Child and Adolescent Mental Health Services

Baroness Keeley Excerpts

Wednesday 7th July 2010 Westminster Hall

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

It is a pleasure to serve under your chairmanship again, Mr Benton, and I congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing an important debate to which many hon. Members have contributed.

I pay tribute to my hon. Friend and to those parents—we heard about them again today, and our debate has been enriched—who have campaigned for vital improvements to services. As of yesterday, 136 Members from all parties, including my hon. Friend and, I expect, others here today, had signed early-day motion 160, which highlights the fact that 10,000 children with autism use child and adolescent mental health services every year. It also highlights a survey showing that using such services will not improve the mental health of two thirds of those children. As my hon. Friend said, the children are not getting the support that they need.

Children with autism are particularly susceptible to developing mental health problems, and many Members mentioned the fact that there is a range of reasons for that. Such children may experience social isolation, and 70% of children with autism struggle to make and keep friends, compared to 10% of other children. Children and young people with autism also find it challenging or impossible to express how they are feeling. The struggle to communicate causes frustration and anger, which can lead to mental health problems.

With the right support given at the right time, many of those problems can be prevented. Given that one child in 10 who accesses child and adolescent mental health services has autism, that should be a priority for the professionals in that service. However, only just over half the parents surveyed by the National Autistic Society thought that staff working in CAMHS had a good understanding of autism. Many of the professionals to whom the society spoke felt strongly that there were not enough training opportunities—many hon. Members touched on that point. Professionals need to develop their clinical expertise in order to work with children with autism and mental health problems. There is good experience of that happening up and down the country.

The high number of children with autism, coupled with the lack of skilled professionals, leads to many children being seen by professionals who are unable to meet their needs or simply being turned away. I have some questions for the Minister; I may be repeating some of them, but it will not hurt to do so. Will the Government ensure that all child and adolescent mental health professionals are provided at least with basic autism training, so that they can meet their duties to make “reasonable adjustments” under the Disability Discrimination Act 1995 and provide services that meet children’s needs? How will the Government ensure that specialist autism support is available within CAMHS?

As we have heard, autism is a complex disability. When mental health problems arise in children with autism, they are harder to recognise, evaluate and treat. Professionals need a good working knowledge of autism to do those things. Providing mental health support to children with autism is a specialist skill, and research conducted by the National Autistic Society found that if an autism specialist is involved in the support of such children, outcomes and service satisfaction improve dramatically. Indeed, those parents whose children had received support from a specialist in autism were twice as likely as those whose children had not to agree that the child and adolescent mental health service had improved their child’s mental health. Sadly, coverage is not good, and only two in five parents say that their child has had such support.

Specialist autism support is vital. We need to adapt therapies and interventions so that they are effective. Skilful adaptations will obviously make them relevant and useful to children with autism. Many Members spoke of the importance of early intervention. Autism specialists can also help other professionals to develop their skills, and they should share their experience with schools and social services.

The subject of commissioning was mentioned by a number of Members. It is particularly important, given the radical changes that the Government have indicated that they wish to make to local commissioning. The way services are commissioned locally for children with autism and mental health problems is clearly important.

Commissioners obviously need to know how many children with autism live in their area, how many of those children also have mental health problems and how local services are working. They need expert advice on what is needed to deliver the right mental health services. They then need to use those data to plan the right services for the children. If the commissioning changes that have been signalled are to be made, it is important to take those factors on board.

Commissioning must also take account of CAMHS waiting times, rates of return and family outcomes for children with autism. Specific local pathways should be developed for the mental health support of children with autism. Parents and children affected should be involved in the commissioning process, together with front-line professionals.

The Labour Government introduced a vital new duty, which came into force in April 2010. Children’s trusts now have to plan to meet the needs of children with special needs and disabilities. That represents a significant step forward. What action will the Government take to build on Labour’s work, to ensure that services are planned and commissioned at the local level so that every child with autism and mental health problems starts to get the support they need? How will the Government ensure that parents and young people are involved in the development of services to ensure that they meet local needs?

