Assessment and Treatment Units: Vulnerable People

Baroness Keeley Excerpts

Tuesday 6th November 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the long-term seclusion and deaths of autistic people and people with learning disabilities in assessment and treatment units.

[The Minister for Care (Caroline Dinenage)]

I want to address the care that the NHS and social care system gives to some of the most vulnerable in our society. The millions of people who work in the NHS and social care do so every day with compassion and commitment to care for us all, but sometimes the system gets in the way, and when we see that, it is our task and our duty to change it. That is the case with the care given to people with some of the most significant and complex needs, such as those with learning disabilities and autism who are in-patients in assessment and treatment units and other mental health in-patient settings across the country. The care received by some of the people with the most significant needs quite simply is unacceptable.

With respect to in-patient care in assessment and treatment units and other in-patient settings, I absolutely share Members’ concerns about reported deaths, and I want to restate my Department’s commitment to reducing the number of preventable deaths among people with a learning disability. NHS England is ensuring that relevant investigatory processes have been followed in respect of each and every one of the cases it has responsibility for, and it is seeking assurance from all relevant clinical commissioning groups that they too have ensured appropriate investigation. As it stands, there is no indication that any of the deaths were untoward or that due process was not followed in every single case, but we are double-checking each and every one.

The hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned seclusion. Like everyone in the House, I have been incredibly moved by reports of the care for Bethany and by the dignity of her dad, Jeremy, who has described the daily battle he has fought to get her the best possible care. It is completely unacceptable for seclusion to be used in this way. Restrictive practices must only ever be used as a last resort, and we must strive to totally eliminate them. With that in mind, the Secretary of State has instituted a serious incident review in Bethany’s case, and we will act to ensure that she gets the best possible care for her.

However, this is not just about individual cases; it is about the system. Three years ago, the Government committed to reducing the number of people with learning disabilities or autism detained in mental health hospitals by at least a third. The latest information we have shows that the number is down by around 20%, but that is not nearly enough. Today, 2,315 people with a learning disability and/or autism in England are held in mental health hospitals. I want to see that number drastically reduced, and in the first instance I want us to meet the target of reduction by a third. I want to see everyone who can be cared for with their family living as normal a life as possible.

The Secretary of State has instituted a wide-ranging review into the inappropriate use of prolonged seclusion and long-term segregation as restrictive practices. He has asked the Care Quality Commission to initiate that review immediately, and it will be undertaken in two stages. Furthermore, he has asked the NHS to address this issue in the long-term plan that it is writing for the future of the NHS, and I know that NHS leadership shares our passion to get this right. We will also address the role of local authorities in the social care Green Paper, and both of those will be published before Christmas.

[Mr Speaker]

Order. I remind the House that this question must finish no later than 1.45 pm, and if people have not got in by then, I am afraid that it is too bad.

[Barbara Keeley]

I want to put on record my disappointment that the Secretary of State tried to shoehorn an issue of this severity into an NHS policy announcement yesterday, and my thanks to you, Mr Speaker, for allowing this urgent question.

The treatment of people with autism and learning disabilities in assessment and treatment units is nothing short of a national scandal. Six years ago, these units were described by the then chief executive of NHS England and the chief executive of the Care Quality Commission as a model of care that has

“no place in the 21st century”.

Seven years after the Winterbourne View scandal, the Government have not rid the country of these units or substantially cut their use. Indeed, as the Minister said, there are still 2,315 people in assessment and treatment units, including 230 children, and the number of under-18s has been increasing.

A Sky News investigation last week revealed that, since 2015, at least 40 people with a learning disability or autism have died while in assessment and treatment units, and nine of those who died were aged 35 or under. Some of the country’s most vulnerable people are being exposed to physical abuse in institutions that the chief inspector of mental health services described as being

“in danger of developing the same characteristics that Winterbourne View did.”

Can the Minister tell us why the NHS is still sanctioning the use of settings that expose thousands of vulnerable people to abuse, at a cost of half a billion pounds, despite the Government pledging to close them?

The transforming care programme has manifestly failed. What are the Government going to do to ensure funding is available for cash-strapped local councils to pay for community placements with care support for autistic people and people with a learning disability? The Times has revealed that the private companies running these units are making millions of pounds out of detaining vulnerable people in unsafe facilities, in one case funnelling £25 million into a secret bank account in Belize. Can the Minister tell us what the Government are doing to immediately stop private companies that have a vested interest in keeping people with learning disabilities in these Bedlam-like conditions from doing that?

On Saturday, as the Minister has outlined, the Secretary of State ordered the Care Quality Commission to undertake a thematic review of assessment and treatment units, and he has ordered a serious incident review in the case of one young autistic woman, Bethany. Reviews are not urgent action, there are very many Bethanys trapped in seclusion, and 40 people have died in these units. Will the Minister tell us the timetable for the completion and publication of the CQC review and what urgent action can be taken to free all the young people and adults trapped in these appalling conditions?

[Caroline Dinenage]

Hon. Members will be very aware of and concerned about the report published this week by University College London. As the hon. Lady said, the report, which was commissioned by the NHS, draws attention to how people with learning disabilities die on average 15 to 20 years sooner than the general population, often for reasons that are not an inevitable consequence of any underlying medical condition. I was reassured that this report shows that programmes and opportunities that Government are putting in place to improve outcomes for people with learning disabilities and autism are addressing some of the concerns. However, I share very strongly her views and the views of this report that there is still much further to go and that now is the time to take action.

As hon. Members will know, the LeDeR report—the learning disabilities mortality review—is looking into the deaths of all people with a learning disability. It published its second annual report in May and in their response in September the Government accepted all the recommendations and included detailed actions for implementing them. NHS England has also committed that the long-term plan for the NHS will include learning disability and autism as one of the four clinical priorities. The long-term plan will also set out the future of the transforming care programme, which the hon. Lady raised.

Government policy on restrictive practices, including seclusion, is to reduce their use. Where such interventions have to be used, they must be a last resort and the intervention should always be represented as the least restrictive option to meet immediate needs. Incidents of restrictive intervention are recorded in the mental health services dataset and this data is published. The Mental Health Act code of practice highlights the particularly adverse impact of seclusion on children and young people. It advises careful assessment and periodic reviews.

I want to turn to the Care Quality Commission review into the inappropriate use of prolonged seclusion and long-term segregation. The first stage of the review will focus on settings that relate most closely to Bethany’s circumstances, focusing on people of all ages receiving care on NHS and independent sector wards for people with learning disabilities and/or autism and on child and adolescent mental health wards. That will start immediately and this stage will report in May next year. It is very important that service users, their families and people with lived experience are able to contribute to that. The second stage will report in the winter and will examine other settings in which segregation and prolonged seclusion are used. That stage will include NHS and independent sector mental health rehabilitation wards and low secure mental health wards for people of all ages, as well as residential care homes designated for the care of people with learning difficulties and/or autism. As I have said, individuals who have been subject to segregation and/or long-term seclusion and their families and carers will be invited to provide evidence, including through interviews. The Care Quality Commission will make recommendations at the end of both stages, which will seek to eliminate system-wide inappropriate use of prolonged seclusion and long-term segregation, and ensure that vulnerable adults and children supported by health and social care are accorded the best possible care.

I should point out that not all the numbers that the hon. Lady spoke about are in separately identified assessment and treatment units. The data reports there being 2,315 in-patients with a learning disability and/or autism in mental health in-patient settings as of September, but some 360 of them were in in-patient settings described as for people with acute learning disabilities

It is important that commissioners should be able to access very high-quality, value-for-money care in their local area, whichever organisation provides it. We recognise the concern that people have expressed about what happens in the transforming care process, but I see it very much as a process and not as an event that will continue. The NHS has transferred more than £50 million to ensure that the right care is put in place in respect of community support, so that people are better cared for when they are out in the community.

Points of Order

Baroness Keeley Excerpts

Monday 5th November 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

On a point of order, Madam Deputy Speaker. The treatment of autistic people and people with learning disabilities in assessment and treatment units is nothing short of a national scandal. Seven years after the Winterbourne View scandal, the Government still have not got rid of these units or substantially cut their use. Now we get, with no notice, the whole issue rolled into another oral statement on public health. The shameful treatment of 2,300 people in Bedlam-like conditions is too important to be dealt with in this way. Can you advise on how to get the Secretary of State for Health and Social Care to take this issue more seriously in the way that he communicates to the House?

[The Secretary of State for Health and Social Care (Matt Hancock)]

Further to that point of order, Madam Deputy Speaker. I have come to the House at the first available opportunity to explain very clearly, and with some force, I hope, how strongly I feel about people with learning difficulties and autism being held in seclusion units. It is unacceptable morally and unacceptable medically. It has to stop, and it is going to stop.

[Barbara Keeley]

Further to that point of order, Madam Deputy Speaker. What I was complaining about was that this was done with no notice—no notice to the shadow Secretary of State, no notice to me or the team, and no notice to Members of this House who were not here to ask questions. We should have had notice that this important issue was being dealt with.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the hon. Lady and the Secretary of State for their points of order. Obviously, the Secretary of State will have heard the point that the hon. Lady has made. I am sure that she will wish to pursue this further. The Secretary of State and the Leader of the House are here on the Treasury Bench, so I am sure that if there is further information forthcoming, that will be the way to proceed.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

Of course winter always challenges the NHS, and this year will be no different. We have put in extra funding, including more capital funding, to ensure that we get the best possible flow through A&E and to ensure there is further funding for social care so that people who do not need to be in hospital can leave hospital.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Last week, The Times reported that a young autistic woman with severe learning disabilities and an IQ of 52 was sexually exploited for months after her care provider had a court accept a plan for her to have sexual relations with men at her home. It is unacceptable that the agency charged with the care of this young woman decided that unsupervised contact with men for sex was in her best interest, yet the Government would give all such care providers a role in assessing the mental capacity of the people for whom they care. Will the Secretary of State urgently investigate this case? Given that the case illustrates the conflict of interest that arises from involving care providers in mental capacity assessments, will he pause the Mental Capacity (Amendment) Bill to allow time to make it fit for purpose?

