Stroke Treatment

Baroness Wheeler Excerpts
Wednesday 27th March 2024

(1 day, 17 hours ago)

Lords Chamber
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Asked by
Baroness Wheeler Portrait Baroness Wheeler
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To ask His Majesty’s Government what steps they are taking to improve treatment and care for those of working age who are affected by stroke.

Lord Markham Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
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The Government are taking three major steps to improve treatment and care for strokes: first, a whole series of prevention measures to help avoid a person having a stroke in the first place; secondly, an updated and evidence-based stroke care pathway using AI, the latest technology in stroke rehabilitation, to maximise the chances of recovery; and, thirdly, post-stroke rehabilitation care and support to maximise the chances of recovery.

Baroness Wheeler Portrait Baroness Wheeler (Lab)
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I thank the Minister. We know that one in four strokes happen to working-age people, and that it is also a leading cause of disability. Speech and physiotherapy support after stroke is therefore vital, because it helps recover key skills such as motor functions and cognitive ability, and it can be the difference between returning to work and not returning, or giving up altogether. With serious delays across the country in getting people to hospital and scanned, and in providing the speech and physiotherapy that is needed, and with chronic staff shortages across the country in hospital and community settings, good care is just not the reality for thousands of stroke sufferers. Some 40,000 people missed out last year on essential six-month, post-stroke reviews. When will the up and coming major conditions strategy be published? How will it specifically support effective stroke rehabilitation and recovery, and what timescales will be set for that?

Lord Markham Portrait Lord Markham (Con)
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I thank the noble Baroness for her tireless work in this area. As she quite rightly points out, aftercare and rehabilitation is the vital third leg of the three-step process I spoke about. In the major conditions strategy we talk about how we are basing it on a national model for an integrated stroke care service, based around personalised, wraparound care, for as long as is needed, with reviews every six months. I have seen some fantastic examples when I have been out and about, such as in Royal Berkshire and Leighton. The proof of the pudding is in the results; we have seen the number of people who are achieving a full recovery increase from 16% to 48%. That is the target we are going after.

Sodium Valproate and Pelvic Mesh

Baroness Wheeler Excerpts
Monday 25th March 2024

(3 days, 17 hours ago)

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Lord Markham Portrait Lord Markham (Con)
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Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.

Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, the Patient Safety Commissioner’s report is all the more valuable because it is drawn from patients’ experiences, including physical, psychological and emotional impacts and their daily struggle with accessing health and other key services such as social security benefits and special educational needs support for the valproate-harmed children they are raising. What is being done to support mothers and families as they cope with the indecision and delay over the Government’s response to the commissioner and await the vital support they need?

Lord Markham Portrait Lord Markham (Con)
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We have completed four of the initial recommendations in the report of my noble friend Lady Cumberlege, and another three are in process. The most important of those, to answer the noble Baroness’s question, is the setting up of these nine specialist centres which can provide the support needed, not just in terms of redress surgically or treatment-wise but in terms of the support that people need to help them cope with the issues.

NHS: Dementia Commission Report

Baroness Wheeler Excerpts
Thursday 22nd February 2024

(1 month ago)

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Asked by
Baroness Wheeler Portrait Baroness Wheeler
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To ask His Majesty’s Government what actions they are taking in response to the NHS Innovation and Life Sciences Commission’s Dementia Commission: 2023 Report.

Lord Markham Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con) (Con)
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We welcome the Dementia Commission: 2023 Report and are taking steps to address each of the recommendations. The Government remain committed to improving dementia diagnosis rates and providing high-quality care and support following a diagnosis. The Government have committed to double funding for dementia research to £160 million per year by the end of 2024-25. We welcome all research that will help us to improve how we diagnose and care for people with living with dementia.

Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, the commission’s wide-ranging and comprehensive report is very welcome, but it heavily reinforces the urgent need for radical change in the way we diagnose, treat and care for dementia patients and support their families and carers. To ensure timely, speeded-up diagnosis, the training of primary care practitioners in dementia-specific symptoms and diagnostic methods is crucial. What steps are the Government taking to strengthen general practice and community pharmacy in this regard so that individuals with dementia can receive appropriate care and support as early as possible?

