Safeguarding Adults with Learning Disabilities

Baroness Keeley Excerpts

Tuesday 17th October 2017 Westminster Hall

[Catherine McKinnell]

That is an interesting suggestion. As a constituency MP, I work closely with the organisations I have mentioned so that I may correspond with and represent people with learning disabilities. There are local solutions and, potentially, national ways to support MPs. That is a good suggestion to ensure that those voices are heard in Parliament, and the intention of this debate is very much to give voice to some of the concerns. I am sure that other hon. Members are present for the very same reason.

The issues that I have outlined are just some of the frankly depressing ones faced by people with learning disabilities. Such issues were commented on by Mencap in its response to the Equality and Human Rights Commission report, “Being disabled in Britain: a journey less equal”, which was published earlier this year. In responding to the EHRC report back in April, Mencap commented:

“Rather than move forwards in the past 20 years this report shows how inadequate action and a constant stream of cuts have condemned disabled people to a life of poverty and inequality.

With the employment rate for people with a learning disability currently standing at less than 6% and with cuts to Employment Support Allowance coming into effect this week, it’s not hard to see why so many disabled people are struggling to find money for things as basic as food. People with a learning disability also face inadequate housing, poor access to health care and a society that misunderstands them.”

One challenge facing people with learning disabilities and their families is of course being able to access the right social care support at a time when adult social care budgets are at breaking point after years of punitive cuts to local authority funding since 2010, combined with rising cost pressures. The Local Government Association outlines that some 127,725 adults in England under the age of 65 were receiving long-term social care from their local council for a learning disability in 2015-16, meaning that about one third of councils’ annual social care spending, or approximately £5 billion, is used to support adults with learning disabilities.

The LGA also highlights, however, that the number of adults with a learning disability needing social care is set to rise by 3% a year, piling further pressure on local authority finances. Overall, councils face a £2.3 billion shortage in funding by 2020. I therefore strongly urge the Chancellor to address this issue next month as part of his autumn Budget, as well as the ongoing and serious concerns about the potential historic and future costs associated with sleep-ins, following the change in Government guidance on them, which have significant implications for the future provision of support to adults with learning disabilities.

As I said, there is a particular reason that I secured this debate, which I have been trying to do so for several months. Undoubtedly, all Members of Parliament frequently have to handle very distressing issues, and I have dealt with a lot.

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

My hon. Friend is making a valiant attempt. This is a very difficult subject and she is talking about a very distressing and tragic case. To go back to the point about greater public awareness, I have been a Member for 12 years and have certainly never been offered any training about learning disabilities. There is so much to know and she has just given us a useful range of facts. I encourage the Minister to take away what my hon. Friend has just raised as things we should all know.

[Catherine McKinnell]

I thank my hon. Friend for her intervention. It is hard to imagine a more harrowing and disturbing case than that of Lee Irving. My thoughts remain very much with Lee’s family, particularly his mother, Bev, who I know is determined to ensure that something positive comes of her son’s death. I am sorry; I must do this subject the justice of staying composed. I am particularly conscious that Lee’s mother is watching this debate online in Newcastle and that having to relive what happened to her son clearly will always be upsetting. However, it is important that right hon. and hon. Members appreciate the gravity of this case.

Lee was a 24-year-old vulnerable young man with learning disabilities from the West Denton area of my constituency, who was tragically murdered in 2015. In the months leading up to his death, he was living on and off—perhaps existing would be a better word—with a group of people he had befriended and trusted, at their home in the Kenton Bar area of Newcastle. During that time, he was the victim of sustained abuse and exploitation. Lee’s mother, Bev, had reported him missing on three occasions in the weeks before his death, and indeed had alerted the authorities to where he was staying and of her serious concerns about Lee’s safety, given the previous behaviour of those individuals towards her son.

Tragically, Lee’s badly beaten body was found on 6 June 2015, dumped on a grass bank near the A1 in Newcastle, not far from the house he had been occupying with those who were accused of his murder. The cause of Lee’s death was given as respiratory failure due to multiple severe injuries that were inflicted upon him at the house in Kenton Bar between 28 May and 5 June 2015. The injuries included fractures to his nose and jaw, the fracture of 24 ribs and damage to underlying organs, after he had been drugged with a combination of morphine, Valium and buprenorphine—medication used by heroin addicts—which enabled his attackers to conduct sustained physical beatings against him. The four people responsible for Lee’s death also prevented him from receiving the urgent medical attention that he clearly required on several occasions.

Following Lee’s death, a safeguarding adults review was established to hear from the myriad organisations and agencies involved in providing support to Lee and his family during his short life. The review explains:

“The relationship between Lee Irving and his killers was described as one of subservience with Lee beholden to the primary perpetrator”—

James Wheatley—

“for drugs and shelter and where Lee looked up to the primary perpetrator and desperate to fit in tolerated continued violence and abuse. This coercion and drugging were used to control him, prevent him seeking help and over a period of time drawing him back to the house at 33 Studdon Walk.”

Indeed, Mencap has informed me of its concern that Lee’s case is not an isolated one, commenting:

“There are many examples, both reported and unreported, of people with a learning disability who have been abused physically and psychologically by people who they thought were friends. This has given rise to the phrase ‘mate crime’, where individuals take advantage of someone’s vulnerabilities, bullying them physically, psychologically or stealing money or possessions.”

I believe that the safeguarding adults review instigated after Lee’s death raises serious issues, not just for Newcastle, but about how we, as a wider society, support and safeguard adults with learning disabilities. Vida Morris, chair of the Newcastle Safeguarding Adults Board, said after the review had been published:

“Lee’s story will be used locally, regionally and nationally to improve safeguarding and protect vulnerable adults.”

That absolutely must be the case.

It is evident from the review that Lee’s vulnerabilities, which were the result of his learning disability, were clearly identified by a number of local agencies some years before and right up to his death. On six occasions between 2010 and 2014, different organisations considered the risk to Lee to be such as to merit formal multi-agency adult safeguarding written referrals. Examples of Lee’s known vulnerability include an assessment undertaken by Percy Hedley School when he was nearly 18, which described him as

“socially immature and impressionable, a very vulnerable young man who could not ignore people who are distracting him, naive in social situations, easily influenced by others, and unable to identify people’s motivations and intentions.”

The national probation service in Northumbria had numerous interactions with Lee, as he was arrested 30 times between May 2011 and March 2015 for various offences. In December 2012, Lee was sentenced to nine months’ imprisonment for the offences of burglary and theft, and was

“treated as an adult fully responsible for his own actions and able to understand the consequences of the measures imposed.”

Yet the year before, in 2011, the NPS carried out an assessment of Lee and identified that he was

“incredibly vulnerable to the influence and harmful behaviour of others he encounters; that he was financially vulnerable from others. In addition, he was assessed as being vulnerable in custody and in a hostel setting.”

A further NPS assessment stated:

“Lee seems to understand that he is being used and bullied but seems to put up with it rather than be rejected by his peers.”

Another commented:

“Lee is not aware of the risks that he places himself in e.g. spending time with homeless people, sleeping rough, sharing taxis with strangers and giving his clothes and money away. His level of Learning Disability means that he behaves in a way which is focussed on pleasing people, to develop acceptance within groups and possibly to gain kudos through offending for others.”

Despite those assessments, no safeguarding alert was raised by the NPS about Lee Irving during its interaction with him in 2011 and 2012.

An assessment carried out in 2010—five years before Lee’s death—under the Mental Capacity Act 2005 confirmed that Lee’s overall reasoning and thinking abilities were the same as or better than only 0.2% of adults his own age. In other words, Lee’s intellectual abilities placed him in the bottom 1% of adults his own age. There is also a concern that Lee’s intellectual ability may at times have been overestimated, because his relatively better verbal skills may have masked his deficits in other areas.

In March 2015, shortly before Lee’s death, a further Mental Capacity Act assessment was undertaken, at which both he and his family were present, after his family reported that he had returned to live with the people who were exploiting him. That assessment identified that he did not have the capacity to make decisions to keep himself safe when alone in the community. The assessment resulted in an exploration of supported living options, which were still being explored at the time of his death.

The safeguarding adults review notes:

“Throughout his long engagement with services Lee failed to attend nearly half his numerous appointments with various services. While in his early teenage years his family often ensured his attendance, when in his late teens, his family’s influence declined and his chaotic lifestyle led to less frequent attendance at appointments, making it…difficult for…agencies to deliver the care and support that Lee needed.”

I find it hard to understand why that behaviour did not set more alarm bells ringing about Lee’s welfare, given that his vulnerabilities were well documented.

