Coronavirus
Baroness Wheeler Excerpts(5 years ago)
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Baroness Wheeler (Lab)
My Lords, I thank the Minister for repeating the Statement and once again pay tribute to the medical, public health and NHS staff who are working so hard to deal with this crisis, both in the UK and internationally. Last week, the Minister underlined the importance of all public health authorities and the NHS working closely together to ensure clear co-ordination. Now that the World Health Organization has declared the virus a public health emergency of international concern, this is more important than ever.
As we have heard, 93 British nationals have now been repatriated to the UK and transferred to a dedicated NHS facility in the Wirral as a precautionary measure. Can the Minister update us on the health and well-being of those people in quarantine? There have also been reports that 15 health workers have been diagnosed in China. We know that the virus mainly spreads through contact with an infected person. Can the Minister outline what protections are in place for health workers, particularly for those in the Wirral and in Newcastle, who are in close contact with those in incubation?
One of the disturbing findings from the early stages of the virus so far has been reports that a number of the people who have sadly died had pre-existing conditions. Does the Minister have any further information on this, including on the particular types of pre-existing conditions and what steps will be taken here to advise and support these very vulnerable people in the UK?
On vaccine development, there have been suggestions that human trials of a vaccine could start soon and be progressed with unprecedented speed. I welcome the reference to this in the Statement. The Times today reports that the head of the Coalition for Epidemic Preparedness Innovations has mentioned that an investigational vaccine from gene sequencing of the pathogen through to clinical testing could happen in 16 weeks, with the earliest stages of clinical trials taking two to four months. We welcome the Government’s £20 million contribution to the coalition’s research to speed up development of a vaccine. Has the Minister any specific further information on how quickly they expect the vaccine to be available and ready to distribute?
The Minister will be aware that many east Asian people living in the UK have reported being the target of racist abuse linked to the outbreak, while Chinese businesses are suffering from bogus claims that Chinese culture is to blame for the coronavirus. Their community leaders have expressed concern about repercussions, as Chinese students, workers and tourists in Europe become a focus of fear and confusion about the virus. What steps are the Government taking to combat racism, stereotyping and making assumptions during the outbreak of the virus?
Finally, we fully support the Government’s public information campaign centred on simple preventive measures to minimise the risk of the virus spreading, such as by washing hands and using tissues when you sneeze. Can the Minister reassure the House that the campaign will be proportionate to the risk currently faced by the general UK population? While we need to alert the public, we all want to avoid causing unnecessary stress or creating a panic.
Baroness Brinton (LD)
I echo the thanks to medics, staff involved in logistics and especially the scientists working so rapidly to sequence the genome of the coronavirus. I support many of the points made by the noble Baroness, Lady Wheeler.
Our concerns are more about some of the very practical arrangements and the fact that the UK seems to be responding 24 or 48 hours behind some other countries. I note the Statement says that
“anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel.”
It also says:
“Anyone who has travelled to the UK from mainland China in the past 14 days and is experiencing a cough, fever or shortness of breath should self-isolate”.
It is interesting that the Philippines, New Zealand, the USA, Singapore and Australia are now barring all foreign nationals from mainland China from entering their countries at all. I know that the World Health Organization is not yet saying that we should follow that, but I noticed that a report at the weekend said that about 340-odd people had come in from Wuhan just before the arrangements were put in place and that the Department of Health was now trying to track these people. Given that we now know that the disease can infect people prior to symptoms emerging, has the Department of Health been able to identify those people who arrived prior to the Government’s arrangements being put in place? Do the Government now have absolutely clear procedures to identify people coming not just from Wuhan and Hubei province but from mainland China so that they can contact them urgently if there are issues? Is everyone travelling in from China getting specific advice about who to contact and what to do?
Finally, what are the numbers of cases in regions outside Hubei? The press is reporting that at least 24 provinces, municipalities and regions in China have now told businesses not to resume work before 10 February at the very earliest. These account for 90% of exports from China. Given that many of our businesses rely on just-in-time manufacturing, I wondered whether the Government were assessing what the impact on our businesses would be if there was a gap in production and exports from China.