Lord Markham Portrait Lord Markham
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I thank the noble Baroness for this Question. As ever, I have found that one of the real strengths of being in this position is that the questioning here makes me explore an area. This has been another area which I have enjoyed and found fascinating. Early detection is absolutely key, and what I have been learning from that is that, yes, we need to arm primary care staff and a potentially vital front line in terms of primary care staff are opticians, because retinal scans are a really good way to early diagnose. Apparently, people more than ever will have a frequent eye check. I have pulled together a panel to understand this more, and I invite the noble Baroness and others so that we can look at the latest research and really understand this more.

Care of Critically Ill Children

Baroness Wheeler Excerpts
Monday 29th January 2024

(1 month, 4 weeks ago)

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Lord Markham Portrait Lord Markham (Con)
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The noble Baroness is correct: the number of young people with life-limiting conditions has gone up, from about 33,000 around 2001-02 to about 87,000 more recently. A lot of that is, conversely, good news in that we have more and more treatments that can keep these children alive for longer. Clearly, that requires the wraparound-type service that the noble Baroness is talking about. It is the responsibility of the ICBs to provide that; I will provide details of the progress of individual ones when we meet.

Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, I emphasise that the task force recommended by Nuffield to oversee its key recommendations needs to get to work urgently. The family-focused research work with parents, including parent carers, about their experiences of shared decision-making with healthcare professionals on care and treatment, is vital, as is the comprehensive information and guidance for parents and staff that is called for across the 16 Nuffield recommendations. What timescales are the Government envisaging for this crucial work to commence and become operational, including guidance to clinical and ethical committees?

Lord Markham Portrait Lord Markham (Con)
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My understanding, now that the task force composition has been set up, is that this will be arranged shortly. I completely agree with the noble Baroness that these are important, as well as often heart-wrenching, matters, so urgency is required. As I have said, good progress has been made in a number of areas. Already, the MoJ is setting up a round table on this. The regional conflict managers have been established. We have training courses online so that communication can improve. A lot is being done, and the task force will push that forward further.

Dementia

Baroness Wheeler Excerpts
Thursday 18th January 2024

(2 months, 1 week ago)

Grand Committee
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Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, I thank the noble Baroness, Lady Browning, for this debate and for giving us the valuable—if nowhere near long enough —opportunity to shine a spotlight on many key issues that were at the heart of the scrutiny of the social care cap provisions of the Health and Care Act. In particular, I note its impact on people with dementia and our concerns about how NHS continuing healthcare operates arbitrarily with regard to people receiving free care or having to pay for it themselves, as well as how we move towards genuine parity between the NHS and social care and how good social care is vital for people with dementia and their carers. The current social care system is just not set up to meet these needs.

I have three points. First, on carers, the 60% of people with dementia drawing on care at home are being cared for by their spouses and relatives—mostly unpaid carers, as my noble friend Lady Pitkeathley again reminded us. As a carer myself, I meet many unpaid carers locally who are daily, for 24 hours, looking after loved ones at various stages of dementia, most of them with breaks of only a few hours a day or a week. The carer role is often rewarding, but it is also relentless for many. We urgently need a comprehensive national carers strategy, and I look forward to the Minister’s explanation of why we do not have one.

I turn, secondly, to care costs and the devastating impact of the financial costs for those living with dementia and their families—an average of £100,000 is spent by individuals over their lifetimes. Despite extensive modelling at the time of the 2022 Act showing that just 19% of people with dementia would reach the care cap, and despite the disproportionately detrimental impact on dementia sufferers in some of the poorest parts of the country, it would have made a start as part of a wider package of reforms that Labour argued for. Instead, the new reform money has been allocated largely to propping up the existing social care system. What action are the Government taking to tackle the staggering care costs faced by individuals with dementia in the absence of the care cap implementation? Can we please be updated on the Government’s plans for social care charging reform?

Thirdly, on NHS continuing care, the excellent Lords Library briefing reminds us of the CHC’s ill-defined primary health need assessment criteria and the huge inequities in the current system, particularly relating to the funding—or lack of funding—for care costs for dementia, either in the home or in care homes. The Alzheimer’s Society has pointed out that NHS England’s stats do not record diagnostic details, so there is no way of knowing how many people with dementia receive CHC or have been turned down. There is also no way of making assessments or comparisons from which transparent criteria could be developed. There are also huge geographical variations in the length of time taken to assess claims and handle appeals. Can the Minister update the House on what work is being undertaken to improve the transparency of CHC processes, procedures and decision-making, and also to address the urgent problem with assessing the eligibility for CHC of people with dementia?