[The Minister for Care (Caroline Dinenage)]

The hon. Lady is absolutely right to raise this incredibly concerning case. Unfortunately, because the case is ongoing and due to be heard before the High Court very shortly, we are unable to discuss the specifics of the case, but we are incredibly concerned by what it suggests. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure that the services they commission are safe, effective and high quality. Once this case has gone through the High Court, we will look to take further action.

Autism and Learning Disability Training: Healthcare Professionals

Baroness Keeley Excerpts

Monday 22nd October 2018 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I am pleased to speak with you in the Chair, Mr Austin, which I think is a first for you and me. I pay tribute to Dame Cheryl—who was in the Chair until a few moments ago—for her work in this House on autism. I thank the Petitions Committee for bringing forward this debate. It is sometimes important that the Petitions Committee does not wait for 100,000 signatures, but is prepared to move earlier on an important topic. I particularly thank my hon. Friend the Member for Cambridge (Daniel Zeichner) for his excellent speech.

I know people were anxious about this debate, because it coincides with the statement from the Prime Minister on the October EU summit, but we have heard from a number of hon. Members. There were interventions from my hon. Friends the Members for West Ham (Lyn Brown), Hartlepool (Mike Hill), Bristol East (Kerry McCarthy) and Bristol North West (Darren Jones), and the hon. Member for Central Ayrshire (Dr Whitford). We heard speeches from the hon. Members for Kingswood (Chris Skidmore), Dudley South (Mike Wood) and Bath (Wera Hobhouse), and my hon. Friend the Member for Sheffield, Hallam (Jared O'Mara), who spoke very movingly. We also heard from my hon. Friend the Member for Hampstead and Kilburn (Tulip Siddiq) and the Scottish National party spokesperson, the hon. Member for Livingston (Hannah Bardell). There were concerns about the clash in timing, which was really unfortunate.

Like everyone else who has spoken, I congratulate Oliver’s parents, particularly his mother, Paula McGowan, on their persistence in ensuring that Oliver’s case was brought to our attention through the e-petition, which now has 51,351 signatures, according to the latest figure I have seen. She has raised the vital issue of how we treat people with autism and learning disabilities in our health and care services.

The e-petition, which calls for the introduction of mandatory training on autism and learning disability for healthcare professionals, states:

“One in four healthcare professionals has never had training on learning disability or autism. This is unacceptable. Two thirds want more training, and one in three think a lack of Government leadership is contributing to the problem of avoidable deaths. The Government must ensure all healthcare professionals get mandatory training to address the huge health inequalities facing people with autism and a learning disability.”

The Government response says:

“Everyone has the right to high quality, safe health care so it is crucial that all health workers are given the skills and education to confidently deliver care that meets the needs of all their patients. This is a priority for the Government.”

If this is a priority, let us end this debate by discussing the action that we need to see.

Some 10 years ago, Mencap published the campaign report “Death by indifference” in response to the ongoing poor treatment and care in the NHS of people with a learning disability, and their premature and avoidable deaths. One of the main contentions in that report is that diagnostic overshadowing is a key barrier to people with a learning disability getting equal treatment. Diagnostic overshadowing is when doctors make dangerously faulty assumptions about people with a learning disability, revealing an overall lack of training, skills and under- standing. They may wrongly believe that a presenting problem is a feature of someone’s learning disability and that not much can be done about it, which can often lead to the wrong diagnosis of a medical condition that needs treatment. That report came out 10 years ago.

In its report, the former Disability Rights Commission called for “improved staff training” explicitly to reduce the risk of diagnostic overshadowing and unequal treatment.“Death by indifference” led in 2008 to the report “Healthcare for all”, an inquiry into healthcare for people with learning disabilities. Its first recommendation was that:

“Those with responsibility for the provision and regulation of undergraduate and postgraduate clinical training, must ensure that curricula include mandatory training in learning disabilities. It should be competence-based and involve people with learning disabilities and their carers in providing training.”

That was 10 years ago, but Oliver’s case underlines the degree to which people with learning disabilities and autism still do not get the healthcare treatment that they should expect from any civilised, compassionate society.

On a slightly different note—it is all of a piece—last week, I raised in the House the case of Bethany, a young autistic woman who is being held in seclusion in a private hospital, in a locked, cell-like room and fed through a hatch. We have heard too frequently in recent months of more cases showing the mistreatment, neglect and abuse of people with learning disabilities and autism.

Oliver’s tragic case typifies cases in which people with learning disabilities have died avoidably in healthcare settings. He was a young man with a full life expectancy, who had overcome so many challenges to excel as a footballer and an athlete. He inspired and enriched everyone he met, but he was let down repeatedly, because clinicians simply did not understand the nature of his autism.

Oliver’s death was the result of a catalogue of failures and communications that were not adapted to his needs. Repeated warnings that Oliver was not to be given antipsychotic medication were ignored with fatal consequences. The parallels between Oliver’s case and those reported 10 years ago in “Death by indifference” show just how little progress has been made in giving clinicians the right training about people with learning disabilities and autism. As my hon. Friend the Member for Cambridge mentioned, Public Health England’s 2016 survey found that only 17% of localities reported having an autism training plan across all health and care staff, while 10% reported having no plan in place.

Oliver’s case was included in the learning disabilities mortality review, which revealed scandalous health inequalities between those with autism and learning disabilities, and those without those conditions. Want of better clinical training causes those scandalous health inequalities. Men and women with autism, a learning disability or both simply should not die 20 or 30 years before those without either condition. That report was published on the morning of the local election results, when attention was inevitably directed elsewhere, which looked like an attempt to bury the findings, causing even more distress to the families of those who had died avoidably. In the words of Dr Sara Ryan, the mother of Connor Sparrowhawk, who tragically lost his life as a result of the negligence of Southern Health, the NHS trust charged with caring for him, it made it seem that the lives of their relatives “simply don’t count.”

As with earlier reports, the cases reported in the learning disabilities mortality review reinforce just how much more Government, and our health and care system, need to do to give people with autism and learning disabilities the good quality healthcare and social care that they ought to expect as a right, and to which they are entitled in law. The lack of training given to clinicians played a pivotal role in Oliver’s death and the deaths of many other people whose cases were included in that review.

As we have been reminded, almost one quarter of clinicians surveyed subsequently by Mencap revealed that they had never attended any training specifically on learning disability. More than half of clinicians would have welcomed more on-the-job training to enable them to provide better support. We have an NHS workforce that would welcome the training and a Government response that says that giving the skills and education to healthcare staff is a priority, so we now need to inject some urgency into moving forward.

Oliver’s case, the case of Connor Sparrowhawk and the cases of 1,200 people with learning disabilities who die an early death each year make that an urgent task. We need swift action, not further consultations. We need a culture change. Doctors are the decision makers and they must own the development of the training in autism and learning disability.

I hope the Minister will reflect on the debate and treat the introduction of mandatory training as an urgent priority. Can she tell us the Government’s timetable for implementing mandatory training following the close of the current consultation? What progress is being made against the recommendations of the learning disability mortality review, particularly the introduction of a named healthcare co-ordinator and the plans to help providers to make reasonable adjustments?

In the last 10 years, we have had reports, inquiries and reviews on the serious matters we have discussed in the debate. Now is the time for action to develop the training that clinicians and other staff working in health and care need. Now is the time for clinicians to own the culture change that would bring about what we all want to see—the Oliver McGowan mandatory training.

[The Minister for Care (Caroline Dinenage)]

It is a pleasure to serve under your chairmanship, Mr Austin, and that of your predecessor, Dame Cheryl, who has done more to further the cause of people with autism than any other Member of Parliament. I put on record my thanks to all hon. Members who have taken part in the debate. There have been some impressive and high-quality contributions. In particular, I thank the hon. Member for Cambridge (Daniel Zeichner) for bringing the case before us and the Petitions Committee for permitting the case to be brought. I also thank the hon. Member for Sheffield, Hallam (Jared O'Mara) for his testimony, although he is no longer here. I am sure we all agree that it was incredibly powerful, extremely important and exceptionally brave.

It is hard to hear the story of Oliver McGowan, which inspired the debate and the petition that triggered it. I am the mum of a teenage boy a bit younger than Oliver, so I find it heartbreaking to even think about what Paula and her family have been through. I have been in this role for nine months, and one of the great honours of the job is being able to speak to some incredible, awe-inspiring people, but surely the most amazing of them are the mothers who have turned the unthinkable heartbreak and anger at the loss of a child into a crusade for change.

Dr Sara Ryan, who has already been mentioned, whose son Connor Sparrowhawk drowned in a bath while under the care of Southern Health, is the most remarkable campaigner for the way that we support adults and children with learning disabilities. Another example is the incredible Paula McGowan, Oliver’s mum, who I met last month. To say that I feel humbled by her story is a massive understatement. The way that she has been fuelled by the unspeakable tragedy of Oliver’s death to fight, to battle and to campaign to ensure that other children and parents do not have the same experience is incredibly brave and courageous. She is nothing short of an inspiration, and she inspires me to strive to tackle the inequalities that people with autism and with learning disabilities face and to do my best to prevent further avoidable tragic loss of life.

The health inequalities between people with learning disabilities and autism and the general population are well understood—virtually every hon. Member present has mentioned them. In recent years, there have been ongoing efforts to address them, but the shameful case of Winterbourne View Hospital is an example of how things have not worked.

