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.

--- Later in debate ---

[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.

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[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.

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[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.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 28th January 2020 Commons Chamber

[Caroline Dinenage]

The Prime Minister has set out his plans. He wants to seek political consensus and bring forward a plan for adult social care this year, and we are looking at a whole range of solutions, including free personal care. The issue we see in Scotland is that the initiative must be backed up with a huge amount of money. The money that the Scottish Government used to give to individuals covered around 50% of their care home costs and now only covers around 25%. That is why we must ensure that we address this issue with a long-term view.

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

It is time to tackle unmet need, which is clear from my hon. Friends’ questions. Ministers say that they want to seek a consensus on the future of social care, but we already have a proposal with wide-ranging support, including from former Conservative Chancellors in the Lords, major national charities, and the official Opposition: free personal care funded from taxation. Will the Minister accept that the way to move things forward is for the Government to join the existing consensus on introducing free personal care?

[Caroline Dinenage]

The Prime Minister said that the Government will deliver on our promises. We will bring forward a plan for social care this year—

[Barbara Keeley]

When?

[Caroline Dinenage]

This year. However, there are complex questions to address. A Joint Committee of the Housing, Communities and Local Government Committee and the Health and Social Care Committee came up with an entirely different solution—a social insurance model—which shows why we want to build a consensus. Even the Liberal Democrats have said that they want to build cross-party consensus, but we know the hon. Lady’s view on cross-party consensus: her way or the high way.

--- Later in debate ---

[Ms Dorries]

The best way to improve life expectancy is to prevent health problems from arising in the first place. Prevention is one of the top five priorities for the health service, and we are taking action to help people live longer and healthier lives. The Government have a proven track record of reducing the harms caused by obesity, tobacco and other substances. That is where we need to focus our efforts to ensure that life expectancy rises in all areas throughout the country.

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

The most shocking trend in life expectancy is that people with learning disabilities die so early—on average 25 years younger than the general population. We must see action to learn the lessons from each of those early deaths. The contract for the University of Bristol’s running of the learning disability mortality review ends in May, and there is now a growing backlog of cases, so will the Minister tell the House what the future of this important review is, and what staff resources are needed to continue the vital work of reviewing and reporting on early deaths?

[Ms Dorries]

We will introduce mandatory training for all health and social care practitioners. I hope that that will address the particular problem that the hon. Lady has brought up. It comes back to the substantial life expectancy issue, which is that regardless of the group, prevention is key.

Health and Social Care

Baroness Keeley Excerpts

Thursday 16th January 2020 Commons Chamber

[Matt Hancock]

I will have a look at that early-day motion. This is an incredibly important subject that we must get right. Of course it is fair for those who use the NHS to make a contribution to it, and we have made changes to ensure that those who give birth get the support they need. The point I think the hon. Lady is making is not only about the exact details of the rules, but ensuring that people are not put off because of a concern about what the rules may be. I am very happy to take up that point. On social care, I hope we can reach a broad consensus.

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

I want to give the Secretary of State a chance to be clear, following on from the question from the right hon. Member for Forest of Dean (Mr Harper), about what he intends to do. The Secretary of State will know that I raised with him, on the day of the previous Queen’s Speech in October, that we would be willing to sit down and talk about this issue. Three months have been lost with nothing happening. All we hear from the Prime Minister is that something will happen in this Parliament. Why does he not use this chance at the Dispatch Box to say where the plan is. We have proposals. Where is his plan? When is he going to produce it?

[Matt Hancock]

The Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), wrote to the hon. Lady after the election and has not had a reply. We are up for this conversation. The Prime Minister has been absolutely clear. We hope we can do it in a spirit of cross-party consensus. I hope we can have an approach to the health service that has some consensus. The truth is that I like the shadow Secretary of State. His politics are quite close to mine, although I do not agree with his approach on PFI. There has been good news for both of us recently. Both of us got the election result we wanted. [Laughter.] I did not want Jeremy Corbyn to be Prime Minister and we discovered from the hon. Gentleman’s friends that neither did he. So let us go forward in a spirit of as much co-operation as possible.

Let me, if I may, go through each of the six measures in the Queen’s Speech in turn. In addition to the NHS Funding Bill we announced yesterday, there will be our long-term plan Bill. The plan, created in consultation with NHS colleagues, sets out how the NHS will improve the prevention, detection, treatment of and recovery from major diseases including cancer, heart attack and stroke.

--- Later in debate ---

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

Today’s debate has shown how important the NHS and social care are to Members on both sides of the House, and has been wide-ranging. It has been great to listen to contributions from, I think, 32 Back Benchers, but, because we are short of time, I will focus on paying a special tribute to the 12 who spoke for the first time.

