Adult Social Care: Long-term Funding

Caroline Dinenage Excerpts

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

Absolutely. The Committee did not discuss the ownership of care homes, but we did discuss the number of homes that had gone out of business or had been contracted back to local authorities. This is an ongoing and very real problem. We need not just a well-paid and well-trained workforce but viable care providers, so the money needs to be there for the providers as well as the workforce.

[The Minister for Care (Caroline Dinenage)]

I thank the Chairs, the members and the staff of both Committees, and congratulate them on producing an exceptional document. I also congratulate them on their extremely collaborative approach to their work, which is incredibly refreshing. For too long this issue has been used as a political football to be kicked around, but I am afraid it is too late for that now. We no longer have that luxury; we must reach a sufficient settlement. As other Members have pointed out, successive Governments have failed to address this issue. The Committees’ consultative, collaborative and constructive approach has been very positive and has been warmly welcomed, as, indeed, has been their engagement with the citizens’ assembly.

As has been made clear by the Secretary of State for Health and Social Care, we want to integrate plans for social care with the new NHS plan that the Prime Minister announced recently. It would not make sense to publish it before the NHS plan has even been drafted, so our Green Paper will be published at the same time as the plan. It will cover the Government’s proposals on a wide range of social care issues, including, but not limited to, the need for the social care market to be sustainable for the future. It will also build on policies such as our “Carers action plan”: we will, for example, consult on proposals to provide better support for unpaid carers.

The report will be incredibly valuable to our work. It will enhance our plans for the Green Paper, and will ensure that it can offer people a sustainable future and the knowledge that as they approach their later years, they will do so in security and safety and with quality provision.

[Mr Betts]

Again, I thank all the members and staff of the Committees for their work. The challenge now lies with the Government and with Ministers. There should not be any more long grass out there to kick things into. We want to see Government and Opposition working together and starting to make the difficult decisions that need to be made for the benefit of the people who need the care, both the elderly and those of working age.

Complex Regional Pain Syndrome

Caroline Dinenage Excerpts

Tuesday 19th June 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for High Peak (Ruth George) on securing this debate on such an incredibly important issue. She has articulated quite beautifully the hell that people suffering from complex regional pain syndrome go through. The only thing that I can even slightly identify with is the pain of childbirth, but even after that it is unimaginable for us to conceive of the sort of day-by-day endurance and the relentless pain that people suffer. It is a devastating condition and can lead to an overwhelming impact on sufferers and their families, so I thank the hon. Lady for bringing this subject to the House.

The potentially extreme nature of the condition and its symptoms, some of which the hon. Lady described—the excruciating pain, burning, swelling and skin discolouration —can be totally disruptive to everyday living and destroy a person’s quality of life. She spoke very movingly about her constituent Victoria Abbott-Fleming, whose story is incredibly upsetting. I very much forward to meeting Victoria and assuring her that I will do everything I can to move forward on the issues that the hon. Lady mentioned. In circumstances in which extreme decisions have to be considered, high-quality care and support can sometimes make a huge difference to someone’s experience of our health and care services.

I hope that, as I am sure the hon. Lady intended, this debate will help to raise awareness of this very debilitating and extremely painful condition. It has actually been recognised as a medical condition for around 150 years, but problems remain with the diagnosis of CRPS in its very earliest stages. Diagnosis involves excluding a lot of other more common conditions—such as infection or things like rheumatoid arthritis—that can have similar symptoms, and the causes remain largely unknown. Precipitating factors can include injury or surgery, but there is no relationship to the severity of trauma and the development of the pain. In some cases, there is no precipitating trauma at all. It is considered likely that because of the complex nature of the condition, there is absolutely no one single cause. That means that it is difficult to estimate how prevalent CRPS is, as many cases may not have been correctly diagnosed in the first instance.

To improve public awareness, the NHS Choices website provides comprehensive advice on the causes, symptoms and treatment of CRPS. In addition to that, various charities work in this area. The hon. Lady mentioned Burning Nights, which was set up by her incredibly brave constituent; if someone is in unimaginable pain, I can only imagine what a comfort it is for them to be able to speak to or hear from somebody who has experienced it themselves. The charities do great work to support not only the patients who have the condition but their families.

As the hon. Lady says, general practice is where patients with CRPS are most likely to be seen in the first instance. CRPS is a key part of the GP curriculum; it is identified as a key area of clinical knowledge in the Royal College of General Practitioners’ applied knowledge test content guide. The test is a key part of GPs’ qualifying exams, and it ensures that they have the knowledge needed to work as a GP in the NHS.

To improve identification and management of the condition, in 2013 the Royal College of Physicians published best practice guidance for clinicians on the diagnosis, referral and management of CRPS. This guidance was developed with the involvement and endorsement of 21 key organisations involved with the care of people with CRPS, including the Royal College of General Practitioners, the British Orthopaedic Association, the British Pain Society, the British Society for Rehabilitation Medicine and so on.

The guidance, as the hon. Lady says, recommends prompt diagnosis and early treatment. This is to avoid the secondary physical problems associated with disuse of an affected limb and the incredible psychological consequences of living with undiagnosed chronic pain. It has been shown that an early referral to physiotherapy, for example, and encouraging gentle movement as early as possible, may prevent progression of the symptoms. Patients with CRPS are generally best managed in specialist pain management clinics.

[Ruth George]

Will the Minister look at the proposal to set up protocols in fracture clinics and clinics where carpal tunnel surgery is performed? Prevalence of CRPS following such surgery or an injury is particularly pronounced.

[Caroline Dinenage]

I will certainly look at that.

The hon. Lady mentioned delays in referral to a pain clinic, which is something that concerns me. Waiting times should be about 13 weeks once a GP has referred someone, but, as she says, some people wait longer. NHS England commissions the highly specialised pain management services for adults and children, and we will raise the issue with it. The National Institute for Health and Care Excellence has also published guidance for the pharmacological management of neuropathic pain, which includes CRPS. The guidance was updated earlier this year to reflect the latest available evidence.

Patients with CRPS will usually be managed through routine access to primary or secondary care. For patients with the most chronic and intractable pain, a referral can be made to a highly specialised pain service, commissioned by NHS England. Here, patients can receive multidisciplinary expert care and specialised treatment. Once diagnosed, patients can expect access to a range of other healthcare professionals for support and on-going treatment. This includes physiotherapists, occupational therapists, neurologists, a psychologist to help with the associated psychological problems caused by living with CRPS, and other healthcare professionals trained in pain relief.

The hon. Lady spoke about research. The National Institute for Health Research welcomes research funding applications for any aspect of human health, including CRPS. The CRPS UK clinical and research network was established in 2006. It is a research collaboration between a number of UK NHS trusts and academic institutions with an interest in the disorder. Its primary aim is to raise awareness and understanding among health professionals, patients and the general public. This year it is 10 years since the network established the CRPS registry, which now holds over 500 records and contributions and has contributed to seven different national and international research studies.