It is a sad fact that it takes an avoidable tragedy to spur the action that we want. Since then, significant programmes of activity have been devoted to tackling the inequality that has blighted the experiences of people with learning disabilities in society—inequality is not confined to health and social care. That activity is not only about reducing the number of deaths that may have been preventable, but about improving people’s genuine experiences of care, reducing the use of restrictive interventions, increasing health and wellbeing, and ensuring that people are not hospitalised when they can be better supported in the community.

The existence of the learning disability mortality review programme—LeDeR—testifies to our commitment to reduce the number of preventable deaths among people with a learning disability. LeDeR is focused on learning disability, but has important lessons that relate to the care of autistic people. The programme, led by the Norah Fry centre at the University of Bristol, was introduced to ensure that local evidence-based action is taken to improve support for people with a learning disability. The result is that commissioners are focusing their attention on their local mortality rates and the reasons for them, and are highlighting the further national action that is needed. We must learn from those deaths quickly and translate that learning into effective remedial action that prevents any repetition.

In May, the University of Bristol published the second annual LeDeR report, which showed that 13 deaths had involved circumstances where an individual’s health had been adversely affected by entirely avoidable external factors. The report also found that, based on the examples that were reviewed, the median age of death is 23 years younger than the general population for men and 29 years younger for women. It makes for shocking and chilling reading. LeDeR is ongoing, so many reviews are still to come. Since then, there has been significant action to increase the number of reviews undertaken, including NHS England investing an additional £1.4 million in support of them. Hon. Members from across the House will feel, as I do, that the report is a stark message that we need to do much more to ensure that people with a learning disability receive the best quality care.

In the Government’s response to the LeDeR report, which we published on 12 September, we set out a clear action plan to make progress against each of its national recommendations. The key theme is that of facilitating better care for people with a learning disability by sharing information on their needs and by making reasonable adjustments to improve access and the responsiveness of services to meet those needs. It highlighted some actions that I am glad to say were already well under way, as well as many new actions.

[Barbara Keeley]

The Minister has used the word “action”. If we had been able to discuss the Government’s response to the LeDeR report, which came out the day before the conference recess, I would have said to her that there is very little action in it. The whole point of the cross-party feeling of the debate is that we want action. There are an awful lot of consultations in the response but, as I highlighted in my speech, we have had 10 years of reviews, starting with the report that came out 10 years ago. The Minister used the word “action”—can we not just get on with some?

[Caroline Dinenage]

We have accepted every single recommendation in the LeDeR report, and the only reason we are consulting on the recommendations about training is that we have to do that to introduce legislation and change the regulations. We need to do that properly and ensure that we take on board the experiences of people from a wide range of backgrounds so that it actually works. Training is already in the guidelines for healthcare professionals, but the hon. Lady and many other hon. Members have said that it is simply not happening. This is not about action for the sake of it or to say that we have ticked a box to make it happen, but about meaningful action that will save lives. That is why I want to get it right. I am not going to hang around; it will be done to a timescale, which I will explain more about in a moment.

An example of action is that NHS England is working with NHS Digital to add a reasonable adjustment flag to digital care records to indicate the potential adjustments that people with a learning disability may require. The flag will be available to all organisations that provide care. It will support improved communication between patients, their carers and clinicians and lead to more personalised, safer patient care and better outcomes. That capability is being developed for piloting in the NHS summary care records application this summer. We are also exploring with NHS England and NHS Digital the potential for a comparable autism flag.

We have also commissioned Oxford Brookes University to look into best practice in co-ordinating the support for people with a learning disability and a long-term condition. Hon. Members have raised the difficulties that autistic people and people with learning difficulties experience in communicating their needs to health professionals, and also highlighted the importance of hospital passports in overcoming these difficulties and ensuring that their hospital stays are safer and more comfortable. However, I know that Oliver had such a passport and it was not read, so that needs to be taken into consideration as well.

As part of our governance arrangements for the autism strategy, we have set up a task and finish group on health, care and wellbeing, which is looking at barriers to care. We will ask it to consider how we can best disseminate tools such as the hospital passport, to ensure that patients receive effective, personalised care.

Of the new actions, the one that most concerns us today is the commitment to consult on mandatory training. I believe that the steps we are taking will address the shameful inequalities that people with learning disabilities continue to experience. Everybody has the right to receive effective, compassionate and dignified care, and having a learning disability or autism should not be a bar to that.

I am absolutely committed to ensuring that all staff have the skills that they need, whether for learning disability or autism, to deliver excellent and compassionate care. We are already taking forward actions in this area, which I will set out before moving on to discuss mandatory training.

We have supported the development of the learning disability core skills education and training framework, which sets out three tiers of knowledge and skills in relation to learning disability. We are also working towards the development of an autism core skills and competency framework for health and care staff, and for staff in organisations with public-facing responsibilities.

In addition to the existing criteria for professional regulation and registration, there are also existing health and social care regulations that are designed to ensure staff have had appropriate training. However, it is clear from the tragic deaths of Oliver and the many, many like him that that is not enough; we need to go further. One of the recommendations in the LeDeR report echoes the petition in saying that there should be mandatory learning disability training for all health and care staff.

We welcome that recommendation and we have made a commitment to consult formally on it, and we will conclude the consultation by the end of March. I can also confirm that we will include autism within this consultation. My aim is not to mess around with this work, as I have already articulated; the Government’s plans will be published by the summer and regulations could be introduced by the end of 2019. A formal consultation is essential if we are going to change regulations, which is one of the routes by which we can ensure that training is absolutely mandatory.

I appreciate that several hon. Members have asked me specific questions about all sorts of logistical issues, what the content of the training should be and how it might be different for different staff groups. Of course those are all the sorts of issues that we will consult on. We need to canvass the widest possible range of opinions and we clearly are not in a position now to guess the outcome of the consultation. If it was up to me, I would want to embed this training in initial training through all the professional bodies, royal colleges and training providers, having it at all levels of health and social care, so that anybody who has any role in a health and care setting would be mandated to receive some level of this training, obviously with different levels of training for people who work in reception and for those who are medical staff.

One of the key elements of the recommendations in the LeDeR report is that people with learning disabilities should be involved in the training. We will work with people with learning disabilities and autism, and with the groups that represent them, such as Mencap, in shaping the consultation and identifying the key questions that we have to ask. I am absolutely thrilled to say that Paula McGowan has agreed to help us with this.

The petition also refers to mandatory autism training. Of course, LeDeR looks at the deaths of people with learning disability rather than autism, but when it comes to inequalities and the patient experience there are clear parallels between the experiences of both groups and in the sort of reasonable adjustments that might be made to support both groups. It would be a missed opportunity if we did not consider in our consultation the training requirements of staff to better support autistic people as well those with learning disabilities.

Our response to LeDeR and the implementation of Building the Right Support are part of wider efforts to tackle inequality for those with learning disabilities and autism. I will briefly highlight three of these efforts in particular that have great potential. First, there is quality checkers. NHS England is developing toolkits for GP services and mental health in-patient services. These will support people with a learning disability to act as quality checkers, to examine services from their perspective and to have a dialogue with providers and commissioners on what needs to improve.

Secondly, and so importantly, there is stopping the over-medication of people with a learning disability, autism, or both, which is known as STOMP. This national programme brings together multiple organisations in the health and care field, with a common purpose to stop the over-medication with psychotropic medicines of people with a learning disability, autism or both.

Finally, commissioning guidance on autism services, and an accompanying best practice toolkit for local health and care commissioners, are due to be developed shortly and are expected to be available by next spring.

As we develop the consultation on mandatory training, it is particularly helpful to hear these issues and concerns, which hon. Members and their constituents want to see being addressed. We will reflect on, and listen to, those issues and concerns in our consultation. The consultation document will be issued in the new year, giving us sufficient time to conclude the formal consultation period by the end of March, and of course I am extremely happy to discuss with any hon. Member, or any lord in the other place, any particular issue that they would like to see reflected and indeed tackled by the consultation at any time, either before or during the consultation.

[Barbara Keeley]

I asked the Minister earlier whether she could give an outline of the timetable after the consultation. When does she believe that we will see regulations to make this training mandatory?

[Caroline Dinenage]

I believe I have already answered that question. I said that I would like the Government plans to be published by the summer and the regulations to be amended by the end of the year.

[Barbara Keeley]

Can the Minister give a date, rather than a seasonal time?

[Caroline Dinenage]

I am afraid that I am not the scheduler, but that would be my aspiration as the Minister. Obviously, I do not have the timing for the Government, the Chambers and what have you, but that is definitely my aspiration.

It is absolutely vital that we do everything in our power to get this matter right. We owe it to Oliver and to the many, many young people with autism or learning disabilities whose lives have been tragically shortened. We owe it to Paula and Tom, and to the many parents and family members who have suffered unimaginable grief. We owe it to ourselves—a country should be judged on how it cares for its most vulnerable and on this, we must not be found wanting.

Social Care Funding

Baroness Keeley Excerpts

Wednesday 17th October 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I beg to move,

That this House notes that eight years of Government cuts to council budges have resulted in a social care funding crisis; further notes that 1.4 million older people have unmet social care needs; notes that Government grant funding for local services is set to be cut by a further £1.3 billion in 2019-20, further exacerbating the crisis; recognises with concern the increasing funding gap for social care; further recognises that proposals from the Government to invest £240 million will not close that gap; and calls on the Government to close the funding gap for social care this year and for the rest of the Parliament.

In October 2016, the Prime Minister told this House that her Government would provide a long-term sustainable system for social care that gives people reassurance. Then the Conservative manifesto said:

“Where others have failed to lead, we will act.”