I congratulate my hon. Friends the Members for Luton North (Sarah Owen), for Ealing North (James Murray), for Enfield North (Feryal Clark) and for Vauxhall (Florence Eshalomi), as well as the hon. Members for Sevenoaks (Laura Trott), for Bishop Auckland (Dehenna Davison), for Watford (Dean Russell), for East Dunbartonshire (Amy Callaghan), for Peterborough (Paul Bristow), for Twickenham (Munira Wilson), for North West Norfolk (James Wild) and for Carshalton and Wallington (Elliot Colburn). As the right hon. Member for Ashford (Damian Green) said earlier, the standard of maiden speeches we have been hearing is breathtakingly high. Those new Member all made excellent speeches, and reminded us of the qualities and commitment to public service of their predecessors. They also highlighted their own commitment to health and social care, and we heard of much personal experience of the wonderful job being done by our staff in the NHS and social care. Earlier, my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Health and Social Care Secretary, mentioned the loss of our colleagues Paula Sherriff and Julie Cooper, whom we miss. It was also good to hear kind words about our former Labour colleagues Helen Goodman, Lisa Forbes and Stephen Pound, whom we also miss.

Last month’s performance figures show the NHS struggling to cope with demand, unable to provide beds for patients and leaving them languishing on trolleys in A&E departments. More than 1,400 patients were left stranded in hospital each day last November. They were patients who were well enough to leave but unable to do so because of a lack of social care. The Government’s failure to address the crisis in social care is having a profound impact on the lives of people who need care, and on our struggling NHS. The Health Foundation said last week:

“No plan for the NHS will work while social care remains the Cinderella service. Long overdue action on social care is needed to…reduce the pressures on the NHS.”

Proposing a solution to the crisis in care should be the Government’s top priority, as we have heard in many of the speeches this afternoon. However, despite the Prime Minister’s earlier pledge to

“fix the crisis in social care once and for all, and with a clear plan we have prepared”,

he now says only that he will do something “in this Parliament”. After 10 years of inaction, is that the best the Prime Minister can say, alongside a vague offer of cross-party talks?

There are four key areas where action is needed to ensure that people have access to a functioning social care service that meets their needs. Labour has plans for a national care service, and we have made it clear how we would have addressed these four key areas. The first is funding. The Association of Directors of Adult Social Services tells us that, since 2010, £7.7 billion has been cut from budgets for adult social care. Councils just do not have the funding required to deliver the care that people need. The second area is access to publicly funded care. Age UK estimates that 1.5 million older people are going without the social care and support they need every day, and that number is increasing year after year while the Government fail to act.

The third area is capping care costs. Too many people are faced with catastrophic costs for their care. In 2014, the Government proposed to introduce a cap to limit the amount people must pay for their care, but they dropped that in 2017. In the past three years, 9,000 people who have been paying for their own care have completely depleted their savings or assets and approached their local authority for help with their care. The people who face the highest costs are those with dementia. So just how will the Government deliver on their promise that no one will be forced to sell their home to pay for care? Will they introduce a cap on care costs, as Labour would do?

The final area is the care workforce. Skills for Care tells us that there are 122,000 vacant care jobs. Care staff do not get the pay, working conditions or access to training that they deserve, meaning that many of them leave working in care for better-paying jobs in retail or hospitality. We need to pay care staff the real living wage, provide them with training to develop their careers and end the use of zero-hours contracts.

But it is not just in social care that there is a workforce crisis, as we have just heard from the hon. Member for Gloucester (Richard Graham). More than half of mental health professionals have said that they are too busy to provide the level of care they would like to give to their patients. We need more mental health nurses and more psychiatrists to meet demand. Three out of four children with a mental health condition do not get the support they need, and others wait months to be seen. Mental health patients continue to be sent hundreds of miles from home because their local NHS does not have the beds or the staff to provide the care they need. Placements are sometimes in private hospitals that provide inadequate care, and that includes the 2,200 autistic people and people with learning disabilities trapped in inappropriate institutions. Last week, the Prime Minister stated that that number was falling rapidly, but the Secretary of State for Health and Social Care, who is now sitting here with us, knows that that is not the case.

Eight years after a Conservative Prime Minister promised to end the use of such institutions, the speed of change has been glacial. It took the Health and Social Care Secretary 14 months to resolve the case of Bethany, a young woman with autism held in a series of inappropriate placements, and I remind him—I notice that he is not listening—that there are 2,200 more Bethanys who are too often subject to inappropriate seclusion and restraint, as she was. I was glad to hear the hon. Member for Thurrock (Jackie Doyle-Price) raise the matter of early deaths at in-patient units and to hear from my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on the need for homes, not hospitals.

From older people left without the care they need to children waiting months to see a mental health professional, we have seen people across the NHS and social care let down by this Government. Disappointingly, the Queen’s Speech did not set out measures to fund the NHS and social care properly. The Government must provide the necessary funding for both services and, importantly, must now put forward plans to fix the crisis in social care once and for all, as has been promised. I urge right hon. and hon. Members to support our amendment to guarantee that both the NHS and social care get the resources they need.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 29th October 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

Absolutely; I thank my right hon. Friend for putting it so eloquently. This just shows what can be achieved. We have seen great results from the soft drinks industry levy. The average sugar content of drinks subject to the levy decreased by 28.8% between 2015 and 2018, so we have been able to make significant investments in activity and healthy eating in schools.

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

Mr Speaker, as this is the last time that we will have Health questions with you in the Chair, I want to thank you for being a fantastic Speaker—particularly through your support for Back Benchers and ensuring that we can be heard through urgent questions.