Noble Lords’ priorities for dementia today have focused on urgent improvements to diagnostic rates, speeding up the introduction of vital modifying drugs to help slow down disease progression, investment in the dementia diagnostic infrastructure, and rebuilding the workforce and addressing the 152,000 vacancies in the adult social care workforce. This needs to be a fully comprehensive plan that is fully integrated with the NHS workforce plan if we are to avoid exacerbating the already chronic social care workforce crisis that we have.

Care Home Staffing

Baroness Wheeler Excerpts
Thursday 18th January 2024

(2 months, 1 week ago)

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Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, the Minister told the House on Tuesday that hospital discharges have recently been reduced by 10%. However, he knows that this figure goes up and down as some people leave hospital while more come in at the other end, and it depends on which period of time is measured. From July to November last year there was in fact a steady rise, so we need to be specific about dates when we talk about making progress. On the care settings that patients are being discharged to—care homes—how are the Government keeping track of how the extra funding allocated to deal with chronic local staff shortages has supported the discharge process? Will it continue in the longer term?

Lord Markham Portrait Lord Markham (Con)
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The noble Baroness is correct that the numbers are a result of flow. We are seeing thousands more people hospitalised through A&E, so the fact that we have managed to reduce the back end indicates a positive way forward. To measure precisely what the noble Baroness asked about, we have now set up a kind of flight control system for each integrated care board, as I have mentioned, which looks at data across the system to monitor the number of hospital beds and places needed on a case-by-case basis. The noble Baroness is absolutely correct that having that data is key.

Adult Social Care: Staffing

Baroness Wheeler Excerpts
Tuesday 12th December 2023

(3 months, 2 weeks ago)

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Lord Markham Portrait Lord Markham (Con)
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I will absolutely clarify the number to the noble Lord in writing. It is of course a range, according to different local authorities, but I think we would all agree that it is a level that, as a percentage, is too high.

Baroness Wheeler Portrait Baroness Wheeler (Lab)
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The Nuffield Trust has called the NAO findings a

“damning indictment of the Government’s progress towards delivering social care change”.

To follow on from my noble friend’s question, the NAO points out that only 7.5% of the much vaunted £265 million allocated by the Government to addressing social care staff shortages and recruitment for 2023-35 has actually been spent, heavily impacted by the DHSC’s staff recruitment freeze. What specific actions are the Government taking to address this and ensure that the money they say is there is actually paid out?

Lord Markham Portrait Lord Markham (Con)
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There were five parts to the programme of reforms mentioned and the £265 million. There was international recruitment, which we have done; it has worked well, and we need to continue doing that. The second part was a volunteer programme, which, again, we have done and it is working well. Thirdly, there were digital skills passports, so that staff could swap from place to place and take their qualifications with them; we have done that. The two other things will take longer. The care workforce pathway is out for consultation. It will mean that people can have a long- term qualification that can get them into other professions as well, such as nursing. Lastly, there is the care certificate qualification. That takes time. Everyone knows that, for that qualification to be meaningful, it will take time to set it up. That is the key expense item. The digital platform is going to be launched next June, so it will be rolling out from there.

Mental Health: Children and Young People

Baroness Wheeler Excerpts
Thursday 23rd November 2023

(4 months ago)

Lords Chamber
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Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, this has been an excellent debate, with the knowledge and expertise we expect from across the House and from the very moving and comprehensive introduction from the noble Earl, Lord Russell, in particular on the consequences of family poverty for children’s and young people’s mental health. I too I congratulate the noble and learned Baroness, Lady Hale, on her powerful maiden speech. This is an appropriate debate for her to make her first Chamber contribution to the work of the House. We fully understand the reasons for the long wait to hear her.