But the Government have failed utterly to act and people in need of care have paid the price of that inaction. It is approaching a year since the Government promised they would deliver a Green Paper, yet it is still nowhere to be seen months after the planned publication date originally scheduled for summer. Since then, we have seen a further £1 billion cut from social care because of the cuts the Government have made to the budgets of the councils that deliver it, with disastrous consequences for the social care system.

The Prime Minister has not heeded her own warnings about failing to act. During last year’s election campaign, she said that

“the social care system will collapse unless we do something about it. We could try and pretend the problem isn’t there and hope it will go away, but it won’t. It will grow each year.”

That is exactly what has happened. The problem has not gone away and it has grown in the past year.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Does my hon. Friend agree that in addition to the immediate injection of £2.5 billion funding for social care, with 20% of the poorest local authority areas losing nearly £280 million in the past year compared with 20% of the most affluent local authorities gaining £55 million, we also need to address the issue in relation to the deprivation grant funding allocation?

[Barbara Keeley]

We do need to address that. Things have come to a pretty serious pass.

[Mr Jim Cunningham (Coventry South) (Lab)]

Following on from that point, one issue I have raised on a number of occasions in this House is the lack of local authority funding for social workers. We end up with a situation where people cannot be released from hospital—we used to call it bed-blocking. Does my hon. Friend agree that this is causing major problems both for local authorities and the patients concerned?

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[Barbara Keeley]

Indeed. My hon. Friend makes a really good point. I noticed that the number of delayed transfers of care due to care packages has started to rise, even though it is not fully winter—[Interruption.] Yes, they have, over the last couple of months. The Care Quality Commission has said that in some parts of the country the social care system has now reached the tipping point that of warned of two years ago.

The response from the Secretary of State was to announce that £240 million would be given to councils to deliver packages of home care to people this winter. That is nowhere near what is needed. The social care funding gap is already over £1 billion this year and, as my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, it will reach £2.5 billion by 2020 unless the Government intervene.

By my calculations, the Government’s offer will provide only three months’ of care packages for 70,000 people, so when the Secretary of State gets to his feet, will he tell us what will happen to people who need publicly funded home care when the money runs out? What plans do the Government have to provide care beyond the winter?

[Mrs Madeleine Moon (Bridgend) (Lab)]

For some people, it is not possible to wait for money to be available. A third of people who are diagnosed with motor neurone disease will die within one year and over half will die within two years. A delay of a matter of weeks can alter someone’s pathway towards death. Does my hon. Friend agree that there is no time to delay?

[Barbara Keeley]

I very much agree. In recent months, I have met carers of people with MND and one becomes aware of how much time presses on them.

Our motion deals with social care funding, but this debate is really about people, such as the people my hon. Friend just referred to. It is about how society treats older and younger adults, how we should enable them to live independently and with dignity, and how this Government are badly letting them down. I will look today at the damage caused by Government inaction—damage to vulnerable people who rely on social care to live with dignity, damage to the lives of unpaid family carers who have had to step in to care for their friends and relatives, and damage to 1.4 million hard-working care staff, many of whom are so badly paid and so overworked that they cannot deliver the care that people need.

[Layla Moran (Oxford West and Abingdon) (LD)]

I am not sure whether the hon. Lady knows that in Oxford this is now starting to affect the local NHS. The John Radcliffe Hospital had to suspend non-urgent operations on two separate occasions in March because 170 beds were being bed-blocked. Does she not agree that it is time to see the promised Green Paper on social care, before this winter?

[Barbara Keeley]

Indeed. As I said, it is now coming up to a year since that was promised and it is about time that we started to see some plans. However, we have to bear in mind that a Green Paper is only the first stage of change—and a very early stage at that, really.

I want to pay tribute to the care staff I just mentioned. There has been a lot of talk recently about low-paid staff and how they will fare in terms of migration policies. Being low-paid does not mean that caring roles are low-skilled. Caring staff are highly skilled. They are a credit to this country, and without their dedication the problems facing social care would be immeasurably worse. Unfortunately, their efforts cannot paper over the cracks that have emerged because of this Government’s hammer blows to council budgets. I will come on to talk about the impacts that social care cuts have on people.

[James Cartlidge (South Suffolk) (Con)]

The hon. Lady talked about the Green Paper and how we will fund this in the long term. Obviously, we all have to contribute to that. I was interested that in the last debate she said her party was looking at such things as a wealth tax. I wonder whether she has developed her thoughts on how we should pay for this and whether it will be considering a wealth tax.

[Barbara Keeley]

We have indeed been doing more work on this, but we laid out in our manifesto—the hon. Gentleman’s party did not—what our future plans for social care funding were. We said what the three options for funding social care were and that it would either be one of those three options, or perhaps a combination of all three—I think that the party that is being left behind here is his.

The impact of social care cuts means that less care is now available for older and younger adults alike. Four hundred thousand fewer older people got publicly funded care in 2015 than in 2010, and 1.4 million older people now have unmet social care needs. Put simply, that is over 1 million people who are not getting help with washing, dressing, going to the toilet, making meals or taking medication.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The hon. Lady mentions the plans in the Labour party’s manifesto, but since then the Health Committee and the Communities and Local Government Committee have produced a joint report on the future funding of adult social care that unanimously recommends adoption of the German-style social insurance system. Will Labour consider those recommendations? Is she minded to support that cross-party recommendation?

[Barbara Keeley]

The hon. Gentleman asked me the same question six months ago, on our last Opposition day debate on this subject, and I will give him the answer I gave him then: he should really be trying to influence his own party. I thank those Committees for the work they did, as the Prime Minister did today. Labour has got as far as producing a White Paper—not a Green Paper. We have a 2010 White Paper, and I have a copy with me. I recommend that Conservative Members who keep asking about this look at the extensive proposals in that White Paper, which followed a Green Paper and an extensive consultation. The party being left behind is the Conservative party.

[The Secretary of State for Health and Social Care (Matt Hancock)]

For the information of the House, will the hon. Lady answer the question from my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake)? Does she support the measures recommended by the Select Committees—yes or no?

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[Barbara Keeley]

It is really up to the Secretary of State, whose party has not produced any proposals, to answer that. On the point about cross-party working, it is the Conservative party that has no proposals. The only proposals it has come out with are the damaging ones that have now been abandoned.

[Melanie Onn (Great Grimsby) (Lab)]

My hon. Friend is doing a very good job of reminding the Government that they are the ones in power and the ones with the decision-making powers. If they support the Select Committees’ report, they should bring forward their Green Paper and adopt them all in full. They have the opportunity to do that.

I want to ask my hon. Friend about unmet need and the growing gap between social care funding and continuing healthcare funding. I am increasingly seeing severely disabled individuals in my constituency with very high levels of need being bounced from pillar to post between continuing healthcare funding and social care funding, neither of which is meeting their needs. What does she suggest the Government do to bridge that gap?

[Barbara Keeley]

I suggest that the Government start with the cash injection that our social care system needs. The Labour party promised a £1 billion injection upfront to ease us out of the crisis and £8 billion across this Parliament. I suggest that that would be a starting point and that the Conservative party then tell us how it will fund social care in future.

[Several hon. Members rose—]

[Barbara Keeley]

No, I will not give way; we have very limited time.

As my hon. Friend the Member for Great Grimsby (Melanie Onn) just said, the effects of reduced access to care are very keenly felt, especially by older people, but I want to highlight what happens to young adults with learning disabilities and autism when there is too little funding to support them in the community. A recent BBC “File on 4” programme on transforming care highlighted the impact on young people with autism or a learning disability of being kept in assessment and treatment units for long periods.

The nature of these settings is chilling. A young woman with autism and extreme anxiety called Bethany, aged 17, is being kept in seclusion in St Andrew’s Hospital, Northamptonshire, in a cell-like room and fed through a hatch in a metal door, at which even her father must kneel to speak with her when he visits. She is being detained and held in seclusion despite an assessment that the current hospital setting cannot meet her needs and a recommendation that she be moved to a community residential setting with high support. As “File on 4” pointed out, however, moving a young person such as Bethany to a community setting would involve her local council paying £100,000 to £200,000 a year from the adult social care budget, instead of leaving the NHS to pay what is a much higher bill—in this case, £676,000 a year, or £13,000 a week.

The lack of funding is clearly a factor here. Bethany’s dad was told by the Walsall Council officer responsible for her placement that her care had already cost the council £1.2 million. To be frank, he said, “Walsall could do with a breather.”Bethany is being treated shamefully. It is hard to imagine someone making a similar comment about the cost of treatment for a young person with cancer.

Bethany’s case highlights a growing problem which is part of the crisis in adult social care. Underfunding social care places people with a learning disability or autism at risk of being left for long periods in institutional care settings. Now that I have raised this case, the Secretary of State must look at the state of funding, which leads to perverse incentives for private hospitals like St Andrew’s to charge the NHS for keeping vulnerable young people with autism or learning disabilities in expensive and unsuitable placements because the local council does not have the resources to fund a community placement.

The journalist Ian Birrell recently wrote about Bethany’s being kept in those appalling conditions, in seclusion in a tiny cell. He asked, “Have we moved far from Bedlam?” The answer is, I am afraid, that we have not. The transforming care programme is making hardly any progress. The most recent data, published in May this year, show that 2,400 people—people like Bethany, with a learning disability or autism—are still in in-patient units, and that is an increase from an earlier figure. Many people in such units are subject to over-medication, inappropriate restraint and seclusion. They can be far from home, and they can be kept there for a very long time. The average stay is more than five years.

As the National Audit Office found, such placements are extremely expensive. In 2012-13, the NHS spent £557 million on people with a learning disability in mental health hospitals. Will the Secretary of State tell us why the Government are still funding the institutionalisation of so many people with learning disabilities, or autism, at great cost, seven years after the scandal of Winterbourne View, after which they promised to cut those placements by half?