Last week, we found that the number of people receiving publicly-funded social care has fallen by 15,000 in the past year. We know that 95 people a day die while waiting for care and that cuts of £7.7 billion have been made from social care budgets since 2010. Older and disabled people are paying the price. Labour has set out our plans to deliver free personal care for people aged over 65 who need it. We are providing dignity in old age. When will the Secretary of State give people the dignity and care they deserve, and bring forward the Government’s plans for social care?

[The Minister for Care (Caroline Dinenage)]

The hon. Lady will be aware that the Queen’s Speech announced a Bill to tackle the cost of adult social care. She will also know that the Prime Minister said on the steps of Downing Street that the Government will set out plans to fix the social care crisis once and for all. We need to get through Brexit, and Labour Members need to vote for the methods that will help us to deliver that, because we can then get on to the things in life that really matter, such as ensuring that no one will ever have to use their home to pay for their care.

The National Health Service

Baroness Keeley Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

This is another incredibly important point. I will be working with the new Minister for Defence People and Veterans, as well as the Minister for Mental Health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), to address exactly that sort of concern. This is a long overdue—

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

Before the Secretary of State leaves mental health, will he address this issue of the 2,300 autistic people and people with learning disabilities who are in in-patient units, as it has been around for far too long? Last week, the Care Quality Commission announced that one in 10 of those units was inadequate. He knows—and I have written to him about it—that Bethany, a young woman, is in seclusion and still in a locked cell. When will he do something about those 2,300 people?

Social Care Funding

Baroness Keeley Excerpts

Tuesday 1st October 2019 Westminster Hall

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

It is a pleasure to speak in a debate with you in the Chair, Sir Charles. I think that this is the first time I have done so. I join others in congratulating the right hon. Member for Twickenham (Sir Vince Cable) on securing this important debate.

The number of Members contributing in this debate makes clear the appetite to speak on the matter, and it is a pity that more Government time—or even an Opposition day debate—has not been allocated. It is appropriate that on this International Day of Older Persons we have talked largely, though not entirely, about older people. That should remind us all that growing old with dignity is a fundamental right that we should all enjoy.

By my count we have heard 12 Back-Bench speeches and six interventions, and by the time we get to the Minister we will have heard three Front-Bench speakers. Many have rightly focused on the cuts to social care budgets and the harm caused to people who rely on and need social care. We have heard powerful examples of the impact of those cuts. That harm, however, is not inevitable. If social care is properly funded and delivered well, it can be life changing. My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) gave an example of how life can be changed in the wrong way if social care is not available.

Social care can keep someone connected to their community rather than isolated and lonely. It can support people to live the lives they want to live, rather than just survive from day to day—sometimes not even that—when the care disappears. But that is not what our social care system looks like today. Over the past nine years nearly £8 billion has been taken out of local councils’ social care budgets as a result of cuts. Hon. Members have mentioned the swingeing cuts experienced by many local authorities. As a result, hundreds of thousands fewer people are receiving the care they need. That is the straightforward result of the cuts.

Age UK tells us that 1.4 million older people in this country are struggling with everyday activities. Whether that means getting washed or eating a meal, they are not getting the help they should be getting. Older people are being left trapped in bed all day and perhaps going unwashed all week because their children can visit them only on weekends. They are having only microwave meals, because that is all their neighbours or family friends have the time to buy in for them. That is not what this country’s older and disabled people deserve.

I am glad that many hon. Members have mentioned the immense pressure that the state of our care system puts on unpaid carers. Wherever the Government pull back from funding social care properly, the UK’s millions of unpaid carers have to step in. As we have heard, that includes young carers in the constituency of my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard). It is very important to identify and support those young carers. I have tried three times to bring in legislation, including to identify young carers. The Minister’s predecessor did not support it, but we could still do it. I might give the Bill to my hon. Friend so that he can resurrect it.

It is a dire picture, including for young carers. Half of unpaid carers now spend 50 hours a week providing care, while 38% spend 100 hours of every week caring. One quarter of carers have not received any support, either for themselves or for the person they care for. Two thirds of carers say that they do not get as much social contact as they would like with other people. More than eight in 10 say that they cannot spend time doing things that they enjoy or value, and 40% of carers say that they have not had a day off for more than a year. In fact, a recent Carers UK report noted carers saying that if they had a respite care break, they would use it to visit their own GP for a medical appointment, which is very sad.

Even for the smaller number of people who manage to get a social care package, cuts mean that the care provided will not be of the quality expected. One in five social care services has been rated by the Care Quality Commission as either “inadequate” or “requires improvement”. The number of complaints to the local government ombudsman about social care provision has trebled since 2010, rising to more than 3,000, and two thirds of those complaints are upheld. There is very much wrong with our system. I find it deeply concerning that one in five care homes, housing as many as 9,000 older and disabled people, are now rated as unsafe.

These are not services that any of us would like a family member to have to rely on. The situation can mean care homes that are so unclean that residents are at risk of infection, or residents being at risk of malnutrition because nobody is monitoring what they are eating. Care in one’s own home can mean visits by staff who have not been subject to basic checks or who have not completed any training. It can mean staff being so rushed that they do not have time to take off their coat while they are getting people up and dressed. The reality is that some care providers cannot provide high-quality services with the funding available; sadly, other providers choose to protect profit margins rather than the people who use their services.