We know that the number of children with learning disabilities and of children with autism who use such services are similar. It is clear from improvements to services for children with learning disabilities achieved under Labour that having the right measures in place does make a difference, which was mentioned during the debate. As my hon. Friend the Member for Stalybridge and Hyde said, the Labour Government achieved improvements to services for children with learning disabilities through the 2004 national service framework. That highlighted the importance of providing adequate child and adolescent mental health services for children and young people with learning disabilities.

Specialist training, the adequate resourcing of learning disability specialist support and access to specialist in-patient support were also recommended. As we heard, a specific indicator was recommended for local authorities to rate themselves on their provision. As a result, specialist support for children with learning disabilities more than doubled between 2005 and 2007. In 2010, two thirds of primary care trusts rated themselves four out of four for their provision of CAMHS for children with learning disabilities. Based on the improvements for children with learning disabilities made under Labour, I urge the Government to commit themselves to achieving the same benefits in the coming months and years for children and young people with autism.

I shall speak briefly about early intervention. As was said by my hon. Friend the Member for Dumfries and Galloway (Mr Brown) and my right hon. Friend the Member for Oxford East (Mr Smith), putting support in place early makes a big difference in the long run. It can help to prevent difficulties from escalating into mental health problems. Over recent years, there has been a strong focus on improving support for children with autism and improving the emotional well-being of children with autism in schools. I hope that that continues.

The autism inclusion development programme has helped to improve teacher training. The social and emotional aspects of learning programme has helped pupils at school to gain emotional and social skills, and has helped them with self-awareness and managing their emotions. The early support programme has helped families of disabled children under the age of five to get co-ordinated support and information early, so that problems do not escalate.

Hon. Members touched on the fact that Labour initiatives, such as the Every Child Matters agenda, also helped to ensure that agencies work together, which is important in providing support to our most vulnerable children. Parents at the Every Disabled Child Matters reception in the House yesterday wanted assurances from the Minister that schools would continue with the initiative. They felt that they had created the initiative, and that it was not just a Government thing.

Government leadership over recent years has made a significant difference to aspects of the mental health system for children. In today’s debate, we are asking for similar action for this other group of children. We must continue to prioritise children and young people with autism because they are among some of the most vulnerable people in our society.

The Minister with responsibility for care services, the hon. Member for Sutton and Cheam (Mr Burstow), spoke about the campaign to make good mental health for children with autism a reality:

“There is no doubt that these changes can happen, where there is a will on the ground to make them happen.”

I hope the Minister confirms that the Government have that will, as many hon. Members from all parts of the House have shown that they have in the debate today.

--- Later in debate ---

[Anne Milton]

I am sorry, there is no time. I already have far too many questions to answer. If hon. Members feel that their questions have not be answered or addressed, I urge them to write to me and I will make sure that we respond.

[Barbara Keeley]

When there have been a great number of questions, it is more usual for the Minister to agree to write to us rather than expect us to write to her.

[Anne Milton]

I am sorry for that error. I thought that I said that I would write. I thank the hon. Lady for raising that.

I have only two minutes left. The hon. Member for Stalybridge and Hyde said that staff working in child and adolescent mental health services should have the necessary values, competences and skills. That is vital. The coalition document made it clear that we are committed to supporting the most vulnerable and to tackling health inequalities, and we will make more announcements about public health. Appropriate tier 4 child and adolescent mental health services should be available to all children who require them, including children with autism. There are a number of other vital issues, including diagnosis and transition. I am proud of my own field, which was highlighted by the previous Government, for some of the things that they achieved on transition. I should also like to pay tribute to Sara Truman, who has done a huge amount of work with the National Autistic Society.

