Social Care Provision and the NHS

Caroline Dinenage Excerpts

Thursday 3rd May 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Dame Cheryl. I thank the hon. Member for High Peak (Ruth George) for securing the debate and setting out the issues so articulately. I congratulate her on making it to the debate, and I thank you, Dame Cheryl, for allowing it to take place. It would have been a great concern to us all if that had not happened.

As hon. Members will know, I am relatively new to my role as the Minister for Care in the Department of Health and Social Care. That is why I am really grateful for the chance to focus on the interface between social care and health, and to outline how integration is absolutely at the heart of what we do. The renaming of the Department of Health as the Department of Health and Social Care must be more than just a change of title; it must provide a sense of direction and a change of culture. We know that health and social care are umbilically linked, and that one is a key driver of the other.

We recognise that many of our challenges stem from the very good news that people are living longer, which is to be celebrated. Worldwide, the population aged 60 or above is growing faster than all other age groups. In developed countries the proportion of the population aged 65 and above is expected to rise by 10% over the next 40 years. That means that, in England, by 2026 the population aged 75 and above, which currently stands at 4.5 million, will rise by 1.5 million. By 2041 it will have nearly doubled.

People’s expectations and wishes are also changing. The traditional model of social care is based on care homes, but we know that increasingly people want care to be delivered in their own homes. We want to encourage people to live independently and healthily in their homes, where many people want to stay. We know that nine in 10 older people live in mainstream housing, and that only 500,000 of those homes are specifically designed for their needs. Adapting homes to make them more suitable is therefore incredibly important. The disabled facilities grant has a vital role to play. Home adaptations and investment can be incredibly effective. Not only do such adaptations allow people to lead independent healthy lives, but our analysis shows that for every £1 spent, more than £3 is recouped, mostly through savings to the health and care system. Housing that enables people to live independently and safely allows us to reduce the number of people who need to go into hospital or have other social care requirements.

We have to look at the way we provide and fund services for the long term. Complex conditions must be addressed, and we must move to a system in which care, whether social care or health care, is individually tailored to people’s needs. The hon. Member for Glenrothes (Peter Grant) put it beautifully when he talked about how we need to stop using social care and our health service as a political football. We need to champion where there is good practice, not just talk about where it is bad. We need to look at how we can produce much more person-centred care, where we address an individual’s needs. We need to celebrate the amazing places up and down our country where it is going right, and we need to support the incredible workforce in this country—both the informal workforce, and the dedicated hospital and social care workforce. A number of pieces of work are ongoing. As the hon. Gentleman said, we need to have the courage to tackle the difficult questions, and that is what is happening.

A number of key pieces of work are happening at the moment to address many of the issues that the hon. Member for High Peak raised. Many of those issues will be tackled in the forthcoming Green Paper. We have an ongoing workforce strategy that is taking place jointly between Health Education England and Skills for Care. In order to address the challenges of our ageing population, we need to attract more people into the workforce. We need to ensure that they are properly rewarded for their work, that there is continuous development within that work, and that we attract people from a much more diverse range of backgrounds.

As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, we also have a carers action plan, which is to be published shortly. She spoke about her constituent, Katy Styles.

[Barbara Keeley]

The person I was talking about is not a constituent; she is a national campaigner for the MND Association, and she has an e-petition. It is important to note that she is running a national campaign.

[Caroline Dinenage]

I am grateful to the hon. Lady for clarifying that. I would say to Katy Styles that the decision about whether it is called a strategy or an action plan was taken before I was in my role, but an action plan sounds to me like a much more positive thing.

Actions speak louder than words. We are talking about not just a sense of direction, but what we are doing and how we intend to do it. That is why the carers action plan will be a really important piece of work. I massively value the work of carers up and down the country—indeed, my mother was one—and I want to ensure that we properly recognise and reward what they do. We must be doing what we can, and not just through the Department of Health and Social Care but in collaboration with colleagues across Government, to help and support carers and ensure that the issues they face on a daily basis are tackled.

