Independent Medicines and Medical Devices Safety Review

Baroness Keeley Excerpts

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

I thank my hon. Friend for her comment. She is absolutely right. The report is entitled “First Do No Harm”, and we here have to do some good in response to it. Work is being undertaken—the all-party group for valproate and other anti-epileptic drugs in pregnancy works incredibly hard. It is about getting information out there. For some women with epilepsy, sodium valproate is the only drug that works, and the pregnancy prevention programme works alongside this. As I have said, I cannot comment on Primodos, but work is ongoing. We have seen a decline in the number of pregnant epileptic women taking sodium valproate. That decline needs to be driven down even further, in tandem with the pregnancy prevention programme, but my hon Friend is absolutely right. I hope that nobody ever has to come to the Dispatch Box again to discuss a report such as the Cumberlege report and have to apologise for what happened, with the glaring inconsistences in treatment that has been provided to those women who have not received the information they should have received when taking those drugs.

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

After decades of having their concerns dismissed and struggling to be heard, the victims of these scandals deserve both the apologies we have heard and ex gratia payments for the avoidable damage they suffered. Will the Minister confirm that it will be a priority to establish the independent redress agency recommended to help those affected by these scandals and a priority that the agency will be able to move quickly to provide the redress that the victims deserve? They have waited long enough.

[Ms Dorries]

Every recommendation in the report is a priority and everything will be given equal consideration. I hope that either I or the Secretary of State will be able to come back to the House as soon as possible after the report has been evaluated in full and make our own recommendations at that time.

Coronavirus

Baroness Keeley Excerpts

Tuesday 7th July 2020 Commons Chamber

[Matt Hancock]

I will certainly look into the last point. However, that categorisation is not quite right. The beauty industry is an important industry in and of its own right. While we do still have restrictions in certain areas and categories, that does not mean that they should all be lumped in together. The beauty industry is an incredibly important industry and we will get it open as soon as it is safe to do so.

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

At the start of this crisis, the guidance for care homes was unclear. They could not get PPE, and patients were being discharged from hospitals to care homes without being tested for covid. The Prime Minister’s comments have given offence. Does the Secretary of State accept that care home providers cannot be blamed for the deaths of their residents, and that it is time to give care staff the pay and respect they deserve, and to bring forward plans to fund social care properly?

[Matt Hancock]

The need to reform social care is no less urgent than before the crisis. Indeed, we have learned through the crisis yet more about the nature of the reforms needed, because we have seen the positive impact of much closer, system-level working between the NHS and social care and local authorities. That should inform our thinking about the long-term social care reforms that this country needs to see.

Covid-19 Update

Baroness Keeley Excerpts

Monday 29th June 2020 Commons Chamber

[Matt Hancock]

Yes, absolutely—in real time, effectively.

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

As the Secretary of State has detailed, when areas are put into local lockdown, businesses will have to close, including some that had probably been preparing to reopen this week. Can he confirm that any business impacted by a local lockdown in Leicester, and in other areas in future, will be able to access the furlough scheme as it currently exists, rather than having to subsidise the wages of staff who cannot work?

[Matt Hancock]

Of course the furlough scheme is available, as it is across the country. In addition, we have provided the councils in question—both Leicester and Leicestershire, because some of the affected area is in the conurbation of Leicester that is technically in Leicestershire—with support to use at their discretion for this sort of purpose.

Covid-19: R Rate and Lockdown Measures

Baroness Keeley Excerpts

Monday 8th June 2020 Commons Chamber

[Matt Hancock]

I thank my hon. Friend for that question. It is incredibly important that people follow the social distancing rules. Where the demonstrations that we saw over the weekend did not follow the social distancing rules, they risk increasing the spread of the virus. That is the clear scientific evidence. It is a mistake for people to participate in demonstrations that help to spread this vile disease. Instead, we should all be doing our bit to reduce the spread.

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

With the R number above 1 in the north-west in one model, we need action to prevent a second wave of infections and deaths. The Secretary of State has talked about local lockdowns, but will he commit to ensuring that Public Health England supplies more local information on the spread of the virus to assist in that? Will he also tell us whether there will be additional powers and financial support for areas covered by a local lockdown, as called for yesterday by our Greater Manchester Mayor, Andy Burnham?

[Matt Hancock]

Yes, we hope very much to be able to publish more and more granular, localised information and to work with local leaders to deliver on what is needed to act upon it.

Covid-19

Baroness Keeley Excerpts

Tuesday 12th May 2020 Commons Chamber

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

I speak today as an MP from one of the areas outside London that has been hardest hit by covid-19. Tragically, 246 people in Salford died due to covid-19 in the first two months—a death rate of 95 per 100,000 of our residents. Our thoughts are with their families and the families of everyone who has died due to the pandemic. At the start of—[Inaudible.]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. We have a problem. Can we please try audio-only to see if that is an improvement?

[Barbara Keeley]

Do you want me to start again, Mr Deputy Speaker?

[Mr Deputy Speaker]

No, there is still an audio problem. Let us go to Theresa May and come back to Barbara Keeley.

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

Thank you, Mr Deputy Speaker. I speak today as an MP for one of the areas outside London that has been hardest hit by covid-19. [Inaudible]—with their families and the families of everyone who has died due to the pandemic. At the start of this crisis, the Government said they would do whatever it takes to defeat covid-19. [Inaudible]—council took them at their word and has done a fantastic job in supporting vulnerable people, our care system and our local businesses, but now the Government seem to be backtracking and expecting councils to foot not just the bill, but the crisis response. Across—[Inaudible.]

[Mr Deputy Speaker]

Order. I am sorry, but that has not worked. Can we move on to Neil Gray?

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

I speak as an MP for one of the areas outside London that has been hit hardest by covid-19. Tragically, we know that 246 people in Salford died due to the disease in the first two months—a death rate of 95 per 100,000 of our residents. Our thoughts are with their families, and the families of everyone who has died due to the pandemic.

At the start of this crisis the Government said that they would do whatever it takes to defeat covid-19. Local authorities such as Salford City Council took them at their word, and have done a fantastic job in supporting vulnerable people, our care system, and local businesses. The Government now seem to be backtracking and expecting councils to foot the bill for the crisis response. Across Greater Manchester, Government support for local authorities is already £400 million lower than the costs our councils have incurred, with Salford Council spending £33 million extra in the first six months of the year.

Can the Minister confirm that Government Ministers meant what they said and that all additional costs incurred by councils will be covered by Government funding? Will the Government look carefully at the suggestion from our Greater Manchester Mayor Andy Burnham about English regional representation at Cobra meetings?

On the sustainability of local businesses, I have heard from businesses across my constituency that are not eligible for the funding support that they need—from private limited companies to veterinary businesses, from dentists through to the Veterans Garage, which operates in a shared space to provide vital support for veterans.