We have not touched on the health outcomes for people with autism and mental health problems, but if we look at them we will find that they are truly shocking. Parents and carers carry a huge burden. There are many issues that we have not covered, including respite and research. We still do not understand why people get autism. We also need to look at those children who are not yet diagnosed. There are significant challenges that will require real commitment and buy-in from the staff who work hard in CAMHS across the country, but I am greatly encouraged by the number of contributions here today and by the amount of expertise that is sitting here. There is a role for Government to play. I hope that hon. Members appreciate that we cannot provide all the answers—

Supporting Carers

Baroness Keeley Excerpts

Thursday 1st July 2010 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Benton, and to speak in this important debate on carers. I thank the Minister for his comments on my new role. He may know that carers issues were of importance to me before I came to this place. I have always made it a priority to champion carers and carers organisations. It is very important that a number of hon. Members who have spoken today feel the same way and might take on that role, too. If we believe that carers have been a silent army, it is up to us, as Members of the House, to be a voice for them in relation to Government. Many hon. Members here today will be able to do that, and I hope that they do.

I pay particular tribute to the work of the all-party carers group, which has always been a very strong voice in the House. The chair, the hon. Member for Banbury (Tony Baldry), has just spoken. The group is ably supported by Carers UK. I pay tribute to the work of the Princess Royal Trust for Carers, Crossroads Care, Age Concern and the many other organisations that provide vital advice and support to carers. I also pay tribute to the standing commission on carers—whose chair, Philippa Russell, is with us today—because it provides a voice for carers.

In relation to supporting carers to have a life outside caring, I think that the key issues are respite care and breaks, supporting carers financially and supporting young carers and the people for whom they care, so that those young people do not have to take on the heavy burden of caring that many of them do. In the debate, we have already touched on most of those issues.

The Labour Government’s vision for carers as detailed in the updated national carers strategy identified the following outcomes. It stated that

“carers will be respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role; carers will be able to have a life of their own alongside their caring role”—

the subject of our debate—

“carers will be supported so that they are not forced into financial hardship by their caring role; carers will be supported to stay mentally and physically well and treated with dignity; children and young people will be protected from inappropriate caring and have the support they need to learn, develop and thrive, to enjoy positive childhoods and to achieve against all the Every Child Matters outcomes.”

I hope that the Minister supports those or similar outcomes in the refreshed carers strategy that he announced. New Members may not know that we did not have a national carers strategy at all until 1999. It has been refreshed once, but however good those strategies are, looking at them again and taking them forward is very welcome.

I support the comments of the hon. Member for Blackpool North and Cleveleys (Paul Maynard). The revised NHS operating framework mentioned making dementia a priority, but did not mention support for carers, which carers organisations have noted. I hope that it is an omission that can be corrected in the next revision. We did not have an oral statement in the House when the important changes in the revised operating framework were announced, so today has been the first chance that we have had to ask questions about that. I hope that it can be taken on board. Ministers and civil servants need to understand that these days there is so much support in the House for carers that if carers are not mentioned in a document, it will be noticed pretty quickly.

My hon. Friend the Member for Llanelli (Nia Griffith) and other hon. Members rightly highlighted the importance of respite care and breaks for carers. The coalition agreement states that the Government will use better community-based provision to improve access to respite care. I asked the Minister yesterday to tell the House how the Government planned to deliver that promised increase in access to respite care through improved community support provision, because support provision is already starting to fall away. Carers organisations are reporting that cuts in local authority funding are already leading to cuts in funding for charities and other providers of care. The Minister repeated the commitment that the Government will deliver on their promises to carers, but he did not give us any more information. Carers and carers support organisations need to know exactly how community support provision will be improved.

A 25% cut in local authority budgets, together with further pressure from the council tax freeze, could pose a substantial risk to essential care and support services. My hon. Friend the Member for Hammersmith (Mr Slaughter) made a passionate case against the local council action to axe the carers centre in his area. I am very glad that he was able to do that. I hope that his contribution helps to highlight the case against what sounds like a damaging and unnecessary action by that council.

In debates last year, both the Minister and the former shadow Minister for care services, who is now the Under-Secretary of State for International Development, expressed concerns about whether the £150 million allocated to primary care trusts for emergency respite care was used for the purpose for which it was intended. If the Minister and his Conservative colleagues were concerned to see ring-fencing of budgets for respite care, I hope that now that they are in government, they will be committed to ring-fencing of budgets for essential social care services. I am not convinced that the transparency at local level that he mentioned is enough. History has proved that ring-fencing is the best way to ensure that money goes where it is intended to go.