[Barbara Keeley]

It is worth clarifying this point while the Minister is talking about the action plan. I told her that I did that piece of work years ago on the first national carers strategy, which came out in 1999 and went right across Government. The difference I see is that that was signed by many Departments, with commitment from those Secretaries of State, but the action plans under the coalition, and those we have seen recently, are just signed by Social Care Ministers; they are very much smaller things. Departmental action plans are not the same as cross-Government national strategies, and I understand why carers feel that strongly.

[Caroline Dinenage]

The hon. Lady has a surprise coming—this action plan is signed by Ministers from across Government.

The hon. Member for High Peak raised cost pressures. We can all admit that local authority budgets have faced pressures in recent years. They account for about a quarter of public spending, so they have had a part to play in dealing with the historic deficit that we all know we inherited in 2010. That means that social care funding was inevitably impacted during the previous Parliaments. However, with the deficit now under control, we have turned a corner.

Thanks to a range of actions taken since 2015, the Government have given councils access to up to £9.4 billion of more dedicated funding for social care from 2017-18 to 2019-20. Local authorities are therefore now estimated to receive about an 8% real-terms increase in access to social care funding over the spending review. In Derbyshire, the hon. Lady’s local council has seen an increase of £33 million in adult social care funding from 2017-18 to £201.8 million, which is above the 8% figure—it is a 10.3% increase on the previous year. The Care Act 2014 places obligations on local authorities and the extra funding is designed to help them meet those obligations.

[Ruth George]

I did not want to turn the debate into a political tit-for-tat, but I do not want my constituents in Derbyshire to think that suddenly there is a £33 million increase and everything is rosy for social care. The council has seen its funding cut by £157 million over the past seven years. Unfortunately, that increase is a drop in the ocean. In particular, the rise in the cost of the living wage impacts on care costs. What the council is getting back is nothing like what it has lost.

[Caroline Dinenage]

I have already recognised the fact that all local authorities have had to make some really tough decisions. We know it has been difficult for everybody. Taking that action to control the deficit and get the country’s finances under control has meant that we have turned a corner and we are now beginning to put that funding back in. I do not think we can deny that there were years that were very difficult for all local authorities. There is dedicated funding in adult social care; the funding goes to a specific cause, which is really important, and allows local authorities to support and sustain a more diverse care market. It also goes on to help relieve pressure on the NHS, including by supporting more people to be discharged from hospital as soon as they are ready.

The money is already beginning to have an impact. Delays of transfers out of hospital due to adult social care hold-ups have reduced by more than a third over the past 12 months, freeing up 820 beds. A key tool in developing more and better out-of-hospital services is the better care fund, which is a mandatory, national programme for integrating health and social care. It joins up services so that they are designed around people’s needs, enabling them to manage their own wellbeing and to live as independently as possible. By mandating the pool of funds, the better care fund has helped to join up health and care services and incentivise local areas to work better together with increasing amounts of funds being used in that process. Some 90% of local leaders have reported that the better care fund has helped them to progress integration in their areas.

We know that the burden of care cannot and should not continue to fall simply on hospitals. We need to move care into the home and into the community. There are great examples of how that is working in practice up and down the country. Public Health England, the Chief Fire Officers Association, the Local Government Association, NHS England and Age UK already have a joint working approach to establish how local fire and rescue services, for example, can be commissioned to check on people in their homes, to check on the safety of people’s homes, and to check on things such as trip hazards—all things that can lead to people being admitted to hospital or needing the support of social care services. They work together to encourage joint working around intelligence-led early intervention and, in doing so, reduce preventable hospital admissions.

Evidence has indicated that longer hospital stays for older patients can lead to worse health outcomes and an increase in their care needs on discharge. We know that for a healthy older adult, 10 days of bed rest leads to a 14% reduction in leg and hip muscle strength and a 12% reduction in aerobic capacity, which is the equivalent of 10 years of their life, which is a massive incentive to make sure we get people back into their own homes and active as quickly as possible, in the interests of their own wellbeing.