The review further states that

“Lee’s life slid into a chaotic cycle of offending, being reported missing and associating with so called ‘friends’ who exploited him. In October 2014 a decision was taken to award Lee with a direct payment—giving him control of some of his monies in order to directly purchase services or other forms of support… later that control passed to Lee himself.”

Again, given the circumstances in which Lee was living and the fact that his mother was already reporting that he was being financially exploited, I find that hard to understand.

Tragically, given what was to happen later, the police actually attended the address at which Lee was being held between 28 May and 5 June 2015, when we know that Lee was inside the house and already injured. However, no search was conducted, despite Lee having been reported missing by his mother, her belief that he was at the house and the police being aware of the extensive criminal records of those living at the property, including for violent offences.

The safeguarding review notes:

“It is clear that all agencies tried hard to deliver a service to Lee and/or his family but on many occasions this was made difficult due to Lee’s lack of engagement and his determination to keep bad company…these efforts were not adequately co-ordinated or led by each of the main agencies…Throughout the long engagement with agencies the lead changed according to the circumstances…Therefore, no agency was able to take overall responsibility for co-ordination and leadership, however, as noted in the report agencies were in contact on a regular basis with each other.”

The review adds:

“Lee Irving was a difficult person to help. His reluctance to engage with services and his failure to attend appointments made it extremely difficult for agencies to support him and his family. Despite this, agencies persisted in their attempts to help and protect him. It is clear that all agencies approached Lee Irving with the best of intentions.”

I continue from the review:

“Many agencies were involved in Lee’s complex case over a lengthy period. They saw him in different ways according to their discipline and…many did not appreciate the risk attached to his lifestyle and disability. There were, however, clear indications of Lee Irving’s vulnerabilities and recorded Safeguarding Alerts pointing to the threats present at the house at 33 Studdon Walk where he lived latterly and where he was killed…his specific vulnerabilities were accurately identified. The cumulative effects of these risk factors were not, however, weighed or considered in a multi-agency forum when planning for his care.”

The review also made clear:

“Perhaps as a consequence of a lack of co-ordination a number of options for intervening in the case of Lee Irving were not considered. No legal advice was sought from agencies solicitors and the possibility of Court of Protection proceedings or other legal options”—

deprivation of liberty—

“were not pursued.”

Whether any of those options would have succeeded in intervening in Lee Irving’s decline and eventual death will never be known.

Extremely worryingly, the safeguarding adults review suggested that:

“The behaviour of Lee was perhaps interpreted by some professionals as consistent with his choice of an antisocial and criminal lifestyle. Whilst not held by all agencies this interpretation meant that his criminal conduct was not always considered as a symptom of his disability, increasing vulnerability or the exploitation that he was subject to.”

Of particular concern to Lee’s mother, Bev, following her son’s death, are the challenges that parents of adult children with learning difficulties face in continuing to be involved in decisions about their care. The safeguarding adults review outlined that Lee’s family

“described the difference in the way professionals were able to respond to Lee as an adult as being frustrating and difficult to understand…Lee was…classed as an adult while his mental capacity remained that of a child”.

It also recorded that, on Lee reaching adulthood, Lee’s family

“felt excluded from some of the key decisions about his care. They felt that some professionals excluded or disregarded them and that decisions about options for the ongoing care of their family member were made without their input. In particular, they express severe concern that despite their specific warnings about Lee’s living conditions at the home at Studdon Walk, the measures taken to protect him were unsuccessful.

In conclusion, the family felt that while more should have been done to protect Lee towards the end of his life such was Lee’s determination to place himself at risk that only secure accommodation would have protected him. Whilst they had resisted this option at the time, with the benefit of hindsight they recognise that other measures were unlikely to have succeeded.”

Indeed, following the publication of the review in June, Lee’s mother, Bev, commented:

“Nobody listened to each other, but my main concern was nobody listened to me. If I had been listened to, then my son would still be alive now. I had my son reported missing three times in the previous few weeks up until his death and they wouldn’t bring him back. They wouldn’t inform me where he was, which I find very, very hurtful. It’s disgusting.”

In response to that, the director of people at Newcastle City Council stated:

“I know that Lee’s family felt excluded from some of the decisions that were taken about his care and that their warnings about his living conditions were not acted upon effectively. For that we are truly sorry.”

The safeguarding adults review highlighted that Lee’s family “had two main recommendations” following their son’s death. First, that

“the move from Children’s to Adults’ services be better managed to ensure a smoother transition without loss of support and that services consider the capacity rather than the age of the individual.”

Secondly, that

“families remain part of the decision-making process in the case of vulnerable adults and be fully involved/consulted on ‘best interest’ and other decisions relating to family members.”

Bev Irving has explained that she hopes those changes will be made so that, in her words,

“Lee’s name can live on in the name of Lee’s law”.

I look forward to hearing the Minister’s response to the recommendations and whether the Government can act on them to help ensure that the lessons from Lee’s case are genuinely learned across the country.

There is one further aspect to the case that I find deeply concerning. James Wheatley was found guilty of murdering Lee in December 2016. His mother, Julie Mills, his then girlfriend, Nicole Lawrence, and Barry Imray, who also had learning disabilities, were found guilty of, or admitted to, conspiring to pervert the course of justice and causing or allowing the death of a vulnerable person. Wheatley was sentenced to a minimum 23-year term and the original sentences of Mills and Lawrence were increased after the Crown Prosecution Service successfully appealed them as being unduly lenient, with the support of the Solicitor General. I know that the family are grateful for that.

Both the CPS and Northumbria police believed that the multiple and horrific offences perpetrated against Lee were motivated by his disability. Indeed, the safeguarding adults review commenced with that view. However, the trial judge, in his sentencing remarks, told Wheatley that

“In order to reach the conclusion”

that the offence was aggravated by disability

“the statute requires me to be sure that, at the time of committing the offence or immediately before or after doing so, you demonstrated hostility towards Lee Irving based on his disability or that your offence was motivated by hostility towards persons who have this or any disability. I am not satisfied on either basis. Although your texts”

to one of the other accused

“show repeated use of the repellent word ‘spastic’, I am not able to infer that such language was used towards Lee Irving at the time or immediately before or after your murderous assault. Furthermore, in my judgment you were motivated in this offence not by hostility towards those with disability but by your vicious and bullying nature which particularly takes advantage of those who are unable or less able to resist.”

That calls into question whether the current legislation—section 146 of the Criminal Justice Act 2003, which provides for an aggravated sentence—is fit for purpose, as it is unclear how anyone could prove a disability hate crime under the threshold unless the perpetrator made such an admission. I raised this issue with the Solicitor General, to which I received a response that the judge’s

“finding that the offences were not motivated by hostility is a finding of fact. Such findings are incredibly difficult…to challenge on appeal to the Court of Appeal, since I need to satisfy the court not only that the judge was plainly wrong, but also that it is in the interests of justice to overturn his finding of fact.

My decision was that I would not succeed in overturning the finding of fact in this particular case. I only reached this conclusion after receiving advice from the leading counsel at trial, the CPS’ hate crime stakeholder manager, and a senior barrister who is a specialist in these kind of cases. I also looked at general advice from First Senior Treasury Counsel, the Government’s most senior barrister in criminal matters, on how to apply the hate crime provisions.”

I am aware that the CPS has recently published revised guidance setting out the factors to be taken into consideration when reviewing cases and prosecuting offences classified as disability hate crime. However, in Lee Irving’s case the issue was not with the police or CPS not recording or prosecuting the barbaric offences committed against him as disability hate crimes but that the judge could not be sure that, at the time of committing the offence, or immediately before or afterwards, the perpetrator demonstrated hostility towards Lee based on his disability, or that the offence was motivated by hostility towards people with disabilities—the threshold set in the existing legislation. That is concerning at a time when we know that disability hate crime is a significant issue.

Mencap highlights that some 73% of people with a learning disability and autism responding to a 2016 Dimensions survey said that they had experienced hate crime, while recorded hate crime based on disability has increased by 44% since last year. The true extent of the problem is being masked by people with a disability or learning disability who are too scared or do not feel able to report incidents. I strongly urge the Minister to ensure that the Government look at this issue again, in the light of Lee’s case, although I am conscious that it is not within her departmental remit.

I fully recognise that I have raised a number of wide-ranging issues this afternoon, many of which do not fall directly within the Minister’s portfolio. However, I am pleased to have been able to put on record the different, and very important, concerns that Lee’s mother has raised with me following her son’s death. Those ultimately responsible for Lee Irving’s horrific abuse and murder are now locked up in prison where they belong. Indeed, thanks to the intervention of the Solicitor General, some sentences were increased for being unduly lenient. However, the current legislation needs to be reviewed, because if Lee’s case could not be regarded as a disability hate crime, it is hard to know how the current threshold could be met.