Given that none of the businesses that I have highlighted are eligible for any support apart from loans, what reassurances can the Minister give them about their situation? Ministers also need to look again at the need for support for self-employed people in the creative industries. I have been contacted by many constituents working at MediaCityUK in Salford quays, who are not eligible for support.

The Prime Minister’s announcement on Sunday, and the guidance published since, have led to confusion about what is and is not allowed. Many of my constituents now fear that they will be forced back to work before it is safe for them. I have heard from one constituent whose son has been told to report back for work this week, despite the fact that he lives with his mother and she has been told to shield. The son has been on furlough but was asked to go back to work yesterday, even before the covid-19 secure guidance had been published.

Will the Minister confirm that businesses will be required to put the necessary protections in place and that no staff will be expected to go back to work until they can be sure it is safe to do so? Will the advice on shielding cover the issue of how that can work when another family member has to go out to work, increasing the risk?

Finally, I want to talk about family support. The Prime Minister set out a plan for getting people back to work, but the only concession for family contact was allowing one person to meet one member of another household outside, while maintaining social distancing. I was contacted after the Prime Minister’s speech by a new mother who had given birth to her baby during lockdown. None of her family or friends has been able to meet her baby or support her, and she is now feeling exceptionally isolated.

My constituents are being directed back to work, where social distancing is advised but is not even guaranteed. Why is it acceptable for someone to meet large numbers of people at work, but not get the support they need with a new baby from family members? Can the Minister clarify when we will see updated guidance for that new mother and when she will be allowed to meet family members to get the support that she needs with her baby?

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 5th May 2020 Commons Chamber

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

What recent assessment he has made of the adequacy of support available to childcare providers and nurseries during the covid-19 outbreak.

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

What assessment he has made of the effect of changes to the coronavirus job retention scheme on the ability of nurseries and childcare providers to retain staff.

[The Parliamentary Under-Secretary of State for Education (Vicky Ford) [V]]

We have two key priorities at this time: making sure that there is sufficient childcare for critical workers and vulnerable children; and ensuring the longer-term sustainability of the vital early years sector. Therefore, the Government will continue paying local authorities for the hours that we normally fund, and, where appropriate, providers can also access business rates relief, grants, a business interruption loan and the self-employment support scheme, which is especially helpful for childminders. In order to retain staff, providers can also furlough up to the proportion of their salary bill that would normally be considered as being paid from non-public funding sources.

--- Later in debate ---

[Mr Speaker]

Order.

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

Changing the guidance on the job retention scheme at the last minute has pulled the rug from underneath many nurseries and childcare providers. A survey by the Professional Association for Childcare and Early Years has found that 40% of childminders are not confident that their business will survive this crisis. Despite the answers that the Minister has given, there is a lot of confusion. Will she do the right thing and bring forward a comprehensive plan to protect the childcare sector during this difficult time?

[Mr Speaker]

Let us have a brief answer from the Minister.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 10th March 2020 Commons Chamber

[The Minister for Health (Edward Argar)]

It is vital that the people of Grantham are able to access 24-hour care for both accident and emergency and urgent treatment needs. I urge my hon. Friend to continue to work with his local health services and commissioners to develop plans to ensure the needs of his constituents are met. I know he has already been a strong advocate on this matter in this House for his constituents since his election, but I am of course very happy to visit him in Grantham if that would be helpful to him.

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

Personal protective equipment can be as important in social care settings as it is in hospital or GP settings, but care staff report having to buy their own gloves and one care provider had their order of protective equipment requisitioned by the NHS. The Secretary of State says that he is all over this issue, so what plans does he have to ensure that care staff have access to protective equipment to protect them and the people they care for?

[Matt Hancock]

Of course care staff too are absolutely vital in the national effort to address coronavirus, not least because of the increased risk to many people who are in residential settings and who receive domiciliary care. The work to make sure that protective equipment is available extends to social care staff. Of course, most social care is provided through private businesses, and the delivery model is therefore different, but that does not make it any less important. I am very happy for the hon. Lady and the Minister for Care to have a meeting to make sure that we can listen to the concerns that she has heard about, because we want to address them.

[Barbara Keeley]

There are already 120,000 vacancies in the care workforce and we now face the prospect of large numbers of care staff having to self-isolate because of coronavirus. With the NHS also needing staff, as we have discussed already, what plans does the Secretary of State have to ensure that care providers are still able to fulfil their contracts and provide their clients with support?

[Matt Hancock]

This is also an incredibly important issue that we are considering and working on. We will make sure that we address any barriers to social care operating. In all contingency plans on the reasonable worst-case scenario, plans are needed for being able to operate with a 20% reduction in workforce, but making sure that the best care can be provided in what is going to be a difficult time for social care is a really important part of the effort that we are making.

Eating Disorders Awareness Week

Baroness Keeley Excerpts

Thursday 5th March 2020 Westminster Hall

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

It is a pleasure to speak in this debate with you in the Chair, Mr Rosindell. I congratulate my right hon. Friend the Member for Knowsley (Sir George Howarth) on securing this important and timely debate, and for the excellent way he opened it, which was very helpful. It has been a compact debate, but he covered a wide range in what he said.

I welcome the contributions of the hon. Member for Broxbourne (Sir Charles Walker), particularly when he spoke about the moving case of his young constituent who took her own life, which is always sad to hear; the hon. Member for Strangford (Jim Shannon), and the SNP spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). I agree with her about using the debate today as a starting point. There is much that we should be talking about.

As we have heard, eating disorders are serious mental illnesses that affect too many people in this country. It is estimated that there are currently 1.25 million people in the UK with an eating disorder. It is a serious issue that we should be talking about, even more so because that is only an estimate as we do not have reliable data on the prevalence of eating disorders in the UK. The hon. Member for Strangford talked about that; it is an issue that we must take forward from the debate today. It is part of a broader problem with our data on mental health conditions, although we must acknowledge that some of it comes down to the stigmatisation of eating disorders.

Eating disorders can affect people of all ages, from instances among children as young as six years old, which should alarm us, to women in their seventies. Around three quarters of people with an eating disorder are women but, as we have heard in the debate, eating disorders also affect men. We need to be careful not to stereotype when we describe people affected by eating disorders because it can deter men and young men from seeking help.

Anorexia has the highest mortality rate among all psychiatric disorders because of the severe medical complications that it can cause, but all eating disorders have an impact on the daily life of people who live with them. It is vital that eating disorder services are there to support people when they need it. It is my belief that too often people with eating disorders are being let down by our NHS, and those of us who are interested in this must take that forward from here.