[Dr Sarah Wollaston (Totnes) (Con)]

The very troubling case that the hon. Lady has described illustrates why we, as a House, must get this right. Does she accept that there has been political failure to resolve the issue of how we fund social care, and will she commit herself to taking a constructive, cross-party approach to getting it right?

[Barbara Keeley]

The hon. Lady has asked me that question a number of times, and I always find it difficult to answer. She will know that my party really tried, but when we produced that White Paper in 2010—when we had a way forward and a set of funding proposals—all that we heard was “death tax”. In last year’s Budget, the Chancellor raised the issue of the “death tax” again: he said that it was not an option. I wonder how the hon. Lady thinks that Labour Members can talk to a party whose Chancellor has ruled out one of the options right at the start, before anyone sits down and discusses anything. I think that that is impossible. I value the hon. Lady’s role as Chair of the Health Committee, of which I used to be a member. Perhaps she will write to the Chancellor, and ask him to stop doing that.

[Dr Wollaston]

As the hon. Lady will know, this is a pattern that has pinged backwards and forwards with successive Administrations. I repeat that we must get it right. We cannot continue these cycles of political failure. We will only solve the problem—particularly in a hung Parliament—with a constructive, cross-party approach.

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[Barbara Keeley]

I am constantly astonished when Conservative Members talk about a cross-party approach. It is up to their party to come up with some proposals. When it has some proposals, there will be something to talk about. All that we have seen the Conservatives do is to abandon all the proposals that they have previously had. We legislated, in the Care Act 2014, for a cap on care costs and a lifting of the ceiling—the asset threshold—but the Conservatives have abandoned that now. They had a set of policies at the time of the election last year, but they have abandoned that. The hon. Lady needs to speak to her own Secretary of State, and I hope that she can have a constructive conversation with the Chancellor as well.

The Government’s cuts have not just reduced access to care in the ways that I have outlined; they have reduced care quality. Cuts mean that there is less good-quality care, which causes great indignity to both older and younger adults. The Care Quality Commission tells us that one in five care services—about 4,000 facilities—requires improvement or is inadequate. In too many care facilities quality is hanging by a thread largely because of the good will and dedication of care staff, but there are times when even their efforts cannot prevent standards falling. In a recent case in Tameside a care home rated inadequate was eventually forced to close for financial reasons. Care home staff were not only not being paid themselves, but they had paid out £5,000 for the food for care home residents, and an agency was owed £37,000 to pay care staff. An earlier CQC report had noted that that care provider had been made bankrupt. During the time before this home was closed, care quality was scandalously low. In 2017 the CQC found that one resident had been left in bed for five months without a bath or shower. It beggars belief that the Government think that care home managers in such situations should be given responsibility in the process for assessing a cared-for person’s mental capacity under the proposed mental capacity legislation currently in the other place, but that is what the Bill currently says—even care home managers in that failing home would be given a part in the process of assessing mental capacity—and it seems that the Government will not shift from that. I join others in the other place and urge the Secretary of State to pause the passage of the Mental Capacity (Amendment) Bill and listen to the concerns being raised about his proposals, because that is not a role that should be dumped on care home managers in the way the Bill is trying to do.

[Thelma Walker (Colne Valley) (Lab)]

The Kirklees Solidarity Economy Network in my constituency is working to establish a community-based care co-operative. The model it is developing seeks to demonstrate that a better way is possible by putting people before profit, valuing, rewarding and respecting careworkers, and ensuring that the people receiving care and the workers providing that care have a real say in how the service is run. Does my hon. Friend agree that we could all look to that model in the future?

[Barbara Keeley]

I very much do and thank my hon. Friend for making that point. There is a great place for co-operatives and mutuals and other such organisations. Organisations like Shared Lives are producing outstanding care in some parts of the country, and we must look at all those models.

I want to talk about hard-pressed family carers, because the situation of less care and lower quality care means that family carers are under pressure as never before to step in and provide care. The strain of caring has seen almost three quarters of carers suffer mental ill health and nearly two thirds suffer physical health problems, according to Carers UK. But too few carers can access respite from caring; they are at breaking point.

Problems with poor care quality and a lack of support were highlighted earlier this year in a report by Age UK entitled, “Why call it care when nobody cares?” At the launch of that report, both I and the Care Minister heard from carers like Joyce. At 73, Joyce cares full-time for her husband David who has had a stroke and a massive brain haemorrhage. Joyce has to do everything for David to make sure he is

“clean and comfortable at all times”.

That involves regularly lifting him in and out of his bed or chair to wash him, or take him to the toilet, throughout the day and night. She said:

“It is extremely hard to get good respite care where we live in Cheshire. Our local care home is no longer an option due to being cut as a provider by the local council. I had to fight tooth and nail for the care David currently gets in a day centre—but it just isn’t enough.

I don’t know how I’ll continue to cope without more support and regular respite breaks. Our care was cut in March, the third time that we have had respite care pulled. I am so angry and frustrated, I am so worried at what is facing us at the moment I hardly dare think about it.”

What carers like Joyce need is comprehensive support and carers breaks to allow them to look after themselves as well as the person they care for. What they have received from the Government is the damp squib of a “carers action plan” in place of a proper national strategy.

Labour has already pledged to deliver a national carers strategy as we did with our second national strategy in 2009. That national carers strategy pledged £150 million of funding for respite care breaks for carers. That funding has now disappeared into a black hole in the better care fund, leaving carers like Joyce to fight “tooth and nail” to get any respite at all.

[Kevin Hollinrake]

rose—

[Barbara Keeley]

I must make progress.

For care staff, the combination of cuts to social care funding and increasing demand for care has created the perfect storm of pressures, affecting the quality of care. Care staff themselves are reporting seeing a major decline in standards of care over the past couple of years.

Kim, one member of care staff, told her trade union, Unison, that she

“found it increasingly difficult to provide a good standard of care because of staff shortages and the greater need of clients. Often visits to clients have to be rushed, making medication mistakes by staff more commonplace and no social time for clients.”

Another care home staff member from Lancashire said that

“a lot of the time it feels like we are operating a ‘people warehouse’ and just offering the basics of feeding and personal care.”

I find those comments deeply troubling. They show the direct human impact that the underfunding of social care is having. Staff are rushing from one appointment to another, with no time to talk. They are being seen as

“heartless robots as opposed to a lifeline service”.

That is how one care home staff member described her job. Care staff are some of the most dedicated and highly skilled workers in this country, but these pressures, added to their pitifully low pay and their poor terms and conditions, are driving people from a sector where they have never been needed as much as they are now.

The care sector is teetering on the edge of a cliff. Without an urgent response from the Government, it could topple altogether. Ministers in this place talk glibly about making hard choices, but the truth is that this Government have chosen to pursue austerity on the backs of older people and vulnerable adults, who rely on social care. If austerity is now over, as the Prime Minister has claimed, the Government must put in the funding that social care needs to bring it back from the brink.

At last year’s election, Labour outlined a plan to invest an additional £8 billion in the social care system. We want to lift the quality of care and to lift access to care and support for carers before moving on to build our new national care service, as outlined in our White Paper. The Prime Minister said last year that the Government would act. They must now commit to a sustainable long-term funding plan. I urge hon. Members to vote for our motion tonight, to ensure that the Government honour the Prime Minister’s promise, because the people who need care, their family carers, and the care staff who care for them deserve better than this.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Each and every one of us in this House recognises and values those who care, from care workers to nurses to the millions of unpaid carers who look after loved ones. I think the whole House can unite behind the statement that how we care for the most vulnerable is a mark of our civility as a society. Across our country, in our NHS and in our care homes, so many people dedicate their lives to caring for others. I want to address the pressures we face in our social care system in the short term, as well as the long-term reforms we must take to ensure that our social care system is sustainable and fit for the future.

Right at the start, I want to address the individual case of Bethany, which the hon. Member for Worsley and Eccles South (Barbara Keeley) rightly raised. On seeing the reports of the case in the media, I immediately asked for an investigation inside the Department, along with NHS England and the Care Quality Commission. This is clearly a distressing case—it was initially brought to my attention by Ian Birrell—and we will get to the bottom of it. More broadly, the number of in-patients is now down to 2,375, a fall of 17% from March 2015, including 600 who had previously been in hospital for five years or more. So there has been some progress, but there is clearly more to do and the hon. Lady was right to raise the issue.

[Barbara Keeley]

I gave the House a statistic of 2,600. Bethany’s dad, who is campaigning on her behalf, wants to see her in a proper community placement, but there are thousands of Bethanys. This is a serious matter. We had a debate here on transforming care a few months ago, but very little has happened since.

[Matt Hancock]

As I said, progress has been made. There has been a reduction of 17% in the number of in-patients—down from 2,875 in March 2015 to 2,375 on the latest figures—but I would fully acknowledge that there is more to do and I am determined to see that happen.

Our population is ageing. More people are living longer and, as a society, we must address the challenge that that creates for social care. To put that into context, over the next 25 years, the number of people aged 75 and over is set to double and the number of people aged 85 will rise by more still. Of course, this is good news. It is down in part to the hard work of our NHS. Cancer survival rates are at a record high and strokes are down by a third, but with such successes come new challenges. For instance, we are seeing a rise in dementia and in age-related conditions, with 70% of people in residential care homes now suffering with dementia.

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[Barbara Keeley]

On a point of order, Madam Deputy Speaker. Yet again the Government sit on their hands and refuse to vote on a key social care motion. We have heard in this debate some moving cases of people whose lives are being damaged by the crisis in social care, but no solutions from the new Secretary of State for Health and Social Care. We do not need more warm words which we have just heard from the Care Minister and other Ministers. We need action to close the funding gap. If the Government disagree with our motion, they should have the guts to vote on it, and shame on them for not doing so.