The coalition Government say that they understand the urgency of reforming the social care system to provide much more control for individuals and their carers and to ease the cost burden that they and their families face. The Minister said yesterday that an announcement will be made soon about the commission on long-term care; I should be grateful if he would tell us more about that today. I am pleased that all the options for funding care will be considered, including an inheritance levy, which the Opposition support.

The Government have pledged to extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power. The Labour Government made the social care reform grant available to local authorities to enable the development of personalised care and personal budgets, but that grant is now in its final year. How will the Government encourage local authorities to extend the roll-out of personal budgets and to provide more control to individuals and their carers, given that, as we heard earlier, local authorities are facing cuts to their social care budgets?

I shall touch on the caring with confidence programme. Training for carers in their caring role is a vital way of supporting them and giving them confidence. The hon. Member for Banbury mentioned that aspect. The Minister announced the decision to cancel the caring with confidence programme; will he consider how local carers groups and carer centres are to fund that vital training? Offering materials for free is to be welcomed, but the organisations also need trainers and premises and to have their costs covered if they are to run that training. The carers strategy aims to ensure that carers will be supported so that they are not forced into financial hardship through their caring role. I hope that the Minister will support that aim. However, many carers are now concerned about Government plans that will hit disability and carer benefits. We have heard quite a bit about that this afternoon, and rightly so.

Concern was expressed this afternoon about the measure to increase benefits annually by the consumer prices index rather than the retail prices index. Carers UK estimates that indexing carers allowance by the consumer prices index over the past 10 years would have cost carers £5 a week, or about £270 a year. The Labour Government did not do that. As my hon. Friend the Member for Stretford and Urmston (Kate Green) said, whatever the country’s financial difficulties, carers should not have to take the biggest hit. Under the coalition Government’s plans for indexing benefits, carers allowance would be worth £62.95 by 2015 if uprated by the retail prices index, but only £60.35 if the consumer prices index is used. That is a difference of some £130 a year. Does the Minister think it fair to hit carers in that way? Carers and those whom they care for will also be affected by a similar change to the attendance and disability living allowances. Carers UK has said that single parents caring for a disabled child, a partner or elderly parent may have to rely on carer’s allowance, disability living allowance and the other means-tested benefits as their only source of income. Carers UK believes that making savings in that way will hit hard the incomes of the most vulnerable—those who are already struggling to make ends meet—and I agree.

Hon. Members have referred to the extreme concern among unpaid carers caring for relatives with disabilities about the introduction of a medical assessment for the disability living allowance. If the person cared for becomes ineligible for the allowance, the carer’s own income would be hit, as carer’s allowance and other benefits are based on the disabled person receiving a certain level of disability living allowance. A poor medical assessment could spell financial disaster for carers and their families. I understand that the Office for Budget Responsibility questions whether savings could be achieved, given the cost of implementation and the large volume of subsequent appeals. I urge the Minister and his colleagues to ensure that any changes are fully thought through, and that they avoid the stress and anxiety that a new system or poor decision making, or both, could cause.

My final thought about carers and financial hardship is on the axing by the Government of the savings gateway scheme, mentioned by my hon. Friend the Member for Stretford and Urmston. The savings gateway would have given carers in receipt of carer’s allowance an additional 50p for every £1 that they saved. I am sure that Members will have seen research by Carers UK showing that carers spend their savings over the years, which leaves many of them caring unpaid around the clock, and with no savings and no buffer against large purchases. That places an enormous strain on carers.

My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) made a strong case for raising carer’s allowance. When the Minister was in opposition, he asked the then Minister for a timetable by which carer’s allowance would be raised. He also asked for its eligibility to be extended so that pensioner carers would get proper recognition in the payments that they receive. Will the Minister take on board comments about the coalition’s plans for benefits for carers and those whom they care for, and will he consider giving us the timetable that he asked for when in opposition for increasing carer’s allowance and dealing with the eligibility of pensioner carers?