Wuhan Novel Coronavirus: UK Citizens
Baroness Wheeler Excerpts(5 years ago)
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Baroness Blackwood of North Oxford
I am very happy to look at the advisory from the Canadian Government. I hold in high regard the CMO from that nation, whom I have met. The action that this Government have taken in putting in place enhanced measures at ports and giving advice to nationals has been proportionate but robust. So far, we can be pleased that all of the 131 cases tested for in the UK have been negative.
Baroness Wheeler (Lab)
My Lords, I underline the support from these Benches for the plans for organised quarantine. Both the medical evidence on the incubation period and the limited evidence of spread from people not yet showing symptoms highlight the need for this. Keeping evacuated people together is important. We also strongly support the recognition by government that dealing with this is a top priority, and give our praise and thanks to the medical, public health and NHS staff who are working hard to ensure that preparations are in place in the UK.
Can the Minister explain a little more about the evacuation arrangements and what discussions have taken place? What discussions has the UK had with the World Health Organization on difficulties with evacuation? Can the Minister advise what action the Government are taking to ensure the safety and welfare of British nationals stranded in Wuhan due to the delay in evacuation if they are unable to board a flight as they display symptoms of the virus? Those who make it on board will have to sign contracts agreeing to the 14-day quarantine at an NHS facility on their return to make sure that they do not have symptoms of the virus. What staffing resources will be available to carry out quarantine and screening procedures? What happens if various people refuse to sign the contract? Clearly, these teams will be of great importance in preventing the spread of the virus to the UK. I look forward to the Minister’s response.
Baroness Blackwood of North Oxford
I thank the noble Baroness for her extensive questions. We are doing everything we can to get British people in Wuhan safely back to the UK. A number of countries’ flights have been unable to take off as planned. We will continue working urgently to organise the flight to the UK as soon as possible. We are working with British nationals who wish to leave and we are developing a package for them once they arrive. The plane will have medical staff on board to assess and manage the passengers; obviously, this is on the direct advice of and with support from our Chief Medical Officer, who has specific expertise in this area. A team from Public Health England and the NHS will meet passengers, and any passengers who have developed symptoms will be assessed and transferred to NHS care, as appropriate. Asymptomatic passengers will be transferred to an isolation centre; we do not want to provide details on that at this stage. We are working with the Chinese authorities to unlock the issues to allow the plane to take off.
Young Carers: Health and Well-being
Baroness Wheeler Excerpts(5 years, 1 month ago)
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Baroness Wheeler
To ask Her Majesty’s Government what plans they have to ensure that young carers receive the social care, family, mental health and financial support they need to ensure their own health, development and well-being.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we are committed to supporting young carers to ensure that they maintain their health and well-being and have the same life chances as their peers. We will continue to carry out the commitments made in the Carers Action Plan. These aim to increase the identification, support and recognition of young carers. This year, we will publish reports on young carers identification and work on carers from seldom-heard groups.
Baroness Wheeler (Lab)
My Lords, there are now an estimated 800,000 young carers delivering care to family members, and there has been an alarming 83% increase in children as young as five, six and seven undertaking this role. Is it not clear that the Government’s continued failure to tackle the social care funding crisis means young carers having to undertake care and support, at great cost to their own well-being, education and mental health, that should be available in the social care system? In particular, short breaks for respite care funded by local authorities are vital for disabled children and their families, including their siblings, many of whom are young carers. What action are the Government taking to make sure that they fill the annual £434 million funding gap in local authority funding for social care for disabled children in England, identified by the Disabled Children’s Partnership?
Baroness Blackwood of North Oxford
The noble Baroness will know that we take with the utmost seriousness the need to put social care funding on a sustainable footing. I heard the serious debate about this that we had on Thursday in the Queen’s Speech debate, and took back the seriousness with which this place takes those issues. On carers’ leave, the Government want to combine rewarding careers and the education of young carers with being able to care, and do not want young carers to take on inappropriate levels of caring. Therefore, the Government have committed to supporting unpaid carers with a leave entitlement of one week per year, which will be taken up in the employment Bill. In addition, I take the noble Baroness’s point about respite care and I will provide her with further detail in a note.