That issue is clearest in the social care workforce. There are 1.4 million people—or there would be, if the vacancies were filled—working in social care. These people provide vital support day in, day out, but they simply do not get the respect they deserve for the work they do. More than a quarter of those care staff work for a minimum wage, and the same proportion of the workforce are on zero-hours contracts. It is no surprise therefore that there are 110,000 vacancies in the care sector. Those important issues have been touched on by many Members in this debate.

Rather than providing the empathetic care that they want to offer, care staff are often reduced to visits lasting 15 minutes or less. They must rush through their tasks with barely any time to talk to the person they are visiting. This deterioration in the quality of care is the result of nearly a decade of cuts, care staff stretched to breaking point and services that barely deserve to be called “care”. Hundreds of thousands of people have to go without basic support.

[Melanie Onn (Great Grimsby) (Lab)]

My hon. Friend is making an excellent speech and paints a picture of social care in this country. On 15-minute visits, does she agree that the issue is not just the time limit but the ever-changing individual presence? With vulnerable people, consistency of care and the ability to build up a relationship are equally important.

--- Later in debate ---

[Barbara Keeley]

My hon. Friend is absolutely right. For people with dementia and learning disabilities, seeing a familiar face every day can be crucial.

We cannot allow this crisis to continue. We must see action to ensure that everyone is able to access the care that they need to live with dignity. That is why Labour has announced that we would introduce free personal care for all older people who need it and expand such provision to working-age adults as soon as possible. That would end the scandal of people having to sell their home to pay for basic care. We will fund social care in the only fair, sustainable and understandable way—through general taxation. That is how we fund our NHS and our schools, and it is how Labour will fund our national care service.

Before we can build this new system, we must also repair the damage caused by years of budget cuts. We will invest £8 billion in more care packages, in improved training and in better community support. The apprenticeship levy is not enough for training; skills for care should be better funded.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Barbara Keeley]

I do not have time.

A few months ago, we pledged £350 million a year for community resources, aimed specifically at helping to bring autistic people and those with learning disabilities out of in-patient units—over 2,000 of them—in which they are trapped. It is a scandal that we do not have the social care and community resources that are needed to prevent people being trapped in abusive care. Time and again, the reason given for people being in those units is that there is no resource in the community. My hon. Friend the Member for Plymouth, Sutton and Devonport has spoken about the burden that falls on social care authorities if they end up with a very expensive case. We have to get round that.

We can fix the crisis in social care only by properly funding the system, as the Labour plans will do. Two years after the Conservatives’ disastrous 2017 manifesto plans, which were later dropped, we are still waiting to hear what they will do. The Government’s promised Green Paper has been delayed and delayed, and now it looks to many—including many in this Chamber—as if it has been dropped altogether. The hon. Member for St Ives (Derek Thomas) mentioned how embarrassing that was. It is not just embarrassing; people lose hope waiting for the care they need.

A cap on care costs, which would stop people facing catastrophic costs, and for which we legislated, was ditched by the Government in December 2017. I am sorry to say that instead the Government have provided only small, one-off cash injections—sticking plasters—rather than the long-term funding settlement that social care needs. Will the Minister tell us where the Government’s proposals on social care are? If the Government want to resolve the crisis that their funding cuts have created, as I hope they do, why have they constantly kicked social care funding reform into the long grass? It is time for a solution to the crisis that this Government have created. Labour Members have pledged a way to solve the crisis, which in itself gives hope to many people who need social care.

Mental Health Act 1983

Baroness Keeley Excerpts

Thursday 25th July 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hanson, as it was to serve under Ms Buck earlier. I join others in congratulating my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) on securing this debate and echo their comments about the moving way in which he opened the debate. He started with his own family experience and then made a very powerful speech. I am sorry that you missed it, Mr Hanson. We heard contributions from the right hon. Member for New Forest East (Dr Lewis) and the hon. Member for Plymouth, Moor View (Johnny Mercer), as well as my right hon. Friend the Member for North Durham (Mr Jones) and my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Stockton North (Alex Cunningham). I am sure we all want to thank Sir Simon Wessely and his team for their work in reviewing the Mental Health Act.

The wide range of perspectives in the debate is welcome. It shows how wide-ranging the work is and how it touches on so many different aspects. One thing on which we can all agree is that the current Mental Health Act is not working. It is too often overly restrictive and fails to give people the support they need, as we have heard. Before I discuss the contents of the review, I want to mention why it is so important that we get this right, because being detained under the Mental Health Act, although it is sometimes life-saving, can be immensely damaging if it goes wrong, and we have heard already about how it can go wrong. I, too, am going to talk about a case: the case of Matthew Leahy.

On 7 November 2012, Matthew was admitted to a mental health hospital under the Mental Health Act. On 15 November, he hanged himself in his room at the hospital. The Parliamentary and Health Service Ombudsman has identified failures in Matthew’s care that may have led to his death, but they have taken seven years to come to light. My hon. Friend the Member for Croydon North (Mr Reed) talked about delays. They are exasperating, concerning and impossible for families who have to live with the loss of a loved one. Some of the failures in Matthew’s case were truly shocking. He complained that he had been raped in the mental health hospital. The ombudsman found that had Matthew not phoned the police himself, it is not clear that staff on the unit would have done so. Anyway, the police failed to take action.