Someone with an eating disorder will currently wait an average of three and a half years before receiving treatment. Too often someone goes to their GP to ask for help, but simply does not get it, as we have heard. The eating disorder charity Beat, which we have all rightly mentioned in our speeches, found that nearly one in three people who seek a referral to an eating disorder service did not get one from the first GP to whom they spoke. These delays clearly go against the NICE guidance on ensuring prompt access to specialist services, and they come with an enormous emotional toll for the person involved. The hon. Member for Broxbourne talked about where that emotional toll can take somebody. Imagine having finally built up the confidence to go and ask for help only to be told, “You won’t get to see a specialist”.

Earlier this week, I spoke to people who are now recovering or recovered from eating disorders, who told me about their struggles to get support. I thank Beat for organising that meeting with MPs. One person was told by a doctor that she weighed too much to have treatment for an eating disorder, despite weighing only 38 kg, which is less than 6 stone. Let us imagine that weight. I also heard about a doctor praising over-exercising, as if that were a good thing. We heard from my right hon. Friend the Member for Knowsley that Mel C had the problem of obsessively exercising, which is another way people can seek to lose weight. Finally, a person was told that she needed to find the willpower just to eat. My right hon. Friend rightly criticised the attitude of underestimating the difficultly of the condition and the danger of the “just get a grip” attitude. We have to get over that and clearly it is even more damaging when it comes from clinicians.

People with bulimia have been denied treatment based on the frequency, or lack of frequency, of their bingeing and purging episodes. The continued focus on weight that we have talked about is particularly concerning as bulimia, along with other over-eating disorders, does not always lead to excessive weight loss. My right hon. Friend and the hon. Member for Strangford talked about Hope Virgo, the campaigner who leads the Dump the Scales campaign. That campaign tells us that clinicians are still using measures such as BMI to assess whether someone is eligible for eating disorder treatment, as I was told by the young person I met this week.

That is another instance where NICE guidelines are not being correctly followed, meaning people are being turned down for the support they should receive. Is someone who has been told they are ineligible for help after visiting their GP really going to go back and ask again and again, until they get the help they need? Or are they going to struggle with their eating disorder, potentially deteriorating to the point where they need to be admitted to hospital?

We should emphasise that the situation is not necessarily the result of medical professionals not caring about eating disorders, but a reflection of the fact that medical schools have less than two hours’ training on eating disorders across the average medical degree. In fact, one in five medical schools do not cover eating disorders at all and, where they are covered, the subject is not in the final exam, meaning students will give it a lower priority.

We see doctors who think people cannot have an eating disorder if they have a healthy BMI, family GPs who are not confident that they should make an urgent referral to a specialist service and many doctors who have never seen a patient with an eating disorder before. The Parliamentary and Health Service Ombudsman and the Public Administration and Constitutional Affairs Committee have both recognised this and call for all doctors to receive proper training on eating disorders. The General Medical Council has said that it will engage with medical schools on the lack of training, but that is a long way from guaranteeing that all newly-qualified doctors will have basic levels of knowledge on eating disorders.

Will the Minister act as a champion for improved training on eating disorders, so that patients can see a doctor who has a basic understanding of what an eating disorder is and of how important it is that a patient sees a specialist? That would be a first step in ensuring that the NHS gives people with eating disorders the support they need. I say a first step, because even when people can secure a referral to a specialist eating disorder service, there is no guarantee that they will then get the help they need.

Colleagues have brought a number of statistics into the debate. In 2017-18, an adult referred to a specialist eating disorder service could expect to have to wait an average of nine weeks to start treatment. That is clearly not good enough. In no other area of mental health would we accept a wait of more than two months to see a specialist. The Government seem to have accepted that in the case of children and young people, where we are finally seeing the introduction of waiting time targets, but waiting time targets for adult services are still being piloted. Can the Minister tell us why that is the case and when the Government will introduce waiting time targets for adult eating disorder services, to ensure that everyone can access timely support?

Simply setting targets will not solve this problem. I am afraid we are seeing that in services for children and young people where, despite some progress since the introduction of targets, people with eating disorders still face a postcode lottery up and down the country. In my constituency, 97% of young people referred to a specialist eating disorder service are seen within a month, but if they live just yards away, across the border in Wigan, the chances of their being seen in that timeframe fall to 66%. That is not good enough. We need all areas of the country to be given the resources they need to give people with eating disorders appropriate and timely support.

Sometimes the right support can mean the person with an eating disorder getting hospital treatment, but there are only 649 specialist in-patient beds for people with eating disorders in England, and just 249 of those are for children and young people. According to NHS data, the most common age for admission to hospital for eating disorders is 13 to 15. More than 4,400 children were admitted to hospital for eating disorder treatment last year.

When their local hospital does not have enough beds, children are being sent miles away from their families for special treatment, because the NHS does not have the resources to treat them closer to their homes. My right hon. Friend the Member for Knowsley also raised the issue of the use of private healthcare companies and private hospitals; too often, in the case of beds not being available, the NHS relies on private healthcare companies to deliver the services. My concern is that many of those services have been falling well below the standards expected. Some 28 privately-run mental health units have been rated as inadequate by the Care Quality Commission in the past three years. Vulnerable people with mental health conditions deserve much better.

Another issue worth mentioning is that the available treatment does not match the length of duration of adult eating disorders, even when a patient can have treatment. Two thirds of adult eating disorders last for three years or longer, but the current NICE-recommended adult out-patient therapies span only one year, or something like 20 to 40 sessions, 30% of which will be in-patient services. Fewer than 20% recover. There is a mismatch in the resources, there is a mismatch in the number of beds and there is a mismatch in the length of time that therapies last. If we catapult somebody out of a service before they are recovered, then clearly there will be a relapse. We need more research on that, and the NHS needs more mental health beds to cope with demand.

My final point is that services also need to be properly funded. The Minister will know that for too long we have seen money intended for mental health services diverted to meet other short-term financial concerns in the NHS. Given the pressure on NHS services now that we have the coronavirus to deal with, one can see that there will be even greater pressure not to spend money on mental health, but to spend it on other services.

Until mental health funding is both increased and ring-fenced, mental health services will remain a lower priority than patching up buildings, meeting demand for physical health services or even increasing services to deal with coronavirus. If we want to see eating disorder services improve, we must do everything we can to ensure that mental health services are properly funded, starting with increasing and then ring-fencing the funding.

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[Ms Dorries]

Absolutely, and the Green Paper, which I am sure the hon. Gentleman will be aware of, references the mental health of young people in schools. However, it is also about the trailblazer schemes, peer support workers and other people who go into schools who specialise in how to identify this and pick it up. Teachers have a huge job, and I think if we were to say that they needed to pick up when someone is suffering from an eating disorder, they would probably throw their hands up, because it requires specialised training. It is a skill, and it takes careful handling when identifying someone who is suffering from an eating disorder. So yes, of course we work across Departments, but it is those specialised and trained mental health workers in schools who will pick this up.

