I think they knew they were delivering a good service and serving their patients well. I am aware of the variability across general practice. If integrated care is going to mean something, the Larwood practice—which was selected for us by NHS England because it is doing well—and practices like that show the way. My challenge to the Minister is, how do we help all those other GP practices to rise up and perform in the same way?

Although not the direct subject of the report, the other huge area of integration that is so important that I cannot fail to mention it is the join-up between health and social care. The Committee wrote a separate report on that earlier in the summer, jointly with the Housing, Communities and Local Government Committee, which I thought had excellent recommendations. I am absolutely convinced that integrated care providers will not succeed in providing the integrated care we want unless social care has been put on a proper and sustainable financial footing so that it really does work hand in glove with our NHS at every level, primary and secondary.

Our report has been really useful in slaying a few myths about privatisation. Some of those myths have been around for a very long time. When Simon Stevens gave evidence to the Committee, he did a particularly good job—he went back through some of the allegations of privatisation of the past 20 years or so and showed that, over that period, those various allegations had not proved well-founded.

I very much welcome the Government’s commitment to amend the legislation where necessary, and where helpful to provide better-integrated care. That is a sensible and pragmatic step, which I would expect from the Prime Minister and the Government. It is very welcome

I very strongly agree with what the hon. Member for Stockton South (Dr Williams) said about prevention. He said something very true about the Committee that I have never forgotten: he said that we are a Health and Social Care Committee, but sometimes we could be mistaken for an NHS Committee. That is not because he and I do not think that the NHS—the organisation that is there to look after our health—is absolutely brilliant, but because health is wider than the NHS.

Unless we are absolutely passionate about dealing with childhood obesity—I am the chair of the all-party parliamentary group on obesity—and improving air quality levels in our inner cities, where children with asthma and other illnesses are deeply affected by breathing in poor air every day; unless we get more of our fellow countrymen and women walking and cycling; unless we do something about reducing the proliferation of takeaways, which sell highly calorific food; unless we do something about getting our supermarkets and big food producers to do better in producing healthier food, we will not succeed in this key area of prevention.

It comes down to detailed things such as planning policy for local authorities, which should not have to fight a rearguard action against the Planning Inspectorate to limit the number of takeaways in an area. They absolutely need to ensure, as we build new houses—which we desperately need to do—that cycle routes are built into new housing developments so that as many people as possible, including children, can cycle to stay fit and healthy.

It is worth noting that the integrated care partnerships are helping that to happen. The Committee heard from Ian Williamson from Manchester Health & Care Commissioning. When we were in Sheffield, he said that he thought conversations were now starting up about how Manchester could reduce childhood obesity and reduce the emissions and pollution that harm the local population. Such conversations are happening, but we need more than conversations; we need action, and we need to join up these different policy areas and produce results, because they are urgently needed.

14:22

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, welcome the opening speech of the hon. Member for Totnes (Dr Wollaston), who is a superb Chair of the Committee. The marketisation in NHS England goes back more than 30 years—it has certainly been happening for most of my career. It started with terms such as “resource management”, and in 1990 the internal market—the purchaser-provider split—was introduced. In the early 2000s under Labour, private companies started to introduce independent treatment centres. The Health and Social Care Act 2012 turned it into a massive external market and created the pressure to put all possible contracts out to tender.

The problems are well known. If we base a system on competition and not on collaboration, we inevitably create fragmentation and destroy integration. That has broken up patient pathways and made the system very confusing, to the point that CCGs were looking to employ what they called primary providers, which would have been another layer of cost and health organisation, to try to join things up for patients. Thankfully that has been shelved, because there is a sense of going in a different direction, but up to now there has been a repeated sense that everything can be solved through a healthcare market. That is why, in Scotland, we have grave concerns. One of the 24 powers coming to Scotland is power over public procurement—we do not see the market as the solution to everything.

Just five years on from the actual on-the-ground changes of the Health and Social Care Act, NHS England is facing another big reorganisation. As other Members said, unfortunately the rushed sustainability and transformation plans and the lack of consultation with both the public and staff has created anxiety and fear. As is now recognised, the term “accountable care organisations”, which was copied from the American system, was a PR mistake of the highest order.

In 1999 in Scotland—after devolution—we simply went in a different direction. We merged trusts and then abolished them in 2004. We got rid of primary care trusts in about 2009. We already had an area-based health service for the entire population—not just for people registered with their GP—based on per-capita funding. That meant that we could start to look at how to integrate acute hospitals with community hospitals and even local village hospitals for step up and step down—not everyone who is unwell and cannot be at home needs to be in some big, shiny 10-storey block, and might just need a bit of extra care for a few days, so there is an argument for community hospitals.

In 2014, we started looking at integrating health and social care. Because of the fragmentation in NHS England, it will be necessary to integrate health first, and then integrate social care. Integrating social care is much more challenging because it is made up of different players in the market and is done in a different way. As the hon. Member for Totnes pointed out, the overarching difference between free healthcare and means-tested social care creates major challenges.

[Andrew Selous]

The hon. Lady used the term “village hospital”, as well as the term “community hospital”. “Village hospital” is a new one to me. Could she elaborate on what it means?

[Dr Whitford]

It is not a particularly formal term. I simply mean that there has been a tendency to think that, because community hospitals cannot provide the full range of acute healthcare, they have no place, whereas someone might require only a low-level of in-patient care, such as an elderly person who has a urine infection and lives on their own may need intravenous antibiotics, fluids or extra care. Such hospitals allow us to have much more healthcare—things such as minor injury units—close to the public. The more we take forward to people, the less worried they will be about the fact that we are coalescing specialist services. If they see services coming towards them, they will not have the sense that everything is being taken away. We have utterly failed to impress on the public that healthcare is not about buildings, but very much about people and services. That is what integrated care should be about.

[Diana Johnson]

I am very interested in what the hon. Lady is saying about Scotland. Does she know that areas of England have integrated financial plans involving local government and health to try to bring together that continuity and put patients at the centre?

[Dr Whitford]

That is exactly what we have in Scotland—it was introduced in legislation in 2014, and all areas were up and running by the beginning of 2016. More than 60% of the budget goes to what are called integrated joint boards, which use innovative solutions to deal with all sorts of local groups to try to prevent people who do not need to be in hospital from ending up there, and to try to allow people to come out of hospital when they are ready. It has led approximately to a 9% per year decrease in things such as delayed discharges. Those two measures—acute admissions that could have been avoided and delayed discharges that lead to people being stuck in hospital—are very much looked at. In my early career, if someone was in a bed and ready to go home, they would be told, “Well, it’s your problem. We don’t have room.” There was always friction between secondary and primary care, and between health and social care. That is where we are, but it is not easy—it is not even as easy as integrating within health.

There is no escape from legislation. Some legislative change is critical for NHS England to be able to take the barriers out of the way. At the moment, as the hon. Lady mentioned, people are trying to work around those barriers, but when things change in an informally integrated care system, the acute hospital is put into financial difficulties. It is being asked not to admit people, but the existing tariff system rewards the hospital only when it admits people, so when it starts to get into difficulties, we are asking it informally to sacrifice its budget line for the greater good. I am sorry, but tariffs need to be reformed. It is a bizarre system if the aim is not to admit. Hospitals make money on the people who almost do not need to be there and lose money on the sickest, who do need to be there.

[Diana Johnson]

Again, that is very interesting. A good model of that, which is already happening in England, is in my own backyard: Hull. The hospitals have agreed that they will take a sum of money and will not look for additional money from the CCG if they need to treat more people. That is an integration of social care—the local council—and the acute sector, which is important in making this work. It can be done without legislative change, but overall I agree that change is vital.

[Dr Whitford]

That is fine in one place with good leadership and good relationships, but if things got tight it would be very difficult for one chief executive to accept the failure of their budget in order to keep the whole system going. Legislative change is crucial, towards more per-capita funding and away from tariffs, and towards more area organisation of that integrated care partnership.

Reform of section 75 of the Health and Social Care Act 2012 is crucial, because it pressures CCGs to put out to tender all possible contracts. In Surrey, six CCGs were sued by Virgin not for breaking a contract but for not renewing one. We estimate—actual figures are hidden behind commercial confidentiality—that more than £2 million ended up away from the frontline, instead going into Virgin’s pockets, which is not helpful.

In fact, the administration of the bidding and tendering market is estimated to cost between £5 billion and £10 billion, which contributed to the debt that NHS England got itself into by 2015, a mere two years after the changes in the Act came into effect in 2013. Before that, by looking down the back of the sofa and scraping around, and with a little bit of moving money around, the NHS in England usually managed to get to the end of the year in balance.

Moreover, that debt has led to rationing. The problems are not hypothetical ones on a piece of paper. They result in older citizens—we will be having a lot more of them—being held back from hip or knee replacements, cataract surgery and other things that allow them to see or walk, get out and meet friends and keep active, which is crucial.

Finally, it is critical for the accountable care organisations or whatever they are called now to be statutory. The model contract published last August would still allow a private company to bid for and run an entire integrated area. The report states that that is unlikely, but it should be simply ruled out in order to get rid of a huge amount of concern about a threat that might lie around the corner or down the line. Without that statutory basis, a company could hide from freedom of information requests and use its commercial sensitivities even though it is being handed billions of pounds of public money and getting to decide what is delivered to the population in its area. I am sorry, but that cannot be a private company and has to be a statutory body.

There are challenges ahead and we all face similar ones—increased demand, workforce and tight budgets—but we have talked about that before. At the moment, however, the structure for NHS England is hampering the staff on the frontline who are trying to look after people. The challenge of merging a free system with a means-tested system will not go away; it will have to be addressed. In Scotland, we have a slight advantage because we have free personal care, which takes away one of the problems, because it allows us to keep more people at home—in their own home, where they want to be—rather than in hospital.