I have also outlined how important it is for adults with learning disabilities to receive the right care and support to enable them to live independent lives where that is appropriate. However, I have real concerns about the issues raised by Lee’s case, and the fact that those charged with safeguarding Lee—an extremely vulnerable adult—did not get the balance right between independence and protection. Nor does it appear that the many agencies that interacted with Lee shared information with each other about his vulnerabilities, or properly listened to or acted on the concerns repeatedly raised by his family, which might have resulted in Lee still being here today.

It is critical that lessons are learned from Lee Irving’s case as quickly as possible, right across the country. I look forward to hearing from the Minister how she intends to ensure that that will be the case.

--- Later in debate ---

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

It is an honour to speak with you in the Chair, Mr Wilson. As other hon. Members have done, I congratulate my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell). It is usual to congratulate another Member on securing such an important debate, and she has been persistent in trying to secure this one; the dignified and passionate way in which she set out a deeply tragic case made it an important speech to listen to.

As my hon. Friend said, Lee Irving’s extreme vulnerability due to his learning disability was known about three years before the tragic murder of her constituent. It is disturbing that, despite knowing that, the national probation service did not raise an alarm or a safeguarding alert. As we heard, Lee was being treated as an adult, not a vulnerable adult. The failings highlighted by the safeguarding adults review in the case of Lee Irving included a failure to involve his family in decisions about his future. Mencap has also highlighted the fact that only 1% of hate crimes reported against disabled people result in prosecutions.

Mencap has also called for greater public awareness of learning disabilities. It is important that we have talked about that issue in this debate, and that we have realised that MPs do not have much training on it. Clearly, there is much to know, and many of us could help with that and bring about greater public awareness. I shall say more later about the Mental Capacity Act 2005 and the impact that it can have on the families of people with learning disabilities, and their ability to stay involved in decisions about vulnerable people such as Lee Irving. I share the view of my hon. Friend the Member for Newcastle upon Tyne North that lessons must be learned from his case. There is much to learn.

I want to mention the campaign Justice for LB, which was set up to campaign on learning disability issues following the tragic death of Connor Sparrowhawk while he was in the care of Southern Health NHS Foundation Trust. My hon. Friend the Member for Newcastle upon Tyne North touched on the case earlier. We have discussed issues at Southern Health a number of times in debates, because Members of the House have had deep concerns about the safety of the care and services provided by the trust. Connor Sparrowhawk was left to drown in a bath; and there were many other deaths. The Mazars investigation, commissioned by NHS England, looked at all deaths at the trust between April 2011 and March 2015. It found that during that period 10,306 people had died. Most deaths were expected, but 1,454 were not. The likelihood of an unexpected death being investigated by the trust depended on the type of patient. The most likely group of deaths to be investigated was deaths among adults with mental health problems, of which 30% were investigated. For those with a learning disability the figure was just 1%. Parents and families left bereaved and grieving want to see accountability, but too often they do not.

There has not, for example, been accountability at Southern Health NHS Foundation Trust. In fact, the opposite has happened. Last October, I asked the Health Secretary to investigate the way the Southern Health Trust created a sideways move, to an advisory role at the same salary, for Katrina Percy, the chief executive who was criticised for leading the trust through the time when it failed to investigate all those patient deaths. Six weeks later she resigned from that newly created advisory role and received a £190,000 salary pay-off that was signed off by the Department of Health and the Treasury. How does the Minister think that makes bereaved and grieving parents feel? Justice for LB called the pay-off “utterly disgraceful”, and I agree with that, but the Health Secretary would not investigate it.

Campaigns such as Justice for LB are asking that provision for people with learning disabilities should be an integral part of health and care services—not a specialist branch that can be ignored, as it appears to have been ignored at the trust in question. They believe that the law should be changed so that every unexpected death in a secure or locked unit is automatically investigated independently. It is also an important point of crossover with the case that my hon. Friend the Member for Newcastle upon Tyne North put so well today that they want to stop the Mental Capacity Act 2005 being used to distance families and isolate people—particularly young people.

The Justice for LB campaign, which obviously focuses on different issues from those relating to Lee Irving, has asked for a critical look to be taken at the system of inspection and regulation under which catastrophic events have happened—as they have: from Winterbourne View to the Southern Health NHS Foundation Trust there are too many. Sadly, failures carry on over many years. Last week, Southern Health NHS Foundation Trust was fined £125,000 after a prosecution in the case of a patient who fell from the roof of the mental health complex of Melbury Lodge in Winchester. The prosecution was brought following the injuries sustained by a patient known as Mr AB. Since 2010, a number of patients detained under the Mental Health Act 1983 had climbed onto the roof of Melbury Lodge in a bid to abscond. The trust’s own security review had recommended safety measures, including anti-climb guttering, but those improvements had not been made.

Mr AB had climbed on to the roof earlier, in March 2012, slipping twice and nearly falling before he was brought down. Three years later, he was admitted to Melbury Lodge again. His family were so worried that he might try again to abscond and climb on to the roof that they asked the staff to keep a close eye on him. However, in the early hours of a morning in December 2015, Mr AB again climbed on the roof of the lodge and fell to the ground, sustaining very serious neck injuries. Despite that accident, three more patients were able to gain access to the roof in February 2016, two months later, and one of them was injured.

The court was told that the trust had not taken action to deal with the risk as there was no money to spend on the remedial work. This is a trust that paid a consultancy firm more than £5 million for a contract originally tendered for £288,000, while another firm was awarded a contract for £600,000, for which it did not even have to bid. It makes things worse that both companies awarded contracts were run by former colleagues of the trust’s chief executive, Katrina Percy. Nearly £6 million of NHS funding went from that trust to a company called Talent Works, described as experts in culture and behaviour change. It is not good enough that an NHS trust spends £6 million on culture and behaviour change consultants when it cannot get the basics right and safeguard its patients or a young person put in its care.

Those events, and everything we have heard in the debate, leave us questions to answer, which I will put to the Minister. Why were only 1% of the unexpected deaths of people with learning disabilities at a trust such as Southern Health investigated? Why do only 1% of hate crimes against people with learning disabilities result in prosecutions? Parents from both campaigns for better safeguarding of people with learning disabilities urge us to stop the Mental Capacity Act being used to distance those families and isolate people, particularly young people.

My hon. Friend spoke powerfully of the need to give families of adult children with learning disabilities much clearer and increased rights over their adult child’s welfare. She highlighted well the horrific events that can occur when families do not remain part of the decision-making process. I will repeat, because they are important, the two recommendations of Lee Irving’s family. The first is that the move from children’s to adults’ services be better managed, to ensure a smoother transition without loss of support, and that services consider the capacity, rather than the age, of the individual. That was clearly an important factor in the case of Lee Irving. Secondly—and very importantly, because this matters to many families—they recommend that families remain part of the decision-making process in the case of vulnerable adults and are fully involved in and consulted on best interest and other decisions relating to family members.

In a dignified and passionate speech, my hon. Friend also argued convincingly of the need to introduce a new offence of disability hate crime, to send a clear message that what happened to Lee Irving will not be tolerated in 21st-century Britain. It is unusual to have such a small debate, but it has been worth while to lay out that case and make other points. We must continue to have an informed debate about the status of adults with learning disabilities as full citizens, but more important than anything is that we should listen to them and their families. We should remember the deeply disturbing words of Lee’s mother, Bev:

“nobody listened to me. If I had been listened to, then my son would still have been alive now.”

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I join everyone else in paying tribute to the dignified and passionate way in which the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) outlined her case. It is truly heartbreaking. Lee’s mother is watching today. She put her trust in the institutions of the state to care for her son, and we failed her. It should never have happened, and for that I am truly, truly sorry. I give the hon. Lady and Bev my commitment that I will take lessons from this. I hope the hon. Lady will act as my conscience in ensuring that I do so. The issues highlighted across the Chamber today need to be acted upon, to ensure that we do our best by all our constituents.

I was struck by the way that the hon. Lady talked more generally about people with learning disabilities. It is, frankly, the reason we all get involved in politics—we get involved in politics when we see the state failing and to make sure we do the best for everyone in society and for the people we can see being failed. I do not think that any group is failed more than people with learning disabilities. They have potential and the ability to live independently, but all too often they have been parked. My hon. Friends the Members for Henley (John Howell) and for North Swindon (Justin Tomlinson) outlined examples of where, with some support, people with learning disabilities can lead very productive lives, but it requires support and investment. Sadly, that is not always forthcoming, and without it, they are very vulnerable, as this tragic case all too clearly illustrates. We owe it to them and to ourselves, in order to make the best of society, to do all we can to help people with learning disabilities to live independent lives.