A further matter is the work being done by carers organisations, with primary care trusts and schools, to identify carers and refer them to sources of advice and support. In Salford, The Princess Royal Trust for Carers has two excellent projects to identify and support carers. One works with primary care teams and the other with local schools. The primary care project run by the excellent Julia Ellis has developed effective partnership working with teams at Salford primary care trust and at Salford Royal hospital. Over recent years, Salford has moved from having a low level of recognition of carers to a situation that sounds as good as might exist elsewhere. There is a carers link in most GP practices and a new GP toolkit; NHS staff and staff at the Salford Royal hospital act as the lead on carers issues; there are carers information files on all wards at Salford Royal; and there is increased awareness among carers’ social workers at the hospital. Another recent development is that pharmacists and other professionals in Salford are now supporting the work of identifying carers.

The coalition Government propose radical changes to primary care trusts; they also propose that schools could opt of local authority control. I am anxious that excellent practice in identifying carers, such as that developed in Salford, will be affected by the changes. How can carers organisations ensure that a strategic view of the needs of carers in an area can be taken once GPs and schools are acting independently?

The importance of signposting carers to sources of information should not be underestimated. Signposting is done by carers centres and carers support groups, but I believe that it can and should be done more by GPs, their primary care teams and by hospital staff. However, we must be realistic about the work that it entails. Members have spoken of the big society and volunteers, but identifying carers means reaching a large number of people working throughout the health service. The figures for NHS and social services staff in 2008 are as follows: there are 33,730 GPs and 88,435 hospital doctors; 92,000 people working in primary care trusts, including 4,200 doctors involved in primary care delivery; and 49,800 social workers, of whom 2,205 provided health-related social work.

The role of reaching out to all those GPs and primary care staff, hospital doctors and health-related social workers cannot be left to primary care projects such as the one in Salford. The Princess Royal trust has recently worked with the Royal College of General Practitioners in developing an action guide to help GPs and their teams to support carers. That guide has been distributed to every GP practice. The royal college also piloted a training programme for GPs. I believe that the Government could give more of an incentive for GPs to undertake the vital task of identifying carers.

I commend to the Minister and the House the private Member’s Bill that I introduced to the House in April 2007—the Carers (Identification and Support) Bill. The Bill would require health bodies to identify patients who are carers or who have a carer, and would require identified carers to be referred to sources of help and support. It would also require health bodies to ensure that health services for patients and carers took the carers’ needs into account. In a second version, it would have required schools to have a policy to identify and support young carers. Without such legislation, GPs have as an incentive only three points in the quality and outcomes framework awarded for work undertaken to identify carers in their practice population. That does not seem much of an incentive. I hope to reintroduce my Bill to the House, and I hope that the Minister and all present today will support it. I understand that the Minister has said that he wants to see GPs identifying carers more often.

An important link has been identified today—that of raising the matter with GPs and developing similar guidance for schools. Ofsted highlighted in a report that local authorities were identifying fewer young carers than might have been expected. We do not know the precise number of children and young people who care for family members. In my Worsley and Eccles South constituency, the young carers project supported by Salford carers centre is doing some excellent work on identifying and supporting young carers in two local high schools. I met the young carers on an adventure day out and also when they launched their DVD on bullying—bullying is a serious problem for young carers.

Family pathfinder projects have done some good work on improving support for young carers. The Labour Government provided funding to the Princess Royal Trust for Carers and the Children’s Society to help them raise awareness of the issue and to build skills in supporting young carers. They published guidance for schools, developed information sheets for GP practices and produced other materials, such as DVDs on listening to young carers. I hope that the Minister and his colleagues in the now Department for Education support the continuation of that funding, and adopt and develop the good practice coming out of the 19 young carer pathfinder projects.

My hon. Friend the Member for Hartlepool (Mr Wright) spoke movingly about the needs of young carers and the difficulties that vulnerable young people have in their transition to adult services. A possible impact of the personalisation agenda might be that a family that includes a young carer of a person who is self-funding through an individual budget may have little or no contact with professional agencies. If professional agencies are not good at identifying carers when they have contact, they will definitely not be good at it if the family is managing the budget themselves. There is concern about that, and it makes awareness-raising work with professionals important. The role of schools and GPs in identifying carers becomes crucial to ensure that the child or young person gets help and support.