I thank the hon. Lady again for bringing this important debate to the House. I have attempted to answer as many of her questions as I can, but I will come back to her with anything that I have not covered. I hope that the debate has been helpful in raising the profile of this very difficult and distressing condition.

Question put and agreed to.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 19th June 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

Commissioning high-quality health and social care services is a local responsibility. The Care Quality Commission monitors, inspects and regulates services that people with a learning disability may use. Where quality and safety standards are not met, it will take action.

[Kate Hollern]

The Association of Directors of Adult Social Services warned this week that social care services are on the verge of collapse. Despite the announcement of £20 billon yesterday, there was no mention of social care. Cuts of more than £7 billion have left hundreds of thousands of elderly and disabled people without adequate support. What specific measures are the Government taking to ensure that the elderly and disabled are receiving proper care?

[Caroline Dinenage]

Adult social care was mentioned yesterday, specifically in the news that we plan to bring together the way in which health and social care interoperate. We need more collaborative work between health and social care to reduce the amount of pressure that one puts upon the other. We have set out very clearly that we will produce a Green Paper later this year to address how we will tackle the challenges that we face in adult social care, and we will look at how we fund that.

[Julia Lopez (Hornchurch and Upminster) (Con)]

Providers of day care services for people with learning disabilities are not currently subject to an inspection regime. Will the Minister consider bringing such services within the scope of the Care Quality Commission to reassure families about quality and safeguarding issues?

[Caroline Dinenage]

My hon. Friend is absolutely right to draw attention to the fundamental importance of being reassured that all services that are provided are safe and reliable. Since the CQC has been looking at services up and down the country, it has brought to them a level of transparency and, indeed, quality. We keep under review the services that it regulates, and this is certainly something that we can discuss with it.

[Laura Smith (Crewe and Nantwich) (Lab)]

Will the Government end uncertainty for people with learning difficulties who need social care by funding the historical liabilities associated with the sleep-ins crisis?

[Caroline Dinenage]

We are aware of concerns in the sector with regard to sleep-ins and we are looking very carefully at the options. We have been developing the evidence base very carefully. We have been engaging with the European Commission, the sector and other Government Departments.

[John Howell (Henley) (Con)]

Oxford Health NHS Foundation Trust recently won a bid under the Beyond Places of Safety scheme to put in place IT support for users of learning disability services. Is that not a very useful way of taking forward such projects?

[Caroline Dinenage]

My hon. Friend makes an excellent point. It is vital that when we look at how to move forward with both our health and social care services, we are able to capture all the latest technology to ensure that we improve the experience for all our service users.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Much of the health and social care for people with learning disabilities in Plymouth is provided by Livewell Southwest, a social enterprise. The new pay increases for NHS staff will not be mapped over to social enterprise staff, so when they merge back into the NHS, we risk a two-tier workforce. Will the Minister consider extending the pay increases to support those who work with people with learning difficulties in the social enterprise sector so that we ensure that everyone doing the same job is paid the same amount?

[Caroline Dinenage]

The hon. Gentleman makes an excellent point. It would be terrible to see a health and social care sector in which people doing the same work are valued differently, so I will look carefully at the point he raises.

[Luke Graham (Ochil and South Perthshire) (Con)]

5. What steps his Department is taking to support UK life sciences and medical research.

--- Later in debate ---

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

14. What recent assessment he has made of the potential merits of including autism in NICE guidance on epilepsy.

[The Minister for Care (Caroline Dinenage)]

NICE is currently in the early stages of updating the clinical guidelines on the diagnosis and management of epilepsies in adults, and plan to go out to consultation on a draft scope in October this year.

[Dame Cheryl Gillan]

The UK’s autism research charity Autistica advises that up to 40% of people with epilepsies are, in fact, autistic, and that epileptic seizures are the leading cause of early death for autistic people with a learning disability. NICE guidance has never mentioned autism when referring to epilepsy, and autistic people have distinctive types of epilepsies that require different clinical approaches. Will the Minister please ensure that NICE includes autism in the guidelines on epilepsy?

[Caroline Dinenage]

At this stage, it is too early in the update process for NICE to say exactly what its guidance will cover. However, my right hon. Friend is chair of the all-party group on autism and vice-chair of the all-party group on epilepsy, and she was the driving force behind the Autism Act 2009. I think that NICE would do very well to heed her advice.

[Mr Speaker]

And that advice will be proffered on a very large number of occasions in this Chamber until the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) gets what she seeks—I think I can say that with not just confidence, but certainty.

--- Later in debate ---

[Afzal Khan (Manchester, Gorton) (Lab)]

T9. One of the biggest causes of regional health inequalities is the broken social care system, yet yesterday’s announcement postponed social care reforms again until the autumn. There is no end in sight for the overstretched and underfunded social care system, and without reforms to care, the extra money for the NHS will be wasted. Will the Minister bring up the timetable for those reforms before the care system collapses?

[The Minister for Care (Caroline Dinenage)]

The fundamental issue here is that we need a social care system that works hand in hand with our health services—the two are umbilically linked. The key plank of the new NHS 10-year plan must be the full integration of health and care services. It does not make sense to publish the Green Paper before the NHS plan has even been drafted. We will bring forward a Green Paper, but in the meantime, spending on adult social care has gone up by 8% this year.

[David Duguid (Banff and Buchan) (Con)]

Like many others, I welcome the announcement yesterday of the £20 billion investment in the NHS. Will my right hon. Friend join me in seeking assurances that the £2 billion extra for the Scottish Government shall be allocated to spending on the NHS in Scotland?

Terminal Illnesses: Continuing Healthcare

Caroline Dinenage Excerpts

Wednesday 13th June 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is an absolute pleasure to serve under your stewardship, Ms McDonagh. I start by congratulating the hon. Member for Islwyn (Chris Evans) on securing this important debate on NHS continuing healthcare. I pay tribute to him for the inspiring work he does on the all-party parliamentary group on motor neurone disease. I also pay tribute, like him, not only to those who suffer from this very cruel illness, but to those who provide the unstinting care and compassion to loved ones who go through that horrible experience.

One of my first experiences as a Member of Parliament was helping a constituent who had motor neurone disease to get her continuing healthcare package to kick in during a very difficult part of her life. I am completely aware of the people to whom the hon. Gentleman refers. I met a few carers for people with motor neurone disease earlier this week, as part of carers week. As ever, I was completely overwhelmed by their incredible sense of duty and the commitment that they give to those for whom they care.

The hon. Gentleman is right to ask for further clarity on the issues he raised, and I hope that today I can provide him with some reassurance on those issues about which he is most concerned. We know that continuing healthcare is provided to some of the people with the highest and most complex health and care needs in the country, and they deserve our support. Of course, the nature of the situation presents some challenges. The hon. Gentleman made some valid points about the current issues facing the NHS continuing healthcare system, including some of the issues raised in the Public Accounts Committee earlier this year. I will set about trying to address them all, and will drop him a line afterwards about anything that I miss out.