We need to do more to tackle the whole issue of prejudice. The hon. Member for Newcastle upon Tyne North said she has been very persistent in trying to secure this debate, but perhaps it is fitting that the debate is happening in the middle of National Hate Crime Awareness Week. That is the perfect backdrop against which to address her case. It is fair to say that we are still early in the day when it comes to hate crime prosecution. There is slowness in reporting all hate crime, and suddenly people have become more aware.

People with learning disabilities are generally victims of quite widely held prejudice. It is not just the fact that they are targeted because of their disability; the agencies that should support them do not necessarily give them the support they need because of their disability. We have seen across the board, in so many examples of abuse, that particular social groups who are not the best at representing themselves do not always get a fair deal at the hands of the organisations that support them. We should look at that under the umbrella of hate crime, but it is slightly different; it is about prejudice more generally that we can all help to tackle. It is a very real inequality that we are tackling.

Central to our job as Members of Parliament is supporting people who have been victims of maladministration and who are not getting enough support from the state. In many cases, that is people with learning disabilities. I have always found that some of the most rewarding work I do as a Member of Parliament is in supporting people with learning disabilities. It is also the most inspiring, and it is great to see the enthusiasm that my hon. Friend the Member for North Swindon referred to.

Unfortunately the Minister for Disabled People, Health and Work, my hon. Friend the Member for Portsmouth North (Penny Mordaunt), is no longer in her place, but the fact that she was here is testimony to her support for this work. We are very keen that people with learning disabilities receive more attention. I give the hon. Member for Newcastle upon Tyne North that commitment, and we will continue to engage with her as this work develops.

I agree with the hon. Lady that people with learning disabilities are among the most vulnerable in our society, and it is the responsibility of all of us to protect them from risk. I will not pretend that we have got this perfect—there is a hell of a lot more to do. There has been significant progress in identifying and managing risk, but it is not consistent, and there are too many occasions when it just does not happen.

The hon. Lady articulated clear views on a specific case of hate crime. She will appreciate that that falls outside my bailiwick, but I will make a few observations, in so far as I can without treading on other Departments’ toes. As she said, the judge concluded that hate was not a factor in the motivation behind the crime. That is a matter for the courts, and it is for them to interpret, but I come back to the issue of prejudice. That case throws up a number of issues that we all need to be more vigilant about. We know that people with learning disabilities are very vulnerable to bad people, and bad people will find vulnerable people to prey on. I am aware that young women with learning disabilities are often preyed upon sexually, which is a real hidden issue that we need to think about. There is also the whole issue of modern slavery. People with learning disabilities are often subject to that. In this case, Lee was obviously being exploited financially by the people who murdered him.

[Barbara Keeley]

I did not manage to raise the very important point that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) raised about the fact that Lee Irving was labelled as difficult to help and classed as an adult who could choose a lifestyle, with such tragic results. That has echoes of other forms of abuse because, as my hon. Friend so clearly pointed out to us, his intellectual skills and reasoning were at 0.2% of those of adults of his age. Why were agencies saying that he could choose that awful lifestyle, which ended up having such a tragic result?

[Jackie Doyle-Price]

I totally agree with the hon. Lady. As she says, we have seen that in other cases of abuse. We can look at Rotherham and how the agencies behaved there. It is almost as if there is a view that, “He’s a bad ’un; he doesn’t deserve protection.” That is absolutely not the case. We need to be thinking about the person in a very person-centred way. It was very clear that Lee had a learning disability and did not have the capacity to act as an adult, yet he was treated as one. That is one of the real lessons of this case.

With specific regard to the requests of the family, the whole area of transition is certainly of concern to me. We see this issue in relation not just to learning disabilities, but to mental health. In both cases, families are often completely unable to influence support or care for their loved one; they are utterly powerless because they are in the control of institutions. We need to be learning the very clear lessons there.

We need to raise awareness of hate crime against people with disabilities. Too often, we look at hate crime through the prisms of race and gender. To be honest, we look at hate crime through those prisms because it is the victim of a hate crime who will raise it as such and, frankly, people with disabilities are in less of a position to do so. That said, things are getting better. As I said, it is early days for the offence and prosecution of hate crime, but I am told that in the past year the police have recorded an additional 5,558 disability hate crimes; the number is up by 53%. That suggests that people are more inclined to report it and that the police are more inclined to identify hate crime due to disability, but we continue to monitor the situation and see what else needs to be done to protect the vulnerable.

Health

Baroness Keeley Excerpts

Monday 16th October 2017 Ministerial Corrections

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned.

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

The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence?

[Mr Hunt]

Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff.

[Official Report, 10 October 2017, Vol. 629, c. 143-45.]

Letter of correction from Mr Hunt:

Errors have been identified in the responses I gave to Questions to the Secretary of State for Health.

The correct responses should have been:

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is right to draw attention to the issues around Southern Health, which will have directly affected a number of her constituents. That organisation is being turned around. However, she is also right to say that too many people are travelling out of area for their treatment. We have record numbers of children’s beds commissioned, but in the end this is about the capacity of the system of trained psychiatrists, psychologists and therapists, which was why we announced the extra 21,000 posts.

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

On World Mental Health Day, may I thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for wearing yellow for #HelloYellow on behalf of our team?

The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence? [Official Report, 16 October 2017, Vol. 629, c. 4MC.]

[Mr Hunt]

Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff. On top of that —she asked about money—we have committed an extra £1 billion a year by 2021 so that we can employ even more people. We are the first Government to admit that where we are now is not good enough. We want to be the best in the world; that is why we are investing to deliver that.

Autism Diagnosis

Baroness Keeley Excerpts

Wednesday 13th September 2017 Westminster Hall

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

It is an honour to speak with you in the Chair, Mr Howarth. I very much congratulate my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) on securing the debate. It is an important one because, as we have heard, diagnosis is the vital first step towards getting support for people with autism.

For children with autism, and their parents, getting a diagnosis is the first hurdle that they need to get over, to secure the support and education to which they are entitled. As my hon. Friend the Member for Enfield, Southgate mentioned, the NICE quality standard on autism recommends that people should wait no longer than three months once they are referred for their first diagnostic appointment. It is clear that people have to wait too long for a diagnosis of autism and that the waiting time can be gamed by delaying later appointments. Waiting to wait is not acceptable.

We heard that research has shown that waits can be two years for adults and three and a half years for children, but we have also heard of examples where things have taken much longer. We touched earlier on the Public Health England survey and the fact that in one local authority it is admitted that there are waits of 125 weeks. Hon. Members have spoken powerfully about long waiting times and their constituents’ experiences—and their own, in the case of my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds).

I was contacted by one of my hon. Friends who could not take part in the debate, and want briefly to refer to the experience of one of her constituents. When her son was 18 months old, he suddenly stopped talking. That was raised with the health visitor at the child’s two-year review. The health visitor almost did not make a referral to a speech and language therapist, saying that the criterion for referral was that a child could say fewer than 10 words. At that time, the little boy could say only one word: “No”. It took a nine-month wait to get a first appointment with a speech and language therapist. At the second appointment, six months later, she said she would refer the child to a paediatrician. In the end, it took almost two years to get a diagnosis of autistic spectrum disorder from the paediatrician and the speech and language therapist working together.

Since then, the child has been discharged from speech and language therapy, despite the fact that he is still not speaking. His parents have had to get therapy for him privately, paid for with his disability living allowance money. The child spent half his young lifetime—from age two to age four—without the support that he needed to help his development. The mother says she felt

“let down by the system”,

but also that their family was one of the lucky ones, because, as we have heard, other parents had to wait longer to get a diagnosis. The issue for her was

“the lack of availability of professionals…had we seen professionals when appointments were due I think it would halve the time to get a diagnosis”.

Delays in diagnosis can hinder the implementation of effective support and intervention strategies, but they can also—understandably—lead to parents losing confidence in healthcare professionals, particularly if they feel that appointments and waiting times are being gamed in the ways we have heard about. By contrast, surveys have shown that a positive diagnostic experience is associated with lower levels of stress and more effective coping strategies, which is what we are talking about giving to families, if waiting times for diagnosis can be cut. For adults with autism, a diagnosis can end years of feeling misunderstood and isolated. We have heard about an increased risk of suicide.