[Madam Deputy Speaker (Dame Rosie Winterton)]

The hon. Lady has put her point of view on the record. As I am sure she knows, there have been undertakings by the Government that in response to situations like this there will be a report back to the House at a future date, and I am sure those on the Treasury Bench will have heard the points made.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 24th July 2018 Commons Chamber

[Matt Hancock]

I pay tribute to my hon. Friend’s long campaign in this area, and I very much look forward to working with him on it to ensure that we get the right evidence-based approach to using all kinds of medicines and technologies for the benefit of patients.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I welcome the new Secretary of State to his post. He has said that the whole workforce of the NHS and social care should have the chance to fulfil their potential, but the care workforce has an annual turnover of 27% and a vacancy rate of 7%, and, sadly, care staff learned last week that they would not even be paid the national minimum wage for sleep-in shifts, which will potentially drive even more people away from working in social care. Will the Secretary of State demonstrate the leadership that this Government have lacked on this issue and ask the Chancellor to change the regulations on the national minimum wage for sleep-in shifts, to show care staff that they matter?

Perinatal Mental Illness

Baroness Keeley Excerpts

Thursday 19th July 2018 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this important debate and on how they opened it. We have heard contributions from the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for Canterbury (Rosie Duffield), the hon. Member for Bath (Wera Hobhouse) and the Scottish National party spokesperson, the hon. Member for Glasgow Central (Alison Thewliss). We also heard interventions from the hon. Member for Thirsk and Malton (Kevin Hollinrake), my hon. Friend the Member for West Ham (Lyn Brown) and, just a moment ago, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger).

Pregnancy, birth and becoming a parent can be a special and rewarding time for many people. As we have heard, it is a time to celebrate new life and the start of the exciting journey into parenthood. However, for others, the stress and upheaval of pregnancy and becoming a parent can trigger existing mental health problems or spark new ones. Perinatal mental health issues can include severe mental health disorders that require severe immediate hospital treatment, such as postpartum psychosis. It may affect only two cases in 1,000, but it is a very serious condition and can put new mothers at risk of harming themselves and their baby. The issues can also include most common mental health conditions, such as depression, anxiety, post-traumatic stress disorder, obsessive compulsive disorder and panic attacks. My hon. Friend the Member for Stockton South spoke very well about the impact of those mental health conditions on the child’s development.

Given the expectation that pregnancy and becoming a parent should be a joyful time, women who experience those conditions can feel even more stressed and unhappy, and often that they are somehow to blame for their condition. A study by the Boots Family Trust in 2013 described some of those experiences. One mother said:

“I avoided friends at all costs as I lost the ability to communicate and became very isolated”.

Another said:

“I’m currently into my second pregnancy and think I am suffering from depression…I feel scared and feel like I have trouble bonding with this pregnancy…I don’t know what is wrong with me.”

We know that one in five women will experience mental health problems during pregnancy. Given the high prevalence of mental health issues in new and expectant mothers, the woman I just quoted should not have had to feel like something was wrong with her. We have heard many excellent examples in the same vein in this debate. One way to prevent women from feeling isolated or somehow to blame is by identifying those mental health issues and ensuring the proper support is put in place. Unfortunately, as hon. Members said, too often that does not happen.

Hon. Members rightly highlighted that identification is a major barrier to accessing support for mental health issues. I join them in congratulating the National Childbirth Trust on its #HiddenHalf campaign. The research underpinning that campaign shows that nearly half of all the mental health problems that new mothers experience are not picked up by health professionals.

As we have heard, early intervention is key. The sooner issues are identified, the quicker people can access appropriate support, and that surely drives better outcomes. It is simply not good enough that only half of perinatal mental health issues are picked up. As my hon. Friend the Member for Stockton South detailed, GPs should offer a post-natal check about six weeks after the baby’s birth. We have heard that a properly delivered check-up can have a transformative effect on new mothers who are experiencing mental health problems. Research by the National Childbirth Trust found that women directly questioned by a GP about their mental health were almost seven times more likely to disclose a mental health problem. If mental health problems are left untreated, they can escalate into much more severe mental illness.

The National Childbirth Trust also found that 95% of women who had experienced a mental health problem felt it affected their ability to cope or look after their children or family relationships. As we have heard, the six-week post-natal baby check is mandatory, but the maternal check was left out of the GP contract. As a result, the maternal check is often not done at all or becomes a rushed conversation at the end of the baby check. In one third of cases, the maternal check was estimated to last three minutes or less.

The National Childbirth Trust recommends that the Government fund the six-week maternal post-natal check so that GPs have the time to give every new mother a full appointment for the maternal check. As we have heard, the National Childbirth Trust also recommends an improvement in the guidelines for best practice around maternal mental health, including a separate appointment for that maternal six-week check, and they recommend better methods of encouraging disclosure of maternal mental health problems.

I have looked at the NHS England guidance, which states:

“There are no set guidelines for what a postnatal check for mothers should involve.”

It also states:

“The following is usually offered, though this may vary according to where you live...You will be asked how you are feeling as part of a general discussion about your mental health and wellbeing.”

We can and must do better than that.

I have already mentioned the pressure on women to feel happy after the birth of a child and how mental health issues can lead to their feeling that there is something wrong with them. It can often lead to women putting on a brave face. One woman, responding to the Boots Family Trust survey, said:

“I was terrified to admit to any health professional as I was scared they would take my son away.”

That is exactly the point made by the hon. Member for Glasgow Central and it demonstrates the challenges that GPs face in identifying mental health issues. Merely asking how a new mother is feeling is no substitute for a properly trained staff member identifying mental health issues and knowing how to encourage disclosure.

The National Childbirth Trust recommends that NHS bodies should support and invest in initiatives to facilitate and further develop GP education on maternal mental health. Earlier, my hon. Friend the Member for West Ham touched on the fact that investment in perinatal mental health would result in savings. It is worth thinking about how much that might be.

The statement from the Royal College of General Practitioners about perinatal mental health said that post-natal depression, anxiety and psychosis carry an estimated total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK, and 72% of the cost relates to adverse impacts on the child. That reinforces the very important points that my hon. Friend the Member for Stockton South made earlier. More than a fifth of those total costs—£1.7 billion—are borne by the public sector: mainly NHS and social care. I hope that that all helps to give the Minister ammunition. Sadly, the average cost to society of one case of perinatal depression is estimated to be £74,000: £23,000 relates to the mother and £51,000 to the impact on the child. There is every reason to try to make the case being made in the debate today.

We must make sure that, where a diagnosis has been made, appropriate treatment and support is made available. According to the Maternal Mental Health Alliance, a quarter of pregnant women and new mothers cannot access specialist perinatal mental health services that meet the full National Institute for Health and Care Excellence guidelines. Only 7% of the women who reported experiencing a maternal mental health condition were referred to specialist care. It took more than four weeks for the 38% of the women who were referred to be seen. Shockingly—we have heard several examples—some women waited up to a year for treatment. My hon. Friend the Member for Canterbury talked about such an example. In fact, it was recently revealed that there were only 131 specialist perinatal beds in the whole of the UK, with none in Northern Ireland or Wales.

We know that pressure on mental health trusts comes from money earmarked for mental health services being used to pay for other areas of the NHS. The Labour party would ring-fence mental health spending so that funding for mental health services is not siphoned off to pay for other priorities. In this debate we have heard much detail of the #HiddenHalf campaign. The Opposition support that important campaign and we would look at implementing it in government. We call on the Government now to make resources available so that every mother is given the perinatal support that she deserves. It is important that we also include that commitment to ring-fence mental health spending so that the funding that is meant to be for mental health services does not go to other priorities in the NHS.

The Government have made some commitments on perinatal mental health, and I am keen to hear from the Minister, if we have time, what progress has been made. The five-year forward view for mental health set a target to ensure that by 2021 at least 30,000 more women each year would be able to access specialist mental health care during the perinatal period. Given that we are now halfway through that phase of the five-year forward view for mental health, can the Minister tell the House what progress has been made towards that target and whether NHS England is on track to meet it?

In autumn 2017, at the maternal mental health ministerial roundtable, a number of commitments were made to improve perinatal mental health services. They included a commitment that the Department of Health would work with health system partners and other Government Departments to deliver improvements in perinatal mental health services, and a commitment that NHS England would expand specialist mental health services by 2021 to meet the needs of women in all areas. We have heard, as we hear in so many debates on health and social care, about very unfortunate postcode lotteries, so how is NHS England doing in expanding those specialist services to meet the needs of all women?

[Luciana Berger]

My hon. Friend is making a strong case, as have other colleagues, about the inconsistency of the availability of perinatal mental health services. Although there has been some investment, there are still many areas where there is no sufficient, adequate or indeed any immediate access, and mothers still have to travel too far across the country to access a bed if they need one in a mother and baby unit. Does she share the concern expressed by the British Medical Association that there is a 20% difference in referral rates in some areas, which illustrates the inconsistency of care? When the issue is so critical not only for the mother but for the child in its lifetime, that is something that the Government should urgently address.

[Barbara Keeley]

I absolutely agree with my hon. Friend. It is very important that the Minister tells us now or after the debate what is happening to expand the services so that we do not have what are almost deserts, where women have to travel either to get a bed or to get the service that they need.

Finally, there was a commitment in autumn 2017 that NHS Health Education England would support the roll-out of GP perinatal mental health champions across England. I am sure it would help if there was in every area a perinatal mental health champion speaking up for their own area. Will the Minister tell the House what progress has been made on these important commitments?