It has been a pleasure to be part of this debate today. Some 10 Members and the Minister have made contributions. As the hon. Member for Banbury said, the Minister understands the issues for carers and for social care. He also understands, I think, the strength of our expectations that he will continue to be a champion for carers. It is delivery on commitments that matter to them.

[Mr Burstow]

I absolutely agree with that point, and that is why we will not promise to pay cash sums into the NHS baseline that therefore cannot be delivered to where Ministers claim that they will be delivered, and it is why we will ensure that we, as a Government, will provide both leadership and, when appropriate, direction to deliver the sorts of things that hon. Members on both sides of the Chamber have outlined today.

This helpful and useful debate will help to take our thinking forward as we begin our work on refreshing the carers strategy. Hon. Members cited many examples of good practice on the ground, and they offer beacons of hope for how services might look across the country. Challenging those who commission services locally to ensure that they learn from such examples of good practice is a task for not just the Government, but everyone. Examples of best practice do not come from the statutory sector alone, even though the most innovative parts of that sector are themselves beacons. As many hon. Members have said, we also have to applaud and encourage the social enterprises and social entrepreneurs who have spotted opportunities to do something for their communities and found the resources to do so.

I have identified a number of key issues from this debate: what we can do better to identify carers, whether they are young, old or from ethnic minority communities; what we can do to provide information and support for carers so that they can navigate their own way through the system; and what we can do to make the system simpler so that it is not the maze of benefits and complex rules about which we have heard so much in the debate. We realise that people who wear the label “carer” are not all the same. Carers are unique individuals confronting unique circumstances that require individualised and personalised responses. I agree entirely with hon. Members’ points about the need to empower carers as well as the people being cared for.

I will try my best to answer the questions that have been put today, but if I miss anything out, I guarantee that I will write to hon. Members with a fuller response than I can give today. I will also ensure that the points that have been made, particularly in respect of benefits, are raised in cross-ministerial and cross-departmental discussions on the carers strategy at the right place and at the right time. I want them to be taken into account as the work around simplifying and modernising the benefit system is taken forward.

The hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke for the Opposition, made a number of points, many of which we can work on together. Many hon. Members will be aware of her track record inside and outside the House. Elements of her speech made me feel that she expected me to take full responsibility for the things that the previous Government did not quite get right, such as the times when their implementation of a measure was flawed or when they failed to take note of representations. Although it is entirely fair for her to rehearse the points that I made in opposition—I certainly take those to heart—she will understand if I say to her that the last Government’s record left a lot to be desired, by which I mean that the improvements for which carers were hoping were not actually delivered.

Reference has been made to the huge financial pressures in many of our public services at the moment. I was struck quite strongly by the way in which the cuts that have been in train in local authorities for many months are somehow being laid at the door of this Government. In reality, those cuts were initiated and conceived under the last Government, and I just wish that there was a bit more humility and understanding of that. We have a shared challenge when it comes to dealing with the huge public sector deficit in this country. It is all well and good challenging this Government about what they will do in terms of the spending review over the next few months, but it would also be appropriate for a responsible Opposition to offer up suggestions that they believe would be painless that we could do instead.

[Barbara Keeley]

I do not know whether the Minister has experienced this during his parliamentary career, but the constituency that I represented between 2005 and 2010 covered two local authorities, and it was interesting to see the different priorities that those authorities gave to their work in social care and for carers. We heard a very good example of that in the debate, as Hammersmith and Fulham is adopting a swingeing policy that could take away a vital resource from carers, which I hope that something can be done about. I have heard the leader of Salford council hotly defend the fact that he would rather spend money on adult social care than on potholes, yet quite a lot of people in the city want money spent on potholes. Transparency and localism is one thing but, as with other aspects of health and support services, we could end up with a situation whereby a council such as Hammersmith and Fulham could remove a service, leaving its carers with nothing, while another area, such as Salford, would have excellent voluntary organisations and a council that prioritised social care.