Decisions about NHS continuing healthcare are important because they have a very big impact on people’s lives. It is right that there is a careful and considered decision-making process in place. The hon. Gentleman talked about people not being aware of continuing healthcare, which was a really good point. It is fundamental that we raise awareness of continuing healthcare and ensure that those who are entitled to it during a particularly difficult period of their lives claim it. Work on that by NHS England and the Department of Health and Social Care is under way, and will be announced later this summer, as we have confirmed to the Public Accounts Committee.

My Department is responsible for the NHS continuing healthcare national framework, which the hon. Gentleman mentioned. An updated version of the framework was published on 1 March, and will be implemented on 1 October this year. The revised framework follows an extensive period of external engagement with stakeholders and patient representative groups, including the Continuing Healthcare Alliance and those working within the NHS and local government. The update incorporates a new structure, which is intended to provide clarity, reflect legislative changes such as the Care Act 2014, and include minor clarifications on some policy areas. It is really important to underline that none of the changes is intended to alter the eligibility criteria for NHS continuing healthcare or the extent of the service provided by the NHS.

The hon. Gentleman mentioned progress and the next steps on the NHS continuing healthcare assessment tools. As set out in the Government’s response to the Public Accounts Committee, my Department is working very closely with NHS England to review the NHS continuing healthcare checklist tool. That work is due to report by this autumn. However, we know that those changes alone are not enough to deliver all the necessary improvements, particularly on some issues such as the variation in eligibility criteria, which the hon. Gentleman highlighted. That is why we are working very closely to support NHS England with their NHS continuing healthcare improvement programme.

It is important to be clear that there will always be some variation in NHS continuing healthcare eligibility rates. Such variation can be due to a wide variety of reasons, including the age dispersion within the local population and variation between geographical areas in health needs. It is really important that NHS England is working to understand the unwarranted variation in eligibility rates between clinical commissioning groups, and helping them to apply the national framework more consistently. NHS England is also developing a pilot to test the feasibility and the cost of running a sustainable case-level audit of eligibility decisions across clinical commissioning groups, to provide that kind of assurance on consistency and fairness in the provision of NHS continuing healthcare, which we all know is utterly vital.

Another area that NHS England is working to improve is the length of the NHS continuing healthcare assessment process. A quality premium is now in place to incentivise clinical commissioning groups to carry out more than 80% of assessments within 28 days. There is, of course, also a fast track for those who need the service much quicker. Clinical commissioning groups with the highest numbers of delayed cases are required to establish improvement plans to set out key milestones and planned measures to improve.

The hon. Gentleman will be pleased to hear that progress is being made. The latest quarterly data shows that in the last quarter of 2017-18, 66% of assessments were completed within 28 days. That is still not good enough, but it is up from 58% at the beginning of the year. The number of clinical commissioning groups delivering the expected standard of 80% within 28 days has gone up from 52 to 87 so far this year. As I have said, there is steady progress, but more to do.

The hon. Gentleman raised the target of £855 million of efficiency savings that we are planning by 2021. It is really important that I make it absolutely clear that that is not a cut in spending, but a reduction in growth in spending. Spending will continue to rise in real terms, with a projected budget increase of almost 4% a year, and of 20% between 2015-16 and 2020-21. I think he will agree that that rate of growth would be the envy of many other areas of health and care spending—indeed, of many other Departments.

The eligibility threshold for NHS continuing healthcare has not changed. The assessment of needs by a multidisciplinary team, as well as the primary health need test that we set out in the national framework, must be adhered to when deciding on continuing healthcare eligibility. No financial considerations or efficiency programmes alter that. Any planned efficiencies are not predicated on changes to eligibility or on limiting the care packages available. Clinical commissioning groups have an absolute responsibility to ensure high-quality standards of care, and any reduction in the growth in spending must not affect that.

It is vital that we continue to work closely with NHS England, local authorities and key stakeholders to ensure that we keep improving the system for those who need it. I know that there is still work to do, as the hon. Gentleman has highlighted, but I hope that he can appreciate that the Government and NHS England are aware of the challenges that we face in the provision of NHS continuing healthcare. I hope that he is aware of my personal dedication to getting this right. I am confident that the steps we are taking to improve the system are the right ones and will deliver an improved experience for patients, families and carers.

Question put and agreed to.

Death Certification England and Wales: Reforms

Caroline Dinenage Excerpts

Monday 11th June 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

My noble Friend the Parliamentary Under-Secretary of State for Health and Social Care (Lord O’Shaughnessy) has made the following statement:

Between March and June 2016 the Government consulted on a package of reforms to the death certification process and the introduction of medical examiners. The reforms aim to improve engagement with the bereaved in the process of death certification and offer them an opportunity to raise any concerns, as well as improving the quality and accuracy of medical certificates of cause of death. Safeguards will be enhanced in the process to enable medical examiners to report matters of a clinical governance nature to support local learning and changes to practice and procedures.

As part of the drive to further improve patient safety, I have today published the Government’s response to consultation on the introduction of medical examiners and the reforms of death certification in England and Wales, and a copy is attached. This sets out the Government’s intention to introduce a system of medical examiners in England. The Welsh Government consulted separately in Wales.

Medical examiners are a key element of the death certification reforms, which, once in place, will deliver a more comprehensive system of assurances for all non-coronial deaths regardless of whether the deceased is buried or cremated. Medical examiners will be employed in the NHS system, ensuring lines of accountability are separate from NHS acute trusts but allowing for access to information in the sensitive and urgent timescales to register a death.

The response to the consultation demonstrates that there is widespread support for the aims of the reforms and for the introduction of medical examiners, but there were concerns about some aspects of the proposals. In particular concerns were raised about how the proposed model, based in local authorities, would work in practice and about the timeframes for implementing the system. Feedback on a proposed funding model was also received.

Since the Government consulted on the package of death certification reforms, events have moved on. New information about how a medical examiner system could be introduced has been generated by the Department of Health and Social Care’s (DHSC) medical examiner pilot sites and early adopters of the medical examiner system, as well as from the learning from deaths initiative.

There will be two stages to funding the ME system to enable its introduction while legislation is in progress. Initially, medical examiners will be funded through the existing fee for completing medical cremation forms, in combination with central Government funding for medical examiner work not covered by those fees. Following this interim period and when parliamentary time allows for the system to move to a statutory footing, the funding of the system will need to be revisited. The existing medical cremation forms and fees payable associated with those forms will continue to apply for the interim period.

The Government have proposed that all child deaths (up to age 18) be exempt from the cost associated with the medical examiner system. This aligns with the broader purpose of the Government’s recent announcement about steps to ensure that no bereaved family will have to pay for the essential costs of burying or cremating their child.

Attachment:

1. Response to consultation (180611 Government response to ME and death certification consultation.pdf)

Attachment can be viewed online at http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-06-11/HCWS755/

[HCWS755]

Carers Action Plan

Caroline Dinenage Excerpts

Tuesday 5th June 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

I am today publishing a “Carers Action Plan 2018-2020—Supporting carers today” in the week leading up to Carers Week (11 to 17 June).

The cross-government carers action plan is an essential step towards realising the Government’s commitment to value, recognise and support carers to provide care in a way that supports their own health and wellbeing, employment and other life chances.