[Barbara Keeley]

We have a few moments left, so I refer the Minister back to the point I raised about relapse. We are largely talking about adults, and there is a mismatch between the average duration of an adult eating disorder—a large number of patients have severe and enduring illnesses—and the shortness of the therapies that they get. Professor Janet Treasure told me that a solution could be to increase the knowledge and skills of patients with those long, enduring conditions and their carers, so that they can self-manage the illness in parallel with clinical care. She is working on a pilot of that. I do not know if the Minister has heard about that, but I wanted to raise it as something that we ought to give attention to.

[Ms Dorries]

That is incredibly interesting. I had not heard about it, but I am sure that my officials will take note of it. We have an open door for anything that we can identify that helps us in targeting and providing services. We are looking for solutions to the problem. As I said, the money is there. Claire Murdoch, who I mention in almost every debate, and Professor Tim Kendall are rolling out mental health services across the country via NHS England. They have probably heard of it and are probably looking at it, but I am sure that we will take note and check if that is the case.

Although eating disorders are commonly first experienced by people when they are young, they can continue into adulthood. Following a report on how NHS eating disorder services were failing patients, NHS England convened a working group with Health Education England, the Department of Health and Social Care and other partners, which goes to the point that my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made. We are working in collaboration to address the report’s recommendations and to take them into account when planning for improvements to adult eating disorder services. Work is in progress on that.

We are continuing the investment in mental health services through the NHS long-term plan, as I think most people know. The £2.3 billion is with NHS England, which has a long-term plan to deliver on mental health and is moving at incredible pace. Even today, although it is not relevant to the debate, it announced the opening of gambling clinics across the UK. Community services are being rolled out across the UK so that people in mental health crises do not end up in casualty. It is an incredibly impressive roll-out of mental health services across the UK, including for eating disorders.[Official Report, 5 March 2020, Vol. 673, c. 12MC.]

That long-term plan will give an additional 345,000 children access to mental health support; 380,000 adults access to psychological therapies; and 370,000 adults access to better support for severe mental illness by 2023-24. It commits to the delivery of eating disorder waiting time standards, which I have already spoken about, and I hope that we will reach those before the end of next year. The plan has also committed to the design and roll-out of a new integrated model of adult community mental health care.

To increase further the number of people seeking treatment for their eating disorder, the Government recognise that raising awareness and reducing stigma are incredibly important. Here I should come on to a few of the points made by the right hon. Member for Knowsley. I shall go through them backwards, because that will be more positive in terms of affirmative answers. He mentioned social media providers, their role in body image and the impact that they have on young women. My right hon. Friend the Secretary of State for Health and Social Care has already—this happened recently—held a roundtable with social media providers. It was an incredibly positive meeting, but that is something that needs to continue, because when it comes to social media interactors, providers and platforms need to be aware of the impact that their forums have on young women, so we are continuing that dialogue with them and, I hope, are continuing to push that point.

The right hon. Gentleman made a point about the entertainment industry and its relationship and responsibilities with regard to body image. I announced two weeks ago that I am holding a roundtable with the entertainment industry. That was as a result of the death of Caroline Flack, who took her own life. For me, that was a watershed moment. It is time for the entertainment industry to be aware that it does not have a duty of care only to the people who they take on a contract to work with them. This is not just about sudden fame and reputation loss. The industry has a wider responsibility in relation to images that it projects and how it projects them, because young women and, indeed, many people absolutely are influenced by what they see—their perceived role models—through the lens of television or the cinema. The entertainment industry definitely has a responsibility, so in response to the right hon. Gentleman’s question, I can say that I have already put that in train.

In relation to a review of the long-term effectiveness of CBT, I defer to the expertise and knowledge of our friend from the Scottish National party, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who made the point that short-term CBT may not be as effective, in terms of how it is delivered, for such long-term conditions. It may be part of the treatment, but as we know, when it comes to eating disorders, treatment is very prolonged in some cases. I am sure that CBT has a definite role, but it should not be seen in isolation. Management of eating disorders takes the input of physicians and psychologists—people who are expert in managing these conditions and working in this field. Therefore I would say yes, but not in isolation.

[Ms Dorries]

I am sure that Claire Murdoch and Tim Kendall at NHS England are all over that and very aware of that. A streamlining approach to treatment is about getting people seen within the first week. If people are first seen within the first week when they present with their first crisis, that is the time when greater intervention can happen and when that treatment plan can be designed and put in place and there can be that entire care pathway through. I will not say that I think that that would shorten the illness, because I do not know. The hon. Lady probably knows more than I do, but I would think that an effective treatment plan with CBT and everything that is involved in that would provide a better outcome than piecemeal interventions along the way.

The right hon. Gentleman’s first point was careful consideration of Beat and so on. I am a huge admirer of Beat. It provides an incredible service. Its helpline deals with 30,000 people a year, I think, if I am not mistaken—it is a few weeks since I saw Beat. The support service that it provides, particularly to young women who are looking for someone to talk to and advice and help, is second to none. We are absolute supporters of Beat.

Let me just go on to the point made by my hon. Friend the Member for Broxbourne (Sir Charles Walker) about diabulimia. It is also of course the point that the right hon. Member for Knowsley raised repeatedly. We are absolutely committed to ensuring that people with diabulimia receive the treatment that they need. That is why NHS England announced in February 2019 the piloting of services. The services are being piloted on the south coast and in London, and NHS England will evaluate and monitor the pilots and take the learning from them. I will raise what the results show, if the results are through yet from the pilots, and what learning there has been and how it will apply across the UK.[Official Report, 19 March 2020, Vol. 673, c. 13MC.] I am sure that the officials will take a note, and when I have had that meeting, I will report back to the right hon. Gentleman and let him know exactly what the findings are and where we are going on that. The group that we are talking about is very small, but it is at the extreme end and requires very serious consideration.

I think that those are all the points that were raised and that I need to answer.

[Barbara Keeley]

Could I remind the Minister of another two? I think that a number of us raised the issue of training, and I asked whether she would be a champion of improving training.

[Ms Dorries]

Sorry, yes, I will reply to that.

[Barbara Keeley]

There is also the question about when waiting time targets will be introduced for adult eating disorder services.

[Ms Dorries]

Absolutely. On training for GPs, I take the hon. Lady’s point exactly. The NICE guidelines are incredibly clear, in terms of the Hope Virgo campaign and taking BMI, weight and other things into consideration. The NICE guidelines are clear, and it is up to the clinical commissioning groups to ensure that GPs and others do not take weight as a consideration. Tim Kendall is all over this and is working on it. We want GPs and others to abide by what are already very strict NICE guidelines. We have the guidelines; we just need the medical profession to implement them, but I had an idea when the hon. Lady asked her question. We are talking about training for GPs with the General Medical Council and we will continue to hold conversations about that, and I am sure that NHS England is doing exactly the same thing, but there are quicker ways to get information through to GPs.