[Mr Burstow]

The hon. Member for Hammersmith (Mr Slaughter) made some important points about the situation in his constituency and what his local authority was doing. The hon. Member for Banbury (Tony Baldry) also made references to the impact of tendering. Those are issues to consider, but I am not going to become a Minister responsible for micro-managing every single local authority and the decisions that they take on the allocation of resources—that is not a Minister’s job. However, we do need to ensure that there are not unintended consequences with respect to the rules and procedures followed by local authorities that fall under the Government’s responsibility. I will be very happy to hear further from both hon. Members, either in this debate or afterwards, to ensure that we have the correct rules. We want to support local services that are appropriate to a local community and that the community actually values.

--- Later in debate ---

[Mr Burstow]

I wish that I had not put it that way, but there we go. That is the trouble with putting things on record.

We heard about the National Audit Office report on Jobcentre Plus, and it is important that the Government pay close attention to the work of the NAO. I was a member of the Public Accounts Committee during the last Parliament, and when the NAO identifies opportunities to obtain value for money and get more out of existing resources, it is important that we take them. If the report is not already required reading for DWP Ministers and officials, it should be.

The hon. Member for Blackpool North and Cleveleys also discussed the care to share forum that was set up to consider respite. We see peer support as a powerful part of what the big society is all about. It enables people to step up and support each other, rather than seeing local authority services as the solution to everything. The right to respite has been discussed a lot in this debate. It is often not the case that a carer wants a week off; a matter of hours can make a huge difference. When I was visiting some services in Newham recently, I met the people who run a telecare project and several carers who had benefited from it. It was clear that what was important to them was the knowledge that the person for whom they cared was safe so they could have a cup of coffee with a friend, a chat and a bit of real life, as that refreshed them. We need more such opportunities for many others.

The hon. Member for Llanelli (Nia Griffith) discussed how we can ensure that carers can both stay in work and return to work. She also mentioned Alzheimer’s and dementia, and research into those diseases. I am sure that she will know that, in the coalition programme for government, we indicated a clear commitment to prioritise dementia research. I am the Minister who chairs the board with responsibility for considering the issue, and we will be making announcements about how we will take it forward in due course.

The hon. Member for Banbury said some kind things, as a result of which I now feel immense pressure—thank you very much! He also made a good point about carers week that I read in this way: carers week is not an annual event; it is every week. We need to find ways to make that not just a platitude but a reality for carers throughout our country. He spoke a lot about the role of GPs as commissioners and the difference that they can make. They are one of the universal services and they see many carers. We must ensure that all GPs understand that when someone comes to see them because of a sickness or disability, the person with them is often the carer, who needs to be identified and offered the signposting and support that will make a difference for them.

The hon. Member for Banbury mentioned the caring with confidence programme, as did several other hon. Members. I purposely included it in my opening remarks because I wanted to be up front about what I had decided to do. My view, having considered the evidence about the programme, was not that the training materials were not excellent—they are well regarded by the carers who have been through the programme—but simply that we were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly. Now the money will be reinvested into delivering more training—including GP training, which has been mentioned—and more support for carers. We will make further announcements in due course.

[Barbara Keeley]

As with other developments, I did not hear about this in the House; I heard about it from carers organisations. Does the Minister realise the extent to which carers support groups and organisations are concerned? They were geared up and trained to deliver the programme. Having useful materials will be a good thing, but materials are not enough to run a course. They need somewhere to run it, a trained person—probably paid—and resources during the day. It would be useful if some of the money could be diverted to training GPs, but that is a mainstream NHS matter. I emphasise that there is a great deal of concern among carers organisations about the programme, so anything that the Minister can do will be a help.

[Mr Burstow]

I am grateful to the hon. Lady for that point. I spent time earlier this week on the phone with all the carers organisations that have a direct interest in the matter. We are discussing actively with them the best way to reinvest the money to deliver good outcomes for carers. As and when that becomes clearer, I will certainly make further announcements to the House.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Burstow]

The hon. Gentleman makes an excellent point. We shall be getting some guidance from the National Institute for Health and Clinical Excellence in a year’s time, and absolutely the answer is yes.