The plan sets out a two-year programme of targeted work to support unpaid carers. It puts a focus on practical actions to support carers and gives visibility to the work already under way or planned within Government.

In 2016, the Government ran a call for evidence to seek the views and experiences of unpaid carers. A summary of the 6,800 responses received will be published alongside the plan. Their contributions have informed its development and content, helping us to focus actions around the following five themes:

Services and systems that work for carers

Employment and financial wellbeing

Supporting young carers

Recognising and supporting carers in the wider community and society

Building evidence and research to improve outcomes for carers

In this way, we will seek to build accessible carer-friendly communities and public services, promote innovative local projects and support carers to stay in work.

The Government recognise there is more to do and that is why the needs of carers will be central to the forthcoming Green Paper on care and support, as set out in the Secretary of Health’s speech in March.

The plan has been developed in close collaboration with Ministers and officials in other Government Departments including the Government Equalities Office, Department for Education, Department for Work and Pensions, Department for Business, Energy and Industrial Strategy and Department for Digital, Culture, Media and Sport.

The Government want to ensure that caring is a choice or responsibility that is always recognised and valued. The publication of this carers action plan today is an important part of that commitment.

“The Carers Action Plan 2018-2020 [for England] —Supporting carers today” is available as an attachment online and on gov.uk.

Attachments can be viewed online at:

https://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-06-05/HCWS732/

[HCWS732]

Accrington Victoria Walk-in Centre

Caroline Dinenage Excerpts

Wednesday 23rd May 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Hyndburn (Graham P. Jones) on securing the debate. He made a very powerful case on behalf of his constituents and very carefully set out the enormous strength of feeling in his constituency, as of course he should as the local Member of Parliament. I am grateful to him for articulating his case so powerfully.

Following a three-month public consultation, the East Lancashire clinical commissioning group made the decision to close Accrington walk-in centre from Sunday 17 June. Other services provided from the Accrington Victoria Community Hospital, such as the minor injuries unit, and X-ray and in-patient and out-patient services, are not affected by the changes and will of course remain available. I understand that there has in fact been a delay in the closure taking place, as the walk-in centre was due to close in the spring. However, following consultation, the CCG has decided to close Accrington walk-in centre on Sunday 17 June. This extension to the originally planned closure date was made to ensure that there is a smooth transition to the new models of care, once the walk-in centre closes.

East Lancashire CCG has implemented an extended access service in Hyndburn as a new model of service provision. This service is being provided under contract by a local GP provider organisation, the East Lancashire Union of GPs. The contract is for 12 months from 11 December 2017, and the extended access GP scheme in Hyndburn has been operating since December. It is important to note that while the extended access service in Hyndburn is a new model of service provision, it is not meant directly to replace the walk-in centre per se.

GP services are accessible to patients through their own GP practice from 8 am until 6.30 pm, Monday to Friday, as usual. Pre-bookable appointments will also be available in the new extended GP service after 6.30 pm on weekdays and at the weekend. These appointments will be booked through the patient’s own GP practice. This new model of extended GP access meets the principles that were tested and supported by local people through a formal consultation process. In addition, the NHS 111 service can signpost patients to the most appropriate services, including an appointment with an out-of-hours GP, if required. We understand and appreciate that this is a real change for patients who are used to being able to walk in and see a GP, rather than phoning up for an appointment.

[Graham P. Jones]

Does the Minister accept that the consultation had flaws, and will she look at that? Does she accept that replacing 88 hours in a walk-in centre with 18 and a half or 19 hours of extended GP opening hours is a reduction in GP access, which goes counter to what was said in the consultations run by me and the CCG?

[Caroline Dinenage]

I take on board what the hon. Gentleman says about the consultation and also the consultation that he ran on Facebook. I know how worrying it must be for local people when a service closes, but it is the responsibility of the local NHS to follow the Government’s guidelines. The Government’s four tests for any service change are that it should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. The Lancashire overview and scrutiny committee alone has the power to refer the decision to the Secretary of State or the Independent Reconfiguration Panel, and it was minded not to. That is the unfortunate situation.

Alongside improving and extending GP access, East Lancashire CCG has invested significant sums in social prescribing and care navigation. Those additional services are helping to guide patients and co-ordinate their journey through the health and care system to get the right help and support quickly.

There are benefits from the Hyndburn extended access service, including the provision of seven-day access to GP care, the addition of a minimum of 49 additional delivery hours per week, and 162 additional appointments per week. The facilities are linked to the out-of-hours service, with the ability to secure urgent GP appointments at weekends. I understand that that provision is for Hyndburn patients only until the walk-in centre closes in June, but it will then be expanded to cover patients from the wider east Lancashire area.

The extended access service run by the East Lancashire Union of GPs already has robust information-sharing arrangements in place with Hyndburn practices to ensure continuity of care for patients utilising an electronic record. That level of record sharing has not been available to patients attending the walk-in centre. The patient and public involvement network in Hyndburn has been fully consulted, and has assisted in the production of communication materials to ensure that local patients have been informed of the changes and have the information they need to direct them to the most appropriate service for their health needs.

The extended access service will have the ability to generate electronic referrals that core GP practices can review and progress. The service will collate monthly data, including patient profiles and the reasons why people access the service, to shape service redesign and help to build a clear picture of patient health needs locally. That service will be delivered from an existing modern LIFT—local improvement finance trust—building, which is on a local bus route and easily accessible to the public. Use of the service has been building progressively and is being closely monitored by the CCG.

I thank the hon. Gentleman again for bringing this debate to the House and for his ongoing support for his constituents in Hyndburn.

Question put and agreed to.

Helen and Douglas House Hospice

Caroline Dinenage Excerpts

Friday 11th May 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing a debate on this really important matter. As MPs, we are all aware of the crucial role that hospices play in supporting our local communities at a time of need. That is a testament to the dedication of staff, the incredible efforts of volunteers and the amazing feats of fundraisers, many of whom have been inspired by hospices’ incredible support to their loved ones in the last days of their life, or the respite care that children’s hospices often give. Hospices step up to deliver amazing care at some of the toughest times of life, and I pay tribute to all of them. I totally understand the concerns that the hon. Lady raises and share many of them myself.

Hospices across England have been delivering exceptional end-of-life care and supporting their local communities for many years. A testament to that is the fact that the Care Quality Commission’s “State of Care” report, which was published in October 2017, showed that 70% of hospices are rated as good and 25% as outstanding—the figures are higher than those for any other secondary care service in the country.

In 2017, Helen and Douglas House was rated as good by the CQC. Like the hon. Lady, I congratulate its incredible hard-working staff and volunteers on ensuring that children and young people get the personalised care and support that they need and deserve, both at the hospice and through its outreach services. In the same year, I understand that Helen and Douglas House raised an impressive £8.8 million through fundraising and trading activities. That was £300,000 more than the previous year, which shows its value to the local community.