I am particularly interested in understanding how intermediate care—step-up and step-down services—can reduce the impact of health crises on individuals. A relatively minor infection or a temporary worsening of a chronic condition should never spiral into a prolonged hospital stay with a detrimental impact on long-term quality of life. The real goal of integrating health and social care is not simply a benefit to the system, but an emphasis on person-centred care. We need multi-disciplinary teams working around a person to maximise the effectiveness of interventions, and therefore minimise disruption to the individual.

The hospital to home programme brings together practitioners across health and social care to develop solutions for more patient-centred care, focusing on how to keep people at home. It shows how urgent and emergency care services, community services, primary care and social care can all work together to make sure that people get the right care at the right time and, crucially, in the right place. That partnership goes through everything that local partners do, whether providing interlocking services or commissioning the right pattern of services.

How can we push forward these aims and create a sustainable settlement for social care? In March, the Secretary of State for Health and Social Care outlined seven principles for the Green Paper on care and support and for adult social care reform, and he put a key focus on the need to integrate services around the individual for a seamless, whole-person approach to both health and care. We have committed to publishing the Green Paper by the summer, and when it is published there will of course be a full public consultation, through which we want to seek the broadest possible range of views. I look forward to the contributions of Members under that national discussion.

[Dame Cheryl Gillan (in the Chair)]

The hon. Member for High Peak has a couple of minutes to wind up if she so wishes.

Draft Employment Rights Act 1996 (NHS Recruitment-Protected Disclosure) Regulations 2018

Caroline Dinenage Excerpts

Wednesday 25th April 2018 General Committees

[The Minister for Care (Caroline Dinenage)]

I beg to move,

That the Committee has considered the draft Employment Rights Act 1996 (NHS Recruitment—Protected Disclosure) Regulations 2018.

It is a great pleasure to serve under your chairmanship, Ms Dorries. The draft regulations prohibit certain NHS employers from discriminating against job applicants who have disclosed certain information—often called whistleblowing. Applicants have a legal recourse should they feel they have been discriminated against, with appropriate remedies if their complaint is upheld. An NHS employer discriminates against an applicant if they reject the job application or otherwise treat them less favourably than other applicants.

We want to ensure that the NHS is the safest and most transparent healthcare service in the world. To achieve this, those who work in the NHS must feel safe speaking up and raising concerns at work, and confident that action will be taken without having a negative impact on their career or employment opportunities. The draft regulations will help to send a very clear message that openness, transparency and fairness should be the norm within the NHS. They will also increase the trust that patients, other service users and the wider public, have in the NHS.

We want NHS employers to be exemplars in fostering a culture of openness and willingness to report problems. We want an NHS in which lessons are learned, to provide the safest possible care for patients.

--- Later in debate ---

[Caroline Dinenage]

I am grateful to the hon. Gentleman for his support in this important matter. For too long, we have failed to protect those who are brave enough to speak out when others do not. We learned from the Mid Staffs case about what happens when there is a defensive culture and people cover up mistakes. We want to make the NHS the safest healthcare system in the world, so we must build a culture of openness and transparency. If we are to do that, healthcare professionals need to feel that they are safe to speak out about problems in the workplace. We want them to feel safe in raising problems, so that speaking out becomes the norm and not the exception. These important measures should ensure that staff can raise concerns, knowing that they are protected by the law and that their career in the NHS will not be damaged as a result of doing the right thing.

The hon. Gentleman asked a number of important questions and I will attempt to answer as many as I can, but I will respond in writing on any that I omit, if that is acceptable. We need the draft regulations, in addition to the Employment Rights Act 1996, to protect people from detriment when they have spoken up in the public interest when they reasonably believe that they witnessed wrongdoing. “Worker” has a wide meaning in this context: the original legislation does not include job applicants, so the draft regulations address that. In addition, they provide that discrimination against a job applicant by an NHS employer is actionable as a breach of statutory duty. That gives job applicants additional protection and includes the right to bring a claim in the civil courts for a breach of statutory duty—for example, to prevent discriminatory conduct.