My hon. Friend the Member for Bermondsey and Old Southwark referred to the level of sexual assaults on patients—an appalling record, as reported by the CQC. It should be of deep concern to us that that is happening. Staff also failed to act when Matthew reported, and he had physical injuries that could have been caused by rape, which should have been a major cause of concern. It is also deeply concerning that his care plan was falsified and other paperwork was lost. Although he had a care plan for his first 72 hours in the unit, staff produced a fuller care plan only after he died. That that should have happened when he was apparently under the protection of the state is unacceptable. We must ensure that we know what went wrong in his and other cases of death so that we can act to prevent it from recurring.

There have also been issues with the subsequent investigation. The initial report by the NHS partnership contained inaccuracies about how Matthew’s care had been planned. Across the board, the partnership failed to learn the lessons of Matthew’s death, which compounds the tragedy of that young man taking his own life while he was in the care of the state. As my hon. Friend the Member for Croydon North has said, there should be independent investigations of deaths that occur in mental health hospitals. I know that the Minister has been asked before to set up an inquiry into Matthew Leahy’s death. I ask her to commit to doing so now, so that we can learn the lessons from that tragic event and prevent such a thing from happening again.

Sir Simon’s recommendations will not solve every problem with our in-patient mental health services, but the Opposition believe that they would improve them, and would remove many of the major issues with the Mental Health Act. Although we have a little time, we cannot focus on all 154 of the recommendations. I just want to discuss the principles that he felt should be central to the operation of the Act. My hon. Friend the Member for Bermondsey and Old Southwark outlined those four principles in his opening speech.

The first principle is choice and autonomy. Of course, it should go without saying that, wherever possible, we give people control over what is happening to them. I am glad that the Government have committed to introducing advance choice documents. Those will be central to ensuring that people can exercise choice over what happens to them. We have heard in many of today’s speeches why that is important. I ask the Minister to confirm today, if she can, when those plans will be brought forward. There will be instances when people cannot exercise the choice themselves, so Sir Simon’s proposals for the new nominated person role and increased use of advocates will ensure that in those circumstances people are still able to influence their care.

During the passage of the Mental Capacity Act 2019 there was a great deal of discussion, involving my hon. Friend the Member for Stockton North, about advocacy. We must ensure that local authorities are fully funded to provide those vital services. It would be a travesty if someone were denied a voice because of budget constraints at their local council. Can the Minister tell us whether the Government will provide additional funding for advocacy to ensure that that does not happen?

The second principle is that of least restriction. It seems self-evident that we should try to ensure that people retain as much of their freedom as possible, but we have heard of the number of ways in which that does not happen. It might mean supporting people to enter mental health hospitals voluntarily rather than their being detained, or ending the use of seclusion and segregation and the terrible cases of restraint that we heard about.

The third principle is therapeutic benefit. Again, it should be self-evident that everything done under the Mental Health Act should be clearly aimed at helping the person in question to recover. If it is not, what is the justification for detaining them? My hon. Friend the Member for Bristol East talked about people with autism and learning difficulties in mental health hospitals, and we have to question how often their detention for periods of five years, or five and a half years, helps them at all, and whether any of what happens to them could be talked about as treatment.

Finally, Sir Simon emphasised the importance of treating the person as an individual. In particular, that section of the review focused on the current experiences of young people and people from BAME communities in mental health facilities. We have heard about that in speeches today. My hon. Friend the Member for Bristol East talked about the lack of support for families of children with out-of-area placements. Sir Simon recommends that, while those still exist—my party pledges to do away with them—financial assistance should be available when a young person is admitted to a placement away from their family. We are committed to ending inappropriate out-of-area placements, but my hon. Friend the Member for Bristol East talked about a case where, if a facility was the only one that would be able to provide the care, a parent would choose it. However, that support and financial assistance must be available. It is not right to cut off a young person’s support network when they need it most.

My right hon. Friend the Member for North Durham also talked about why the powers under the Act are being used more with people from BAME communities, and we must focus relentlessly on the facts.

[Mr Kevan Jones]

Does my hon. Friend agree that we cannot leave the matter where it is? We need an inquiry into it. Sir Simon calls for more research, but unless we have an inquiry we will not be able to get the policy changes to identify what is, clearly, going wrong.

--- Later in debate ---

[Barbara Keeley]

Indeed, and what my hon. Friend the Member for Croydon North has said, today and in speaking about the Mental Health Units (Use of Force) Act 2018, has helped us to focus on the issue of the number of times when young people—particularly from BAME communities—are subject to the Mental Health Act, segregation and restraint. It is not acceptable. None of those cases is acceptable, but it is totally unacceptable if one group seems to be singled out in society for such measures—particularly tragically in the case of Seni. I applaud my hon. Friend the Member for Croydon North for taking that one case and pushing it through to legislation, and the Minister for supporting it.

All the principles I have outlined are important. It is only by following them that we can ensure that a reformed Mental Health Act will work in the interest of those it is designed to help: people with mental health conditions. Will the Minister confirm whether the Government will accept recommendation 1 of the review, that the four crucial principles be put on the face of the Act? We had a bit of a battle during the passage of the Mental Capacity Act 2019 in getting the Minister to accept that things should be on the face of the Bill, but things such as advocacy are pretty important, and it will not be acceptable if they can be overlooked or treated as a budgetary problem.