As we have heard, this debate is taking place in the context of deep concern over the realities and consequences of the Government’s failure to provide for the genuinely “oven-ready” update of the Mental Health Act in their legislative programme for the rest of their time in office. We are also considering the mental health of children and young people, with the timely report from the noble Baroness, Lady Hollins, on the impact of the long-term segregation of people with learning difficulties and autistic people in mental health settings and in assessment and treatment units in the forefront of our minds.

The updated Bill provides clear provisions for improving recognition of and information on the legal rights of detained children and adults in terms of treatment choices and information that must be provided to them, their parents, carers and families. Patients’ choices would have been given greater weight and it would have been easier for people with learning difficulties and autism to be discharged from hospital. As we have heard underlined by the right reverend Prelate the Bishop of St Albans, the discrimination and inequalities that leave black people four times more likely to be detained under the 1983 Act would have been addressed.

I look forward to hearing from the Minister how these and other steps can be implemented in the absence of the framework of the new Bill and within the continued constraints, approaches and outdated attitudes in the current 40 year-old Act. How will care and treatment of people detained under this Act be “improved” by the “‘non-legislative commitments” that Ministers promised in the King’s Speech and in response to the continuing concerns raised by noble Lords about the impact and consequences of the Government’s decision?

The noble Baroness’s report is the subject of the short debate following this one, so we will revisit this later. I welcomed the Minister’s promise last week during the Oral Question on mental health to meet with the noble Baroness, my noble friend Lord Touhig and others from these Benches, including me, on this very serious issue.

As the House will know, Labour, if it wins the next election, is firmly pledged to reform the Mental Health Act in its first Session of Parliament in the King’s Speech. We have had the expert pre-legislative scrutiny by a Joint Committee on the draft Bill that should have been laid before us—the result of a huge amount of valuable and informed cross-party work and wide consultation among stakeholders. The Government have run out of time on this, and we stand ready, if elected, to meet this pledge, to recruit the thousands more mental health professionals to cut waiting lists and ensure more people can access treatment, and to guarantee treatment inside four weeks for anyone who needs it. We will create an open access mental health hub for children and young people in every community and expand mental health support in schools.

Many noble Lords have rightly underlined the importance of the workforce and the need for more staff across the range of CAMHS, including nurses, psychologists, therapists, social workers and other professionals who specialise in working with children and families. The CQC’s recent annual State of Care report identifies that almost one in five mental health nursing posts is vacant, and that this contributes to an overuse of restrictive practices in mental health settings and ATUs, including restraint, seclusion and segregation.

We have heard how the Government’s failure to honour their pledge on the mental health Bill has caused widespread consternation among key stakeholders, parliamentarians and the wider public—all of us expecting, after such a long wait, the Bill to be a key part of the King’s Speech. As the mental health charity Mind summed it up, the Government have missed the chance to

“overhaul the way the system works when people are in a mental health crisis”

and to

“prevent people being stripped of their dignity, voice and independence when they are sectioned”.

What are the Government’s plans for their formal response to the Joint Committee, which is still awaited? Will they detail exactly how the Bill’s provisions will be taken forward and implemented without new legislation? How, for example, will the proposed new duties on ICBs, local authorities and commissioners to strengthen community provision and services, the new powers for mental health tribunals to direct services in the community, and access to independent mental capacity advocates to support people with autism and learning disabilities, be acted on and enforced?

Emphasising the very serious consequences of the delay is important because the Bill is essential to help reset the culture, tone and attitudes that are needed right across the provision of services in NHS mental health settings, ATUs and local authority education and social care. The CQC’s annual report is the latest of many acknowledging the depth of the crisis in mental health. The continuing impact of the pandemic on the mental health of children—highlighted by every speaker today—the record number of urgent referrals of children to crisis teams, and the NHS Confederation’s estimate that, in the next three to five years, 1.5 million children and young people will need new or additional support for their mental health, as the noble Earl underlined, all reinforce the CQC’s warning that services across the country face one of their most challenging years.

Access to mental health services and the quality of care remain a key area of concern for the CQC, with providers struggling to keep pace with surging demand, alongside staffing shortages and a lack of capacity in community and in-patient care. Long waits for services for children and young people, and children presenting with more complex or specialist needs, are particularly emphasised as worse than before the pandemic.