Healthcare: Brain Tumours
Baroness Wheeler Excerpts(5 years, 3 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what steps they are taking (1) to improve access to palliative care, rehabilitation and psychosocial care for people living with a brain tumour, and (2) to provide support for their carers and families.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, the NHS Long Term Plan sets a clear ambition that, where appropriate, every person diagnosed with cancer will have access to personalised care by 2021. Personalised care includes support planning based on holistic needs assessments, end-of-treatment summaries, health and well-being information and support and a cancer care review with GPs. These interventions align with the comprehensive model for personalised care and should be made available for all cancer patients, including those in need of end-of-life care.
Baroness Wheeler (Lab)
My Lords, International Brain Tumour Awareness Week starts on Saturday, so it is timely to remember both patients and carers. Living with a brain tumour often means coping with life-changing symptoms, such as mental and emotional health issues, communication and mobility problems. Carers also need support in adjusting to these changes in the person they care for, including coping with difficult behaviour and personality changes, disorientation and confusion. Both Marie Curie and the Brain Tumour Charity have highlighted strong concern about inadequate support for carers and the impact on the care journey that carer breakdown in these circumstances can have, often leading to emergency hospital admission. What action are the Government taking to ensure that people with brain tumours, their carers and their families receive care and support that meets their needs and wishes?
Baroness Blackwood of North Oxford
The noble Baroness has raised a very important issue. Obviously, the Government are working to deliver the Carers Action Plan, which retains the strategic vision of recognising, valuing and supporting carers. It includes a commitment to 64 actions across five priorities to ensure that we improve support for carers, including recognition and support, and build evidence to improve outcomes, especially in these very difficult areas. We are also working hard with the Tessa Jowell Brain Cancer Mission to ensure that we improve pathways for those with very challenging brain tumour diagnoses.
Queen’s Speech
Baroness Wheeler Excerpts(5 years, 3 months ago)
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Baroness Wheeler (Lab)
My Lords, I am focusing on health and social care. My noble friend Lady Sherlock’s excellent speech made clear the context in which the Government’s recent rush to show their concern and commitment to the NHS needs to be seen. There have been swingeing cuts since 2010—just to remind ourselves how long this Government have been in office—staff vacancies in key areas such as GPs, nursing, psychiatrists and vital specialities such as radiography are at a record high, and there is still no specific funding allocated to implement the NHS staffing plan, which was finally published earlier this year after a two-year wait. There are some 4.4 million people on NHS waiting lists, nearly 65,000 people have been left stranded on hospital trolleys for four hours or longer, and thousands are waiting in anguish and distress for cancer treatment. Five out of eight of the cancer waiting-time targets were missed in August, including the 62-day waiting-time target which has not been met since December 2015.
The CQC’s state of care report warns of a perfect storm across health and social care, where people cannot access the services they need or where care is provided too late, pushing the NHS and social care nearer and nearer to the tipping point it warned of last year.
We know that two definite health Bills are promised. One is on patient safety investigations and the other is on medicines and medical devices, to try to pick up the pieces after we fall out of EU regulation on clinical trials and access to medicines post Brexit, and to develop new ways of regulating personalised medicine and medical AI. We welcome both Bills and will work constructively with the Government and noble Lords across the House to ensure the vital improvements to patient safety and the access to innovative treatments that are so urgently needed.
We are also promised new laws, although the timescale is unspecified, following last month’s proposal from NHS England for an NHS integrated care Bill, in its words,
“to free up different parts of the NHS to work together and with partners more easily”,
but in reality to dismantle the heavy, laden and bureaucratic structures set up under the Government’s flagship Health and Social Care Act 2012, which have proved such a huge and costly disaster for the NHS. We currently have the ludicrous situation of authorities across the country desperately working around the 2012 Act to try to build the integrated primary and acute care and multispeciality community systems across local authorities and NHS and community settings which implement the NHS long-term plan. Can the Minister tell the House what work has been done with NHS England to develop legislative proposals on a new statutory framework? What is the proposed timescale for the Bill? Is she confident that the work currently being undertaken through CCGs on integrated care system, PACs and MCPs will proceed effectively within the legal and statutory authority contained in the 2012 Act?