A number of Members raised the point that autism diagnosis waiting times are not currently collected as part of the mental health services data set. I understand that the National Autistic Society has worked with the Government on proposals to collect those data. Will the Minister confirm to the House today that the Government plan to commit to the routine recording of diagnosis waiting times from April 2018 and, importantly, tell us what plans they have to speed up the diagnosis process? NHS England does not currently collect data on the number of diagnoses or who is being diagnosed with autism. That makes it difficult to determine where there are gaps in diagnosis. The National Autistic Society says that between 75% and 80% of people who use their adult services are male. However, as my hon. Friend the Member for Enfield, Southgate said, there is concern that there is under-diagnosis of women and girls, who are not getting the support they need.

Likewise, the first generation of people diagnosed with autism are now reaching middle age. That means there is a generation of people for whom autism was not a diagnosable condition during their youth. There could be significant gaps in autism diagnosis among older people. We heard in the debate of a lady diagnosed only in her 40s, and it is important that our focus should not always be on children. I find it heart-rending to think about cases such as the one I outlined, but it can also be difficult for people get a diagnosis when they are older. NICE recently recommended the creation of an autism register so that we can identify areas where autism may be under-diagnosed. Does the Minister agree that such a register might help more autistic people get the diagnosis and the support that they are entitled to? Are there likely to be moves to create one?

An early diagnosis is important. Mental health conditions are more prevalent among people with autism than among the general population. A diagnosis can provide an understanding of why a child finds things difficult and, as in the case that I talked about, suddenly stops speaking. If there are signs of mental health issues or other problems, a diagnosis can make family and friends aware and open access to proper support. However, post-diagnosis support is not always there. A survey of parents with autistic children found that many are left with no support during and after the diagnostic process, and many are not signposted to other advice and help. That is clearly important; there is a feeling of their being warrior parents and battling parents. Let us stop their having to do that. Some are even left without a written report of their child’s diagnosis.

In the example that I outlined, the four-year-old child is still not speaking but has been discharged already from speech and language therapy services, and his parents can obtain therapy for him only privately. What plans are in place to ensure that people who receive a diagnosis have access to the services to which they are entitled, and which their children need? Let us, from now, help the warrior parents and battling parents, and all the people who need a diagnosis to move ahead with their lives.

Adult Social Care Funding

Baroness Keeley Excerpts

Thursday 6th July 2017 Commons Chamber

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

Does the Minister share my deep concern about the state of social care highlighted—

[Mr Speaker]

Order. What the hon. Lady needs to do is just ask the Minister for the statement on the matter, and then she follows with her substantive question when the Minister has given his response.

[Barbara Keeley]

(Urgent Question): To ask the Minister to respond to the Care Quality Commission report on the state of adult social care and on issues of funding social care.

[Mr Speaker]

I call Minister Steve Brine.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Thank you, Mr Speaker—take two.

There are few things more important to any of us than the way in which the oldest and most vulnerable are cared for in our society. First, let me pay tribute to the 1.4 million people who work in the country’s social care sector. They support many of the most vulnerable people in our communities, often in the most difficult of circumstances. I am proud that we have done more than any Government before to improve the quality of social care, introducing a tough system of CQC ratings, new qualifications for care workers, and new standards to ensure that everyone receives the highest-quality support. I am heartened that today’s CQC report shows that even in a time of acute fiscal pressure, 79% of adult social care services are now providing good or outstanding care.

However, it is impossible to ignore the pressure that our ageing population and advances in medicine are putting on the system. We have seen the number of over-65s increase by nearly 1.2 million, or about 14%, over the past five years. Today’s CQC report shows that in some areas, it is completely unacceptable that standards in some settings are below those rightly expected by care users and their families. This Government view social care as a priority, which is why in the spring Budget this year we announced an additional £2 billion over the next three years for councils in England to spend on adult social care services. That means that, in total, councils will have access to £9.25 billion more dedicated funding for social care over the next three years—enough to increase social care spending in real terms. We have also been clear that later this year we will be consulting widely on the future of social care in this country to put it on a stable footing.

My right hon. Friend the Health Secretary updated the House on Monday about action he is taking to address delayed discharges from hospital in advance of this winter. Last year there were 2.25 million delayed discharges, up by 24.5% from 1.81 million in the previous year. The Government are clear that no one should stay in a hospital bed longer than necessary—it removes people’s dignity, reduces their quality of life, leads to poorer health and care outcomes for people and is more expensive, ultimately, for the taxpayer. Since February, there have been significant improvements in the health and care system, with a record decrease in month-on-month delayed discharges in April of this year.

However, we must make much faster and more significant progress well in advance of next winter to help free up hospital beds for the sickest patients and reduce pressures on accident and emergency departments. That is why we have introduced a further package of measures to support the NHS and local government in reducing delays. That package includes guidance, a performance dashboard, plans for local government and the NHS to deliver an equal share of the expectation to free up 2,500 hospital beds, and of course CQC reviews. We have also been clear that we will consider a review in November of the 2018-19 allocations of the social care funding provided at spring Budget 2017 for poorly performing areas. We have been clear that the Budget funding will all remain with local government, to be used for adult social care.

[Barbara Keeley]

I thank the Minister for that response, but I really must ask him whether he shares my deep concern about the state of adult social care, as highlighted by today’s report by the Care Quality Commission. Some 3,200 care services were rated as “requires improvement”, with more than 340 rated as “inadequate”. That means that some 92,000 vulnerable people are receiving poor care and some 10,000 people are receiving inadequate care. The picture is even worse in nursing homes, with one in three receiving the poorest ratings.

Does the Minister share my concern about safety, with one in four care locations failing on protecting people from abuse or avoidable harm? That means thousands of vulnerable people not getting prescribed medicines, being ignored when they ask for help and not having enough time for their home care visits.

The Labour party has repeatedly raised the damaging impacts of budget cuts, with more than £5 billion having been cut from social care since 2010. Does the Minister now accept that that has caused the crisis in care staffing, which is at the heart of the poor care that is being reported? Poor staffing levels and staff training are key factors in those providers with the poorest ratings.

In his written ministerial statement earlier this week, the Secretary of State suggested that the £2 billion allocated in the spring Budget to local councils for social care, to which the Minister has just referred, will now be dependent on performance against targets for delayed transfer of care. That means that some councils could lose funding that they have already planned to spend. Does the Minister accept that threatening local councils with the loss of planned funding could lead to a worsening of the quality and safety issues highlighted today? With social care in crisis, this is not the time to be threatening joint working with local councils, so will he reverse that threat and match the Labour pledge of an extra £8 billion for social care, including an extra £1 billion this year?

[Steve Brine]

I thank the hon. Lady for that response. This subject was much discussed during the general election, and I think it will be greatly discussed during this Parliament.

Nobody is making any threats. The Government are very supportive of the best-performing systems, where local government and the NHS work together to tackle the challenge of delayed transfers of care. We have said that, depending on performance, we will consider a review in November of the 2018-19 allocations of social care funding provided in the spring Budget for areas that are poorly performing. As I have said, that funding will all remain with local government, to be used for social care.

Obviously, we recognise that there are real pressures in the system. That was why we responded—I think the hon. Lady’s party was pleased with this at the time—with an additional £2 billion for social care in this year’s Budget. We have also given councils the chance to raise the council tax precept. My authority, Hampshire, has done that, and I think that has been well received.

Turning to the actual report, it would be easy to duck all of this. Dare I say that I hope we can conduct this debate in a sensible spirit? People out there working in the system who want to pass the mum test, as was said this morning, want us to do that and are watching things closely. Of course, it would be easy to bury our heads in the sand, but let us remember that had we had the rigorous inspection regime that the Secretary of State put in place earlier, a lot of problems, including those in the hospital sector when the hon. Lady’s party was in government, would not have been heard of. We know about the current situation only because of the inspection regime that has been put in place.

The CQC report found a number of things, and obviously we will digest it over the days and weeks ahead. It found that the adult social care sector performed best in how caring its services are: 92% of services were rated good and 3% outstanding. We can kick this issue around all we like, but today’s report shows exactly why we introduced the inspection regime. It is uncovering the care that is good—the vast majority of it—and it is also uncovering the care that is not, which is where we want to help and support local authorities to make sure that improvements are made for the people we represent.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 4th July 2017 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

My hon. Friend and other Leicestershire MPs have made their views very clear to me. I hosted a number of them, from both sides of the House, to discuss this issue. He is aware that the public consultation on congenital heart disease services continues until 17 July. Obviously, we will take all the comments made into account when we come to the conclusions from that report.