Even though it is only five years since the last big reorganisation, NHS England is at another major crossroads, so there will be a lot of upheaval. It is important to get that right and to do it in a measured way in the House. Legislation should allow innovation in different parts of the country but get rid of the barriers. We should be radical and, as Members have said, to put the patient or the person right in the middle of the design. That involves more than just the delivery of treatment. Health is not given by the NHS—the NHS catches us when we fall and ought to be called the national illness service, but we would have even worse workforce challenges if we called it that. I echo the call for health in all policies, within the integrated systems and in the House, so that we are actually investing in the health of our population.

14:35

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Cheryl.

I congratulate the hon. Member for Totnes (Dr Wollaston) on her knowledgeable and measured introduction to this extremely important debate. I also thank the Health and Social Care Committee for an extremely useful and detailed piece of work on a rapidly changing area. In her speech, the Chair of the Committee set out from a patient’s perspective why it is so important for us to have a more co-ordinated approach than we do. “Having to tell the same story over and over again” was a phrase mentioned by not only the Chair but a number of other Members, and we all recognise the frustrations that we and our constituents have when that occurs. She was right to say that it is important that we look at the subject primarily from the point of view of patients. Their experience has to be at the very front and centre of all our plans for the future.

The hon. Lady articulated clearly how the financial pressures in the existing legislative framework, which we have all talked about many times, can inhibit transformation. She was right to say that an earmarked fund for transformation has to be protected, and it should not just be a capital pot. She set out clearly the need for a degree of flexibility.

As always, it was a pleasure to hear my hon. Friend the Member for Stockton South (Dr Williams). He made a pertinent point about the challenge for integrated care partnerships: to be considered successful, they should make a difference for those with the greatest health needs. He is right that we need to do much better as a nation on health inequalities, but how we approach prevention and health generally in this country does not necessarily lend itself to that. It would be most welcome if we can tackle that as part of integrated care.

My hon. Friend also expressed the genuine concern about the risk that changes could affect performance quality and safety, which are the pillars of an excellent health system. He made a strong point about governance and how existing decision-making processes are probably the wrong way round. The report acknowledges that they are certainly cumbersome and do not lend themselves to streamlined decision making. He highlighted well the dilemma faced by CCGs when tackling that agenda. This place needs to take a lead on that. He concluded by saying that integrated care has the potential to transform the lives of millions of patients—that really underscores why it is so important for us to get the integration right.

The hon. Member for Strangford (Jim Shannon) made a typically thoughtful contribution. I agree with him about the need to bring people along with us when we set out our vision for the health service. The report touches on how that has not been as successful as we might like in recent years. His comments on the use of acronyms were particularly perceptive—they may initially save time, but they actually increase complexity. Although I agree with the sentiment that we should keep things simple, anyone who looks at the Health and Social Care Act will realise that at the moment we probably cannot achieve that readily.

The hon. Member for South West Bedfordshire (Andrew Selous) made an important contribution. No one will disagree with what he said about putting patients at the centre of all this and the quote he gave about the kind of care they want. I was very interested to hear about his visit to the Larwood centre in Worksop; that sounds like the kind of model that we need to showcase what a good new procedure looks like.

It is clear from reading the report that I am not alone in being critical of the way some of the proposals in the past few years have been communicated. I do not underestimate the damage that has done to public confidence in the aims of the policy.. Releasing the new draft ICP contract in the middle of the summer with no publicity has not increased transparency about the Government’s agenda. It was interesting that the report described how public understanding of the proposed changes has been seriously compromised by the “acronym spaghetti,” which a number of Members mentioned. At another point in the report there was a reference to the acronym soup of

“changing titles and terminology, poorly understood even by those working within the system.”

That highlights well the difficulty we all get into sometimes when acronyms can take over—that will resonate with anyone who is a member of a political party. The use of food terminology in the report shows that perhaps the author was a little hungry when they wrote it.

To reinforce the point, since the report was published we have ICPs on the horizon—yet another acronym. Although I appreciate that the change was made to avoid conflation with the American model of ACOs, it is clear that we do not need new acronyms, but a clear explanation from the Government along with a timeframe for what they are seeking to achieve and, importantly, the criteria they will use to determine whether those objectives have been achieved. The chief executive of the Nuffield Trust, Nigel Edwards, described this as

“perhaps the biggest weakness, not just with the STP process but arguably with the ‘Five Year Forward View’.”

It is clear from both the evidence sessions and the report itself that confidence in the Health and Social Care Act 2012 is at an all-time low and that the current direction of travel is really an admission that the Act has not worked. As we know, the last top-down reorganisation put in place a siloed, market-based approach that created statutory barriers to integration. Now, there is a lot of tiptoeing around the current legislation but we need an admission that that legislation has had its day. We need new proposals that are properly scrutinised.

The initial STP process was imposed from the top and was based around 44 geographical areas that were determined very quickly without recourse to the public. The Government acknowledged in their response to the report that perhaps that was done rather too quickly. Although some of the areas that emerged after that initial consideration had well-established networks of co-operation, in others there was a vast and unwieldy network of commissioners and providers with completely different approaches put together at very short notice. They were told to produce plans in private, again very quickly, which were focused not on integration but on organisations balancing their budgets. The only beneficiaries of this process seem to be the private consultants who were drafted in to complete those hastily arranged plans. As Professor Chris Ham pointed out,

“most STPs got to the finishing line of October 2016, submitted their plans and breathed a huge sigh of relief. No further work has been done on those STPs.”

Will the Minister set out what his plans are for those areas, as the local bodies appear to be working in a vacuum? They want to work together, but at the moment they have a legal duty to compete.

The report makes it clear that being asked to solve workforce and funding pressures caused by national decisions exacerbates tensions and undermines the prospect of each area achieving its aims for its patients. The report also makes it clear, as my hon. Friend the Member for Stockton South said, that where support has been provided towards integration, it has been directed at those who are furthest ahead. Those at the bottom of the curve, sometimes through no fault of their own, have lost potential funding that they need to work together to improve services. The chief executive of the NHS Confederation, Niall Dickson, told the inquiry,

“There is a sense in which some organisations find themselves in a really difficult position. Just taking their STF money away…is like somebody digging a hole. Instead of…helping them to get out of the hole, they jump in with a larger spade and dig even faster.”

That is a colourful and alarming analogy.

Where local areas are able to proceed to the next stages of integration, there is understandable concern among patients and staff about precisely what that will mean. The integrated care provider contract has the potential to radically alter the entire health and social care landscape, but is continuing without any parliamentary scrutiny. Despite assurances that it is unlikely that a private company will win the contract to be an ICP, it remains the case that it will be possible, as a number of Members have said. As we heard, not long ago the NHS was forced to pay out millions of pounds to Virgin because it lost out on a contract. I am concerned that we will face similar challenges if this process continues without legislation.

It is not scaremongering to say that the Government are introducing a contract whereby a private company could be responsible for the provision of health and social care services for up to 10 years—it is a fact and a possibility under the legislation. The Chair of the Select Committee was right to say it would be extremely helpful to have a clear statement from Government to rule that out. It is within the gift of Ministers to say there will be no private involvement in those bodies in future. Will the Minister make such a commitment today?

It is clear in the report that staff are concerned about the lack of engagement in a process that in some areas has excluded them completely. They are also concerned about their jobs being transferred to non-NHS organisations; hopefully the Minister will deal with that today. Almost half all NHS providers were in deficit last year and we are entering uncharted territory in budget setting, so what steps will be taken in the event that an ICP reaches a significant deficit position that it is unlikely to be able to resolve alone? Given the recent news that loan repayments to the Department of Health are now a bigger financial burden to providers than private finance initiatives, will the Minster confirm that deficits caused by structural funding issues will not be resolved through further loans being issued?

It is also clear from the draft contract that the ICP rather than the CCG will be responsible for managing demand. That raises questions about accountability and transparency. What safeguards are in place to prevent further rationing of services and who will be accountable in the event that patients want to challenge such a decision? These are important questions that I hope the Minister will respond to. Will he also commit to set out in full the direction of travel, the Government’s objectives, the criteria that will be used to determine when those objectives have been achieved, and a timeline for primary legislation, which just about everyone across the sector believes is needed?

[Dame Cheryl Gillan (in the Chair)]

Before I call the Minister I remind him, although I am sure he knows, that we like to leave two minutes for the Member leading the debate to make her closing remarks. I call the Minister.

14:39

[The Minister for Health (Stephen Barclay)]

Thank you, Dame Cheryl, it is a pleasure once again to serve under your chairmanship. I join the hon. Member for Ellesmere Port and Neston (Justin Madders) in paying tribute to my hon. Friend the Member for Totnes (Dr Wollaston) as Chair of the Health and Social Care Committee, and to all the members of the Committee, for a very good report and for raising important issues regularly on behalf of the NHS and the wider health fraternity.

As a country, we are living longer, which clearly is to be celebrated. However, it means that people live with multiple long-term and more complex conditions. For the NHS to continue to deliver high-quality care as it has done for the last 70 years, it is increasingly important for NHS services to work closely with social care. We got a flavour of that from a number of the remarks made in the debate.

I very much welcome the Committee’s conclusion that fears that integration might lead to privatisation are unfounded. Indeed, the Chair of the Committee said,

“The evidence to our inquiry was that ACOs,”—

now referred to as integrated care partnerships—

“and other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”

That relates to some of the points I will make on pre-legislative scrutiny and points to the value of the work done by the Health and Social Care Committee to provide a cross-party view of proposals, which has allowed us to address some of the myths built up in the past. The Committee has done the House a service by slaying some of those misconceptions.

[Dr Wollaston]

I thank the Minister for referring to my remarks, but does he accept that the Committee went on to say that we felt the issue of privatisation should be put beyond doubt in legislation?

[Stephen Barclay]

The Chair of the Committee is absolutely right. We have always been clear that integration is about improving patient care, and that the NHS will remain free at the point of delivery.

A number of key points arose from the debate. Remarks were made about ensuring that the service is patient-centred, and concerns were expressed about whether transformation funding may be diluted. I will come to pre-legislative scrutiny, to which the Chair of the Committee referred, and primary legislation.