The draft regulations also treat the discrimination of an applicant by a worker or agent of the prospective NHS employer as if it were discrimination by an NHS employer. NHS staff who are prepared to speak out are an important asset, and workers who have previously had the courage and the compassion to do this should also be considered a valuable asset by the NHS body that is considering whether to employ them. I am sure that the hon. Gentleman agrees.

The draft regulations give NHS job applicants a right to complain to an employment tribunal if they feel that they have been discriminated against. The draft regulations set out a timeframe of three months, as he identified: that is consistent with the time limit for employment claims generally. The draft regulations also make it clear that, in the case of a decision by an NHS employer not to employ or appoint an applicant, the three-month time limit starts from the date that the decision was communicated to the applicant and not the time that the decision was made by the employer. The draft regulations enable the tribunal to consider a complaint that is otherwise out of time, if it considers it just and equitable in the circumstances.

[Justin Madders]

I know that the Government want to reduce the number of tribunal applications made. Does not the hon. Lady feel that there is a risk that, if employers are putting in applications not in possession of the full facts, more litigation would actually be encouraged rather than less?

[Caroline Dinenage]

The Government will keep that under review. It is important that we keep this as consistent as possible with the time limits for general employment cases, but if there do appear to be any issues along those lines, they can be reviewed.

The draft regulations also set out the remedies that the tribunal may or must award if the complaint is upheld. The employer may be ordered to pay compensation or the tribunal may recommend that the employer take other specified steps or make a provision on the amount of the compensation that may be awarded.

The application to an employment tribunal under the draft regulations is subject to the early conciliation regime, which provides an opportunity to resolve the claim via ACAS. We often find that, when people are able to resolve their differences via ACAS, it helps to alleviate the problem of someone who has had tribunal experience to the detriment of their future employment. It should also help to ensure that only cases that cannot be resolved through other methods actually reach the final step of an employment tribunal.

The draft regulations enable an employment tribunal to order compensation to be paid where there has been an actual breach of the prohibition on discrimination. The power to award damages is discretionary. Ultimately it is for the court to decide whether damages should be awarded, and we expect the court to take into account all the relevant factors when deciding whether that is appropriate, and to act fairly.

The hon. Gentleman is right to ask why the measures focus specifically on NHS employers. That was the original reason behind the legislation. The freedom to speak up is important, though, and we shall keep the regulations under review and assess their impact on the NHS before we assess the possible impact on other employers, such as social care providers.

[Justin Madders]

It was not just the fact that it is applied only to NHS employers, but that it is applied only to some NHS employers. I gave examples of various organisations within the NHS that are not covered by the regulations.

--- Later in debate ---

[Caroline Dinenage]

I totally understand what the hon. Gentleman is saying—for example, GPs are not covered if they have independent contractor status, because the powers for the regulations in the 1996 Act are limited to NHS public bodies. As I said, though, we will keep all of that under review and come back to it if necessary.

We talked about future-proofing. As I said, we will review it over time. It is important that there are existing protections for employers as well; this is not just about employees. Under the draft regulations, the normal route for individuals would be via a normal employment tribunal. The fees have recently been abolished, and I do not think there are any plans to revisit that decision. The Government will keep the matter under review to assess the impact, before making any further decisions.

The hon. Gentleman mentioned the definition of a “worker”, which for the purposes of these regulations would carry the extended meaning under the Employment Rights Act. That is already a broad definition, and we will need to consider carefully whether there is a case for extending it. The test for discrimination includes the concept of appearance to the employer. That is actually in the primary legislation—the Employment Rights Act—and the regulations reflect that. We will again keep under review how that legislation is working.

If there are any questions I have not answered, I shall be happy to write to the hon. Gentleman. I commend the draft regulations to the Committee.

Question put and agreed to.

Social Care

Caroline Dinenage Excerpts

Wednesday 25th April 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for introducing the debate. We want this to be the best country in the world in which to grow old and in which people can face their third age knowing that they will be supported to live healthy, independent lives for longer and for as long as possible, with a choice of good-quality, affordable care that is there, should they need it. Today’s debate is a welcome opportunity to cover the action that this Government have taken to improve social care, highlighting a few examples where real progress has been made, as well as discussing our longer-term plans for the Green Paper, which will be published later this summer.