I want to conclude on a wider point about women’s mental health. Women are more likely to suffer from mental ill health than men, and yet too often women’s specific mental health needs remain a blind spot. Research by Agenda, the women’s mental health charity, has shown that mental health trusts are too often failing to consider women’s specific needs. Only one of the 35 trusts that responded to a freedom of information request by Agenda had a strategy on gender-specific mental health services.

Fourteen years ago, the Labour Government launched a comprehensive women’s mental health strategy to address the specific mental health needs of women. Sadly, that strategy was ditched by the coalition Government, and women’s mental health has since slipped down the policy agenda. The Mental Health Foundation has described it as being “almost invisible” in Government policy.

We have had an excellent debate today in which many useful examples have been given and many good points made. There is a strong feeling that we want to help the Minister do something about this issue. Will she in future match Labour’s commitment to have a national women’s health strategy that would work to deliver the targeted support that women and girls need?

--- Later in debate ---

[Jackie Doyle-Price]

I agree and do not think the two points are in conflict. We need both—we need the wider package of support.

The theme we have been considering—of women not always being asked about themselves, and its being all about the baby—is not confined to the issue of perinatal mental health. Women face that across the board with respect to their health. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about a women’s health strategy and women’s mental health. I co-chair a women’s mental health taskforce with the chair of Agenda, and in the coming weeks we will present our report on a year-long piece of work. It will have information about tools to enable the health service in general better to support women’s mental health. I am also doing more to raise the whole issue of women’s mental health, because I feel strongly that women are often disempowered in health settings. We need to give them the tools to take control of their own care and to feel empowered to engage in good conversations with medical professionals, to benefit their health.

We have heard anecdotal accounts of women’s experiences, and what has come across is the arrogant behaviour of some medical professionals. They see a large number of patients and they are not always sensitive to how best to communicate with certain individuals. We need that practitioner-patient relationship to work a lot better, particularly in the case of women. I am open to representations from everybody about what tool we can use.

The hon. Member for West Ham (Lyn Brown) is no longer in her place, but I have been impressed by her work on hysteroscopies with women. We are developing tools on that. I reassure all Members that women’s health and the way in which the national health service can better serve women are high on my agenda. I am not going to stand here and say that the world is perfect, but we have made perinatal mental health a priority in the five year forward view. We are midway through that review, so I should give Members an account of how far we have got and what more needs to be done.

To go back to 2010, the situation was really quite poor. Only 15% of localities had fully fledged specialist services in the community, and 40% of communities provided absolutely no service at all. People talked about a postcode lottery; clearly, we could not allow that to continue. We need to work towards universal provision. We are implementing the recommendations of the five year forward view for mental health taskforce, which reported in 2016. From 2015 to 2021, we are investing £365 million into perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2021, at least 30,000 more women each year are able to access specialist mental healthcare during the perinatal period. In May, NHS England confirmed that, by April next year, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country. We are making progress. The key to that is community provision.

[Barbara Keeley]

I asked the Minister a specific question: we are halfway towards the deadline for the 30,000 target—does she know how that target is going? Has there been an improvement of 15,000?

[Jackie Doyle-Price]

I will write to the hon. Lady with some detail on the figures, but the point is that the access is there. Obviously, it will take time to become embedded. We have a good direction of travel to deliver against that commitment and we will continue with that. Community-based provision is key, but we also need to ensure that there are sufficient specialist perinatal mental health beds in mother and baby units for particularly severe cases. NHS England has taken a more strategic approach to commissioning, so that there is a level of access that does not involve wide-scale moving out of area.

As ever with transformation programmes, change takes time, but we are on track to meet our commitments. We are investing £63.5 million this financial year to support the development of those specialist perinatal mental health community services across England. Our pace of change is to enable 2,000 more women to access specialist care. Last year that was exceeded, so we should maintain the pace that we planned in the five-year forward view.

I have visited one of the new in-patient mother and baby units in Chelmsford, where there are four new beds. That centre is expanding its capacity. As well as opening new centres, we are expanding the capacity of existing ones to give more support. In Devon, the trust opened a four-bed mother and baby unit in a reused space in April this year while the new unit is being built, so we still have that provision even though there is not the physical space. By the end of this financial year, we will have expanded the capacity of those beds by 49% since 2015 and there should be more than 150 beds available for mothers and babies in those units.

We are also expanding psychological therapy services, which successfully treat many women who experience common mental health conditions such as depression and anxiety disorders during the perinatal period. We have set an ambition for at least 25% of people with common mental health conditions to access services each year by 2020-21, including extending provision to ensure swifter access for new and expectant mothers. However, as we have heard today, getting perinatal mental healthcare right is not just about expanding specialist services in isolation. Many professionals in different parts of the health and care system are well placed to support women in the perinatal period. NHS England is working with partners to ensure that care for women is integrated and joined up effectively. More than £1 million was provided in 2017 to enable the training of primary care, maternity and mental health staff, to increase perinatal mental health awareness and skills.

NHS England has also invested in multidisciplinary perinatal mental health clinical networks, which will include GPs across the country to support that strategic planning, working across services to ensure that those wider services are in place. The role of GPs is central in identifying when someone is suffering from perinatal mental illness, and to ensure that those women are directed towards treatment. The role includes monitoring early-onset conditions, including pre-conception counselling, referring women to specialist mental health services, including access to psychological therapies, and specialist perinatal community teams where necessary.

I am aware of the NCT’s #HiddenHalf campaign; I am grateful for its campaigning on this important issue. The National Institute for Health and Care Excellence recommends post-natal checks for mothers and new-born babies. NHS England expects commissioners and providers of maternity care to pay due regard to the NICE guidelines. My hon. Friend the Member for South West Bedfordshire raised this issue and said that, since this was part of what we should expect from GPs, it seemed anomalous that so many mothers and babies were not getting such checks. We make clear to GPs what we expect of them, as part of their contract, but ultimately we rely on clinical commissioning groups to ensure that GPs deliver against the obligations that we expect of them. This is not the only case where this happens—many GPs are not delivering learning disability health checks either. We need to be clear with NHS England that we expect that obligation to be delivered.

--- Later in debate ---

[Jackie Doyle-Price]

I was coming to that—I was just dealing with the point made by my hon. Friend the Member for South West Bedfordshire.

Moving on from the NICE guidelines, we clearly expect GPs to do their part in identifying and supporting women. We are aware of the campaign, but any changes to GP contracting arrangements to specifically include the six-week check-up would need to be negotiated with the GP committee of the British Medical Association. Those negotiations are taking place and will be completed by September. I cannot give any firmer commitment than that, other than to say that we obviously want to see GPs make their contribution.

[Barbara Keeley]

I just want to reiterate what I said earlier: the Opposition support that campaign and would look at implementing it in government. I outlined that the NCT put a cost of £20 million on it. Clearly, the Minister could have that figure checked out, but it is balanced against the £1.2 billion extra cost to the NHS and social care of perinatal mental health problems in every one-year birth cohort. There really is a point here about investing to save further down the road.

[Jackie Doyle-Price]

I thank the hon. Lady for that. As she says, if we are talking about £20 million in a broader settlement, that clearly should be under consideration given the outcomes that could be achieved on the basis of the evidence we have seen. I am not negotiating the contract, but we will have the outcome of those negotiations in the not-too-distant future. Members on both sides of the Chamber expressed very clearly the view that they want GPs to be able to do more to support new mothers. That message has been well noted, and I thank Members for making it. They said they wished to give me as much as assistance as they could in my battles on these things, and they certainly made a very strong case.

I want to come back to health visitors. I am a firm believer that health visitors are uniquely placed to identify mothers who are at risk of suffering, or are suffering, perinatal mental health problems and to ensure they get the early support they need. In fact, I visited the Institute of Health Visiting only a couple of weeks ago and heard a moving story from a new mum who had gone through a mental health crisis. It is striking that she had experienced all the feelings we have talked about—she felt there was something wrong with her, she could not bond with her baby, and she got more and more depressed and withdrawn about it. The other interesting thing about that case was that it was dad who felt utterly powerless to do anything. Only their relationship with their health visitor enabled them both to reach out for help.

I am under no illusions about the importance of health visitors. I was privileged to meet so many fantastic advocates for them as part of the NHS’s 70th birthday. They are our eyes and ears in so many ways, and they are our intelligence network in tackling adverse childhood events. I am full of praise for the important job they do in supporting new parents and families through a child’s early years. I am really pleased about the success of the Institute of Health Visiting perinatal and infant mental health champions training programme. Those 570 champions play a crucial role in spreading good practice and early identification of mental health problems.

Some hon. Members raised concerns about the decline in the number of health visitors. There was a substantial increase in the run-up to 2015, and there has been a fall since. I am bothered about that, so I will look at how we can encourage local authorities to alter that situation, recognising that in some areas local leaders have realised that health visitors can do so much more to deliver better outcomes for their communities. Blackpool, for example, has substantially increased the number of visits. I am really looking forward to seeing the outcome of that work, so that we can encourage that good practice in other local authorities.

I reiterate my thanks to all Members for their thoughtful comments and questions, but I especially thank the hon. Member for Stockton South and my hon. Friend the Member for South West Bedfordshire for securing the debate. I am very proud of our direction of travel in delivering and transforming perinatal mental health services so that we ensure that more expectant and new mothers are able to access high-quality mental health support, but we should never be complacent about that. I look forward to continuing the transformation programme.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Baroness Keeley Excerpts

Monday 2nd July 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

As hon. Members have said, today’s debate comes in the week of the national health service’s 70th birthday. It is fitting that we should celebrate the NHS, which is one of this country’s most cherished organisations, but this week also marks another less-celebrated 70th birthday: that of social care. It is only right that we recognise the vital role that social care plays in keeping people independent and in supporting them with daily activities. Many hon. Members focused on social care in their contributions, but it is in a worrying state of decline at a time when it has never been more needed.