When I was a nurse and I was training, it was the Nursing Times that informed us, on a weekly basis, of what was new in treatments and operative procedures. For GPs, it is Pulse and other magazines that they receive. I think that there might be a quicker way into GPs’ surgeries to alert them to the fact that the NICE guidelines are not being applied by GPs or by clinical commissioning groups. I think that there may be more inventive ways around that. Yes, training GPs absolutely is important; it is important to include this issue in the GP training programme, but in terms of getting a message through to GPs now, I think that we need to look at a more innovative way of doing that.

On money being diverted and ring-fenced, I think that the hon. Lady knows that the money from the £2.3 billion that goes to the CCGs is ring-fenced for mental health services only. They are not allowed to siphon it off and use it for anything else. We have our own queries as to whether some are doing that, and I know that NHS England, because I raised this with it the last time I met it, is doing an evaluation of clinical commissioning groups and having a look and checking that that money, which is ring-fenced, is spent only on—

Social Care

Baroness Keeley Excerpts

Tuesday 25th February 2020 Commons Chamber

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

I beg to move,

That this House notes that almost ten years of Government cuts to council budgets have resulted in a social care funding crisis which means 1.5 million older people have unmet social care needs; further notes the increasing funding gap for adult social care; believes proposals from the Government for access to additional funding for both adult and children’s social care will do nothing to ease the crisis or address the funding gap; and calls on the Government to bring forward as a matter of urgency plans to reform social care including plans for free personal care.

It is right that we have a chance to debate social care today: it is two weeks ahead of the Budget and there is the ever present hope that the Government will announce much-needed social care reform. This reform is long overdue. After nearly a decade of cuts, our social care system is on its knees. For the people who rely on social care and for their families, the reality is that things have got much worse under successive Conservative Governments. Every day last year, 2,000 older people who had approached their local authority for help with social care were turned down. The result is that there are currently 1.5 million older people who are not getting the support they need—each one struggling to cope with basic everyday tasks. This can mean people left trapped in bed all day or going unwashed all week, because family carers can visit them only on the weekends, and those are the people who are fortunate enough to have help from unpaid carers. Around half the 1.5 million get no help at all—not even from family and friends. They cope as best they can until they end up in hospital, and then they cannot get out of hospital because they can only be discharged safely once a social care package is set up, with the local authorities struggling to find the funding for it.

Another failure in our social care system is where people are held in entirely inappropriate institutions because the local authority cannot fund the care they need to keep them safe in the community. There are 2,200 autistic people and people with learning disabilities who continue to be detained on in-patient wards. This is one of the most egregious failures of our social care system. They should be able to live in their own homes with a support package, but the funding is not there. For eight years the Government have been promising to end this scandal, but they have failed to do so.

[Thangam Debbonaire (Bristol West) (Lab)]

My hon. Friend is making a great start to a very important speech. Does she agree that it is quite astonishing that the Equality and Human Rights Commission has been forced into a position where it is having to threaten to take action over the Government because of their failure to accommodate people with autism and learning disabilities, and it is people who are suffering as a result?

[Barbara Keeley]

I absolutely agree with my hon. Friend. The only way that we will see real change is if the Government put in funding to provide the housing and support needed for those people currently trapped in inappropriate institutions. I first raised this issue with the Secretary of State in October 2018, citing the case of a young autistic woman called Bethany. It took 14 months before Bethany was moved out of a seclusion cell and into a more supported environment. Now we have, as my hon. Friend has said, the Equalities and Human Rights Commission launching a legal challenge against the Department for its failure to move those 2,200 autistic people and people with learning disabilities out of those inappropriate units.

We must see action on this issue, because it is a national scandal. We need to see reform so that more people can get the care they need, rather than being left to struggle on alone. Even when people are able to access publicly funded care, there is no guarantee that it will be of acceptable quality. Last year, one in six social care services was rated by the Care Quality Commission as “inadequate” or “requires improvement”. That can mean care homes that are so unclean that residents are at risk of picking up infections. It can mean home care agencies that have not even carried out basic checks on their staff, or home care staff being so rushed that they do not have the time to take off their coats during a visit.

Twenty per cent of councils in England and Wales still commission 15-minute care visits. That is clearly not long enough to provide care. It is not long enough to get to know someone and support them to do the things that they want to do.

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

A German style system of social insurance would allow somebody who is defined as needing social care to draw down a certain amount of money which they could then use to pay to a relative, a loved one, or a neighbour who understands that person best and who can care for them best. Is that not a sensible basis for a cross-party discussion, between the Opposition and the Government, about whether a German style social insurance system could solve this problem?

[Barbara Keeley]

I thank the hon. Gentleman for making that point; he does make it on every occasion that we debate this subject, so I congratulate him on doing so again. However, the person he needs to be directing his comments about cross-party talks to is sitting on the Government Front Bench. I am hopeful that the Secretary of State is going to tell us what he is going to do about cross-party talks, because those 15-minute visits are really not good enough.

[Mr Toby Perkins (Chesterfield) (Lab)]

I agree entirely about the need for cross-party consensus on this issue, but there can be no consensus until there is an acknowledgement of what has caused the care crisis—the underfunding of the health service and cuts to local government budgets, which have had an impact on A&Es, GPs and other services. Until there is an acknowledgement of what caused the situation, there can be no consensus towards a solution.

[Barbara Keeley]

My hon. Friend is right. I will come to the causes, because it is important to mention them.

The 15-minute care visit reduces the giving of care by care staff to a series of physical tasks, rather than the staff being able to see a person with their own interests, desires and opinions. It really strips them of the time to do the job they want to do. I pay tribute to all care staff, who go above and beyond in their jobs to improve the lives of the people they support. Without them, our social care system would not work, but they do not get the pay and recognition that they deserve.

Care staff, who provide essential practical and emotional support to some of the most vulnerable people in society, are among the most poorly paid workers. The average hourly pay for care staff is below the rate paid in most UK supermarkets. On average, care staff are paid less than cleaners and healthcare assistants in the NHS, and this has led to a vacancy rate of 122,000 care jobs and a turnover rate of 33%. Now the Government are planning to make the situation worse by turning away people who want to come to this country to work in social care. One in seven care workers is from outside the UK, but the average care worker earns £10,000 a year less than the Government’s immigration salary threshold, so will the Secretary of State tell us just how he thinks he is going to be able to fill the large number of vacancies in the social care workforce?

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is making a powerful speech. Does she share my concern that poor pay and conditions mean not only that these workers are exploited, but that there is a high degree of turnover and a lack of investment in training and development, which in themselves have a significant impact on the quality of care that is delivered to some of our most vulnerable residents?