Most of all, however, I want to do something that the hon. Lady forgot to do, which is pay tribute to the extraordinary people—both the social care workforce and the informal carers—who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country.

[Barbara Keeley]

The Minister has just said that I did not pay tribute to informal carers. That is just not true. Everybody who knows me knows that I have never stopped paying tribute to informal carers, and I did so in my speech today. Please will the Minister not attribute comments to me that I did not make?

[Caroline Dinenage]

What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.

[Norman Lamb]

The hon. Lady is right to pay tribute to informal carers, and indeed to paid carers, but does she not feel uncomfortable with the fact that she and all her colleagues on the Conservative side legislated with us to introduce a cap, committed in 2015 to implement the cap, then abandoned it, thus abandoning the very informal carers she says she cares so much about?

[Caroline Dinenage]

We have not abandoned the cap. The Prime Minister said very clearly that we would continue to consult on the cap, and that will come forward as part of our plans for the Green Paper later in the year. We in this Chamber often hear about Labour’s recession and how it led to some hard decisions about public spending to get the country back on track, but we often forget—

[Anna Turley (Redcar) (Lab/Co-op)]

rose—

[Caroline Dinenage]

Let me make a little progress, then I will happily take the hon. Lady’s intervention.

We often forget that we inherited not only difficult spending choices but a social care system that was on its knees because successive Governments—not just Labour—had failed to act. Labour acknowledged the problem in its 1997 manifesto, promising to find a solution. However, 13 years later, after one royal commission, two Green Papers and the 2007 spending review pledging to address the situation, Labour left office without delivering it. Worse than that, by the time Labour left office, despite the booming economy, council tax had doubled and every year 45,000 older people were forced to sell their home to pay for residential care costs.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Let us get back to the present day, because that is what we are debating. Disabled people of working age make up more than half of adult social care users. Given that the UN condemned the Government’s breaches of the convention on the rights of persons with disabilities, particularly article 19 on independent living, what does the Minister estimate to be the impact on independent living for disabled people of the cuts to social care?

[Caroline Dinenage]

If the hon. Lady will bear with me, I will come on to discuss that, but there will be a separate, parallel workstream on working-age adults, who account for over half of the spending—

[Barbara Keeley]

Why?

[Caroline Dinenage]

If the hon. Lady will give me the courtesy of allowing me to finish my comments, I will explain why in a moment.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) wondered why we are going back to the past and looking at Labour’s record, but Labour is asking people up and down the country to vote for them in the local elections, so they will rightly look at Labour’s record and at how it dealt with the social care crisis when it was in government. After 13 years of inactivity and bluster, people need to be able to make a choice based on historically accurate facts.

[Barbara Keeley]

Will the Minister give way?

[Caroline Dinenage]

The hon. Lady had plenty of time to make her comments, so I will make a little progress.

When the Conservative party formed the coalition Government in 2010, it is worth remembering that not only did we have to deal with the parlous state of the country’s finances, but we inherited a burning platform of social care. Of course, that meant taking difficult decisions in those early years, which were challenging times for local authorities.

[Karin Smyth]

Will the Minister give way on the cap?

[Caroline Dinenage]

I will be coming on to the cap later.

To give the Labour party its due, it recognised that we had difficult decisions to make. Had Labour stayed in government, it planned £52 billion-worth of cuts to local government budgets by 2015. However—enough of the history lessons—I intend to make progress and answer many of the shadow Minister’s questions.

[Several hon. Members rose—]

[Caroline Dinenage]

If hon. Members will bear with me, I will now make some progress.

The tough spending choices that we have made have paid dividends, meaning that we have turned a corner in recent years. That is why local government will be able to increase spending on adult social care in real terms in each of the next three years. Our population is growing, ageing and diversifying. At the same time, the money, means and methods that we deploy to serve their long-term health and care needs are under increasing pressure to deliver, and we need to address those issues now.