Historically, the hospice movement was established from charitable and philanthropic donations, so the vast majority of hospices are primarily funded through charity, but they receive statutory funding from clinical commissioning groups, and in some cases from the Government, for providing local services. According to its annual report and accounts, Helen and Douglas House received more than £500,000 of statutory funding in 2016-17, including £280,000 via NHS England’s children’s hospice grant, which is awarded annually.

I am aware of recent announcements by the hospice of plans to close Douglas House, which provides support to young adults between 16 and 35, and I recognise the concerns raised by the hon. Lady and her wider community. The fact that more than 40,000 people have signed a petition shows the strength of feeling in her local community, and it is important that young adults with life-limiting conditions can access the support and care they need. Of course the local community is desperate to hold on to that specific facility, but I am sure the hon. Lady welcomes, as I do, reassurance from Oxfordshire CCG that it is working with the hospice to ensure that local patients being cared for at Douglas House continue to receive the essential healthcare they need.

[Robert Courts]

I thank the Minister for her kind words, which are appreciated. Concern about this issue is felt all over Oxfordshire and throughout the wider south-east. Does she agree that it is important that the CCG continues to engage with all interested parties locally, including Members of Parliament, and that this underlines the importance of a close link between care and the NHS?

[Caroline Dinenage]

I believe that my hon. Friend has visited the hospice and I know that he works keenly on this subject. I totally understand the feelings of local people, and I feel strongly that CCGs need to engage with local communities and ensure that the services they commission meet local needs and support local people.

With Douglas House planning to close from July, the hospice has been discussing with Oxfordshire CCG the future of Helen House, which provides hospice beds for children aged between nought and 18. Oxfordshire CCG wants to look at a more collaborative approach to end-of-life commissioning once its current contract for adult hospices finishes in September 2019. The hon. Lady spoke about how the hospice has been excluded for bidding for certain contracts because of the wide nature of what they entail, but the process allows smaller providers such as Helen and Douglas House to work with others to bid for contracts. In the meantime, Oxfordshire CCG is keen to pilot collaborative working with the hospice, which is why it has offered £100,000 for a pilot project until September 2019. Wider discussions are taking place between the hospice trustees and local partners, including Oxfordshire CCG, NHS England and Oxford University Hospitals NHS Foundation Trust, to examine future models of care and the longer-term sustainability of the hospice. NHS England has also been involved in those discussions.

Across England, there are 223 registered independent hospices and a very small number of public hospices that are run by NHS trusts. Around three quarters of those provide adult services, with the remainder caring for children and young people. Funding amounts vary among CCGs, but on average adult hospices receive approximately 30% of their overall funding from NHS sources. CCGs are responsible for determining the level of NHS-funded hospice care locally, and for ensuring that they meet the needs of their local populations.

In addition to NHS funding for locally commissioned services, in 2017-18 children’s hospice services received £11 million through the children’s hospice grant. This is awarded annually and administered by NHS England. Children’s hospices tend to receive smaller amounts of statutory funding because of the way they have developed and the services they provide, and the grant provides the additional support they need. Unlike adult hospices, which are focused on end-of-life care, children’s hospices can provide support through much of a child’s life. Children’s hospices encompass much more than clinical care, including family support, recreational support, respite care and so on.

In 2016, as I think the hon. Lady mentioned, the Government published the end-of-life care choice commitment, which encompasses a whole-system approach to transforming end-of-life care, placing the patient, and their choices, needs and preferences, at the heart of planning. That is so important. The Government and NHS England need to collaborate with partners in the voluntary sector, including key hospice and end-of-life care charities, to ensure that the quality and availability of services continues to improve, and that our end-of-life care commitment is delivered.

One key objective is to strengthen the provision of services in the community so that when people are approaching the end of their life, they can be supported to be wherever they choose to be—whether in their home, a hospice or a care home. Work is ongoing nationally—the hon. Lady talked about how we can join it up in local areas—to provide sustainability and transformation partnerships with the tailored information they need to address and enhance the services in their own areas. NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospices and their interventions in the community. Amazingly, there is very little evidence in this area, but these resources will build on the range of guidance and support provided by NHS England, Public Health England and our charitable partnerships.

It is very important—today’s debate underlines this—to be able to assess how effectively commissioners are working to improve their services, to measure progress and to improve accountability. We will soon have a new indicator in place, which is designed to measure how well patients are supported in the community. This will help to drive improvements in sustainability, which is the big issue in this case, as well as quality and choice. It is very clear that hospice care remains a key part of the Government’s vision for high-quality end-of-life and respite care both in Oxfordshire and throughout the rest of the country.

Question put and agreed to.

Health and Social Care

Caroline Dinenage Excerpts

Wednesday 9th May 2018 Ministerial Corrections

[Barbara Keeley]

The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was

“absolutely disgusted by the report”

and that the way it had been published at the beginning of a bank holiday weekend

“shows the disrespect and disregard”

there is for the scandalous position of people with learning disabilities shown in the report.

[Caroline Dinenage]

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened. [Official Report, 8 May 2018, Vol. 640, c. 546.]

Letter of correction from Caroline Dinenage:

An error has been identified in the answer given to the hon. Member for Worsley and Eccles South (Barbara Keeley) on 8 May 2018.

The correct answer should have been:

[Caroline Dinenage]

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not formally alert us to publication. We are investigating through NHS England and others why that happened.



The following is an extract from the Urgent Question answered by the Minister of State for Care on 8 May 2018.

[Liz McInnes (Heywood and Middleton) (Lab)]

The front page of the report is clearly dated December 2017, so will the Minister clarify and explain why, as she has stated today, her Department did not have sight of it prior to its publication?

[Caroline Dinenage]

I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document and the University of Bristol decided when it was going to be published. It was published on Friday without permission from or any kind of communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.

[Official Report, 8 May 2018, Vol. 640, c. 553.]

Letter of correction from Caroline Dinenage:

An error has been identified in the answer given to the hon. Member for Heywood and Middleton (Liz McInnes) on 8 May 2018.

The correct answer should have been:

[Caroline Dinenage]

I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document. NHS England and the University of Bristol decided when it was going to be published. It was published on Friday, without permission or official communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us from the university. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.

Learning Disabilities Mortality Review

Caroline Dinenage Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Speaker]

Order. There is a certain amount of chuntering from a sedentary position. The Secretary of State has been with us, but Minister Caroline Dinenage will answer the urgent question, and we look forward to her answer.

[The Minister for Care (Caroline Dinenage)]

The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths may have been preventable and have pledged to do so with different health and care interventions. The learning disabilities mortality review programme was established in June 2015; it was commissioned by NHS England to support local areas in England to review the deaths of people with a learning disability. Its aims were to identify common themes and learning points, and to provide support to local areas in their development of action plans to take forward the lessons learned.

On 4 May, the University of Bristol published its first annual report of the LeDeR programme, covering the period from July 2016 to November 2017. The report included 1,311 deaths that were notified to the programme and set out nine recommendations based on the 103 reviews completed in this period. The Government welcome the report’s recommendations and support NHS England’s funding of the programme for a further year at £1.4 million. We are already taking steps to address the concerns raised, but the early lessons from the programme will continue to feed into our work, and that of our partners, to reduce premature mortality and improve the quality of services for people with learning disabilities.