The joint report by the Health and Social Care Committee and the Housing, Communities and Local Government Committee, which is chaired by my hon. Friend the Member for Sheffield South East (Mr Betts), described a system

“under very great and unsustainable strain.”

The report found that the care system is not fit to respond to current needs, let alone to meet future needs. The Association of Directors of Adult Social Services said in its most recent budget survey earlier this month that the present situation “cannot go on”. The King’s Fund says that progress is “desperately needed” and that the system needs an urgent injection of cash just to maintain things as they are.

The projected growth in demand for services from our ageing population, with its ever more complex care needs, is set to rise substantially. I ask the hon. Member for Mid Worcestershire (Nigel Huddleston) to look at the years of healthy life expectancy, which end in someone’s 50s or 60s in many deprived areas. At the current rate of spending, the system will face a funding gap of £2.2 billion to £2.5 billion by 2019-20, and as we have heard, grant funding from central Government to the budgets of councils that have a statutory responsibility for delivering care has been cut by around 40%. As we heard from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), the budget has been cut by 60% in Liverpool.

As the Select Committees’ report notes, local authorities have also faced other cost pressures, such as the apprenticeship levy, increased national insurance contributions and the so-called national living wage, which has had the most significant impact. Cost and demand pressures on councils are growing, but ADASS reports that £7 billion has been cut from adult social care budgets since 2010. With the Government’s Green Paper now delayed until the autumn, a funding settlement for social care sadly does not seem imminent. According to ADASS, recent Government funding simply is not keeping pace with demand, and the result is that councils are plugging the gap in any way they can. Over half of local councils are unsustainably raiding council reserves, while others are making cuts elsewhere, so other important council services suffer. Local authorities, to their credit, are doing their best to protect budgets for adult social care services, but the increasing financial pressure on councils has meant that both the quality and the sufficiency of care have fallen and are anticipated to fall further.

Care providers’ dependency on dwindling local authority fee levels is leading to the care market becoming increasingly fragile and even failing in some parts of the country. A recent report from Age UK described the emergence of “care deserts” where care is wholly unavailable. Forty-eight directors of adult social services report that they have seen care providers closing or ceasing to trade in the past six months, 44 have had contracts handed back by homecare providers and 58 have seen care or nursing home closures, involving 2,000 people, with 135 care homes ceasing to trade in the past six months—this is from my hon. Friend the Member for Crewe and Nantwich (Laura Smith)—which is more than five a week.

Care homes with predominantly council-funded placements are at most risk of failure. Indeed, some care providers are now rejecting local authority-funded placements because of that funding shortfall. Continued failures of that type would be disastrous for publicly funded care, because councils would have to find care placements with a shrinking pool of providers.



As we have heard, the most serious imminent threat to the viability of the care sector is the unresolved sleep-in care back pay crisis, which my hon. Friend the Member for Crewe and Nantwich referred to comprehensively. As she said, this issue has been going on for several years since a tribunal ruled that overnight care shifts should be paid at the national minimum wage, rather than at a flat rate. Care providers, mainly charities, are facing a six-year back pay bill, which many say they cannot afford without having to withdraw services or close altogether. In a recent survey, 70% of learning disability social care providers said they would cease to be viable if they had to pay this bill. As hon. Members have said, this issue has been handled badly.

Having admitted that previous guidance to care providers had been misleading, Ministers seem to be continuing to ignore warnings that the combined liability of providers —some £400 million—could cause the collapse of parts of the care sector. Perhaps even worse, an estimated 100,000 personal budget holders will be liable to pay thousands of pounds in backdated pay. I join other hon. Members in saying that I hope the Care Minister will tell the House what plans are in place in the event that those care providers go to the wall and what help there will be for personal budget holders.

As we have heard, the Government seem to have no grasp of the urgency of this problem, which could derail the Transforming Care programme and could see large numbers of the most vulnerable people go without care services. Where people are able to get care, it is not always of the best quality. A fifth of care facilities have the worst Care Quality Commission rating. I am concerned that worrying pockets of poor quality are now emerging across both residential and home care, particularly in the north-west and the north-east, with nursing care among the worst affected.

I recently met a group of care staff from different parts of the country, and some of their stories of their current work experience are horrifying. Overworked, underpaid and undervalued care staff are under pressure as never before. Care providers are trying to meet increased demand for care with diminishing fee levels and are even reducing care packages to win procurement bids in the horribly named “reverse auctions.” That has led to staff with many years’ care experience being stuck on zero-hours contracts, with the constant threat of extra hours of work being withheld.

Staff are turning up to work ill because they are not paid sick leave or because they fear having their pay docked. Young apprentices are being left in responsible care positions for which they have no training or experience. Most troubling was to hear of lists showing staff on care rotas when they are actually on long-term sick leave or maternity leave, or rotas including managers and staff who do not provide care.

It is only the experience, dedication and devotion of care staff such as those I met that has stopped care quality sliding even further. The CQC has warned that the resilience of care staff is not inexhaustible. Under such pressure, with no training and little support, the recruitment and retention crisis will get worse.

We know that the impact of cuts to social care budgets is most keenly felt by people who need care and their families, and we know that 1.2 million older people who need social care have unmet care needs. People are not getting the help they need with the basic tasks of daily living, which is robbing them of their dignity. The fragility of the care system is also heaping great pressure on many unpaid carers who have to pick up the slack when formal care is unavailable. Carers are coming under unprecedented pressure, with little opportunity for respite, because most councils now have to charge for care breaks, as Labour research has shown. Four in 10 carers have not had a day off in a year, while one in four unpaid carers have not had a day off in five years. That is taking a heavy toll on their health; almost three quarters of carers told Carers UK that they had suffered mental ill health as a result of caring, while well over half said their physical health had worsened.

Despite the great contribution that carers make to the economy, the Government’s recent carers “action plan”, published in place of a promised national carers strategy, sadly offered no financial commitments to increase support for carers or to increase carer’s allowance, which is still less than jobseeker’s allowance. That is an insult to people whose care is estimated to be worth over £130 billion per year to the economy.

NHS sustainability depends on an effective and properly funded social care system. As we have heard in this debate, there was no money for social care in the Prime Minister’s recent NHS announcement. The announcement also excluded public health budgets, at a time when childhood obesity is reaching epidemic levels, and when there have been cuts to sexual health and addiction services. Just as with social care, underfunding those important preventive services is a false economy and will end up costing the NHS. There is now broad agreement that the need for investment in social care has never been more urgent and doing nothing is not an option, yet all we have from this Government is a proposed Green Paper, now delayed until the autumn, setting the timetable for dealing with the funding crisis in social care back even further.

I want to say in conclusion that that is not good enough. Social care needs funding now to ease the crisis and to stabilise the care sector. It is time this Government showed leadership and acted in the best interests of all the people across the country who need care.

Adult Social Care: Long-term Funding

Baroness Keeley Excerpts

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

I thank the hon. Lady, the Chair of the Health Committee—I think on this occasion, my hon. Friend, because we have worked on a friendly basis on this inquiry. She is absolutely right. One of the important recommendations is about trying to extend the scope of care provision to include those with moderate needs. If we provide care for them, it is quite likely that we will stop them getting into the substantial and critical phase and ending up in hospital in the first place. In terms of the NHS, it is about stopping people getting into hospital by getting them proper care and having care available for people in hospital, so that they do not have delayed discharges. In those two ways, that can be beneficial. Of course, we can also join up services. Can the NHS district nurse who goes into someone’s home and looks at their needs not assess their care needs at the same time? Can we not get that sort of joined-up approach?

It was remiss of me not to thank the staff, as the hon. Lady did, and I will name Laura and Tamsin. The work they did on this was exceptional. To produce a report of this quality in the time available was absolutely first-class, and we should congratulate them on it.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Chairs and the members of the Select Committees for their work on the report, and my hon. Friend the Member for Sheffield South East (Mr Betts) for his statement introducing it. The key points from the report for me are that in its present state the care system is not fit to respond to current needs let alone predicted future needs, and that spending on social care needs to rise. Next week is the 70th birthday of social care, as well as of the NHS, but there is no funding settlement and no celebrations for social care. Does my hon. Friend agree that the time for a funding settlement for social care is now or at least soon, not years down the road?

[Mr Betts]

Yes, I completely agree with that. We have got to get on with it. If we agreed everything now, it would probably take two or three years to put it in place. That is why we suggested the stop-gap measure of the extra business rates in 2020 being made available for local authorities. We thought that was a very important solution. If we get it right, we can have stability for the long term. The Germans did this over 20 years ago. They have a stable system and it works. They have just put extra money into it with general public support, because everyone trusts the system. That is the position we have to get to.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Hunt]

I thought that the report made powerful reading, and I know that my hon. Friend was associated with it. Yesterday the Prime Minister was straightforward about the fact that, if we are to preserve our NHS and make it one of the best systems in the world, the burden of taxation will need to increase, and she was willing to listen to the views of colleagues about the most appropriate way in which that should be done.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Association of Directors of Adult Social Services has reported a £7 billion reduction in adult social care funding since 2010, and Age UK has reported there are now “care deserts” in some parts of the country. There are 1.2 million older people living with unmet care needs, and one in five care services has the poorest quality ratings from the Care Quality Commission.

As well as a long-term funding solution for social care, we need the extra £1 billion this year and £8 billion in the current Parliament that Labour pledged before last year’s general election. However, all that the Government offer is a delayed Green Paper. When will the Secretary of State deal with the current crisis in social care?

[Mr Hunt]

No, that is not correct. Yesterday we made very clear our support for the social care system and our recognition that reform of the NHS must go hand in glove with the social care system, and we said there would be a new financial settlement for the social care system. It is also time that the Labour party took some responsibility for the financial crisis that made all these cuts necessary.