I remind the House, too, that it was this Act that abolished the National Patient Safety Agency, against strident opposition from noble Lords across the House. From an initial reading of the Bill, many of the functions of the proposed new Health Service Safety Investigations Body were undertaken successfully by the NPSA. Does the Minister accept that abolishing that body has proved to be yet another damaging retrograde step under the 2012 Act?
On social care, we have had shameful and inexcusable inaction and delay since the Government abandoned the Care Act and the Dilnot provisions for capping the costs of care in 2016, despite strong cross-party support. Successive Prime Ministers and Health Ministers have all given hollow pledges about “getting on with the job” and have told us that a Green Paper is “imminent”. Now Boris Johnson has promised to fix it all, “once and for all” with the “clear plan” that he has prepared. But we now see that there has been no preparation: he has nothing new to offer. Indeed, recent press reports have revealed that No. 10 is still mulling over all the familiar options, including going back to the care cap and free personal care to match Labour’s long-standing commitments on this.
Meanwhile, the social care crisis continues to get worse. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down; nearly 1.3 million have developed an unmet need for basic care support such as washing, dressing or going to the toilet. Macmillan research shows that 8% of people living with cancer who have a critical or substantial need and who should qualify for council support receive no practical help at all, with 60% of their carers experiencing stress, anxiety or depression.
The Alzheimer’s Society estimates that, over the past 26 months, there have been more than 500,000 delayed transfers of care for people affected by dementia; nearly 3 billion hours of unpaid care have been provided; and, at any one point, more than 120,000 people with dementia in England receive no help from social care or family carers. Where is the PM’s “clear plan”? Does this mean the Green Paper has actually been drafted? What is holding it up? The recent IPPR report showed that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs.
Your Lordships’ economic committee produced an excellent report on what it recognised as the “national scandal” of social care, advocating free personal care for the over-65s. Surely this is one of the first steps to solving the care crisis. What plans are there in place to fulfil Mr Johnson’s pledge to provide older people with the dignity and security they deserve and prevent them from having to sell their homes to meet crippling care costs? In the Minister’s response, I hope she will not simply repeat the Government’s stock answer that we have heard today on so-called extra funding. The King’s Fund, Nuffield Trust and Health Foundation have independently identified both the huge scale of government and local authority social care cuts and the £2.5 billion investment needed just to keep the system afloat in the short term. Emergency cash injections do not address the chronic underfunding of local services, change the eligibility criteria or help people plan for their future care needs.
Finally, on a more positive note, we welcome the pledge to continue the work on the reform of the Mental Health Act following the excellent review last year. However, we are very disappointed not to see a detailed timetable for the actual Bill that has been promised. The CQC State of Care report is again a sharp reality check on the deteriorating state of mental health care. Can the Minister explain why the Government’s NHS capital announcements so far have failed to mention or include urgent funding for mental health hospitals and trusts, which the review has made clear are the worst estate in the NHS?
Personal Healthcare Budgets: Sheffield
Baroness Wheeler Excerpts(5 years, 5 months ago)
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Baroness Blackwood of North Oxford
Personal health budgets play a really important role, not only in supporting individuals to have personalised care but by making sure that we can seek support from social prescribing and community care, just as the noble Baroness mentioned. These plans are designed not only between the general practitioner and the supporter, but with the patient; therefore, the right information is provided to the patient in an open and transparent manner so that they can ensure they get the right care. It is important to note that those in receipt of this care have an 87% satisfaction that they are receiving the care they want in a much more effective way than they were before.
Baroness Wheeler (Lab)
My Lords, NHS continuing healthcare is supposed to provide a lifeline when older people and their families are at their most vulnerable and face sky-high costs as the result of chronic health conditions. However, this system is confusing and the rules arbitrary, resulting in a significant postcode lottery. Since 2015 more than 4,000 adults have died while awaiting a decision on their care to be made. What action are the Government taking to ensure that every person in need gets the support they need promptly, regardless of where they live?