[Barbara Keeley]

Mr Speaker, I think it is disgraceful that the Secretary of State has just run out of the Chamber, rather than answering this question himself—it is disgraceful.

Seven years after Winterbourne View and five years since the avoidable death of Connor Sparrowhawk, the findings of the review show a much worse picture than previous reports about the early deaths of people with learning disabilities. One in eight of the deaths reviewed showed that there had been abuse, neglect, delays in treatment or gaps in care. Women with a learning disability are dying 29 years younger than the general population, and men with a learning disability are dying 23 years younger. Some 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% of the general population who had died by that age.

The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was

“absolutely disgusted by the report”

and that the way it had been published at the beginning of a bank holiday weekend

“shows the disrespect and disregard”

there is for the scandalous position of people with learning disabilities shown in the report.

Only 103 of 1,300 cases passed for review between July 2016 and November 2017 have been reviewed. That is a paltry number. The report cites a lack of local capacity, inadequate training for people completing mortality reviews and staff not having enough time away from their duties to complete a review.

If there are issues around capacity and training, what is NHS England doing to rectify this? Sir Stephen Bubb, who wrote the review into abuse at Winterbourne View, said this in response to the report:

“there can be no community more abused and neglected than people with learning disabilities and their families. How many more deaths before we tackle this injustice?”

Dr Sara Ryan said:

“things have actually got worse than they were 10 years ago”.

What action will the Government take to show the families of people with learning disabilities that their relatives’ lives do count?

[Caroline Dinenage]

I thank the hon. Lady for raising this issue; the report makes for very troubling reading.

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]

As the report clearly identifies, there is still more work to do, and we will work with partners to see how the recommendations may be implemented. We are committed to learning from every avoidable death to ensure that such terrible tragedies are avoided in the future. She mentions Dr Sara Ryan, whose son, Connor Sparrowhawk, died in such tragic circumstances in my own Southern Health Trust area. She and other parents like her are testimony to the incredible dedication of people who have worked so hard to get justice for their loved ones at a time when they feel least able to do so.

We have done several things already. We have introduced a new legal requirement so that from June every NHS trust will have to publish data on avoidable deaths, including for people with a learning disability, and provide evidence of learning and improvements. We are the first healthcare system in the world to publish estimates of how many people have died as a result of problems in their care. Learning from the review is also informing the development of the pathways of care published by NHS England and the RightCare programme, which is tailored to the needs of people with learning disabilities. Pathways on epilepsy, sepsis and respiratory conditions will be published later this year.

We have introduced the learning disability annual health checks scheme to help ensure that undiagnosed health conditions can be identified early. The uptake of preventive care has been promoted and improved, while the establishing of trust between doctors and patients is providing better continuity of care. We have also supported workforce development by commissioning the development of learning disabilities core skills education and training framework, which sets out the essential skills and knowledge for all staff involved in learning disability care.

As I said, the report makes for troubling reading, but we asked NHS England to commission it so that we might learn from these deaths and make sure that trusts up and down the country are better equipped to prevent them from happening in the future.

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

Every preventable death brings personal tragedy, as was highlighted in a 2016 report by Autistica, the autism charity, entitled “Personal tragedies, public crisis”. Autistic adults with a learning disability are 40 times more likely to die prematurely. That is why I welcomed the Government’s announcement in March that reducing the gap in life expectancy for autistic people was one of the top autism priorities in the “Think Autism” strategy governance refresh under provisions in the Autism Act 2009. How will the Minister implement those provisions?

[Caroline Dinenage]

I pay tribute to my right hon. Friend, whose incredible work over many years campaigning on behalf of autistic people up and down the country has made a magnificent difference. She is right to raise this issue. It is of course unacceptable that people with autism have poorer health outcomes, and we are determined to address this. I meet regularly with representative groups and we take on board all their comments about how they would like to see the situation improved.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The report makes tragic reading. Some of our most vulnerable citizens are four times more likely to die prematurely than the general population, and there have been many avoidable deaths because of systemic failures. The situation cannot continue.

Let me ask the Minister three questions. First, will she look at the Scottish patient safety programme, a national programme that has been running since 2008 and is achieving good outcomes? Secondly, given that the Health and Social Care Committee has heard that learning disability nurses are very scarce, will she redouble the efforts to ensure that training for and recruitment to those roles are prioritised? Picking up symptoms early may be crucial to the prevention of morbidity. Thirdly, staff turnaround in social care is a real issue. Social care staff who know a client well, and can notice early changes such as signs of illness and report them timeously to ensure prevention, are crucial, and consistency in care is therefore critical. How will that be addressed?

[Caroline Dinenage]

The hon. Lady is right to raise those points. The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths might have been preventable had there been different health and care interventions. That is why we set up the learning from deaths programme, and have commissioned an investigation of the issue. We are determined not only to learn from every single one of these tragic and avoidable deaths, but to share that learning with those in trusts up and down the country so that they can take a clear look at what is going on under their noses, and ensure that the terrible incidents that we have seen in the past do not happen again.

The hon. Lady was wise to raise the issue of training. It is important to have specialist practitioners, but it is also important to ensure that all healthcare staff, throughout the country, have the training that they need in order to recognise and support the needs of people with learning disabilities. That is something that we have done very successfully with dementia: we record the number of staff in the country who have received tier 1 and tier 2 training, and we are looking into how we can extend that to address the issues of people with learning disabilities.

[Theresa Villiers (Chipping Barnet) (Con)]

In learning lessons from these truly horrific cases, will the Minister commit herself to working closely with the charities that do such incredible work to support people with learning disabilities and their families?

[Caroline Dinenage]

My right hon. Friend is absolutely right. Charities and voluntary organisations all over the country do remarkable work, supporting not only people with learning disabilities but their families and their carers, for whom instances involving their health and wellbeing can be incredibly distressing.

[Sir Vince Cable (Twickenham) (LD)]

The Minister’s statement quite properly focused on hospitals, but does she acknowledge that charities dealing with people with learning disabilities will be among the worst affected by the £400 million back-pay charge? Will she try to ensure that the Government absorb that cost, so that the improvements in hospitals are not upset by a deterioration outside, in communities?

[Caroline Dinenage]

We are looking very carefully at the issue of sleep-ins, and are communicating with social care providers and others. It is important to recognise that we need to support not only the sector as a whole, but the many low-paid workers within it. We will present more proposals on sleep-ins shortly.

[Mrs Maria Miller (Basingstoke) (Con)]

The biggest challenge that many learning-disabled people have is simply making their voices heard. Their legal entitlement to advocacy is not always upheld by health professionals, who often misunderstand that entitlement. Will the Minister look into the commissioning of advocacy services, and, indeed, the understanding of the Equality Act 2010 among NHS staff, to ensure that more learning-disabled people have access to organisations such as Speakeasy Advocacy in Basingstoke, which supports more than 600 people with learning disabilities in north Hampshire, helping to give them the voice that they so badly need?