[Barbara Keeley]

Once again, I absolutely agree. My hon. Friend is right to emphasise that point.

Last week I met home care support workers in my constituency who are campaigning to be paid a real living wage, and they told me about their struggles to manage financially. One staff member talked of working 90 hours for four consecutive weeks at an effective rate of £6.10 an hour. Others talked about being bitten or punched, yet still they continue to do the support job that they love. I pay tribute to their commitment; in the case of social care, doing a rewarding job does not pay the bills.

[Mike Amesbury (Weaver Vale) (Lab)]

Does my hon. Friend agree that far too many essential careworkers are employed on zero-hours contracts, which we really need to see kicked into history?

[Barbara Keeley]

I very much agree. We need to pay care staff the real living wage, provide them with training and end the use of zero-hours contracts.

I think it is clear enough that the Labour party believes that the current system is not working, and I am sure that the Secretary of State knows it too. Councils just do not have the funding required to deliver the care that people need, and they are faced with a stark choice—either they cut back on the quality of care, or even fewer people receive any help at all. Only a third of directors of adult social services think that their budget will be enough to meet their statutory duties this year, which means that thousands of people who approach their local authority for help with their care are turned down for support. Without investment and a plan, social care services will be pushed deeper and deeper into crisis. Expert report after expert report has pointed to social care being on the verge of collapse, and those reports make it clear that councils cannot deliver adequate adult social care provision without a sustainable, long-term funding strategy. Yet what we have seen from the Government, year after year, is short-term and piecemeal funding.

The Secretary of State may repeat, as his colleagues did yesterday, that the Government are allowing councils to raise council tax this year to fund social care services, but the Opposition know that council tax is a deeply unfair way to fund this vital public service. A 2% rise in council tax rates in Wokingham will raise twice as much money as it would in Knowsley. Even if we raised council tax by 2% every year, the Institute for Fiscal Studies says that by the end of the decade social care will make up over half of all local government spending. This means that other vital services will continue to be cut back. That is certainly the situation I see in my own local authority area.

[Alex Cunningham (Stockton North) (Lab)]

The shortage of resource and people in the system means that more responsibility falls on families. I know that my hon. Friend recognises the unsung heroes who are young carers—children who miss out on education, a social life and so much more to care for a parent or sibling. Does she agree that the Government need to do more to help to support organisations like the Eastern Ravens Trust in Stockton, which does so much to help these young carers to have a life of their own?

[Barbara Keeley]

Indeed I do. I am looking forward to the establishment of the new all-party group on young carers, but it is tragic, in a way, that we have to meet in new all-party groups to try to find some way of taking the burden from those young carers.

As local authorities struggle to fund social care, an increasing number of people are forced to take on the financial burden themselves. Some 143,000 people are currently faced with catastrophic costs of over £100,000 for their own care. Over the past three years, 9,000 people have asked their local authority for help after completely depleting their own savings to pay for their care. This means that people are having to sell their homes that they may have lived in for their entire lives to fund the care that they need. The Prime Minister has promised to stop this situation, but with no plan and no proposals for how he achieves that, it is likely that many more people will be put in this position going forward. The Government could drastically reduce the number of people faced with catastrophic costs for their care if they set a lifetime cap on care costs. The Government proposed a cap in 2013. They legislated for it, but dropped it in 2016. That cap would have gone some way towards reducing the number of people now faced with catastrophic social care costs. The Government’s own impact assessment showed that by this year 37,000 people would have benefited from the cap if it had been introduced in 2016.

But reform is not just about protecting housing wealth. It is important to do that, but reform also has to offer a solution to the people who are currently stuck in bed all day unable to get themselves dressed, or needlessly stuck in hospital. The solution that Labour favours is to offer free personal care to ensure that everyone is supported with the basic tasks regardless of their ability to pay. Free personal care was introduced by a Labour-led Government in Scotland in 2002, and it is ensuring that more people there receive publicly funded social care. Free personal care has been backed by the House of Lords Economic Affairs Committee and by charities and think-tanks.

We believe that it is vital that we push forward with this reform because progress to date has been far too slow. In October 2018, the Secretary of State talked about:

“The adult social care Green Paper, which will be published later this year”.—[Official Report, 17 October 2018; Vol. 647, c. 736.]

In 2019, we were told that there would be a Green Paper “that summer” that would set out the future of social care, but it never arrived. It was delayed twice before being dropped completely. Seven months ago, the Prime Minister stood on the steps of Downing Street and said that he had a plan to fix the social care crisis. There is still no sign of it. Perhaps this plan is in the same state as the promised Green Paper. The Government said that they would instigate cross-party talks on social care within the first 100 days of the election. We are now 75 days on and we have yet to hear from the Government on their proposals.

Labour is the only party, as it stands today, with clear plans for the future of social care. Labour’s plan for social care would close the funding gap, cap care costs, and introduce free personal care and improved pay and working conditions for care staff. In contrast, we have no action from the Government on social care. Councils are reliant on piecemeal funding announcements and raising ever higher levels of council tax, yet these measures leave them struggling to meet demand. So Labour’s message to the Prime Minister and the Secretary of State is clear: they need to put in the extra investment needed to stabilise the care system, introduce free personal care, bring back a cap on care costs, and develop a plan to improve the pay and working conditions of the care workforce. I want to make it clear that Labour will be happy to sit down with Ministers and talk them through our proposals, as the Prime Minister does not appear—at this point in time, at least—to have any plans of his own. I urge hon. Members to vote for our motion tonight to ensure that the Government have to finally meet their pledge to fix social care.

--- Later in debate ---

[Matt Hancock]

No. What I am saying is that life expectancy, as I have repeated, is going up, but there are areas where it is not, and we will and we must tackle that. The challenge for us as a country is not to try to pretend that things are different to the facts. The challenge here, which Opposition Members will not accept, is that there are parts of the country where life expectancy is advancing rapidly and there are parts where it is not, and we must tackle that. We cannot have a decent policy conversation if half of the debate will not accept the facts on the ground.

The Marmot report was published this morning. It is absolutely critical that we level up life expectancy. The fact that in Blackpool a healthy life expectancy for men is 53 years yet in Buckingham it is 68 years is a disgrace, and we will put that right, but you cannot put things right if you ignore the facts when you are starting.

[Barbara Keeley]

I just want to round this point off. What does the right hon. Gentleman think happens with life expectancy when 1.5 million older people are going without care? Does he not think that the impact of the lack of social care, especially on women in deprived areas, is a key factor?

[Matt Hancock]

I do not recognise those figures, because—

--- Later in debate ---

[Matt Hancock]

Yes, I have. As the hon. Member knows, my hon. Friend the Member for Chichester (Gillian Keegan) was my Parliamentary Private Secretary, and we talked about this a lot, so I welcome that work. Indeed, the amount of work from various Select Committees and groups in this House has been considerable, as my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) made clear earlier. There has been an awful lot of reports and of very good work, including the work to which the hon. Member has contributed.