There is recognition across the House that even if we had an infinite amount of money to fix the problem, the system would need reform. We are taking steps to make the system more effective and to ensure that it better serves the needs of vulnerable people and society in general. That is why this summer’s Green Paper will complement those measures and ensure that our social care system is placed on a sustainable footing and will serve this nation for generations to come.

The Secretary of State recently outlined the seven key principles guiding our thinking on social care as we approach the Green Paper: quality, whole-person integrated care; control; workforce; supporting families and carers; a sustainable funding model for social care; and security for all. As I have said, this is not just about older people. The Green Paper will cover a range of issues that are common to all adults with care and support needs, but we are committed ensuring that any issues relating to social care that are specific to adults of working age are identified and given the right focus. Work on that is being led jointly by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government.

I will reflect on some of the Green Paper’s themes, but first I will highlight a couple of areas where real progress has been made. I have said that we know there is growing pressure on local authorities’ finances, but it simply is not true that this Government are failing to deal with or acknowledge the crisis.

[Yasmin Qureshi]

The Minister talks about trying to use finances appropriately. My local council has had a 54% cut to the funding that it receives from central Government, which is why it has a shortfall in funding for social care.

The Government have been able to find money to cut corporation tax, capital gains tax and inheritance tax, as well as £1 billion for the Democratic Unionist party. Are they really saying this is all about austerity and choices? Is it not really that the Government have different priorities from the Opposition?

[Caroline Dinenage]

I can honestly say with my hand on my heart that the Labour party does not have a monopoly on care or kindness.

I mentioned earlier that local authorities will receive a real-terms, above-inflation increase in their funding profile. We have announced significant dedicated funding for social care. The Opposition regularly seem to forget that we allocated an additional £2 billion to social care only a year ago, with a further £150 million this year. That means councils have access to £9.4 billion of dedicated funding.

[Thelma Walker]

Kirklees Council has had its funding cut by central Government by nearly £200 million. This year, it has raised its council tax by 5.9% to help pay for services. The three percentage points for social care come to £4.8 million, but there is a shortfall of £12 million a year. Can the Minister tell councillors where the rest of the money for social care should come from?

[Caroline Dinenage]

We are looking at the long-term sustainability of adult social care funding, and there will be more news in the Green Paper later this year. The last Labour Government had 13 years without dealing with the here and now, so I will take no lessons from them.

[Several hon. Members rose—]

[Caroline Dinenage]

I will make a bit of progress.

The shadow Minister asked about Allied Healthcare. She is right to raise that, and I am grateful that she has done so. As she said, Allied Healthcare announced last Thursday that it is proposing a company voluntary arrangement to its creditors. I want to talk about that specifically because people across the country will be concerned. I spoke to the chief executive officer last Thursday to emphasise the importance of continuity of care for everyone receiving its services, both in adult social care and primary care, and the company has made it clear that those who receive services from Allied Healthcare will continue to receive the same level of care and that their care plans will not change.

[Barbara Keeley]

I am glad the Minister has responded in that way, but I asked her how she would ensure that 150 councils can fulfil their statutory duty to provide care if that company goes bust. We need to know a bit more than that she has had verbal reassurance. Of course the chief executive, in his current position, will try to give her verbal reassurance but, under the CVA, the creditors have to be satisfied within four weeks. What is going to happen if this company goes bust? Is it going to be another Southern Cross?

[Caroline Dinenage]

I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are working up contingency plans to ensure individuals’ care and support needs continue to be met.

While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.

[Maria Caulfield]

My local East Sussex County Council is a rural authority, so for decades it has had 49% less funding per head of population, yet it has had the same pressures as the areas represented by Opposition Members. By working together with health services, my council has reduced delayed discharges by 38%. Will the Minister welcome the hard work of East Sussex County Council?

[Caroline Dinenage]

I do welcome it. I recognise the very hard work of local councils that have managed to reduce delayed transfers of care. Indeed, I also recognise the very hard-working NHS staff, such as my hon. Friend, who have also helped to make that a reality.