[Caroline Dinenage]

My right hon. Friend is a fantastic champion for equality issues in her role as Chair of the Women and Equalities Committee. I take on board everything that she has said, and I will certainly look more closely at the issue that she has raised.

[Liz Kendall (Leicester West) (Lab)]

The true disgrace is that none of this is new and we have been here before. Five years ago the Government set out their promises to tackle this appalling death by indifference, yet we have seen no progress. Can the Minister tell me how many hospitals regularly ask the four questions on treatment of people with learning disabilities set out by Sir Mike Richards, how many clinical commissioning groups check and monitor how many health checks and health plans people have in place, and what Health Education England has done to put the training in place to try to start turning the tide on this appalling situation?

[Caroline Dinenage]

The hon. Lady is right that this issue was identified a few years ago. The report was commissioned in 2015 and has been in the making since then. There was a Care Quality Commission report in 2016 which concluded that bereaved families do not often experience openness and transparency. Everything we have done up until this point—the mortality review, the learning from deaths programme and all the other things we have put in place with regard to the transforming care programme and annual health checks—is geared towards addressing this very issue.

[Dr Sarah Wollaston (Totnes) (Con)]

The learning disabilities mortality review programme sets out the stark and unacceptable health inequalities faced by those with learning disability, and I welcome the steps the Minister has set out today. May I press her further, however, on the point about workforce shortfall? What is she going to do not only about recruitment, but about retention of the vital workforce in both health and social care?

[Caroline Dinenage]

My hon. Friend is absolutely right that the workforce in our health and social care system is absolutely fundamental to the way we look after people in our country. We must be able to attract, recruit, retain and bring back into the system people who have left it. We are currently compiling a workforce strategy jointly between Skills for Care and Health Education England, and it will be reporting later in the year.

[Melanie Onn (Great Grimsby) (Lab)]

Parents come to me all the time expressing their grave concerns about what will happen to their children with learning difficulties and disabilities if they are not around to support them. In my constituency I have had reports of instances of bullying from other people in the community, of targeting by drug dealers and of exploitation by private companies such as mobile phone providers and utility companies, and that there are difficulties accessing mental health support. If the Minister is truly keen to show the Government’s desire to improve on the current appalling state of affairs, do not early support and state responsibilities need to be looked at more closely as well?

[Caroline Dinenage]

The hon. Lady is right to make the point more broadly, rather than just about the healthcare outcomes for people with learning disabilities. We need to look at how we protect people more broadly, and this issue must particularly be a terrible worry for the ageing parents. I take on board what the hon. Lady said, and we will definitely feed it into the system to see what more we can do in support.

[Sir Desmond Swayne (New Forest West) (Con)]

What should the CQC be doing that it is not doing already?

--- Later in debate ---

[Caroline Dinenage]

The CQC conducted an inquiry into this issue in 2016 and has a responsibility to check local healthcare provision to ensure it is up to speed. When local trusts start publishing their learning from deaths data from June, the CQC will be able to inspect them on how they bring the data forward and to judge them on that information.

[Mr Ivan Lewis (Bury South) (Ind)]

Societies and Governments should be judged by how they treat the most vulnerable. As well as avoidable deaths of people with learning disability, we have savage cuts to services across the country, so they have no constructive positive activities to participate in, and we have a complete dearth of employment opportunities now for people with learning disabilities. I started my working life 36 years ago working with people with learning disabilities, and we made tremendous progress over a 20-year period. It is a source of tremendous sadness that we have gone backwards in the last 10 years in the support that such people and their families are receiving. It is shameful. We need a cross-Government approach and we need action, not strategies.

[Caroline Dinenage]

It is sad that the hon. Gentleman has sought to politicise this issue. It is nothing to do with funding cuts or cost-saving measures. We have actually invested more money into this programme. We are the first Government in the world to publish a learning from deaths programme so that healthcare trusts are held accountable and have to publish their data on people who die unnecessarily in their care. Making short-sighted party political points is therefore very unfair and does not get to the heart of the issue, which is about supporting people with learning disabilities and making sure that their health outcomes are the same as those of the population as a whole.

[Mr Mark Harper (Forest of Dean) (Con)]

The all-party parliamentary group on learning disability, which I have the honour to chair, will be looking at this area of policy later this year. Mencap, which provides the group’s secretariat, has a Treat Me Well campaign, which is about improving the position, and I know it is keen to work with the NHS. Drawing on some of the other questions, may I ask the Minister what she can do to get the NHS and all the providers to act with a real sense of urgency in making improvements in this regard with the speed that we would like?

[Caroline Dinenage]

My right hon. Friend is right to raise the Mencap report, because in many cases it reflects the recommendations that have been put forward in this particular report. The mandate to NHS England requires a reduction in the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and requests support for them to live full, healthy and independent lives. That is something that NHS England has a mandate to deliver, and we of course support it in doing that.

[Karin Smyth (Bristol South) (Lab)]

If it is a crime to politicise the vulnerability of some people and the Government’s cuts, I stand guilty as charged. Further to the question from my hon. Friend the Member for Leicester West (Liz Kendall), what we have seen since 2013 is the complete decimation of services working together on the ground. This is a local government and health issue locally, so may I press the Minister to tell us what action will be taken to make this happen at local level?

[Caroline Dinenage]

It is not about that. This is about inquiring into the deaths of people who have died in our care. Despite all the really difficult decisions we have had to make to deal with the financial challenges this country faced, which the hon. Lady’s party will be well aware of, we have made progress on this issue in terms of transforming care and the healthcare checks on people with learning disabilities, and this very report on the learning from deaths programme proves how absolutely committed we are to ensuring that not one single one of those deaths goes unrecognised or uninvestigated.

[John Howell (Henley) (Con)]

Surely the quicker integration of the NHS with social care across the board will help to solve some of these problems. Does the Minister agree with that?

[Caroline Dinenage]

Yes, my hon. Friend is absolutely right. The integration of health and social care services is absolutely vital, and that is why we are so delighted that we have renamed the Department as the Department of Health and Social Care. That has to be more than just a title; it has to be a statement of intent.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

Last October, I secured a Westminster Hall debate on supporting and safeguarding adults with learning disabilities, following the horrendous murder of my constituent, Lee Irving. Following that debate, what reassurance can the Minister give me that one of the major lessons coming out of that case—that families must be involved in the decision making about a person’s care—has been learned?

[Caroline Dinenage]

I thank the hon. Lady for raising that case. It was a truly horrible case. The Mental Capacity Act 2005 is all about making sure that we have care that is centred around the individual, and that parents’, families’ and carers’ thoughts are taken into consideration when making decisions about how we care for people.

[Victoria Prentis (Banbury) (Con)]

We can be confident that the right legal framework is now in place, with the Equality Act 2010 and the Health and Social Care Act 2012, but what further steps can the Minister take to ensure that those who work in NHS organisations are aware of them?