This impact has been reinforced by speeches today addressing what is behind the huge numbers, with a unique set of pressures for a generation growing up: the pandemic, the cost of living crisis and ongoing global instability. A wide range of emotional and behavioural problems—anxiety, depression, self-harm, eating disorders, bullying at school, and children embroiled in gambling, as the right reverend Prelate underlined—are all in play at a time of ever-increasing demand for mental health services across the NHS and local government. In the last two years, the number of children and young people being referred for urgent support for eating disorders has increased by nearly three-quarters. The noble Baroness, Lady Hollins, spoke very movingly about the experience of a teenager she is aware of, and the noble Earl, Lord Russell, and the noble Lord, Lord Laming, both referred to this issue.

Under the circumstances, the crucial importance of early intervention in an individual’s childhood and teenage years to avoid future mental health difficulties has been emphasised by all noble Lords. The report in June this year from the LGA and Children and Young People’s Mental Health Coalition called for community-based early support hubs, along with a full national rollout of mental health support teams in schools and colleges. The recent Children’s Commissioner’s mental health annual briefing on early intervention is also an important contribution to charting the way forward on this; the noble Baroness, Lady Tyler, underlined that.

However, the LGA and the coalition warned that progress in expanding support provided to families, children and young people is at the risk of being undermined by

“a lack of coordinated vision and action both locally and nationally”.

Can the Minister tell the House what action, particularly cross-government, is being taken to address these concerns and to ensure that early intervention support will be provided?

Finally, earlier this year, the Government shelved their 10-year plan for mental health and well-being, with the focus instead on the major conditions strategy, wrapping up mental health with several physical health conditions. This was cited by the charity YoungMinds as having further delayed the Government’s action for young people’s mental health, which could have paved the way for reforms that support young people and reduce the prevalence of poor mental health. The noble Baroness, Lady Tyler, mentioned this important strategy, but the Government do not seem to fully understand the widespread concern across the mental health sector that abandoning the 10-year strategy has caused. Added to abandoning the mental health Bill, small wonder that they are questioning the Government’s commitment to mental health as a key priority.

We have had the interim report on the major conditions strategy, but it remains very unclear how the full strategy will address and reduce the highest number of open referrals to CAMHS of children and young people undergoing treatment or waiting to start care—as we have heard, a record 466,250 referrals in May. When will the full strategy be published? Can the Minister explain how it will address the issues that were expected to be outlined in the previous mental health and well-being plan?

Labour’s shadow Health Secretary, Wes Streeting, has stressed that Labour, if elected, intends to revolutionise mental health treatment in this country. We are determined to deliver on this and keep every promise we make. I look forward to the Minister’s response to this excellent debate.

Learning Disabilities and Autism: Solitary Confinement in Hospital

Baroness Wheeler Excerpts
Thursday 23rd November 2023

(4 months ago)

Lords Chamber
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Baroness Wheeler Portrait Baroness Wheeler (Lab)
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I too congratulate the noble Baroness, Lady Hollins, on securing this debate, which is a welcome opportunity to listen to the detail of her excellent report, following on from this morning’s wider mental health discussions, and to the hear the Minister’s full response to the report itself. It is also a good opportunity to focus on the long-term segregation of autistic people and people with learning difficulties, with help from the usual important and insightful contributions from my noble friend Lord Touhig and the noble Baroness, Lady Browning, who are always such strong advocates for improved services for this vulnerable group of people.

It is worth noting that some of the speakers today, including myself, were all participants in the then Mental Capacity (Amendment) Bill 2019, which replaced deprivation of liberty order with liberty protection orders, and along with it all expressing many concerns and reservations about how any new system would operate or could lead to substantial change. As we know, implementation of LPOs was subsequently deferred earlier this year, presumably because of the expectation that even the Government had then that a new mental health Act would be in place this year or next.

I welcome the Minister’s promise in last week’s Oral Question to meet on this matter with the noble Baroness, Lady Hollins, and others, including myself, from these Benches. An urgent meeting is certainly much needed. He mentioned in the earlier debate a round table on mental health. My understanding was that there would also be a separate, smaller meeting specifically on the report from the noble Baroness, Lady Hollins, so perhaps the Minister can clarify this.