The hon. Member for Central Ayrshire (Dr Whitford) raised concerns about private firms and the role of GP-led organisations. The hon. Member for Stockton South (Dr Williams) and my hon. Friend the Member for South West Bedfordshire (Andrew Selous) referred to focusing on prevention and taking a wider needs-based approach. A number of Members referred to information sharing, leadership and the lessons from Liverpool Community Health NHS Trust—the hon. Member for West Lancashire (Rosie Cooper) performed a great service by highlighting that. That is reflected in the work I have commissioned from Tom Kark on the fit-and-proper test.

[Ms Karen Buck in the Chair]

Members focused on the need for a patient-centred approach, which the hon. Member for Kingston upon Hull North (Diana Johnson) emphasised in her intervention. In our approach to integrated care, we seek to build a healthcare solution around what is best for the patient and, in the words of the Chair of the Committee, why it matters to patients. That is very much the Government’s intention.

As the Committee Chair said, financial pressure can both incentivise and impede integration. She will be aware that the up to £20 billion a year that will go into the NHS as part of the Prime Minister’s commitment to funding the service will be front-loaded—there is more in the first two years in recognition of the importance of the double-running to which the Chair of the Committee referred. According to past National Audit Office reports, there have been a number of cross-party initiatives under successive Governments. As she and other Committee members set out, sustainability trumps transformation, which is one of the key challenges for the NHS family as it brings forward its 10-year plan. For the first two years, an extra £4.1 billion will go in, with front-loading of 3.6% compared with the average over the five years of 3.4%, which very much reflects the concerns she articulated.

The tone of the debate was one of broad consensus, and we will realise that first by asking the NHS itself to lead on the legislative changes required. The NHS will bring forward its proposals through the 10-year plan. We will not mandate, but let local areas decide what fits their locality best. That will be informed, for example, by health and wellbeing boards. I met the chair of the Lancashire health and wellbeing board yesterday—that speaks to the concern raised about the need for Health Ministers to take a wider approach rather than, as the hon. Member for Stockton South said, looking purely at the NHS element. We are looking much more widely and bringing in local authorities. Indeed, the Department’s name has changed, and the work of the Care Minister reflects the wider integration in our approach.

Although we welcome the Committee’s work on testing the NHS proposals as part of the long-term plan, we will wait for the NHS proposals before confirming the specific pre-legislative scrutiny arrangements. I hope the approach I have taken in discussions with members of the Committee underscores the importance I place on working in a cross-party way. The approach we have set out very much reflects that.

[Dr Whitford]

Can the Minister commit to looking at legislative change? It is fine for designs to come from the NHS, but if those designs are based on existing barriers, they will not reach their full potential.

[Stephen Barclay]

The Prime Minister has set out that it will be for the NHS itself to come forward, rather than for the Government to specify legislative change in a top-down way. As part of the long-term plan, the NHS will determine what can be done within the existing framework and whether change is needed. That will flow from the work that comes forward later in the autumn from Simon Stevens, Ian Dalton and others in the NHS, who are best placed to lead.

[Dr Paul Williams]

In the short time the Minister has left, will he will address the invitation he was given categorically to rule out integrated care providers being private sector organisations? Does he accept that the language he has used—he said the NHS will continue to be free at the point of use—increases concerns about private sector provision?

[Ms Karen Buck (in the Chair)]

Order. Minister, in responding, will you be mindful of the time and the need to leave the Chair of the Select Committee a couple of minutes to respond?

[Stephen Barclay]

Indeed I will, Ms Buck.

I draw the hon. Gentleman’s attention to the Committee report, which states:

“There is also little appetite from within the private sector itself to be the sole provider of…contracts…There are several reasons why the prospect of a private provider holding an ACO contract is unlikely…Integrated care partnerships between NHS bodies looking to use the contract to form a large integrated care provider would have an advantage over non-statutory providers that are less likely to have experience of managing the same scope of services”.

The hon. Gentleman himself referred to the desire not to rule out GP-led organisations, which are independent. He also mentioned GP-led organisations becoming NHS bodies. I am happy to meet him to explore exactly what he means. It is not the Government’s intention for private firms to run ICP contracts.

[Dr Whitford]

The Minister says that that is unlikely and that private firms do not want to run such contracts, but we are talking about a 10-year plan. Does he therefore recognise that it should be ruled out to give surety? We do not want another Hinchingbrooke, where a private company takes a contract on and an entire area faces a private provider walking away from an integrated care partnership.

[Stephen Barclay]

These arguments were explored at the Committee, which addressed that question. The fear of privatisation has been overplayed.

We are taking a people-centred approach and letting the NHS lead on shaping it. We have said we will respond to the points the NHS raises and act on them, but integration will enable services holistically to deliver better care for patients—as the hon. Member for Strangford (Jim Shannon) said, that includes better data sharing—and put the needs of patients front and centre. That is reflected in the report and in the cross-party consensus on how we want to take integration forward.

14:58

[Dr Wollaston]

I thank the Minister and other Members who contributed to the debate. They spoke passionately and reminded us why this matters, particularly to patients. Everything will be judged by whether integration delivers a better service for patients and those around them. I look forward to meeting the Minister and to his appearing again before our Committee—there are a number of areas in which we would like to press him a little further, but I welcome his comments.

Question put and agreed to.

Resolved,

That this House has considered the Seventh Report of the Health and Social Care Committee, Integrated care: organisations, partnerships and systems, HC 650, and the Government Response, Cm 9695.



Backbench Business

Children in Need: Adulthood

Thursday 6th September 2018 Westminster Hall

14:59

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered supporting children in need into adulthood.

It is a great pleasure to see you in the Chair, Ms Buck. I am grateful to the Backbench Business Committee for granting this debate on a subject that should matter to us all and definitely needs more attention.

The discussions that resulted in the Staying Put initiative for those in foster care—a decision for which I commend the previous coalition Government—have inevitably opened up a much wider debate about our responsibilities for all children in need and their transition to adulthood. Are the existing obligations placed on local authorities, the NHS and other safeguarding bodies sufficient, or is it time for a rethink? That is the purpose of the debate.

I know that the Government are concerned about mental health and have announced additional resources for that area. Of course we should all be worried about the growing numbers of children and young people needing help with eating disorders, self-harm and a host of other problems. When we raise these matters, we tend to be talking about young people where a problem has been acknowledged and the real issue is waiting times or access to treatment. However, what about all those young people who are being missed? The Children’s Society suggests that there may be as many as 240,000 vulnerable 16 and 17-year-olds in England and Wales, but only about 58,000 have been identified as needing support by local authorities. In fact, 46% of children referred to children’s services are turned away without any form of intervention, and 30% do not even reach the threshold for an assessment.

Where young people are in receipt of support, that often changes on the day they reach 18 as there is no legal obligation to provide continuing assistance and no requirement to help with a transition to adult services. In many forces, even the police marker or flag used to identify youngsters at risk or vulnerable to exploitation automatically expires as soon as a young person reaches 18. Disabled children face particular challenges in moving into adulthood when responsibility for continuing support switches from children’s to adult services.

[Andrew Selous (South West Bedfordshire) (Con)]

I wonder whether the hon. Gentleman shares my concern about a gap on the part of Ofsted, which I think is discriminatory. I understand from Bedfordshire police that there is no Ofsted inspection of children’s homes for 16 and 17-year-olds. The schools of children in mainstream education are inspected by Ofsted. Does he agree that there is a gap, and that we need proper regulation in this area, particularly as bad things are happening?

[Steve McCabe]

I am sure the Minister heard the hon. Gentleman’s point. I certainly agree that any provision of that nature should be subject to proper inspection.

Today there are more than 1 million disabled children in the UK, yet fewer than ever are getting the support they need. We also need to give some thought to healthcare improvements and just how scary it can be for a young person to wake up after surgery on an adult ward for the first time. We have an acute shortage of community paediatricians and much more work is required in the health sector in planning the transition for young people from children’s to adult services.

The Children Act 1989 requires every local authority to take reasonable steps to identify children in need in its area and to publish information on the services available. It places a particular stress on the health and development of children and the needs of the disabled, but cash-strapped local authorities are struggling to provide even the most basic services. The reality is that 15, 16 and 17-year-olds often have to be at crisis point before there is any intervention.

I acknowledge that there has been a big focus on, and in some cases a switch of resources to, child protection issues, yet while child exploitation scandals such as those in Rochdale and Rotherham serve to demonstrate that many teenage children suffer even greater risk outside the home than inside it, support is limited for the vast majority, even if their need involves neglect, abuse or exploitation. The Department for Education’s figures for 2015-16 suggest that perhaps 13,500 16 and 17-year-olds are in need because of “going missing”, and about 1,500 are in need because of trafficking.

It is estimated that each year some 12,000 16 and 17-year-olds approach local authorities because they are homeless, often as a result of a breakdown in relations with a parent or carer, violence in the home or other problems at home. Homelessness is not currently recognised as a risk factor in identifying children in need, and consequently there are no reliable statistics about the scale of the problem. However, most agencies working with teenagers identify it as a real risk factor, likely also to expose young people to a risk of drugs, alcohol problems, violence and sexual abuse.

[Stephen Lloyd (Eastbourne) (LD)]

I thank the hon. Gentleman for securing this important debate. I know he received much support from the Children’s Society and its “Crumbling Futures” report, which is essentially what the debate is all about. I and every other MP has had to deal with the harrowing reality of parents coming to us with teenage children who are aged 18 or 19, for whom there is no support at all. That is why I am so glad he has secured the debate. I look forward to the Minister’s response.

Is the hon. Gentleman aware that one of the anomalies resulting from a change to the law a few years ago is that people have to be in education or training up to the age of 18, but—even if a person is disabled and cannot get to school or training on their own—there is no statutory obligation on a local authority to provide transport for 16 to 18-year-olds?

[Steve McCabe]

The hon. Gentleman makes a good point. Quite a lot of problems result from both extending the school leaving age and creating notional rights for children with disabilities if we do not provide the resources to make it possible to deliver on those advances.