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

Today is the sixth anniversary of the publication of the Dilnot commission’s report on the funding of social care. In those six years, Ministers have legislated for a cap and a floor on care costs, and then abandoned those measures. They brought forward disastrous proposals in their manifesto for what became known as the “dementia tax”, and they appear to have abandoned those measures, too. Will the Secretary of State confirm that those policies have indeed been abandoned? Will he tell me, and more than 1 million people with unmet care needs, when he expects to have some new proposals for reform?

[Mr Hunt]

I have great respect for the hon. Lady, because she campaigns consistently on this issue, but I do not think that what she says is a fair reflection of what has happened. In the last year of the previous Labour Government, 45,000 people had to sell their home to pay for their care costs, whereas this Government have made it the law that no one has to sell their home. There is more work to do, but we have made important progress and will continue to do so.

Contaminated Blood

Baroness Keeley Excerpts

Tuesday 25th April 2017 Commons Chamber

[Andy Burnham]

That was the direct content of the Stanford letter. There was a worry that the NHS was using such products in a completely different context, not understanding the difference between the two systems. That was the Stanford letter.

I am not standing here claiming to be an expert on all the papers, because I am not; I am saying what I know, from the people I have spoken to, to be wrong, and linking that to the documents in order to say what I believe to be the case. I may not be right, but we need to find out whether I am right, and that is the point that I will be putting to the Government.

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

I was not going to intervene, but the hon. Member for Worthing West (Sir Peter Bottomley) made the point that generous treatment is needed. The victims of this NHS scandal are not receiving generous treatment. I have a constituent who was infected during the scandal as a child at the Royal Manchester children’s hospital. When he discovered that his cirrhosis, if it remained untreated, meant that he ran a 25% chance of developing liver cancer, he was told that he would be denied treatment by the NHS. The treatment he needed to clear the virus load from his system cost £100,000, and at that point he decided to use the ex gratia payment that he had been given—such a payment is supposed to be some compensation, although it is not enough—to try to do so. That is the situation that victims such as my constituent are in at the moment, and it is a disgrace: they should not be fighting this and having to use their own money for their own treatment.

[Andy Burnham]

It is a total disgrace. Absolutely there must be full, fair compensation now. I say to the Government, do not delay; do what Ireland and other countries have done. They should do that now. They raised expectations and they should do it. We would all support it.

Mrs Bullock, whom I mentioned, is reduced to sending begging letters. She has had to sell the family home and move away from everything. She is sending begging letters to the Skipton Fund for a stair-lift. She is not well herself now. How can that be right? We are making a woman who has lost everything send begging letters for a stair-lift, as she tries to cope on her own because her husband is no longer there. On the point about medical treatment, I understand that Mr Bullock may have been refused a liver transplant because his notes said that he was an alcoholic. There is injustice upon injustice here. It is absolutely scandalous. I hope the House now understands why, as I said at the beginning, I could not live with myself if I left this place without telling it directly what I know to be true.

[Andy Burnham]

Absolutely; I could not agree more. It is downright immoral to make these people carry on begging in the way they have been forced to do. The Government raised their hopes; they should deliver on the former Prime Minister’s promise and do what my right hon. Friend has just described.

The story is becoming clear, is it not? Warnings from the United States were ignored. There was a wish to drive on with these new products from the Oxford haemophilia centre: “We’ll just push them out there to find out the results before we really know whether there is infectivity.” Problems started to happen and perhaps there was the idea, “Oh no, the Government might be exposed to litigation. Let’s not have it in people’s notes so that a story does not build about how there has been negligence and people might have a compensation claim.” That is the story I have got; I do not know what anybody else thinks. Worse, for some people, they said, “Don’t just destroy their notes; falsify their notes.” That is the story. We need to find out whether it is true or not. In my view, these are criminal acts. They did not just happen by chance. A major injustice has happened here.

In making this speech tonight, I think of our late, great friend Paul Goggins, who I miss every single day. He did so much to advance the cause of justice for those who suffered. I also think of his constituents, Fred and Eleanor Bates, and of the promises I made to act for them in Paul’s name. In a 2013 debate like this one just before he died, Paul made an impassioned call for:

“A serious Government-backed inquiry…with access to all the remaining records and the power finally to get to the truth of what happened and why.”—[Official Report, 29 October 2013; Vol. 569, c. 201WH.]

His demand was as undeniable then as it is now, yet it pains me that, in the four years since then, this House has not moved it forward at all. If that continues to be the case after what I have said tonight, I am afraid that this Parliament will be complicit in the cover-up.

In reply to the demand of my hon. Friend the Member for Kingston upon Hull North for an inquiry in a letter she wrote in October 2016, the Prime Minister said:

“the relevant documents have been published on the Department of Health and the National Archives websites and it is unlikely that a public inquiry would provide further information.”

In my view, that is a highly debatable statement. I do not think that a Prime Minister who has a good track record in helping to secure justice for those to whom it has been denied should have put her name to such a letter, which was probably drafted by the Department of Health. I remember exactly the same thing being said to me by those who opposed the setting up of the Hillsborough independent panel. “Everything is out there, it’s already known,” is what they always say. If the Prime Minister is confident in her assertion—I say this to the Minister—then rather than just publishing the documents the Government have selected as relevant, why not publish all the Government-held documents so that we can all decide whether her claim is true? On the basis of the evidence I have presented tonight, I believe it would be quite wrong for this House to resist that call.

To be clear, I am not calling for a lengthy public inquiry; I am calling for a Hillsborough-style disclosure process, overseen by an independent panel, which can review all documents held by government, NHS and private bodies. Just as with Hillsborough, the panel process should be able to view documents withheld under secrecy protections and make the necessary connections between documents held locally and nationally. It should then produce a report on the extent to which the disclosure of those documents tells a new story about what has happened.

So tonight I issue a direct challenge not just to the Government but to all parties in this House, including to my own Labour Front Bench and the Scottish National party: do the right thing and put a commitment in your election manifestos to set up this Hillsborough-style inquiry into contaminated blood. That, in my view, would be the most effective way to get as quickly as possible to the full truth and the whole story, as it was, effectively and efficiently, with Hillsborough.

I want to be very clear tonight with the Minister and with the House. If the newly elected Government after the general election fail to set up the process I describe, I will refer my dossier of cases to the police and I will request a criminal investigation into these shameful acts of cover-up against innocent people. I say to the Minister that the choice is hers. People are asking me why I do not just go straight to the police with the evidence I have, and I owe them an explanation. It is my view that the individual crimes I have outlined tonight are part of a more systematic cover-up and can only be understood as a part of that. If we refer them piecemeal to the police, they may struggle to put together the bigger picture of what lies behind the falsified medical records. That, in turn, may delay truth and justice. If the Government will not act, however, I believe a police investigation is the correct next step and that is what I will request. I cannot keep this information in my possession and not do something with it.

As we know, time is not on the victims’ side, so I will set a deadline. If the Government do not set up a Hillsborough-style inquiry by the time the House rises for the summer recess, I will refer my evidence to the police and request that investigation.

[Barbara Keeley]

My right hon. Friend is making an incredibly powerful case in his final speech in this place. The shadow Health team discussed this matter earlier and entirely support his call.

[Andy Burnham]

I am very pleased to hear that. I hope that means a commitment in the election manifesto of the kind I have just called for.

--- Later in debate ---

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

I thank you on behalf of my constituent, Madam Deputy Speaker. I want to speak further, briefly, about that case. The Minister has made certain assertions and I want to give the House some more information. The main part of the debate has been about the excellent revelations from my right hon. Friend the Member for Leigh (Andy Burnham), but we have also referred briefly to the situation of people who were in many cases infected as children as a result of this scandal in the NHS. We need to keep reflecting on the fact that many people were children when this happened. My constituent was a child receiving the treatment that he needed from the NHS. I have already talked about him having to pay for his own treatment, and for the drug that he needed to clear the hepatitis C virus from his body .

The Minister referred to the consultation recently conducted by Health Ministers on reforming the system. I would like this Minister to know how that has gone down with my constituent. He tells me that he received a letter summarising the proposals. He says:

“For me personally, as someone who has progressed to stage 2, I would be significantly worse off. In real terms, the proposals mean that financial support will decrease over time as the annual payment will no longer be index linked. I will even lose the £500 winter fuel payment, and I will no longer receive a pre-payment prescription certificate which I use for painkillers and anti-inflammatory medication.”

It is disgraceful that people who were infected as children by the NHS are being treated in this way. My constituent goes on:

“I believe the Government is being deliberately punitive and exceedingly cruel in using the affected community’s request to reform the various support schemes to actually make cuts to those people who were infected by contaminated blood given to them by the NHS through no fault of their own.”