The noble Baroness, Lady Hollins, has spoken powerfully about how the 40 year-old Mental Health Act results in autistic people, with often misunderstood and challenging behaviour, remaining stuck in mental health settings and assessment treatment units for long periods of time, where approaches do not fit their individual needs for care and support, including their sensory and communications needs. Understanding and support for autism has thankfully changed substantially since 1983, especially on being clear about what an autism-friendly environment looks like and should be. It is certainly not one that is often found in the mental health settings that autistic people are mostly currently held in. Can the Minister tell the House whether the Government’s decision to abandon the new mental health Bill in this Session of Parliament included an assessment of the impact this would have on patients and patient safety?

The report from the panel of experts led by the noble Baroness, Lady Hollins, highlights deep concerns, including a lack of any therapeutic or rehabilitative benefit from the use of long-term segregation for autistic adults and those with learning difficulties. It calls for the introduction of rules which would radically reduce and place a time limit on the use of long-term segregation and to ban it for children and young people as a serious “never event” that prompts an investigation. These and other key changes are proposed to the existing Mental Health Act code of practice, which will now not be considered until the Bill is before us.

To repeat what I said in the previous debate, it is very hard to understand how the Government envisage that the care and treatment of people detained under the current Act is going to be improved by non-legislative commitments, as promised by Ministers in last week’s King’s Speech debate and ever since. I am not sure whether the Minister covered the issue in the previous debate, but can he explain exactly which significant changes can be implemented in the absence of the framework of the new Bill and with the continued constraints, approaches and outdated attitudes contained in the current Act and the code of practice that the Government have no plans to review, or how the real accountability that the noble Baroness, Lady Hollins, has called for can actually happen?

The report’s description of long-term segregation as one part of a four-stage failure forcefully underlines this, as was stressed by the noble Lord, Lord Allan. The first failure is a lack of community-based support, which prevents a person being taken out of school or away from their family and admitted to hospital. These are major failings in adult social care. The second is the hospital’s failure to provide the learning disability and autism-friendly support that is needed, meaning more trauma, disorientation and restrictions for the patient. The third is the use of restrictive practices, including solitary confinement, and the fourth is a lack of clarity about responsibilities for commissioning and funding the skilled support and case management needed in the community, which goes back to the accountability issue.

The treatment of people with autism and learning disabilities under the current outdated and discriminatory legislation disgraces our society. The need for mental health reform is why Labour, if elected, has pledged to reform the Mental Health Act in our first King’s Speech. It is an urgent priority for us. The current law is not fit for purpose and must change. We want to see the Act updated following the excellent work undertaken by the mental health Joint Committee. The code must also be updated to meet the aspirations outlined today and to reflect the learning and culture change we all want to see in how autistic people and those with learning difficulties are viewed.

I have a quick question, finally, on the timetable for the CQC to commence delivery of ICETRs on long-term segregation. When will the guidance on their role and responsibilities be available? The aim is noted—to make sure that, within 48 hours of a person being put into segregation, the CQC is ready to start an investigation of its suitability—but the process needs a great deal of thought and preparation, and the minimum standards criteria of the place need to be clear. How is Parliament going to be involved and what is the process to review the CQC’s role?

Adult Social Care

Baroness Wheeler Excerpts
Wednesday 22nd November 2023

(4 months, 1 week ago)

Lords Chamber
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Lord Markham Portrait Lord Markham (Con)
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My noble friend is correct, in that having so many local authority and private sector providers means it is a confusing space in which to bring all this together. The People at the Heart of Care White Paper is trying to co-ordinate that and at the same time provide a career structure, because we know that the bedrock of all this is the staffing, and this needs to be an attractive space for people to work in. Therefore, giving them that recognised, transferable qualification which they can take into nursing and other areas as needed is vital in ensuring that we have the workforce to underpin this.

Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, the NAO’s recent figures show that so far, only 7.5% of the much-vaunted £265 million allocated by government to addressing social care staffing shortages and recruitment for 2023-25 has been spent due to the DHSC staff recruitment freeze; and the training workforce development programme has also stalled because the department has not managed to set up the necessary systems to administer provider payments. What is the Minister’s response to this and the ADASS survey finding that government investment in social care so far has just stopped the ship sinking and has not moved local authorities out of the storm they are trying to navigate?