Thanks to some work undertaken by the DFE and other organisations, we know a bit about the common characteristics of children in need: around 13% of them achieve no GCSE passes; they are much more likely to be NEETs—not in education, employment or training—and they are three times more likely than children from the care system to end up homeless. The time has come for a fundamental rethink on what is happening to these young people. We must move away from a model of rationing that allows us to deny help to those who do not reach some arbitrary risk threshold or simply to drop them on their 18th birthday. We must develop an approach that recognises the continuing needs of those vulnerable children and young people who are already in a very disadvantaged position. Of course, that will cost more, but we must not forget that funding for children’s services has fallen by £2.4 billion in real terms since 2010, with an additional £1.5 billion gap for services needed for disabled children. The Chancellor will have to be pressed to address those issues in the 2019 spending review.

I believe there are things the Minister can do. He might look again at the assessment threshold, which many Departments use to thin out the number of young people who even make it to first base, and offer some guidance on the factors that must be considered before an assessment is ruled out. Ideally, every referral by any responsible agency should merit at least a first-stage assessment. I particularly urge him to look at the issue of homelessness among teenagers, to make sure that we do begin to collect reliable data and to instruct local authorities to identify it as a risk factor when assessing children in need. He might also bring wise heads together and demand that they establish proper transition procedures for all those turning 18, so that we put an end to the lottery of assistance and support for vulnerable young people that confronts them as they reach their 18th birthday.

I urge the Minister, in the existing education review, to advocate extending the existing higher-rate pupil premium to all children in need, not just those in care. That would be a real opportunity to help children at an earlier stage. I ask him to consider making it easier for the same children to qualify for discretionary bursaries to help them attend further education or other forms of training. Disabled children and young people would particularly benefit from improved provision of short breaks for them and their carers, and we should at least contemplate the suggestion by the Disabled Children’s Partnership of an early intervention and family resilience fund. In time, such an approach might even be extended to all children in need.

I am not expecting miracles. I know that some things take time and everything costs money, but above all these children need a champion—someone who can lead a real cross-departmental effort to raise the quality of help and support to some of the most vulnerable and deprived young people in our society. I believe the Minister could be that person. We must raise interest in how much we are prepared to do before young people reach crisis point, rather than focusing on making claims about increased funding for services that only become available after youngsters have suffered a major crisis. It is both a moral and an economic issue.

15:13

[Fiona Bruce (Congleton) (Con)]

I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate. I come at it from a slightly different direction in some ways, although not all, but none the less I agree that this extremely important issue deserves more debate in this place.

The Children’s Commissioner for England, Anne Longfield OBE, rightly says in her child vulnerability report published in June that 1.6 million children who are living in families with substantial complex needs

“have no established recognised form of additional support.”

She also says that if we expand

“the range of support we offer to vulnerable children and their families, we can support many more children in a more efficient and effective way. This is about an approach that works with children and their families, to develop resilience, confidence and independence”.

In other words, we need to focus more on prevention, so that children who develop very extensive needs can be helped earlier. As the hon. Gentleman said, early intervention is key.

In supporting the next generation, which I believe we are now calling generation Z or the post-millennials, we need better to recognise that transition into adulthood today is so challenging that they need far greater support from their very earliest years than we did. That support must continue right into early adulthood. Even in the best circumstances, the stage of moving from teenage years into adulthood today—that transition into adult life with regard to relationships, money and employment, to name but a few issues—is challenging and stressful. Of course, as we have heard, for those children needing more support and protection, it can be a particularly vulnerable time.

As the Minister knows, for over a year now a large group of some 60 Conservative MPs have been working on and supporting a manifesto to strengthen families, which contains many practical policies. I believe many of those are important if we are to properly support this generation. This generation has experienced profound changes in family structure, which has had a real impact on young people’s health. Changes in family life, and for some the absence of a father in particular, mean that many new parents have not had the role models that previous generations relied on to teach and guide them.

Beyond a good home life, young people need supportive communities, including the friendship of peers, the company of adults and cohesive neighbourhoods, which many now do not have—a place where people know their neighbours. Where that is the case, adolescent wellbeing and mental health is stronger. The environment in which adolescents grow up today has a major impact on their current and future wellbeing, and many need more support not only within their family and from their carers, but within their community and school environments. That is why strengthening family and community life is so important.

I am delighted that, following a meeting with the Prime Minister late last year regarding the manifesto, she commissioned a piece of work to see what more the Government could do to support children and families, which has resulted in her announcement this summer that she has asked the Leader of the House to chair a ministerial group looking at early years family support. Members of the supportive ministerial group include the Minister and the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for North Swindon (Justin Tomlinson), who has responsibility for family support. I am delighted that there is now a Cabinet-level Minister working on the family issue. I would be very interested to hear from the Minister how he proposes to take forward his work within that team. It is so important that we focus not just on the very earliest years of a child’s life, but right into those later teenage years and beyond, which I hope he will highlight to the team.

One way families and carers can be provided with greater support—the kind of support that Anne Longfield talks about in local communities—is through locally based family hubs. The Children’s Commissioner is very supportive of family hubs and the Minister and I have talked about them many times. They provide a wider range of support for the family, the carers of a child or teenager, and for the child themselves, and they provide that support from childhood right up into early adulthood and beyond. It is not just about those very early years, to which the old Sure Start children’s centres used to be limited. Family hubs are springing up in local communities across the country.

I am delighted that, following the debate a short time ago on family hubs, the Minister indicated that he will continue to look at how the Department can ensure, as he wrote to me following the debate,

“that the local government programme understands fully how the family hub model works and where the most effective practice is taking place.”

He has asked officials to look into that, and I would be grateful if he could give us an update on that work and on his timeframe for reporting on the work that he instituted following that debate.

As I have said, family hubs can provide a solution and early intervention support from a statutory authority, working together with local voluntary groups, charities and so forth, centred in a physical place within a community that families can turn to. They are essential because, as Dr Samantha Callan, an expert in this field, has pointed out:

“the lack of readily accessible family supports, along a spectrum of need, throughout the time children are dependent on their parents (0-19) means that life chances are often severely impaired and social care services are faced with unremittingly high numbers of children who are in need, on child protection plans and coming into care.”

I can give examples. The early intervention provision on the Isle of Wight—family hubs there are well established—means that fewer children on the Isle of Wight are being put on child protection plans. At Middlewich High School in my constituency, when children have special educational needs or disability or mental health challenges, the whole family is supported. After just a few years, the evidence shows the positive impact of the family hub approach on the emotional health and wellbeing of students, with an improvement in GCSE results, which improves life chances.

Another example of a family hub is in the Chelmsford library, which is a one-stop shop for free family services. Everything is included from antenatal contact and school readiness to substance misuse and mental health support, as well as disability support for children up to the age of 25 and so forth. There is a strong base from which late teenage and early adult young people can build their own lives and seek help for themselves as well as through their families.

As I say, I thank the Minister for his follow-up letter in August on family hubs following our debate. I was very pleased to read that

“the family hub approach is one that we would encourage local authorities to adopt if they believe it would deliver improved outcomes for their area.”

I like his approach.

I thank the Secretary of State for Education for the draft guidance he produced this summer on relationships education, which will be a step forward in helping young people build the healthy relationships that are so important if they are to embark upon early adult life in a positive way. The draft guidance emphasises how important it is that children of every background learn that healthy relationships are important as a foundation for future life. As I have said, many of them do not have good role models, but they have an opportunity to learn in school about the importance of family life and bringing up children. The Secretary of State’s foreword, which is very encouraging, says that

“we want the subjects to put in place the key building blocks of healthy, respectful relationships, focusing on family and friendships, both on and offline... All of this content should support the wider work of schools in helping to foster pupil wellbeing and develop resilience and virtues that we know are fundamental to pupils being happy, successful and productive members of society... This should be complemented by development of virtues like kindness, generosity, self-sacrifice and honesty.”

I thank the Minister and his ministerial colleagues for the way in which they are addressing the young people’s challenges. They have genuinely listened to the group of colleagues who are concerned about strengthening family and community life in the ways I have discussed.

[Several hon. Members rose—]

[Ms Karen Buck (in the Chair)]

Order. Before I call the next speaker, I need to say that we will go to the Front-Bench speakers at 4 pm. Several people have indicated an interest in speaking. I do not want an official time limit, but can people think about perhaps seven minutes maximum in order to accommodate everyone?

15:23

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on setting the scene so well. He often has debates on subjects in which I have an interest, and it is a pleasure to come along. It is also a pleasure to follow the hon. Member for Congleton (Fiona Bruce) and her contribution, which is similar to the one that we had before the summer break when we set the scene for family hubs and discussed their importance.

When I was looking at the number of children in care for another debate in the main Chamber this week, I was struck again by the fact that we need to do more for vulnerable children, as the hon. Members for Birmingham, Selly Oak and for Congleton have said. Others will undoubtedly say the same thing, but this is about the next step. We need to do more for those who are transitioning from having little or no power over any decision—where they sleep, what they eat, what school they attend. We then suddenly throw them into a world where they make every decision, where they alone are responsible, and it is not okay and it is not easy. That is the thrust of what the hon. Lady and the hon. Gentleman have said. We need to help more, so I sincerely thank the hon. Gentleman for highlighting the issue and I support him in his aims.

I have a quick comment on the good work that the hon. Lady has done so far in the organisation that she works with in her party. Some 60 to 70 Members are working towards the family hub idea. I say very gently to all Members that we should remember there are many groups out there who can make valuable contributions to young people, such as the Church groups and the faith groups that have a genuine interest in how they can help and step into the gap. There are charitable groups as well, such as the Salvation Army, who are there to help vulnerable people.

When I looked at the NSPCC article relating to children under protection orders in Northern Ireland—I want to quickly give the figures for Northern Ireland—it shocked me to learn that the number of children who were emotionally abused, physically abused, sexually abused or neglected was 2,132 in 2017. If we remember that our population is 1.8 million, it puts the figures into perspective. Those are thousands of children pressing towards adulthood who need support because of emotional scarring, but are we providing that support? That is the question the debate asks.