[Caroline Dinenage]

Of course it is the responsibility of individual employers to ensure that their staff are appropriately trained and competent to fulfil the responsibilities that we ask of them, but we have commissioned Health Education England, Skills for Health and Skills for Care to develop a learning disabilities core skills education and training framework, which sets out a tiered approach to that kind of training and how it needs to be improved.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

This review should shame us all. If we reflect on Sir Stephen Bubb’s final reports from two years ago in 2016, following a report he wrote in 2014 when there had been no progress, we can see that he put forward 10 recommendations. We have seen little or no progress on any of those recommendations. One of them recommended the introduction of the commissioner for learning disabilities, and we need that to happen if we are to see real progress and change. Will the Minister now take that important recommendation forward?

[Caroline Dinenage]

The hon. Lady is right to raise that, but I will point out that we commissioned the review to examine the situation. We are not running away from our responsibilities; we are standing up and facing them. We are allowing them to be entirely transparent and out there in the public domain for people to judge. The deaths that the report covered come from the period starting July 2016, so they are historical, but it is important that they are examined. The hon. Lady is right to mention the issue of the commissioner, and I will look at that.

[Kevin Foster (Torbay) (Con)]

While the review’s conclusions make difficult reading in some ways, it is welcome that it happened, given that it is a world first and that it gives us the chance to have this discussion. What work will be done with councils and other third sector partners on taking away some of the lessons that can be learned from the review?

[Caroline Dinenage]

My hon. Friend is right to say that this is the first time in the world that such a review has been done. We are the first to have a learning from deaths programme and a Healthcare Safety Investigation Branch, so we take such things incredibly seriously. The whole point of the learning disabilities mortality reviews is that the information will be disseminated to local trusts so that they can make plans to avoid such disastrous, tragic incidents happening in the future.

[Lilian Greenwood (Nottingham South) (Lab)]

The gap in life expectancy for people with learning disabilities is deeply troubling. Last week, and at Health questions earlier, the House discussed cancer screening and the need to improve screening opportunities. The Minister will know that screening participation rates among people with learning disabilities are far below those for the general population. What specific actions is she taking to address that gap?

[Caroline Dinenage]

The hon. Lady is right to raise the inequalities of diagnosis of conditions and illnesses for which catching them early can mean the difference between life and death. That is why we have introduced annual health checks for people with learning disabilities. They mark a huge step forward and will help to reduce recognised health inequalities and ensure that reasonably adjusted care needs are much better communicated to other NHS partners.

[Chris Skidmore (Kingswood) (Con)]

As a Bristol-area MP, I thank the University of Bristol for its rigorous review, which marks a milestone in increased transparency and in setting out appalling healthcare inequalities. I note with interest that the review recommends efforts to improve awareness of the signs of sepsis and pneumonia in patients with learning disabilities in the NHS. Will the Minister reassure the House that the NHS will take up that recommendation urgently?

--- Later in debate ---

[Caroline Dinenage]

Yes. Specific work on early detection of the symptoms of sepsis, pneumonia, constipation and epilepsy and on the effective use of the Mental Capacity Act 2005 in urgent care settings is already under way.

[Liz McInnes (Heywood and Middleton) (Lab)]

The front page of the report is clearly dated December 2017, so will the Minister clarify and explain why, as she has stated today, her Department did not have sight of it prior to its publication?

[Caroline Dinenage]

I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document and the University of Bristol decided when it was going to be published. It was published on Friday without permission from or any kind of communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

During my career as a paediatrician, I have seen huge improvements in the care of children and young people with severe and moderate learning disability, many of whom have survived into adulthood when that would not have been the case years ago. Owing to the association between severe and moderate learning disability and other medical problems that may limit someone’s lifespan, it is unlikely to ever be equal to that of the general population, but we should always ensure that the care of the most vulnerable in society is as good as it can be, and I welcome the steps that the Minister is taking to ensure that it is. Such people are cared for jointly in hospitals and in the community, so will she confirm that hospitals and community care will work together following such reviews?

[Caroline Dinenage]

This is something that my hon. Friend, as a healthcare professional, obviously knows an awful lot about. She is right that a person having the ability to communicate, understand and identify when they do not feel well is important. These annual health checks, which are available to children from the age of 14 and into adulthood, are important because they enable any healthcare issues to be disseminated and communicated much more effectively between different healthcare and other providers.

[Mike Amesbury (Weaver Vale) (Lab)]

Can the Minister guarantee that future publications of such sensitive reports will be done in a timely manner and given proper parliamentary scrutiny?

[Caroline Dinenage]

I will certainly put that request to NHS England. It was not in our interest for the report to be published on Friday. This is an independent review, but it would have been much better for us to have had foreknowledge of its publication. We would then have brought a statement to the House. We will pass on the hon. Gentleman’s comments to NHS England.

[Rachel Maclean (Redditch) (Con)]

Sepsis has already been mentioned by my hon. Friend the Member for Kingswood (Chris Skidmore). Is the Minister aware that the mortality rate for sepsis in the Worcestershire Acute Hospitals NHS Trust has experienced a remarkable turnaround from 49% above the national average to 26% below the national average? Will she look at some of the best practice that is down to the hard work of the doctors and nurses, the awareness-raising campaign and all the other education work happening in that hospital, and disseminate it more widely to benefit such patients?

[Caroline Dinenage]

I thank my hon. Friend for raising that important issue. Sepsis is a silent killer. If not identified early, it can lead to life-changing implications or death. She is right that we have made great steps in addressing sepsis. Only a couple of weeks ago, we launched a new e-learning tool to help healthcare professionals better identify the symptoms of sepsis, particularly in children, so they can tackle it early.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister has spoken a lot about being committed to improvements in this area. Does she think it is acceptable that she did not know a report in this important area was to be published on Friday? Why did she not come to make a statement today, rather than waiting to be summoned to the House by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)?

[Caroline Dinenage]

What is unacceptable is that people with learning disabilities have poorer health outcomes than the rest of the population, which is why NHS England commissioned this piece of work and why we are determined to address it.

[Kate Green (Stretford and Urmston) (Lab)]

What steps is the Minister taking to ensure that people with learning disabilities can confidently access good quality sexual health services? What work is she doing with her counterparts in the Department for Education to ensure that young people with learning disabilities receive excellent sex and relationships education?

[Caroline Dinenage]

This is an important aspect, and I will get in touch with the hon. Lady with a more detailed answer to her question.

[Stephen Lloyd (Eastbourne) (LD)]

This is a shocking report, and its conclusions demean us all. A lot of people on both sides of the Chamber have asked the Minister and her Department to come up with some actions. Rather than just talking about it, will she commit today to coming back to the House with a specific action plan to prevent and change what has been an absolutely shocking situation for many decades?

[Caroline Dinenage]

The hon. Gentleman is right to say that this has been a shocking situation for many decades, which is exactly why this report was commissioned so that we can learn from past errors and identify how to stop them ever happening again. There are nine recommendations in this report, and we will work with NHS England on how to adopt every single one of them.

[Stephen Lloyd]

Will you bring it back to the House?

[Caroline Dinenage]

Of course.