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

May I congratulate the Minister on his new role. As my hon. Friend the Member for Gedling (Vernon Coaker) mentioned, carers of people with autism rely on respite care. However, carers organisations are reporting that cuts to local authority funding are already leading to cuts in funding for charities and other providers of support care. How do the Government plan to deliver the promised increase in access to respite care through improved community support provision, when that is already starting to fall away?

[Mr Burstow]

The hon. Lady makes an important point, but perhaps she will be a little cautious with her question, not least because the previous Government made a lot of promises to carers in respect of the amounts of money that were to be invested, only for carers to find that on the ground the money was not delivering changes in services. So this Government are determined to ensure that we not only make promises but deliver on them. That is the commitment that this Government have made.

Health Funding

Baroness Keeley Excerpts

Tuesday 22nd June 2010 Westminster Hall

[Mr Burns]

I can reassure my hon. colleague that it will not. It will be something completely different. It will be a stand-alone body that will be the driving engine of the NHS, in its required field.

By strengthening the link between investment and outcomes, the board will enable the NHS to deliver improved quality, higher productivity and better value for money. I am sure that my hon. colleague will appreciate that I cannot yet discuss the precise functions of the board, nor its composition, but our proposals underline our central belief that resources should be allocated according to need, without ministerial interference.

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

Perhaps the Minister can touch on another hospital situation. I understand that the Secretary of State visited Bury on Friday and overrode a clinically reached decision on maternity units. He said that, in his judgment, Fairfield General hospital’s maternity unit could remain open, against a clinical decision made in the “Making things better” reorganisation in Greater Manchester.

[Mr Burns]

I hope that the hon. Lady is aware of the announcement that my right hon. Friend the Secretary of State made shortly after he assumed his current position, in which he laid down new criteria for determining the reconfiguration of hospital services. Prior to the general election, when he was the shadow Secretary of State for Health, he made it a priority that, in particular, maternity units and accident and emergency units would be looked at far more closely than they had been looked at. That is why, on assuming office, he strengthened the criteria for carrying out consultations on proposed reconfigurations, and brought in four new criteria that will apply to any future reconfigurations, and current ones that are still in the process. They will have to abide by the new strengthened criteria, which include ensuring that the wishes and views of GPs, clinicians, local stakeholders and the general public are taken into account. Decisions that affect local communities and people will have the input of local people, rather than simply being imposed on communities which, for a variety of reasons, do not want what is being proposed.

[Barbara Keeley]

Those of us in Greater Manchester who are affected by the decision and the new process that the Minister is outlining are struggling to understand how to square the clinicians’ recommendation, which was based on things such as the number of doctors available, doctor training and the experience that has to be gained in maternity to deliver a safe service—a clinically led decision was made in that case—and the community’s wish and desire always to keep maternity and A and E units. It is hard for local people to understand how such things can be squared. Most constituency MPs understand that no one ever wants to lose an A and E or maternity unit. Does that really mean that clinically led decisions, such as those in Hartlepool and Manchester, will be overridden if local people do not want them?

[Mr Burns]

No, it does not mean that. What I said when explaining the criteria that the Secretary of State has laid down is that it will strengthen the consultation process leading to decisions, but obviously there will be a number of processes thereafter. The different processes of assimilation before a final decision must ensure that the Secretary of State’s criteria for greater input of clinicians’, GPs’ and local communities’ wishes are taken into account. In the past, reconfigurations have too often left the impression among local communities that they have not been consulted or listened to, and that decisions have been made by managers or others based only on their narrow point of view without taking account of other people’s views.

[Barbara Keeley]

Will the Minister give way?

[Mr Burns]

No. I have been generous, and I want to make progress.

That is the principle for the criteria, but it will not mean automatically that there will never be any changes because there is a block. We are strengthening the process to take account of local wishes and needs. There is a balance to be struck, which will emerge during the reconfiguration process.