Some 52% of children in care were from the Catholic religion compared to 40% who were Protestant, according to Department of Health statistics covering the period to the end of last September. The figures show that 2,983 children were looked after in Northern Ireland, representing 69 children per 10,000 of the child population. Of those, almost one fifth—18%—had experienced a placement change during the previous 12 months, the lowest number in recent years, but the overall total for the last year was the highest recorded number of children in care since the introduction of the Children (Northern Ireland) Order 1995. The number of children looked after in 2017 was 3% higher than in the previous year, but it was 28% higher than it was in 1999. During the past year, 37,618 children were referred to health and social care trusts in Northern Ireland, up 10% on the previous year, which shows a growing trend that worries me.

The Northern Health and Social Care Trust received the largest amount of referrals, and the trust in the area I represent had the lowest at 15%. Police were the source of the largest proportion of children in need referred—some 26%. Whenever the police are involved, it means we are probably at the very difficult stage where it is hard to pull back. Social services referred 21%. A total of 2,132 children were listed on the child protection register, representing 49 children per 10,000 under 18 years. The figures also showed that children in care generally did not perform as well as their peers in key stage assessments. Sometimes we neglect not only their health, security and protection, but their education. We need to address the issue of education and ensure that they get the opportunities they need.

Some 74% of looked-after children achieved at least five GCSEs in year 12, compared with 99% of the general year 12 school population. The equivalent figures for those achieving GCSE at grades A* to C were 48% and 85% respectively. We have a massive shortfall for those who perhaps could and should do better. We have a duty of care to not simply get the children to their 18th birthday, but to get them into the community, into jobs and into a life in which they can fully participate and feel that they are contributing, a life in which they are confident in themselves and their abilities, regardless of their background. We need people around to encourage them. How do we reach that goal? How do we provide support?

The hon. Members for Birmingham, Selly Oak and for Congleton raised many interesting points that must be looked. I support having those points researched. The Minister has had two hard shots in the past two days, but I ask him to respond to the questions that we have put to him, and we look forward to his response. The Minister can be assured that Members attending the debate are concerned, which is why we are here contributing on a Thursday afternoon, which many refer to as the graveyard shift. We feel it is important. I ask the Minister to put his hand to the plough and look into it.

Life is tough for any child—tougher now than it was in my day when things were probably much simpler. Others would probably subscribe to that view. It is tougher than ever before. The ability to bully has moved from the playground to the former sanctity of a child’s home and bedroom, through the power of a smartphone or laptop. School places are limited, jobs are scarce and pressure is immense for all children. To that may be added the instability of not knowing when they will get their next meal, or if they will be taken from their mum and dad and placed with strangers again, and whether they will be placed with their siblings or not. Suddenly they are no longer supported in even those small ways. They are set up in a social housing apartment and told to manage their money—and welcome to life. That is not life. I believe it is more pressure than is bearable for some of those who are trying to make do. Things are not good enough now. We must do more and I support the hon. Member for Birmingham, Selly Oak and his calls to do more and do it better.

15:31

[Alex Burghart (Brentwood and Ongar) (Con)]

It is a pleasure to serve with you in the Chair, Ms Buck. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing the debate. It is a pleasure to serve with him on the Work and Pensions Committee; I know he cares deeply about the matters it deals with. I am particularly delighted that we are discussing this subject.

A few years ago, having worked in child protection for a number of years, I became acutely aware of the needs and problems of children who were not in care but were on the edge of it—children who never quite reached the threshold to be taken away from their parents, but who nevertheless faced considerable problems in their lives. As more research was done on children whose needs were assessed under section 17 of the Children Act 1989, it became clear that a large proportion of those children faced the same terrible outcomes as children in care—indeed, some would suffer worse outcomes. That stands to reason: the children who were taken into care were taken out of the disruptive, abusive, neglectful family environment, and put into long-term, stable foster care, or adopted, so their lives were changed, whereas children who did not reach that threshold often stayed under the observation of children’s social services but did not receive services adequate to improve their condition.

I take my hat off to Social Finance UK, which in Newcastle a few years ago did a seminal piece of work ago that exposed just how poor the outcomes were. It identified that children in need or in care formed a small but substantial proportion of young people in Newcastle, but went on in the long term to form the majority of those not in education, employment or training in the city. That is why it is excellent that the Department, under the current Minister, took up that work and ran it on a national scale. The report published earlier this year showed that children who were in care or in need at some point during their childhood accounted for about 10% of the youth population, but went on to account for 51% of all long-term NEETs in young adulthood. Such disruption to family life has long-term consequences.

It is always a pleasure to speak after my hon. Friend the Member for Congleton (Fiona Bruce), who spoke so eloquently about the need to mend broken families.

[Fiona Bruce]

I thank my hon. Friend for that comment. I saw a statistic yesterday that highlighted to me the need to focus much more on prevention than we do. Family breakdown costs about £50 billion per annum—various figures are quoted, but that has been quoted recently in many places. However, for every £100 spent on that, the Government spend only £1.50 on trying to prevent the breakdown of families. Something is wrong when it costs £50 billion to mend that brokenness.

[Alex Burghart]

Yes, my hon. Friend eloquently sets out the problem. We need to reconsider our approaches to prevention, early intervention and recovery. The problem faced by children in need is not, I believe, a marginal one, although it has been treated marginally for many years. There are about 380,000 children in need at any one time; the number of children in need at some point during any given year is considerably higher—many hundreds of thousands higher. So it was wonderful that the Children’s Commissioner for England, for whom I used to work, and the Conservative party, took on the cause. I was pleased to see that in our 2017 manifesto we committed to the review of outcomes for children in need that the Minister is currently undertaking. I know everyone in the Chamber awaits the findings of that review with eager anticipation. We need to know exactly what is going on behind the scenes that leads to those young people having such poor educational and employment outcomes. I suspect that the findings will not necessarily come as any great surprise to us, but they will have the “kitemark” seal of the Department behind them.

For too long, we have looked at the symptoms, rather than the causes of the problems that these young people face. We talk about neglect, abuse and family dysfunction, and those are obviously important, but we do not always talk about why that neglect, abuse or family dysfunction occurs in the first place. The causes are painfully predictable: poor mental health, long-term unemployment, addiction, family breakdown and the rest. Only when we turn our attention to fixing those root-cause problems will we start preventing the next generation of problems and helping to rebuild the family lives of those children already in the system.

[Wera Hobhouse (Bath) (LD)]

The hon. Gentleman and I are both on the all-party parliamentary group on adverse childhood experiences, which is very much about the issue we are debating. I fully agree that prevention is the way to go, but in my constituency councils are so cash-strapped that they can deal only with the absolute minimum statutory obligations; they do not have the money for prevention. Is not it time that we looked around to release money for councils to do the preventive work that is necessary?

[Alex Burghart]

As the hon. Lady says, we are both in the all-party parliamentary group on adverse childhood experiences, which I co-chair. There is no doubt that we need to work out how we can shift intervention to prevent problems from escalating. We know that there is limited money around, but I feel that there is a number of things we can do, and perhaps do better.

The Government have a major opportunity with the end of the current phase of the troubled families programme in 2020. I—like, I am sure, everyone in the Chamber—am keen to see those contracts reinvigorated for another phase, but the end of the current phase is the time to take stock of the considerable successes of the programme, as well as to consider whether we want to put a particular focus on that money in future. To my mind, the vast majority of children in need are by definition in troubled families. I know how many local authorities already spend the money, and data from the troubled families programme show that when it is spent well, it is excellent at tackling the root-cause problems and stabilising families so that they form a foundation on which young people can rest as they go into adult life. I rehearse all that because I think the best thing we can do to help children in need to move into adult life is to stabilise their childhoods. For some children, that will not be possible and they will need additional, ongoing support, but our first priority must be to make sure that young people do not need further help from us in the future because we have fixed the problems that they face.

An initiative I was glad to look at when I worked at the Centre for Social Justice works by giving children in need long-term mentoring at school. That gives them a stable adult in their lives who can give them the sort of advice that a parent might in a normal family. It is extremely successful in Tower Hamlets and in Hackney, and if we are to find the money for the sort of initiative proposed by the hon. Member for Birmingham, Selly Oak—a form of pupil premium for children in need; perhaps any child who has been in need in the past six years—that is the sort of thing that schools should spend that money on. I am conscious of the time, so I will rest my remarks there.

15:40

[Bambos Charalambous (Enfield, Southgate) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on securing this important debate.

The transition from childhood to adulthood is sometimes very difficult and confusing for some young people. It is hard enough when those changes occur in a typical, safe, loving family environment, but when they occur for children who are identified as in need of extra support, extra help is sometimes needed. The choices made by young people aged 16 and 17 are very important and can have a profound effect on their lives. Even when they have extra support, it is still a challenging time for them. Children also reach maturity at different times, so it is of great concern that 16 and 17-year-olds who are referred to children’s services and receive support see it disappear overnight when they reach 18. We know that vulnerable children left to fend for themselves become vulnerable adults who struggle to thrive.

The true scale of how many children require help into adulthood is not known. Research by the Children’s Society suggests that, in adolescence, 31% of all young people experience vulnerabilities, which are defined as being in poverty, substance abuse, lack of support from their family or having feelings of failure or depression. The research also shows that one in 16 young people aged 16 and 17 experience complex issues in their lives that require their being referred to local authorities for help. It is staggering that one in three of those cases are referred to local authorities by the police.

It is rare for children’s services to transfer cases into adulthood, but the evidence does not suggest that that is because those young people’s problems go away. In fact, there is clear evidence that unmet need at 16 and 17, and limited transition support, leads to extremely poor outcomes for these young people. The Children’s Society research found that children experiencing vulnerability at 16 and 17, including poor health, poverty, caring responsibilities and feelings of uselessness, are up to two and half times more likely to be not in education, employment or training at 18 or 19.