[Barbara Keeley]

The right hon. Member knows that I raised with him on the day of the first Queen’s Speech, in October last year, the need for us to set up cross-party talks. He has done nothing about that since then—nothing has happened on that. There was some vague talk about sitting down with the former Minister for Care for a cup of tea, but that is not cross-party talks. Will he say now: is he going to set up cross-party talks?

[Matt Hancock]

We will fulfil all the commitments in the manifesto, which, as the hon. Member set out, includes one on this subject, and that is part of our plan.

--- Later in debate ---

[Huw Merriman (Bexhill and Battle) (Con)]

It is a pleasure to follow the hon. Member for Chesterfield (Mr Perkins) and all the other contributors. There seems to be cross-party consensus that we need to find a solution for all our constituents. I welcome the new Care Minister to her place. We entered the House together, and I know that this subject is a real passion of hers. I am very excited that she is in post, and I think we can expect great things from her in this area of reform. I also thank her predecessor, my hon. Friend the Member for Gosport (Caroline Dinenage); on the day that the chairs were rearranged, she was in my constituency opening a new hospice, and she was absolutely wonderful to all the staff and patients.

It is a delight to speak in this debate, because this issue is the key concern in my constituency, as it will be in many constituencies. We talk about the fact that 18% of people across the UK are over the age of 65, and that that figure will rise to just shy of 25% of the population by 2040. But in my constituency, 30% of constituents are already over the age of 65. That is absolutely fantastic because we are rich in seniority, but it does mean that there are people who have difficult needs and challenges. In a constituency such as mine, people tend to retire down to the coast and downsize, which means they live in smaller properties and pay much less council tax. However, they also tend to need more services from the local community. It is for that very reason that we cannot continue with the concept of council tax funding social care. It is a postcode lottery, and the places that need the most are given the least when it comes to yield.

I would like to see the system centralised, but rather than having another NHS system, we should inject a bit more reform and interest. That is why I said to the Secretary of State that it would be right for us to follow the German model. In the ’90s, Germany had the exact same issues that we have today, with regional imbalances meaning that parts of the German republic just could not afford social care at a local level. There was also great unfairness in the country because certain people just could not access the care that they needed, and it would wipe out their assets. Both parties then fundamentally agreed that it was in the interests of all their constituents to work together on a cross-party basis to deliver reform. That was when the policy of long-term social care insurance funds was established.

The German model requires individuals to pay in. No individual pays more than €138 a month, and the employer matches that amount. Retired people pay the full amount themselves, so the policy gives a nod to intergenerational fairness. It takes risk out of the system; if one individual has greater needs than another, that is not factored into the amount they pay. Crucially, it has been popular. People do not talk about social care as a political issue in Germany in the way that they do in this country.

In a way, this situation is an absolute tragedy. Opposition Front Benchers rightly talk about the years that we have had in Government in which we could have fixed the issue, but they do not focus on what had gone on since 1997. The Labour Government absolutely ducked this issue and were faced with calls from the Conservatives of “death tax”. In return, we got that back in spades when we talked with honesty in our 2017 manifesto and proposed a policy that was then labelled the “dementia tax”. Our constituents—all of us, across the House—must absolutely despair.

[Barbara Keeley]

Will the hon. Gentleman give way?

[Huw Merriman]

I will give way to the hon. Lady, because a couple of years ago when I made the point that I hoped we could work on a cross-party basis, the talk back to me was, “Actually, that cost you the election, and we wouldn’t work with you on that basis.” I found that response rather frustrating, so I hope for more.

[Barbara Keeley]

I do not recall that I ever said that, but there is a key point in what the hon. Gentleman is saying. Our recollection is that it was not the Labour party that labelled the Conservatives’ proposal the dementia tax. I think it was actually one of the national charities and the phrase then got taken up by the media, so I ask the hon. Member not to pin that one on us. It is important that we establish cross-party talks, but the people he should be addressing his comments to are on his own Front Bench. Ministers have had since October to follow up on the point I raised with the Secretary of State about cross-party talks, but they have done nothing. We keep hearing about cross-party talks, but they are not happening because the Government are not doing anything about it.

[Huw Merriman]

I remember well the exchange that I had with the hon. Lady a couple of years ago. The point I was making was that we did not seem that far apart—she talked about the fact that more funds needed to be raised, and so did we, perhaps with people taking individual responsibility—but the response I got back was more like a lesson on why such policies cost us our majority. That may have been a fair point, but my frustration was that we were being honest and straight with people that if we actually want to reform the system, we may need to ask people to pay more in. Most people do not realise that they already have to pay for it; it is only when they access the service that they fully understand what it really costs them. A lot of people—about 50% of the population—think that the NHS takes care of social care for them. They do not understand.

Whenever we try to propose reform around election times, it turns into a political football. In a way, this is the time to have the conversation, because I do not believe there will be an election for many years to come, so there is the opportunity for us to work cross-party. The hon. Lady is absolutely right: for cross-party talks to occur, she needs a proper invite, and I very much hope that that will be forthcoming. However, given that we now have a Conservative majority, in the event that, sadly, these cross-party talks do not work out—as I say, I hope they do, because that is the greatest chance we have of delivering reform and persuading the public that we are all in this together on their behalf—then I very much hope that we will use our ideas, our mission and our majority to put reform through rather than saying that it has faltered because we cannot get consensus.

The most vulnerable, the elderly and the people who have worked hard all their lives are now lacking in dignity within the system because we simply do not have enough money in place. We have not delivered the reforms that we talk about in this place constantly but still fail to enact. I very much hope that this Government will do that, hopefully on a cross-party basis, but if that does not reach fruition, then by inputting our own principles, our own policies and our own devotion to the people I am talking about, so that we give them and the generations to come a better future.

--- Later in debate ---

[Helen Whately]

I thank the hon. Gentleman for his suggestion. It is almost as if he has seen my notes.

One thing I particularly welcome is the number of hon. Members on both sides of the House who spoke about the importance of careworkers, who provide such important care.

My hon. Friend the Member for Peterborough (Paul Bristow) mentioned that both his parents were nurses in the care sector. He drew on his knowledge of care and rightly said that the profession should be held in higher esteem and that, just as we hugely value NHS staff, we should hugely value careworkers. The hon. Members for Warrington North (Charlotte Nichols), for Blaydon (Liz Twist), for Dulwich and West Norwood (Helen Hayes), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker) and my hon. Friend the Member for Bury North (James Daly) spoke along the same lines, and I could not agree more.