I just wanted to add those observations to what has been a powerful debate. It has already been stated by other Members that our constituents have no time left. This is the situation that they find themselves in, and this miserly treatment beggars belief. It is time we did something better.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

I am happy to congratulate the Cellar Trust, and to pay a visit if I can find the time to do so. My hon. Friend is right to say that voluntary organisations play a vital role. Very often, they can see the whole picture and they treat the whole person, not just the specific NHS or specific housing issue, so he is right to commend its work.

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

Recent figures show that 18 mental health patients were placed more than 185 miles away from their home for treatment, including five from the northern region—Jess is one such example. Their families will have to travel the equivalent of Manchester to London, or further, to visit them. We have also learned that £800 million was taken out of CCG budgets, which could be funding services such as mental health in-patient beds, just to help NHS England balance the books. Will the Secretary of State tell those patients and families why they should be treated so far from home when their local CCG should be able to fund the in-patient beds they need?

[Mr Hunt]

With great respect to the hon. Lady, we are the first Government to count out-of-area placements, and to commit to eradicating them. What she does not tell the House is the context, which is the biggest expansion in mental health provision anywhere in Europe, with 1,400 more people being treated every single day, and an extra £342 million being spent this year on mental health compared with last year.

--- Later in debate ---

[David Mowat]

Much of the money will go through the better care fund and there is conditionality on that. We expect councils to spend this money, as they have requested it, on social care and we believe that that will be the case. We understand the pressures and have acted.

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

But 1.2 million older people are living with unmet care needs. The £1 billion that was announced in the Budget for this year is not enough to prop up the failing care sector, when many councils are suffering contracts being handed back. Given that 1 million people over the age of 65 do not have adult children, will the Minister explain how all those people living with unmet care needs are meant to manage?

[David Mowat]

The figure on unmet care needs comes from an Age UK analysis. I am meeting Age UK to go through its recent report, but we do not accept that analysis because the Care Act 2014, which had cross-party support, set statutory consistent definitions for what care councils have to provide. It is illegal for that not to be met, and our follow-up work with the Local Government Association has indicated that it is being met. Furthermore, we have put in a 17% increase over the next three years.

Health Committee

Baroness Keeley Excerpts

Thursday 16th March 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

(Select Committee Statement): The scale of the avoidable loss of life from suicide is unacceptable. In 2015, 4,820 people in England took their own lives, and across the UK 6,122 people did so in 2014. But those official figures underestimate the true scale of the devastating loss from suicide, which remains the leading cause of death in young people between the ages of 15 and 24, and it is the leading cause of death in men under 50. It is strongly linked to deprivation and is a major contributor to health inequality. However, the key message our Committee heard throughout its inquiry is that suicide is preventable, and we can and should be doing far more to make sure we reduce it. That was the key focus of our suicide prevention inquiry.

First, let me thank all those who contributed to the inquiry, particularly families bereaved by suicide, and those who had experienced suicidal ideation and been users of mental health services. Their evidence was courageous and compelling. I also thank all the voluntary groups and volunteers who are working to provide support for people in crisis, and all our front-line staff. Finally, I thank my fellow Committee members and our Committee staff, particularly Laura Daniels, Katya Cassidy and Huw Yardley.

I shall now move on to what we found in our inquiry. First, let me say to the Government that we welcome their suicide prevention strategy, but as with any strategy the key is implementation. We therefore call on them to go far further in implementing and resourcing it, and to give greater attention to the workforce in order to make the important improvements come forward. We also make further recommendations and we are disappointed that the Government have not gone further in a number of areas. We know that we can take actions to reduce suicide and we highlight a number of these in our report. For example, we know that half of those who take their own lives have previously self-harmed, and we feel it is really disappointing that the experience of so many of those who have self-harmed when they go to casualty departments is that they are made to feel that they are wasting people’s time. We know that liaison psychiatry makes an enormous difference, but there are resourcing issues on that.



We also know that those who have been in-patients in mental health settings should receive a visit within three days of leaving in-patient services, but there simply are not the resources available for that to be put in place. We call on the Government to go further in looking at the workforce and resourcing needed for that to happen. We know of other serious issues, for example, the fact that about a third of people who take their own lives are not in contact with either primary care or specialist health services in the year before their death. We feel that suicide is everyone’s business and we all have a responsibility to reduce the stigma attached to mental health so that it is easier for people to seek help. Again, I pay tribute to all those who are working in this field, reaching out to people in non-health settings and making a real difference. However, many of those voluntary groups are coming under great financial pressure. It is welcome that the Government have announced that there will be £5 million for suicide prevention, although that does not come in until next year, with £10 million in each of the subsequent two years. However, we feel that that is too little, too late, particularly given the cuts to public health grants and across local authorities to those services that can reach out to people who are vulnerable to suicide.

We would like the Government to put a greater focus on adequately resourcing the measures they set out in their suicide prevention strategy. We would particularly like them to look at how those plans are being implemented. It is very welcome that 95% of local authorities have a suicide prevention plan either in place or in development, but there does not seem to be sufficient quality assurance for those plans. We would therefore like a national implementation board to look at how we can move those plans forward, because any strategy, however good, cannot be effective if it is sitting on the shelf and not being implemented. That was one of the key messages we heard from our witnesses, and I know that the Minister will have heard it from the National Suicide Prevention Strategy Advisory Group loud and clear.

We also know that there are things that need to happen when people are in contact with services. It is disappointing that greater focus has not been put on the consensus statement for information sharing. On too many occasions, when someone hears that a loved one has taken their life it is the first time they have heard that their loved one had been in contact with services—nobody had let them know. Understandably, health professionals are concerned about issues of confidentiality and consent, but what the consensus statement makes clear is that if we ask people in the right way, they are much more likely to give that consent to information sharing. We would like to have seen the Government put a greater focus on how we can increase awareness of how health professionals go about sharing information with people’s loved ones, because we believe that will save lives.

We think that measures can be taken across the board both out in the community and within health care settings and specialist settings, but the Minister will know that our inquiry also examines the role of the media. Irresponsible reporting of suicide increases suicide rates, as we know, and far more can be done within the broadcast media, the mainstream media, on social media and on the internet to make sure that we save lives. I was very pleased that during today’s Culture, Media and Sport questions the Culture Secretary agreed to a meeting with me, but I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), will assure me that she will be liaising with colleagues in the Government to make sure we can save lives in that way.

Finally, I wish to touch on the issue of data. We know that there is an issue relating to the increasing use of narrative verdicts which are hard to code. That results in the official data we have on suicide under-representing the true scale of the avoidable loss of life, and with the huge variation we have around the country this makes it much more difficult to understand what works best in preventing suicide. We would like the Minister to revisit the recommendations in our report on how to provide better training to coroners and how we review the evidential standard and move from using “beyond reasonable doubt” to the “balance of probability” in recording suicide. Only in that way can we ensure that we are doing absolutely everything possible to protect families and individuals in future. I commend the report on suicide prevention to the House and call on the Government to go further in implementation.

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

Labour welcomes the recommendations in the report, and I join the hon. Lady in thanking Select Committee members and staff for their work.

The Committee visited the award-winning Salford mental health liaison team, which offers 24/7 mental health support at Salford Royal hospital and has been able to halve the admission rates for people with mental health problems. The Royal College of Psychiatrists reminds us that only 7% of emergency departments provide 24/7 liaison psychiatry services, and said it would be difficult to recruit enough psychiatrists and other staff to provide such a service in every hospital—the hon. Lady touched on that in her statement. What does she think the Government must do to ensure that there are enough trained staff to establish and sustain liaison psychiatry services in every acute hospital to help to deliver the suicide prevention strategy?

[Dr Wollaston]

We need to start right back at medical school recruitment and what happens in medical schools and beyond, to encourage more health professionals—not just doctors, but nurses as well—to consider psychiatry and mental health services as a career. One of the key issues is the lack of a workforce. I know the Government are working with Health Education England to improve the situation, but we would like to see them go further. Also, we need to ensure that resources get to the frontline.

Health and Social Care Budgets

Baroness Keeley Excerpts

Tuesday 14th March 2017 Westminster Hall

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

It is a pleasure to serve with you in the Chair, Mr Bailey. I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing the debate and the excellent way in which she opened it.

Last week, in the spring Budget statement, the Chancellor announced that the Government would provide £2 billion in funding for social care over the next three years. We have heard a variety of comments about that in the debate. It is welcome that Ministers have finally heard the warnings from the Opposition, a wide range of health and care leaders and the three Select Committees represented in the Chamber today about the fragile and underfunded state of social care, but the extra funding has to be seen against the cuts to local council budgets, leading to the loss of about £5 billion from adult social care budgets since 2010. Clearly, the announced funding is not enough.