Homelessness seems to be much more prevalent among former children in need, with research suggesting that as high as 12% of former children in need become homeless. Those who were either in care or receiving support as children are also significantly over-represented in the prison population.

What can the Government do? First, I recommend that support should not stop as vulnerable children turn 18. Their needs do not disappear as they leave childhood. The Government’s review into provision for children in care needs to be widened, encompassing the transition into adulthood. This needs urgent attention. The Government should use that review to address how the education, housing, health and employment needs of vulnerable young people’s transitioning to adulthood will be met. Savage cuts to local authority budgets mean that local councils struggle to provide help in all but the most serious cases. That review must look at how funding can be provided to councils, so that they can give appropriate support to vulnerable young people.

Transition planning for children in need should be made a statutory requirement for vulnerable children moving into adulthood. Young people need clear information and co-ordinated support to deal with the vulnerabilities that they have been identified as having. Similarly, all children referred to children’s services should not be dismissed without an assessment of their needs, including a focus on risks, mental health needs and risk of poverty.

It costs more than £30,000 to keep someone locked up in prison. I invite the Government to invest in children’s support services now, to secure a prosperous future not only for children but for themselves.

15:44

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

I also congratulate the Children’s Society on its great work and my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on securing the debate so quickly after the summer recess. I will focus on an issue affecting young adults in need that crops up regularly in my area of north Staffordshire, where, shamefully, after years and years, no resolution is in sight.

For any family that has to go through them, anorexia, bulimia or other eating disorders are one of the most devastating illnesses that can affect the physical and mental health of children as they grow up. Often triggered by other traumatic life events or the stress of coping with adolescence, the suffering can be immense. Neither that suffering nor their vulnerability suddenly stops when children reach the magic age of 18, but in my immediate area—Newcastle-under-Lyme, Stoke-on-Trent and Staffordshire Moorlands—the commissioning of specialist support and treatment most certainly does.

North Staffordshire has an in-patient facility—the Darwin Centre in Penkhull in Stoke—for children needing treatment for mental health issues, including acute eating disorders. It is run by the excellently led North Staffordshire Combined Healthcare NHS Trust. In total, the annual budget for the North Staffordshire and Stoke clinical commissioning groups to address children and young people’s eating disorders is about £250,000, with more than £300,000 more spent in the rest of the county. For adults, however, the figure is precisely zero; no specialist adult eating disorder services are commissioned by the two CCGs. Instead, after children reach 18—teenagers still—they fall off a cliff and essentially have to rely on the good will of overstretched general adult mental health teams to respond to their needs. It is a scandalous situation that should not be allowed to continue. The CCGs, and their overlord, NHS England, need to act without delay.

Someone in my area needing specialist treatment as they leave school has to leave the area to obtain it, but not everyone is fortunate enough to go to a college or university in a place where the authorities treat such conditions with the seriousness that they deserve. It is especially sickening in my area because a few postcodes away, in other parts of Staffordshire, adults get treatment. There is an in-patient unit in Stafford, the Kinver Centre, run by the recently established Midlands Partnership NHS Foundation Trust. It can admit people from all over the country—not just the county—but not from North Staffordshire or Stoke, as our two CCGs provide no funding. However, the county’s other four CCGs certainly do. Their budgets for treating adult eating disorders is more than £400,000 a year, compared with nothing for constituents and families in my area, and nothing for local children in need as they reach adulthood.

The situation is made even more anomalous as, since last year, the county’s six CCGs have been run by the same accountable officer, Marcus Warnes, whom I am seeing tomorrow, so this is a timely debate. The latest information I cite comes from a response from those CCGs last month after I yet again raised the issue. I do not know how other hon. Members are served by their local health commissioners, but in Staffordshire all letters, including from MPs, are shipped off to a remote correspondence centre in Rugeley—the grandly titled Midlands and Lancashire Commissioning Support Unit— which gives itself 40 days to reply. I must admit that the response on this issue, which particularly affects young adults, came a little quicker, but it was signed, illegibly, on behalf of Marcus Warnes, so I do not even know if he read it or not. After confirming the zero figures for the Stoke and North Staffordshire CCGs, in comparison with the bountiful parts of the county, the reply ended:

“I hope that we have addressed your concerns. However, if there are any outstanding issues, please do not hesitate to contact the Patient Services Team.”

That is how they deal with Members of Parliament, so I hate to think how patients and vulnerable members of the public are treated. Frankly, not only are these people not on the case, but I sometimes think that they are not really on the same planet as the rest of us.

I appreciate that the Minister may well consider health commissioning out of his jurisdiction, but it is also certainly very much to do with children and families. In the interests of joined-up care and provision for vulnerable young adults, he should be aware of anomalies like this, as indeed should everyone in my area who needs such vital specialist services. Pressure really needs to be put—from all directions—on our local health commissioners to correct this situation, not least by members of those groups themselves, so that they actually serve the people they are supposed to represent.

15:49

[Mr George Howarth (Knowsley) (Lab)]

I add my congratulations to my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on a really useful survey of the information that is already known, and on the way in which he has introduced a very important subject and given us the opportunity to debate it.

As my hon. Friend and other hon. Members have provided so much information, I shall focus on just one aspect of the problem—low educational attainment, which is a particular challenge in Knowsley. We know that children considered to be in need are only one third as likely as other children to achieve A* to C GCSE passes in English and maths at the end of key stage 4; the figure is 63% for pupils not so classified. That is a serious discrepancy. We also know that, although this finding is based on a quite small sample, about 13% of young people—16 and 17-year-olds—achieve no GCSE passes at all. However, that is not where the emphasis is. When all the results are published, we publish league tables and show everyone delightedly jumping up and down with their passes, and that is great; we should do that. But what everyone tends to overlook is that huge cohorts of young people are achieving nothing out of their education. I want to focus on that.

We need to take into account the vulnerabilities that the Children’s Society and others have identified, because there is a connection between those vulnerabilities and educational attainment, which I will talk about shortly. A lot of these young people are in poor health. A lot have low satisfaction with life. Just think about being 16 or 17 and being able to identify that you have a low level of satisfaction with life. I suspect that many of these young people experience household poverty. Others feel “useless”. Again, imagine being 16 or 17 and thinking that you are useless. And of course there are those who have caring responsibilities, which is a growing problem among young people.

I do not want to enter into a discussion about sociological despair, because I know where that leads. I am not saying that we do not have to take that into account, but if we say that that is all there is, the consequence is that we do not do anything about the problems. We have to focus on the things that can be done to resolve those problems.

It is important to say that people cannot escape the environment in which they live. They cannot leave at the school gates all the problems in the household or the neighbourhood, which tend to follow people around. The problems that exist in the community also exist, in a slightly different form, in the school itself, but we cannot expect schools to be the only people who can compensate for the problems in people’s lives. In my view, we already overload teachers far too much. We have to look at what other things can be done and who can do them in order to address the problems.

I shall just make three suggestions and then conclude. First, some young people, when they have got to 14 or 15 years of age, have got to the point in their school career where, frankly, the next few years are going to be a complete waste of time. They have fallen so far behind that they are likely to be in that cohort that does not achieve any GCSEs, and attendance at school is sporadic. Sometimes—not in Knowsley, but in other places—some schools overlook absenteeism, because it is better not to have some pupils in the school at all, given the disruption that they cause.

Some young people reach a point at which they need something else in their life. They need some other way of getting back on track to gain some relevant qualifications, some relevant skills. The Department for Education is looking at different options—I welcome this—for alternative provision. Some alternative provision is excellent and provides the sorts of opportunities that I am talking about, but it needs to be said that some of it, to be brutally honest, is no more than cut-price childminding. I hope that the Minister’s Department will start to identify those projects and schemes that can do the work that is necessary with those young people and eliminate the cut-price childminding, which frankly is all too prevalent in some parts of the country.

The second thing that we need to do more of, as the hon. Member for Congleton (Fiona Bruce) mentioned, is to take a more holistic view by working not just with the young people, but with their families. These problems do not appear out of thin air. If there are—as sadly is the case in some families in my constituency—five generations of worklessness in a family, stretching back to the Thatcher Government years, when manufacturing in Knowsley was stripped out almost completely, there is a problem, because no one knows any longer what the relevance of school is. If the future is a life on benefits or of involvement in crime—or a combination of the two—what is the relevance of school? We have to intervene with those families to find ways of getting them to understand the importance of children’s having the opportunities to develop the talent that they have—many of them do have talent. I very much support the idea of that kind of approach.

The final point that I want to highlight is this. There is tremendous scope for mentoring. I know that it became quite trendy in the 1990s to talk about mentoring. Some of it worked and some of it did not. I am not talking about professional mentoring, but there are people in every community—there are many of them in Knowsley—who have successfully brought up their own families. Their children may have gone into useful, productive employment; they may have gone to university. Those people have a contribution to make. Many of them are retired but still fit and well, healthy, and lively in their minds. We have to find ways of linking those people up with families who are struggling, and we need to be very strategic about the way we do that. There is help and advice out there for those families; we just have to find ways of linking them with those people who can provide that help.

I shall conclude by simply saying this. There is a huge challenge that many of us avert our gaze from in our society. The huge challenge is that young people are not achieving what they ought to be at school, yet no one is providing the right alternatives, the right advice and the right framework of support that they need in order to do that. This is not rocket science. I hope that the Minister will take that heartfelt plea on my part seriously, because it is not that difficult to do it. We must have some resources, but more important is the will to do it.

15:59

[Brendan O’Hara (Argyll and Bute) (SNP)]

It is, as always, a pleasure to see you in the Chair, Ms Buck. I, too, pay tribute to the hon. Member for Birmingham, Selly Oak (Steve McCabe) for his passionate, informed and heartfelt speech. He spoke for many of us when he highlighted the consequences of the UK Government’s continued austerity for vulnerable young people and those who are trying to help them.

The hon. Member for Strangford (Jim Shannon) and the right hon. Member for Knowsley (Mr Howarth) made their usual thoughtful contributions, detailing the real consequences for individual children of not getting this right—the social problems and the educational attainment problems.