Baroness Blackwood of North Oxford
One of the actions we have taken today is increasing funding to local authorities to relieve some of the pressures on them, increasing real-terms spending on public health, and also £1 billion for social care. In addition to that, there is a clear impetus from the long-term plan to increase personal health budgets, which are a very important aspect of the solution, because it will lead to an integration of spending and an integrated assessment of NHS care and social care. This is a real gap within the solutions for those who receive this support, which is why we want to make sure that we roll this out much faster than we have before. There is a commitment to have 200,000 people on personal health budgets and we are ahead of our ambitions on that.
Adult Social Care
Baroness Wheeler Excerpts(5 years, 6 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what assessment they have made of the Association of Directors of Adult Social Services Budget Survey 2019 on the state of adult social care.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we recognise many of the issues highlighted by ADASS. People of all ages are now living longer, sometimes with complex care needs. Social care funding for future years will be settled in the spending review, where the overall approach to funding local government will be considered in the round. Meanwhile, we have given local authorities access to up to £3.9 billion for more dedicated funding for adult social care this year, and a further £410 million is available for adult and children’s services.
Baroness Wheeler (Lab)
My Lords, the ADASS survey results provide yet more evidence of the ongoing crisis in social care caused by persistent underfunding and a fragile and failing care market. As the report says, there are planned cuts of £700 million to adult social care budgets in the current financial year and there have been cumulative cuts of £8 billion since 2010. On the last day of our current Session, can the Minister update the House on the timing of the social care Green Paper, which has been delayed six times and is now two years overdue? Given this inexcusable delay and the widespread consensus across social care about what needs to be done, why can the Government not commit to publishing a White Paper with actual proposals? Has the Lords Economic Affairs Committee report calling for £15 billion of extra funding, to include free personal care for people needing basic washing and dressing support, not done the Government’s job for them?
Baroness Blackwood of North Oxford
I share the noble Baroness’s impatience on this issue and I agree with the overall conclusions of the ADASS report that older and disabled people need dignified, high-quality care and support. When properly resourced it does work, and as a nation we must make this an immediate priority. That is why I very much welcomed the incoming Prime Minister’s statement that,
“we will fix the crisis in social care once and for all with a clear plan ... To give every older person the dignity and security they deserve”.
He will make it a priority of the incoming Government and there will be an imminent announcement from the incoming Health Secretary. As I do not know whether I will be part of the department, I am afraid that I cannot commit to this, but I am sure that whoever is in this place when that comes forward will be very happy to do so.
Mental Health: Weight and Shape-related Bullying
Baroness Wheeler Excerpts(5 years, 6 months ago)
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Baroness Blackwood of North Oxford
The noble Baroness has a record of raising this important issue. The Government recognise that poor body image is not only a common problem but is associated with mental ill health. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body, weight or shape. As she rightly points out, in the most extreme cases, that can lead to eating disorders, depression or even feeling suicidal. The Government have delivered a broad programme of body image work over the past six years. We believe that more work can be done but we are working hard to make sure that we expand our eating disorder community care work for children and young people over the next few years. I welcome continuing the debate to see what more can be done.
Baroness Wheeler (Lab)
My Lords, the latest Barnardo’s report, Overcoming Poverty of Hope, showed that 69% of young people,
“feel they will have worse ‘overall happiness and mental health’ compared to their parents’ generation”,
with one young person saying that social media is “massive for mental health” because of the,
“unrealistically high expectations of body image and lifestyles”.
On top of that, the report found that,
“young people with additional life challenges, such as young carers and care leavers are more susceptible to the negative impacts of social media as they are more likely to experience social isolation”.
What are the Government doing to work with mental health charities, such as YoungMinds, and young carers to address this situation?
Baroness Blackwood of North Oxford
The noble Baroness is right that children exposed to persistent bullying risk experiencing these problems. This is related to the experience of face-to-face bullying, but exposure on social media can also cause the problem. That is why the Department for Education is providing over £2.8 million of funding between September 2016 and 2020 to four anti-bullying organisations—Internet Matters, the Diana Award, Anti-Bullying Alliance and the Anne Frank Trust—to support schools to tackle bullying. Of course, all schools must have in place an anti-bullying policy, which Ofsted regulates.