[Alex Cunningham]

Does my hon. Friend agree that one of our particular concerns was the way that the proposals related to young people and the fact that although there appeared to be safeguards that might look after adults, the protection for young people, and provision to give their families the necessary help to support them, was thin?

[Barbara Keeley]

Indeed, and we did try valiantly to get the Minister to accept amendments, but she would not. There is concern. It is a good thing to include 16 and 17-year-olds in the legislation, but not if there are no safeguards. There are real worries. In many cases that I have looked at, and where I continue to try to support families, parents feel ignored and helpless. They feel that mental health hospitals act without reference to the people who know the young person best.

One area in which Sir Simon did not make recommendations was the definition of a mental disorder. Specifically, he concluded that it was not appropriate for his review to decide whether autistic people should remain within the scope of the Act purely because of their autism. I agree with Sir Simon that that is a complex topic, but we should not let it be an excuse for inaction. Autism is not a mental health condition, but the Mental Health Act treats it as though it is. As a result, there are 1,150 autistic people in in-patient mental health facilities. A proportion of them will have mental health conditions that require treatment, but it should never happen that someone is detained purely because they are autistic or because they present with behaviour that could be challenging. I know of many cases where that is happening.

We all saw the deeply disturbing BBC “Panorama” programme on Whorlton Hall, which revealed the shocking treatment that autistic people were subjected to while detained in mental health hospitals. I am sure we would all agree that that treatment is simply unacceptable, but we must do more to prevent it. The best way of doing that is to ensure that people are not put into in-patient environments unnecessarily. If someone does not have a mental health condition that is being treated, they should not be held under the Mental Health Act. Can the Minister confirm that when the Government bring forward the proposals in the review, they will go further than Sir Simon and commit to ending the outdated practice of treating autism in the same way as mental health conditions?

It is eight months since Sir Simon’s final review was published, although it does not seem like it. He made more than 150 recommendations. We did not expect the Government to respond to all of them straightaway, but in eight months they have responded to fewer than a dozen recommendations. The other 140 apparently have to wait for the White Paper. We have heard about more reviews from the new Prime Minister this morning. All we seem to get is more rounds of consultation and more reviews, but Sir Simon consulted widely during the review. His review was informed by the experiences of 988 people, including 467 service users—the inclusion of service users is praiseworthy—and evidence from 75 organisations and 90 professionals working in the field. I hope that that included social workers. I thank my hon. Friend the Member for Stockton North for making such a strong case for the involvement of social workers; I agree with him.

The only reason I can see for further consultation would be if the Government were planning to go further on some of the recommendations than Sir Simon did—for example, in removing autism from the scope of the Act. Can the Minister confirm whether that is the case? If not, can she tell us why she feels that the consultation that Sir Simon carried out is insufficient? Surely it would be better to publish a draft Bill and carry out pre-legislative scrutiny in the normal way than to do what has become known as kicking the can down the road. Six months ago we were promised a new set of guidance on the Mental Capacity Act, but that has not been mentioned at all since then. Those are the things that should be coming forward.

We have also been told that there will be a mental health White Paper to implement the findings of the review—we find ourselves waiting for Green Papers and White Papers. Someone could be forgiven for looking at that and thinking that the Government simply do not care about people waiting for much-needed reforms. I know that the Minister cares, but do her Government care? Can she give us a date for the publication of the Government’s mental health White Paper? It is popular to say a season or the end of the year, but a date is more useful to work with. I realise that it is a time of great uncertainty for Government Ministers—I hope that we will see this Minister in her place in future—but a firm date would help us to hold the Government to account should they let their focus slip.

People with mental health conditions have been let down for too long. The review represents a rare opportunity to make changes that have cross-party support—the consensus in this debate has been encouraging—to a system that does not work properly. I hope that the Minister, and the incoming Government, do not waste this opportunity by delaying it further, which would leave people stuck in a system that is harming, not helping, them.

--- Later in debate ---

[Jackie Doyle-Price]

On mixed-sex wards specifically, I cannot tell my right hon. Friend what the proportion is, but we are ensuring that the guidance on sexual safety on mental health wards is being rolled out. I will write to him specifically on that, if he will indulge me.

[Barbara Keeley]

An important point is that Matthew Leahy phoned the police to report the rape, but they concluded that it was part of his delusion—that was the reason they gave for not taking action. In the case of Whorlton Hall, the police also did not act on reports of assault, although assault was clearly going on. The Minister needs to take that problem up with the Policing Minister. It is not acceptable that what someone says is ignored if they are autistic or detained under the Mental Health Act 1983, because the level of sexual assault is disturbing, as my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) said.

[Jackie Doyle-Price]

That is an excellent point, and it plays into a general prejudice that people who are in detention are just an inconvenience to be managed. In the context of Sir Simon’s review, the whole ethos that any reform we make should be about empowering patients brings with it obligations to challenge other aspects of the system, not just the care providers. The hon. Lady is right to say that I need to take that up with the Policing Minister, which I will do as part of rolling out our preparations for the White Paper. I understand the hon. Lady’s lack of confidence when I say that the White Paper can be expected before the end of the year, but that is certainly my ambition, notwithstanding the fact that I know she has been waiting rather a long time for another paper that she was promised.