Not long after I became the Member of Parliament for Faversham and Mid Kent, I joined a careworker, Kim, on her daily round. By the time I met her at 7.30 am, she had already started washing her first client. By lunch time, she had washed, dressed, fed, medicated and chatted with six or seven men and women. Some of them were grateful and some of them, quite honestly, were not grateful, but they were all utterly reliant on her care. That experience really brought home to me the skill, knowledge and compassion of our social care workers. For those who need help, there are amazing carers with hearts of gold, like Kim.

Our care system depends on an extraordinary workforce of capable and compassionate carers, but we need more people to choose care as a career. That means changing the perception of being a care worker. As a society, we must truly recognise the importance of the work. We must make sure that more people realise the range of jobs in care and the opportunities for progression. The Government are currently investing in an adult social care recruitment campaign with the strapline “When you care, every day makes a difference”. We are working with Skills for Care to support workforce development and there is funding for a workforce development fund. That is really important, but we know that we must go further in making sure that we truly value the important work that the care sector does and to make sure that the care profession attracts the workforce that we need and gives them the opportunities to lead a truly fulfilling career.

Several Members rightly talked about unpaid carers, who also provide so much vital care. We fully recognise the value of that work and know the importance of support for those people who do so much caring. That is one reason why the Government will introduce a statutory right to leave from work for one week a year for the 5 million people who juggle work alongside being an unpaid carer.

My hon. Friend the Member for Bury North talked about quality of care, and it was really important to hear that mentioned as part of the debate. He spoke about how good care is in his constituency, and he is absolutely right that we should talk about how good care is throughout England. Some 84% of adult social care providers are currently rated good or outstanding by the CQC. Let us recognise the high quality of care.

My hon. Friend also spoke about the importance of integration—of the NHS, local authorities and care providers working together—as did my right hon. Friend the Member for Ashford (Damian Green), who is knowledgeable on this subject. The interplay between the NHS and social care is critical. The better care fund and the improved better care fund are a success story in respect of enabling more co-operation between the systems. It is crucial that we continue to build on that success so that our care system meets the needs of the individual, not just of the system.

My hon. Friend the Member for Watford (Dean Russell) made some excellent points about how, paradoxically, we can use technology to help to achieve more human and more personal care for a more cohesive and effective care system.

Both my hon. Friend the Member for Thurrock (Jackie Doyle-Price) and the shadow Minister for Care, the hon. Member for Worsley and Eccles South (Barbara Keeley), mentioned those with learning disabilities and autism who are being cared for in in-patient settings. I am new to this job, but I absolutely appreciate the importance of making sure that we do better in this regard. People should be cared for in the best place for their needs. At the end of last month, the number of those in in-patient settings had been reduced by 24% compared with 2015—

[Barbara Keeley]

indicated dissent.

[Helen Whately]

The shadow Minister is shaking her head; I know that there is more to do.

At times this has been a heated debate, but I heard on both sides truly constructive suggestions for how we can solve our social care challenges. That gives me much hope for cross-party consensus. I heard suggestions from my hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Meon Valley (Mrs Drummond), my right hon. Friend the Member for Ashford, the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Bexhill and Battle (Huw Merriman), whom I thank for his kind words welcoming me to my job. He set the bar high for me to meet.

I am fully aware of the challenges that face our care system and I have no illusions as to the scale of the challenge facing us. In the next 10 years, we expect the number of people over 75 to go up by 1.5 million, and the number of people under 65 with care needs is growing, too. We have a system that is under pressure and the demands are only going to grow.

NHS Funding Bill

Baroness Keeley Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Jeremy Hunt]

My hon. Friend has huge experience of this in local government, and he is absolutely right. The big surprise for me when we were conceiving of the children and young people’s Green Paper was the willingness of NHS professionals to accept that the people who know the kids best are their teachers, rather than GPs, because the teachers see them every day and are probably going to be better at spotting a mental illness and being able to do something about it.

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

I would like the right hon. Gentleman to consider whether he supports an important proposal that we put forward at the general election. It was that there should be a trained counsellor in every school to spot mental health problems. Putting that burden on to teachers and others in the teaching profession is the wrong way forward. In Wales, we have the experience that having trained counsellors in schools relieves the pressure on CAMHS. If we want to take children’s mental health seriously and relieve the pressure on CAMHS, we should do this. I have a couple of schools in my constituency that have trained counsellors, and it really helps. The other thing that we proposed was to have a mental health hub in every local authority area, so that children and their families in crisis would have somewhere to go where there would be professionals and charities that work in mental health. Those ideas that we put forward really should be considered, and I wonder whether the right hon. Gentleman supports them.

[Jeremy Hunt]

They are both interesting ideas. The plan at the moment is that resource will be given to schools for a teacher to volunteer to devote a proportion of their time to this, and that there will be funding for them to do so, similar to the way in which schools have a special educational needs co-ordinator who is a teacher devoted to the special needs of the pupils in that school. I personally would have no objection if that were a separate counsellor, but this needs to be a resource inside the school—someone who is regularly at the school and who knows the children there. That is the important thing.

With permission, Dame Rosie, I would like to comment on some of the other amendments and on some of the comments made by the hon. Member for Ellesmere Port and Neston. He rightly talked about the issues around maternity safety, and I agree that it is vital that we continue the maternity safety training fund. That is not directly the subject of one of his amendments, but it is indirectly connected to it. Twice a week in the NHS, the Health Secretary has to sign off a multi-million pound settlement to a family whose child has been disabled for life as a result of medical negligence. What is even more depressing is that there is no discernible evidence that that number is going down. The reason for that is that when such tragedies happen, instead of doing the most important thing, which is learning the lesson of what went wrong and ensuring that it is spread throughout the whole country, we end up with a six-year legal case. It is impossible for a family with a child disabled at birth to get compensation from the NHS unless they prove in court that the doctor was negligent. Obviously, the doctor will fight that. That is why we still have too much of a cover-up culture, despite the best intentions of doctors and nurses. This is the last thing they want to do, but the system ends up putting them under pressure to do it. That is why we are not learning from mistakes. I am afraid that that is the same thing that was referred to in the Paterson inquiry report that was published today: the systemic covering up of problems that allowed Mr Paterson’s work to carry on undetected for so long. The hon. Member for Ellesmere Port and Neston is absolutely right on that.

I think it is a fair assessment of safety in the NHS to say that huge strides have been made in the past five or six years on transparency. It is much more open about things that go wrong than it used to be, and that is a very positive development. But transparency alone is not enough. We have to change the practice of doctors and nurses on the ground, and that means spreading best practice. Unfortunately, that is not happening, which is why, even after the tragedies of Mid Staffs, Morecambe Bay and Southern Health, we are facing yet another tragedy at Shrewsbury and Telford—I see my hon. Friend the Member for Telford (Lucy Allan) in her place, and she has campaigned actively on that issue. The big challenge now is to think about ways to change our blame culture into a learning culture.