The cuts have already had an impact on the lives of many people. Older, vulnerable and disabled people have had support that they relied on taken away. Others have been turned away by local authorities and left to rely on friends and family for help. Last week, in this Chamber, we debated social care in Liverpool, when we heard that the cuts there meant that care could be funded for only 9,000 people, not the 14,000 people who had previously received care packages, as my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) reminded us today. In one city alone, that is 5,000 care packages lost and, nationally, 400,000 fewer older people than in 2010 receive publicly funded care.

We should remember that, as Age UK tells us, 1.2 million older people have to live with unmet needs for care—older people who do not have help they need to feed themselves, wash or get dressed. Apart from coping with future demographic change, we have to look at that unacceptable level of unmet need, because that is part of the serious state of social care and it is having a knock-on effect on the NHS. As Mark Porter from the British Medical Association said:

“When social care is on its knees, patients suffer delayed transfers, and the personal and financial cost is vast.”

In January we saw a record high in the number of delayed discharges from the NHS. The King’s Fund recently described social care as

“little more than a threadbare safety net for the poorest and most needy older and disabled people”—

it is a threadbare safety net that many people are now falling through, with the NHS left to pick up the pieces.

Given the damage done over the past seven years and the crisis that the Government have caused in social care, the £1 billion announced in the Budget for this year is simply not enough. As we have heard in the debate, the King’s Fund, the Nuffield Trust and the Health Foundation warned the Government about a £1.9 billion funding gap in social care, which means that the Government are funding only half of what is needed now. As for comments outside this place, the Care and Support Alliance has said that the extra funding

“keeps the wolf from the door”,

but no more, while the Academy of Medical Royal Colleges said that

“we’ve now got to get real and recognise that short term measures of the kind we’ve seen today won’t help in the longer term.”

Is it not time to examine the true gap in social funding? Will the Minister acknowledge that £2 billion in funding is needed now, rather than spread over the next three years?

We also heard about the intention to produce a Green Paper on the long-term funding options for social care. The Chancellor said that those options do not include what he described as “Labour’s hated death tax”. As my hon. Friend the Member for Sheffield South East (Mr Betts), the Chair of the Communities and Local Government Committee, said, the Government should not reject options proposed in the past by other parties, and the Chancellor should not label one such option as a “death tax”, because to describe it in that pejorative way is not helpful in securing cross-party support for a sustainable solution to funding social care. That was done back in 2010 for political reasons, and it is being done now for political reasons. Inheritance tax is not called a “death tax”, although it is a tax levied after death. It has been known in the past as probate duty, estate duty and capital transfer tax. The Labour party has not played such political games with the Government’s highly unpopular increase in probate fees, which will affect people in the coming months.

I also challenge what Ministers have said about previous work on a sustainable and long-term funding option for social care. We need to deal with the issue now. In the Budget debate, the Financial Secretary to the Treasury denied that the Government might kick it into the long grass, instead talking about previous reviews. Let us be clear about that, however. In 2010, the Labour Government produced a White Paper called “Building the National Care Service”, a copy of which I have with me. Before that, in 2009, we had a Green Paper and the “Big Care Debate”, involving 68,000 people. Members are right that we need that big conversation with the public, but we have already had it once—we held it in 2009. We had firm plans to build a national care service. In seven years, this Government abandoned those proposals, established the Dilnot commission on the future funding of adult social care, adapted Dilnot’s proposals for their 2015 manifesto and then abandoned them. I call those seven wasted years. We appear to be back where we were in 2009.

As we have heard, it is clear that the demographic pressures in social care have a real impact on the NHS. In a typical hospital at any one time, two thirds of in-patients are over 65 and more than a quarter have a diagnosis of dementia. On top of rising demand, the Government have simultaneously sought to pass on what I see as unachievable savings. As we have heard, hospitals already have record deficits. NHS providers ended last year with a £2.5 billion deficit, although the Nuffield Trust suggests that the real underlying deficit was closer to £3.7 billion. The Public Accounts Committee identified that the NHS is resorting to

“repeated raids on investment funds in order to meet day-to-day spending”.

We have heard those issues covered in this debate.

The decision to provide just £100 million in the Budget for capital investment looks odd, given that the NHS had to resort to raiding £1.2 billion from capital funding this year just for day-to-day running costs and faces a £5 billion repairs backlog. It has become increasingly clear that a £22 billion savings target for the NHS is simply not realistic. The Public Accounts Committee said:

“we remain concerned about whether plans are really achievable”.

Not one independent expert I have seen believes that such savings can be achieved with services maintained at current levels, and I am worried that efficiency savings on that scale will increasingly affect the quality of care that patients receive. We know that the number of trolley waits rose by 58% last year and the four-hour target has not been met since July 2015, and we have now heard about the rationing of hip replacements.

Importantly, the King’s Fund told us this week that the financial pressures on mental health services have been

“a major factor driving large-scale changes to services, which may have had a detrimental impact on patient care”.

Its report states that patients who are able to access treatment get fewer contacts with adult secondary mental health services. That suggests that there is rationing of support in England. It is also clear that the shortage of specialist mental health beds is resulting in a significant increase in the number of patients being sent for treatment away from their home area. In the four months to January this year alone, more than 2,000 vulnerable people in England with serious conditions such as schizophrenia, psychosis and anorexia were sent for out-of-area treatment. Almost half those placements were more than 60 miles from the patient’s home, and one in five of those patients were admitted to a psychiatric intensive care unit.

The Public Accounts Committee said that

“the financial performance of NHS bodies has worsened considerably and this trend is not sustainable.”

In social care, mental health and the NHS, it is evident that the most vulnerable people in our society are bearing the brunt of financial pressures. We have heard a strong consensus in this debate that that has to change.

--- Later in debate ---

[Mr Dunne]

In the sustainability and transformation plans there is the opportunity for commissioners of care and health services to look holistically at the demands of the residents in their area, which to a degree includes palliative care and respite care. As we move towards an STP, there is a greater opportunity for those things to be considered as well.

[Barbara Keeley]

I agree with the hon. Member for Portsmouth South (Mrs Drummond). There is a real dearth now and respite care for carers has got lost. With £120 million, 40,000 carers could be helped with a respite care break. The Minister should look at that.

[Mr Dunne]

As I just said, the STPs provide an opportunity for areas to place greater focus on respite care if they consider that to be required.

I would like to touch on the adequacy of the social care funding package. The announcement means that in the next three years councils will have access to some £9.25 billion of more dedicated funding. That includes extra money going to local authorities through the combination of the improved better care fund and the social care precept, which, for those councils introducing it with effect from next month, will raise some £1 billion extra. The £1 billion provided in the Budget and the £1 billion from the precept amount to the £2 billion called for by external sources for the coming year. That funding will allow councils to expand the numbers of people they are able to support and, in turn, address issues at the interface with the NHS such as delayed discharges from hospital, which as we know cause problems with patient flow through the system.

Questions were raised about how the social care funding is to be allocated. I inform colleagues that 90% will be allocated using the improved better care fund formula to local authorities that have responsibility for adult social care. That distribution takes account of the ability to raise money through the council tax precept for social care and means that it is well targeted at areas of greater need and market fragility. However, in recognition of the social care pressures faced by all councils, 10% of the funding will be allocated using the relative needs formula.

The response to the measures from external audiences reflects comments made by hon. Members today: they have been broadly welcomed. Of course, several hon. Members said that it is not enough, but that is a traditional response to any increase in money—it is always easier to say that it is not enough. Hon. Members have generally recognised that the Government have listened to concerns about social funding. Those of us with responsibility for the health service recognise that there has been a particular problem in dealing with delayed discharges from hospital. Through closer working in the sustainability and transformation plans as they are rolled out across the country, with local authorities working more closely with health service providers, we think that the money will provide a lifeline to help to remove some of those pressures and to improve patient flow through our hospitals.

I would like to touch on the medium-term challenge and how in the coming months we can try to use the development of a social care Green Paper to address the longer-term concerns. The Government are committed to establishing a fair and more sustainable basis for funding adult social care in the light of the future demographic challenges that the country faces. We will therefore bring forward proposals to put the state-funded system on a more secure and sustainable long-term footing, setting out plans in a Green Paper. Some hon. Members asked when the Green Paper will be published. If I was in charge of Government timetabling, I would be in a better position to answer. They will not be surprised to hear that I cannot give a definitive answer, but, to use traditional parliamentary language, it would be fair to say that it is expected to be published in the summer.