I can reassure the hon. Lady on the extent of the work that Sir Simon has done and the engagement we have had, especially with service users. Rather like the hon. Member for Bermondsey and Old Southwark, those service users shared with us their personal experiences, often reliving significant distress. Given that they have participated and that we have raised their expectations, we would, to be frank, be letting them down if we did not address that. I do not think that would be in any way forgivable, so, as long as it is on my watch, we will be pushing ahead.

As the hon. Member for Bermondsey and Old Southwark said, we are dealing with legislation passed in 1983, so although this appears to be a once-in-a-generation opportunity to reform this legislation, I hope that that is not the case. The situation is probably more symptomatic of the fact that we have not given this matter as much attention as it deserves, but clearly that has changed. The world has changed in terms of how we debate mental health, and that is welcome. Chiming in with the discussion we have had today, I am keen that we take this matter forward with consensus.

I pay tribute to the leadership that Sir Simon has shown in this review. As well as not ducking the controversial aspects of examining the legislation, he has engaged in dialogue and dealt with them in such a way that it is accepted that Members, peers, service users and professionals need to consider them. I am incredibly grateful for what he has done.

We talk more about mental ill health now, but when it comes to severe mental illness—the hon. Member for Bermondsey and Old Southwark spoke about schizophrenia —that is something that reveals incredible prejudice in people. As we have heard, if someone is able to manage their condition, they can live a full and independent life, but the key is being able to manage the condition with the appropriate support. We still have a lot to do in educating the public and society about the real impact of severe mental illness.

There are so many issues, but I will try to address them all in the time I have. The hon. Member for Bristol East (Kerry McCarthy) asked about out-of-area placements for people with autism and learning disabilities. I must say that this is something that really bothers me. Far too many people remain in institutional care and in out-of-area placements, and nowhere is that more true than in the field of learning disabilities and autism.

It is interesting, once we dig under the issue, to see that we have been very successful in getting people with learning disabilities out of in-patient care and into the community. However, that has been matched by a bigger increase in the number of people with autism finding their way into in-patient care. That tells me—I do not think this will be a surprise to anyone in the Chamber—that we are not doing enough to diagnose autism early enough, and as a consequence we are not equipping people with the skills to be able to live independently.

The ultimate result is that we end up putting people in in-patient care. Quite often, those people are forgotten about and it becomes very expensive to keep them there, so not only are we failing people by not having services for them early enough, but we are adding significant cost to the taxpayer and, frankly, doing harm, because the longer those people stay in in-patient care, the more their ability to live independently diminishes. As far as I am concerned, that is a major failing that we need to address.

[Jackie Doyle-Price]

I agree with every word that the hon. Lady says. One of our expectations of the new mental health support teams that we are rolling out into schools is that they will be able to work with schools and to spot people who might be in trouble. She is right that, with girls particularly, autism is under-diagnosed, and by the time the challenges start to have an impact on mental health, it is much more difficult to give people appropriate support. Early diagnosis is key.

I am pleased that we are now setting up a unit within the Department of Health and Social Care to look at neurodiverse conditions and what more we can do to improve service provision for them. I am also pleased that NHS England shares my concern about this and that we can expect more work on it, but there remains a lot to do and I do not shirk from admitting that.

[Barbara Keeley]

There is also the financial difficulty that my hon. Friend the Member for Bristol East (Kerry McCarthy) referred to. Private hospitals that autistic people and people with learning disabilities end up in tend to be very expensive—we know that the placements can be as much as £730,000 a year. The answer is to fund placements in the community. Years ago, when we were moving people out of long-stay mental health institutions, there was a dowry system. The Government do not have a dowry system to help with this, so Transforming Care failed because there was no mechanism to transfer funding from the NHS, which is taking the hit on cost, to cash-strapped local authorities. If local authorities are to continue being cash-strapped, and I hope they are not, some mechanism is needed there. My party has pledged to put in £350 million a year of transfers to make that happen. Does that idea recommend itself to the Minister? I know she is bothered about this.

--- Later in debate ---

[Jackie Doyle-Price]

It is a fantastic school. It was amazing how the principle of mental wellbeing ran through the whole school from walking in to the point where the kids pick up a sticker that reflects their mood and put it on the whiteboard, so straightaway the teacher could look out for those who were feeling a bit distressed. The other amazing thing was the teaching assistants, who instead of being based in each classroom all had specialisms and did lots of one-to-one activities outside the classroom. Even more importantly, there was a facility to reach out to parents pre-birth—obviously families tend to go and see schools. I was hugely impressed, and that goes to show how we should be encouraging innovation and imagination with regards to these services. In fact, it is probably the poster organisation to show that mental health is not everybody else’s problem; it is all our problem. The ability for such engagement in school is fantastic, so well done Charles Dickens Primary School.

Members will be pleased to know that Sir Simon Wessely has worked with the sector, and interest groups in the sector, in coming up with his proposals. I am also in regular dialogue with them to discuss the principles. In the spirit with which we all approach reform of the Mental Health Act, we obviously want to keep people safe, so there needs to be the power for potential detention, but most importantly we need to protect the rights of patients and empower them. That is the principle that I really want to underline.