Asthma
Baroness Wheeler Excerpts(5 years, 7 months ago)
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Baroness Blackwood of North Oxford
I thank the noble Lord for his question. I have met with Asthma UK on this issue. As an asthmatic myself, I understand the challenges of keeping up with medication, especially when in the middle of an exacerbation. At the moment, we do not intend to review the prescription charges list. However, there are some exemptions in the prescription list, and we have committed to work with Asthma UK to ensure that those who are eligible for low-income exemptions and for the pre-payment charge are accessing them and to look at any other ways in which we can help those who need life-saving medication.
Baroness Wheeler (Lab)
My Lords, I am sure that the Minister will know about the recent shocking report from the BMA describing the UK health system as complacent about the risks of asthma. It comments on and documents some of the tragic deaths of young children who would still be alive if their chronic asthma had been properly cared for. It shows a sorry litany of absence of a proper asthma plan across primary and secondary care and failure to refer children suffering repeated attacks to a specialist respiratory team or to optimise medical management of the condition. Some clinicians and staff are unaware of national treatment guidelines, prescribing advice or recommendations from the national review of asthma deaths. What is the Government’s response to this? Why has only one of the NRAD recommendations been implemented since 2014? Why are the remaining 18 still to be acted on to try to stop these unnecessary and untimely deaths?
Baroness Blackwood of North Oxford
The noble Baroness will have heard in my opening remarks that we have put treating asthma and respiratory diseases as a key priority within the NHS Long Term Plan precisely because we recognise that we need to improve our performance on respiratory diseases. Working with Asthma UK, we have identified that one of the key challenges in improving performance has been the identification of those with severe asthma and providing them with an appropriate care plan. That is exactly why we are pleased that a new NICE quality standard, QOF and the RightCare programme are in place; these should help to improve referrals and outcomes for patients as is desperately needed.
Social Care: Free Personal Care
Baroness Wheeler Excerpts(5 years, 7 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what assessment they have made of the Institute for Public Policy Research’s report Social care: Free at the point of need—the case for free personal care in England, published on 23 May, and whether this matter will be addressed in the forthcoming Social Care Green Paper.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we welcome the contributions made by recent reports on how social care should be funded in future, including the report by the IPPR. The Green Paper will bring forward ideas for including an element of risk pooling to help protect people from high and unpredictable costs. This Government are committed to ensuring that everyone has access to the care and support they need, and we are clear that people should continue to expect to contribute to their care.
Baroness Wheeler (Lab)
I thank the Minister. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down and that nearly 1.3 million people have an unmet need for basic care support, such as washing, dressing and going to the toilet. Macmillan research shows that 8% of people living with cancer who have critical or substantial needs and who should qualify for council support receive no practical help at all and that 60% of their carers experience stress, anxiety and depression. I hope that when she responds the Minister will not just repeat the Government’s stock answer on so-called extra funding. The King’s Fund, the Nuffield Trust and the Health Foundation have independently identified the huge scale of government local authority social care cuts and the £2.5 billion investment needed just to keep the current system going. May I once again ask the Minister for news of the Green Paper? When is it going to be published? What is holding it up? The IPPR shows that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs. Surely it is one of the key options for solving the current care crisis.
Baroness Blackwood of North Oxford
I thank the noble Baroness for an important question. She is absolutely right that the Green Paper must be a priority. It will set out our sustainable plans for reform. We have welcomed the contributions that have been made by a number of recent reports. The noble Baroness rightly pointed to the IPPR, the Joint Select Committees, the Health Foundation, the King’s Fund and the Resolution Foundation. They have made some important proposals which are being considered as part of the Green Paper’s work going forward. The noble Baroness is right that we cannot wait for that, because there are people who need improvements in care now, and that is part of what the better care fund has been set up to do—to improve the spreading of best practice and the new models of care work which have been put front and centre for the long-term plan improvements. That was introduced in 2015, and has brought in the funds required, taking the total of increased funding to £7.7 billion by 2018-19. We are looking at how we can make sure that that improves. It has brought changes across the system.