The hon. Member for Congleton (Fiona Bruce) is absolutely right that early intervention is vital. Supporting families, where possible, is something I wholeheartedly agree with. The hon. Member for Brentwood and Ongar (Alex Burghart) said that the issue of children in need was not a marginal issue, but had too often become so. He is right that far too often in the past we have looked at its symptoms rather than its causes. The hon. Member for Enfield, Southgate (Bambos Charalambous) said that vulnerable children become vulnerable adults. That is incredibly simple, but it is an incredible truth, which we have to accept. Their problems do not go away, but follow them through life. That is why early intervention is essential if we are going to address this issue.

[Giles Watling (Clacton) (Con)]

Does the hon. Gentleman agree that it is good to take a holistic view of these issues and not just deal with the symptoms? We are looking at many generations of poor parenting, which we have to address. We cannot just deal with the symptoms of the children. If we improved the quality of the parenting, we would start to bring those children into a good place, where they could get a decent education and life.

[Brendan O'Hara]

That holistic approach is something that I will come on to. It is more than good parenting; it is a societal issue. We have to change the culture of how we address these issues, rather than focusing simply on improving parents.

The hon. Member for Newcastle-under-Lyme (Paul Farrelly) gave a powerful testimony focusing on the serious gap in local provision in his area of north Staffordshire. I would like to be a fly on the wall in his meeting with the health officials tomorrow.

Much of what we have discussed is wholly devolved to the Scottish Government. I will share the experience of Scotland, so that we may learn from each other across these islands in this vital area of supporting children in need, vulnerable young people, children with disability and those in care, helping them in that transition to adulthood. We believe it is absolutely essential for the good of us all that children, regardless of their personal circumstances, receive all the support they require to ensure that they can make that transition into adulthood and flourish into the happy, well-adjusted adults that they deserve to be.

I was delighted, therefore, that Nicola Sturgeon, Scotland’s First Minister, in her programme for Government on Tuesday, promised a further £33 million to local authorities to provide targeted initiatives, activities and resources that will help to improve educational outcomes, specifically for care-experienced young people. I wholeheartedly welcome her pledge that the Scottish Government will incorporate directly into domestic law the principles of the UN convention on the rights of the child.

One of the most important pieces of legislation in recent years in Scotland was the Children and Young People (Scotland) Act 2014, which gives all children in Scotland the right to be protected from abuse and neglect. It is the cornerstone of the Scottish Government’s strategy for making Scotland the best place in the world for a child to grow up. The 2014 Act directs public services towards early years intervention. Early intervention and family support are critical. The legislation actively encourages prevention measures, rather than responding to crisis in later life.

The 2014 Act establishes a new legal framework within which services have to work together in support of children and their families. It is underpinned by the Scottish Government’s early commitment to the UN convention on the rights of the child. It seeks to establish a more holistic understanding of child wellbeing and how we, as a society, support our most vulnerable children, helping them to become the happy, well-adjusted young adults we wish them to be.

One of the many initiatives in the Scottish Government’s programme is “Getting it right for every child”, which is a national approach to improving outcomes and the wellbeing of our young people by offering the right help at the right time from the right people. “Getting it right for every child” supports young people and their parents into working in partnerships with the services that can help them best. It is designed to empower children, young people and their parents by, first and foremost, recognising and promoting their rights. That means putting their needs at the heart of any service delivery. “Getting it right for every child” builds on what most families already know: children benefit from a wide network of support, to promote and enhance their wellbeing. It is absolutely right that that support network should start with the family, but then the family can call on social services, the health service and the education services for support, as and when they need it. We all know how important it is to have a positive support network when transitioning into adult life.

The Scottish Transition Forum is another initiative from the Scottish Government. It encourages people to work collaboratively, share learning, identify gaps in current provision and generate solutions. Currently, it has 800 members. It is open to anybody who is committed to improving that transition experience for young people with additional support needs. Crucially, the Scottish Transition Forum involves those young people with additional support needs, their parents and carers in defining its policy.

The Scottish Government have also created the Care Experienced Employability Programme, which is helping hundreds of care-leaving youngsters between the ages of 16 and 29 to move into appropriate work, training and educational opportunities. It will deliver intensive support to young people who are often excluded from attaining their full potential because of their circumstances. It offers work experience, qualifications, practical skills, community projects and life coaching, all of which will be focused on the individual young person. The CEEP is a good example of the Government working with the third sector—in this case Barnardo’s Scotland, Action for Children and the Prince’s Trust, which have come together to form a young persons’ consortium in order to deliver that programme. There is so much being done in this holistic approach in Scotland. I advise the Minister, if he has not already, to speak to his counterpart in Edinburgh to see how Scotland is developing this programme.

Time is pressing, so I will be brief. In Scotland, local authorities have a statutory duty to prepare young people for leaving care once they cease to be looked after. They must also provide assistance to young people who have ceased to be looked after on or after their 16th birthday, and are legally required to provide after-care support until that care leaver turns 19. It is vital that young people are not cast out of the care system and left to fend for themselves; that is a recipe for disaster, which we have seen so often. To ensure that the Scottish Government are doing all they should for children in care, they have recently set up an independent care review, which will look at the existing legislation and the current practices, culture and ethos of the care system in Scotland. It will listen to the voice of young people in care and those who have been through the care system.

When she launched the care review, the First Minister said:

“Every young person should have an equal opportunity to succeed in life, no matter their circumstances. We should celebrate the progress that has been made that has allowed many of our young people who grow up in care to do great things…this review is not about determining if this can be achieved, but how we create a system that puts love for the children it cares for at its heart.”

Help and support for children is not an event, but a lifetime commitment by society. If we see it as an event, we are destined to fail. While in Scotland things may not be perfect, we put the needs of our young people at the heart of policy making and political thinking. That is the only way we can get this right. If we do not put young people at the heart, we will not get it right for them. As I said, we may not be there yet, but there is a firm commitment to make Scotland the best place in the world for children to grow up.

16:09

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It is a pleasure to see you in the Chair, Ms Buck. I thank my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) for securing this important debate on supporting children in need in adulthood. His excellent speech showed us yet again the valuable knowledge and expertise he has regarding children in need.

Yesterday, I reminded the Minister of the dire state of children’s social care thanks to his Government’s lack of cohesive strategic direction and swingeing cuts to local authorities. Early intervention grants have been slashed by up to £600 million, there is a predicted £2 billion gap in local authorities’ budgets for children’s social care by 2020 and, according to the National Children’s Bureau, more than one in three councillors are warning that those cuts have left them with insufficient resources to support children. It was recently revealed that 41% of children’s services are unable to fulfil even their statutory duties. The troubled families programme, which saw the demise of dedicated child in need teams, has spent more than £1.3 billion and had no measurable impact on families. Wider support services, youth services, family support workers—the services that children in need relied on—have fallen prey to the Government’s austerity programme and are disappearing.

In that environment, in any organisation, the roles and responsibilities that have the weight of legislation behind them—the things that absolutely must be done—are always the ones that take prominence. There is no legal requirement for local authorities to continue to support children in need when they turn 18, so it should come as no surprise that those children, on the cusp of adulthood, fall into the abyss. Looking at the current figures for 16 and 17-year-olds classed as children in need, that means that approximately 58,000 children are being cast adrift.

The referral rate to children’s services for those aged 16 to 17 years old is the same as for children of other ages, but they are less likely to be accepted for services and help as children in need. If they are, they are less likely to be subject to future support under a child protection plan than younger children. I do not know about other hon. Members, but at 18 years old, I do not feel that I was ready to make important decisions or to make my own way in the world. I still needed support, and I was damn lucky that I had it, but these children in need often do not. They are grappling with multiple intersecting challenges that many adults would not be able to cope with—and many are grappling with those issues alone.

Department for Education figures show that such children are more likely to go missing or be victims of sexual exploitation and criminal exploitation. They are more likely to have mental health issues or substance misuse issues, and more likely to be homeless or not in education or training. Those serious issues are not fleeting; they can leave enduring and deeply painful physical and emotional scars that last throughout people’s lives.

Similarly, children in need are not given prominence in terms of access to child and adolescent mental health support, as my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly) mentioned. That is not surprising, because cuts to CAMHS have reached more than £50 million and some children are waiting 18 months for treatment. Despite half of mental health problems being present by the age of 14, across England, only 8% of mental health funding goes to services for children and young people.

According to the Children’s Society, 16 and 17-year-old children in need are three times more likely to cite child sexual exploitation as a factor in their assessment than nought to 15-year-olds. Sexual exploitation is vastly underreported, and it is likely that even that is an underestimate. In a report that looked at 16 and 17-year-olds, the Children’s Society found that 50% do not feel that it is worth reporting something to the police. That is for a good reason: 75% of reported cases of sexual offences against 16 and 17-year-olds result in no police action. Again, that is no surprise when up to 43 police forces have pleaded with the Government about cuts that are leading to impossible workloads and delays in investigating complex child sexual exploitation cases.

[Alex Burghart]

The hon. Lady is raising important points. How much money would a future Labour Government commit to children’s services, and specifically to the issues that she has raised? How would that money be raised, given that it did not feature in “Funding Britain’s Future”, the document that Labour published in advance of last year’s general election?

[Mrs Lewell-Buck]

I ask the hon. Gentleman to go and read our manifesto again, because threaded through our manifesto were things to help children, such as investment in mental health and in school counselling. Unlike his own party’s manifesto, it was all fully costed. I would have another look if I were him.

As referred to by my hon. Friend the Member for Birmingham, Selly Oak, the Children’s Society estimates that 12,000 children who approach local authorities at risk of homelessness are sent away without an assessment even taking place. The Homelessness Reduction Act 2017 does not address the vulnerability of 16 and 17-year-olds, who are often sent back to their families, which are the source of the issues that they face such as domestic violence or substance abuse. It is no wonder that those children in need are more likely to go missing, or that they become another statistic in the ever-burgeoning rough sleeping stats.