[Barbara Keeley]

We have moved past the point of discussing people with autism and learning disabilities. I take on board the Minister’s concern, but I wonder whether she could answer my question. Under a reformed Mental Health Act, is she looking at—or minded to look at—changing how people with autism are included as if they have a mental health condition? That is important to a lot of people, and Sir Simon did not rule on it.

[Jackie Doyle-Price]

We need to look at issues about autism in the round. The hon. Lady is right that it is currently treated as a mental health issue for the reasons outlined by the hon. Member for Bristol East: it is not diagnosed until a mental health issue materialises. That is really the issue. I would like us to use the 10th anniversary of the Autism Act 2009 to reboot our approach to ensuring that we are looking out for people with autism. In a way, we must go through the same journey with autism and learning disabilities as we have with mental health. That does not really answer the question from the hon. Member for Worsley and Eccles South.

[Barbara Keeley]

It is about the legislation.

[Jackie Doyle-Price]

As far as legislation is concerned, ultimately people with autism who are suffering from mental ill health will be detained under the Mental Health Act. Perhaps we ought to pick up how that interacts with other legislation as we develop the White Paper. The overlap is a clear problem.

I have paid tribute to Sir Simon Wessely. We are all about making sure that our reforms deliver genuinely person-centred care. We should be removing coercion and control as far as we can.

My hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) talked about Georgi Lopez, who addressed the all-party group and whom I had the pleasure of meeting. She tells a compelling story about her contrasting experiences. She readily concedes that on one occasion being detained under the Act was the best thing that could have happened to her, but on another occasion it did her genuine harm. In fact, Members who read Frank Bruno’s book will find exactly the same story. It is almost as if once someone is on that pathway and under detention, they will always be seen through that prism. We need to tackle the underlying prejudice. People who are suffering from mental ill health are vulnerable; they are not an inconvenience. Any services provided by the state need to be working with them to support them, not to do them harm.

Our overall objective when we asked Sir Simon to look at the Act was to reduce the rising number of people detained under it. I hope that underlines the spirit with which we are approaching the inquiry. We also asked him specifically to address the disparities in how the Act is used, highlighting in particular the impact on black and ethnic minority groups, but also on women. It is of great credit to him that he went much further than that and led a full review of the entire Act. Again, that raises the expectations on me to deliver fundamental reform—but that is fine; it is what I am here to do. He did so with such speed, and having taken so many with him, that he has provided exactly the right conditions to approach reform.

Sir Simon built relationships with service users and carers, and I am riding on the back of them. I meet those people regularly to hear directly from them about their responses to his recommendations. We will continue with that. I have been struck by some of the experiences shared with me by service users and family members, which bring home how disempowering it can be. I often talk about the arrogance of medical professionals who, when someone turns up and says, “Fix me,” send them along. That dismissiveness can be more so in mental health than anywhere else. We need to ensure that we put in a regime that treats people with dignity and respect.

At the heart of this issue, the current Act has much too big a disempowering effect, which does too much to remove people’s autonomy and not enough to support their decision making and influence over their own care. It is dehumanising. We should look at detention as the last resort, because it does genuinely do harm. That is not to be critical: staff will act with the best of intentions, but a lot of it depends on culture. When Georgi Lopez shared her experiences, she talked about the two very different cultures of the organisations in which she was detained. When the CQC visits such places and assesses whether they are well led, it must assess the culture and whether patients are genuinely empowered.

I do not think we should duck the fact that sometimes we will have to detain people for their safety and that of others, but we need to ensure that we have the right guarantees in place. I am struck by something that Sir Simon always says: from the moment of detention, release planning should start there and then. A credible care plan is all about getting people back out and re-empowered. It should be based on consent and empowering the patient.

As has been mentioned, Sir Simon’s report contains 154 recommendations. I will work with the Ministry of Justice on a joint White Paper from both Departments, which will come forward by the end of the year. We have already started to implement the recommendations that we can, and I hope that Members are reassured by how, last week, the previous Prime Minister re-emphasised her commitment to making sure that we tackle the issues regarding black and ethnic minority detainees. I know she will continue to have a full interest in these issues from the Back Benches. I reassure the hon. Member for Worsley and Eccles South that if she sees no sign of a White Paper, she has a good ally on the Government Benches to hold the Government’s feet to the fire. I look forward to engaging with all hon. Members on those recommendations when we come forward with our White Paper, for which we should also consider the issues that have been highlighted during the debate.

As I have said, we want to modernise and ensure that people who are detained under the Act receive better care by improving patient choice and autonomy in their treatment. We will introduce statutory advanced choice documents to enable people to express, in advance of detention, their view on the care and treatment that works best for them.

It is important to talk about the role of family, because we have agreed that patients should be able to identify a nominated person who will have the power to look after their interests under the Act. At the moment, the next of kin is the default. I have heard compelling evidence from patients who have said that that is not always appropriate. Family members can often be a source of abuse or additional pressure and harm, so patients want to be able to nominate someone, which seems extremely sensible. I recognise that that will cause some controversy.