All those factors make it even more disappointing that the Government’s long-awaited child in need review is narrow in focus, and will look only at the educational outcomes of children in need. Of course, I acknowledge that children in need have poorer educational outcomes than their peers, and I wholeheartedly echo the comments of my right hon. Friend the Member for Knowsley (Mr Howarth), but focusing only on educational outcomes—there are approximately 390,000 children in need—and ignoring the other difficulties they are suffering that we have discussed is a little short-sighted.

Respectfully, the Minister should take note of his Department’s figures, because they show stable numbers of children in need, but a high rate of re-referrals. In short, people are not getting the service they need first time round, and things are reaching a crisis point. The Children’s Society found that one in three 16 and 17-year-olds who were referred to children’s services were re-referrals from within one or two years. The reasons for those re-referrals were that their needs did not previously meet the threshold but their situation had now escalated, or that their initial referral did not resolve the issues. Sadly, at that stage, there is no time available to address those now acute issues, because when they turn 18, their case will be closed.

This cohort of young people are in desperate need of a Government who care about their future. The Minister has an opportunity today to prove that they do. He could commit to exploring changes to legislation and/or guidance that would allow properly resourced transitional plans to be put in place for children in need who are approaching 18, similar to those for children who have been looked after—a suggestion that has been advocated by my hon. Friends. He could commit to letting us know what cross-departmental pressure he will put on his colleagues to address the gaping holes in mental health provision and policing, and, vitally, to properly fund children’s social care.

It will simply not be enough, nor will it be acceptable, to say that those children’s needs will be addressed by adult services, should they need them. We all know that that just will not happen. I cannot think of any other scenario where people are identified as being in desperate need of help but they are deemed no longer worthy of that support and their case is closed, purely because of their age. I sincerely hope the Minister will not let us down in his response and, more importantly, I hope he will not let these children down.

16:18

[The Parliamentary Under-Secretary of State for Education (Nadhim Zahawi)]

It is a pleasure to serve under your chairship, Ms Buck.

I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this important debate. He takes a keen interest in the subject in his valuable role as chair of the all-party parliamentary group for looked-after children and care leavers. I echo the hon. Member for Strangford (Jim Shannon) in saying that this is such an important subject that we are here on a Thursday afternoon to debate it. I thank the hon. Member for Enfield, Southgate (Bambos Charalambous), the right hon. Member for Knowsley (Mr Howarth), the hon. Members for Strangford and for Newcastle-under-Lyme (Paul Farrelly) and my hon. Friends the Members for Brentwood and Ongar (Alex Burghart) and for Congleton (Fiona Bruce) for their contributions, and many other hon. Members for their interventions.

The Government are committed to ensuring that all vulnerable children receive the support they need to fulfil their potential, which means getting the support right throughout childhood and as they make the transition to adulthood. I will discuss children in need and care leavers, because both groups have been mentioned today. There are important, indeed fundamental, differences between children who are looked after and other children in need, for whom their parents still retain responsibility. We know that care leavers can experience extra barriers when making the transition into adulthood, including financial hardship and the difficulty of living independently at a young age. That is why we have extended the support that we provide to the children for whom we—the state—have corporate parenting responsibilities, where the baton of parenting has been passed on to us for all sorts of harrowing reasons. However, it is of course vital that we also support children in need to make a successful transition to adulthood. That requires the identification of needs and appropriate responses by a range of agencies working in partnership. Our key statutory guidance, “Working together to safeguard children”, describes how agencies should jointly agree on and deliver joined-up support for children in need.

We know that children’s needs may change as they get older and that older children are likely to have very different needs from younger children. The recent update to the “Working together” guidance is clear that local authorities should consider new approaches, such as contextual safeguarding for older children, if current approaches are not meeting their needs; some very good work on that has been done in the London borough of Hackney. The guidance also offers links to further advice regarding child sexual exploitation.

The update to “Working together” also makes it clear that known transition points for a child should be planned for in advance, including situations where children are likely to transition between child and adult services. The hon. Member for Newcastle-under-Lyme challenged his two clinical commissioning groups on this issue, although I will not comment other than to say that I will ensure that his remarks are passed on to the relevant Minister in the Department of Health and Social Care. As I say, such work includes identifying the points where children are likely to transition between child and adult services. The local authority should hold a review around the time of the child’s 18th birthday to consider whether support services are still required, and to discuss with the child and their family what might be needed, based on a reassessment of the child’s needs.

For all children, getting the best possible education is a critical part of preparing for adulthood; the right hon. Member for Knowsley focused on that point. That is why this Government are delivering on our manifesto commitment to review the educational outcomes of children in need. We have already published significant new data and analysis on the educational achievement of children in need, and I am grateful to my hon. Friend the Member for Brentwood and Ongar for his remarks about the work we are doing. We have received submissions in response to our call for evidence from hundreds of professionals and organisations on what works in practice to improve outcomes. The review is now considering the responses to the call for evidence and conducting further analysis to understand what works in practice to improve educational outcomes for these children.

I want that review to be tightly defined, impactful and focused on evidence. These issues are complex ones, as I think has been demonstrated in the debate today, but if we open things out too widely and try to solve everything, we are in danger of solving nothing. Having said that, our data and analysis publication looks beyond education at NEETs’ outcomes. As part of the data strand of the review, we are examining the possibility of linking with other datasets to understand more about employment outcomes.

The pupil premium was mentioned by a number of colleagues. Children in need have additional needs, which are catered for through the education system. Already the majority of children in need receive support in schools through pupil premium funding. We have provided over £13 billion of additional funding since 2011, targeted at reducing the attainment gap between disadvantaged pupils and their peers. Since 2011, that gap has been reduced at both the age of 11 and the age of 16.

Of all children in need, 49% receive support due to a special educational need or disability. The SEND code of practice explicitly states that all children and young people, whether or not they have an education health and care plan, should be prepared for adulthood and that this preparation should start early. For the 23% of all children in need on an EHCP, there must be an explicit focus from year nine onwards on preparation for adulthood.

Data published in the “Review of Children in Need” document has shown that children in need are more likely than their peers not to be in education, employment or training. We are determined to ensure that disadvantaged students are properly supported in their post-16 education. The Government have invested significantly—£7 billion in the last academic year—to ensure that there is a place in training or education for every 16 to 19-year-old. That is for all young people, regardless of whether they have had involvement with children’s social care. Local authorities have a statutory duty to identify and support all young people who are not in education, employment or training. We are extremely proud—I am extremely proud—that young people are now participating in education, employment or training at the highest levels since consistent records began, although we rightly recognise that there is still much more to do for some young people.

Regarding the funding for 16 to 19-year-olds, we want to make sure that vulnerable children are accessing education beyond the age of 16. In 2017-18, about £520 million was allocated to providers through the national funding formula to attract and retain disadvantaged 16 to 19-year-olds and to support students with SEND. We have also provided around £130 million directly to the young people who need the most help, to cover costs such as transport, which was mentioned in one of the interventions, and course equipment, through the 16-to-19 bursary fund. This fund is available to children who have vulnerabilities such as disability, or who are living independently without the financial support of their family.

Regarding wider outcomes, mental health was mentioned. Although education is of course critical to the long-term outcomes of children in need, in some areas that affect these children disproportionately we are working as a Government to improve services—specifically mental health, child sexual exploitation and of course homelessness services. Poor mental health can have a profound impact on the entirety of a child’s life, which is why we are investing an additional £1.4 billion nationally to transform children and young people’s mental health services.

Time is short and I would like to leave a minute for the hon. Member for Birmingham, Selly Oak to respond to the debate. The only other thing I will say now is that I was very pleased to hear my hon. Friend the Member for Brentwood and Ongar mention the troubled families programme, through which we are now spending £920 million to help 400,000 families. Given that a man with his experience is saying that that is the area we should focus on, I will certainly champion that programme and ensure that our voice is heard in the imminent strategic review.

I thank the hon. Member for Argyll and Bute (Brendan O'Hara) for his passionate articulation of what is happening in Scotland. In England, we are also supporting care leavers. We have extended the support that we provide to the children for whom we, the state, have corporate parenting responsibilities, and the offer of support from local authorities now extends to the age of 25. In addition, personal advisers can help care leavers to get support from mainstream providers as well as provide, or help to facilitate, access to practical and emotional support.

As time is short, I shall end there. Suffice it to say that a number of colleagues made some other important points, including about care leaver accommodation. Of course, my great friend and passionate advocate for family hubs, the hon. Member for Congleton, who I look forward to visiting—

[Mrs Lewell-Buck]

Will the Minister give way?

[Nadhim Zahawi]

I have no time left to give way, because I think we are ending at 4.30 pm and there is only a minute to go, which I want to give to the hon. Member for Birmingham, Selly Oak to respond—

[Ms Karen Buck (in the Chair)]

I think that the hon. Member for Birmingham, Selly Oak is indicating that he may not wish to speak.

[Steve McCabe]

I am happy not to respond to the debate.

[Nadhim Zahawi]

If the hon. Gentleman is happy not to speak again, I am happy to give way to the hon. Member for South Shields.

[Mrs Lewell-Buck]

I thank the Minister for giving way. I am just a little confused about his response to the debate. Children in need are a distinct category from those requiring child protection, looked-after children and care leavers, but most of his comments in his response to the debate were about other distinct categories of children in need and not about the distinct category of children in need themselves. I am just a little baffled by his response. I appreciate that he does not have time now, but could he put in writing to me what the Department is doing about children in need—not looked-after children and not care leavers, but children in need?

[Nadhim Zahawi]

I am very grateful to you, Ms Buck, for allowing that intervention, but I suspect that the hon. Lady, the shadow Minister, may not have been listening to me, because I actually talked very specifically about our document, “Review of Children in Need”, to which we committed in our manifesto, unlike the hon. Lady herself, who could not answer my hon. Friend the Member for Brentwood and Ongar on the funding that she is asking for in order to spend more. I am happy to give her a copy of my speech, which was all about children in need.

16:30

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).