We know that the NHS is busier than ever before, with hospital admissions rising by 33% since 2007, yet we have set clear expectations for reducing delayed discharges. Despite these challenging circumstances, both the NHS and social care have been working hard to free up beds. Since February 2017, more than 1,600 beds per day have been freed up nationally. I need slightly to take exception to the way the hon. Member for Worsley and Eccles South described people being discharged before they are medically fit. If someone is experiencing a transfer of care that has been delayed, it is because a multi-agency team have already assessed them as being medically fit for discharge.

[John Redwood]

Following on from the point about the big variations in how much per head councils get, may I point out that some time ago West Berkshire and Wokingham were cut back because they were very efficient and doing a good job? Will the Minister make sure that in the new formula good conduct is taken into account and does not lead to penalties?

[Caroline Dinenage]

I will certainly take that into consideration.

[Barbara Keeley]

The Minister is just proving that she was not listening to what I was saying. What I said was that the British Red Cross has said that it had found innumerable cases where discharges have happened so quickly that people were discharged without the right amount of care, and that can just lead to a cycle of readmission. A constituent told me that, in the case of Salford Royal, which is an excellent hospital, she felt she had been “thrown out of hospital.” That is what she told me.

[Caroline Dinenage]

I very much thank the hon. Lady for that clarification.

Our funding increases have gone into initiatives such as the better care fund, which provides a mechanism for local authorities and clinical commissioning groups to pool budgets for the purposes of integrated care.

[Rachel Maclean (Redditch) (Con)]

Will the Minister give way?

[Caroline Dinenage]

I hope my hon. Friend will not mind, but I want to make a little progress. The fund has helped to join up health and care services so that people can manage their own health and wellbeing, and live independently in their communities for as long as possible.

Another area where we have made significant progress is quality and safeguarding. The Care Act 2014 placed adult safeguarding on a statutory footing for the first time and established a national threshold that defines the care needs that local authorities must meet. This eliminates the postcode lottery of eligibility across England. Last year, local authorities in England advised more than 500,000 people how to access services to meet their care needs—this includes services provided by leisure, housing, transport and care providers, as well as voluntary groups.

Everyone is entitled to, and deserves, quality care, and we are working to improve the terms and conditions for people accessing care, to ensure that their rights are protected.

[Norman Lamb]

On the sleep-in allowance, is it reasonable to expect providers to fund these back-pay claims, given that at the time the liability was incurred commissioners and providers entered contracts on the basis of what the Government said was right in terms of the minimum wage? When the Government change the position, surely it is not fair on organisations, private or third sector, retrospectively to expect them to pay.

[Caroline Dinenage]

I understand and share the right hon. Gentleman’s concerns on sleep-ins, and will be addressing this a little later in my comments.

We have established adult safeguarding boards to help to protect vulnerable adults in our society from abuse or exploitation. They can also act as an important source of advice and assistance for those using the adult safeguarding system. This Government also introduced the toughest system of care home inspection in the world. Eighty-one per cent. of adult social care providers are good or outstanding according to the CQC, which is a testament to the many hard-working and committed professionals working in care, to whom we owe a huge debt of gratitude. The CQC regime is already having a positive impact and 82% of providers who are rated as inadequate go on to improve.

Regardless of that, there is too much variation in the quality of care. Neighbouring local authorities can have radically different success rates on care quality and we are taking steps to address that. We are working with the adult social care sector to implement Quality Matters, a shared commitment to take action to achieve high-quality adult social care for service users, families, carers and everyone working in the sector.

We welcome the Competition and Market Authority’s recent market study on care homes. It makes difficult reading, but we have welcomed it and as part of developing the Green Paper the Government are carefully looking at all the issues identified. What is more, we have published a package of measures to improve consumer protections in the social care sector after the CMA raised concerns about unfair consumer practices in homes, including the charging of unfair fees to residents and the lack of contractual and pricing transparency.

Those measures, which include working alongside industry to develop model contracts and supporting the CQC to better hold providers to account, aim to put the power back into the hands of residents and their families. We are clear, however, that if improvements are not seen we will look to change the law to strengthen protections so that people can be treated with the dignity and respect they deserve.

That leads me to the third aspect on which I want to focus. Ultimately, the social care workforce are the backbone of the care sector. We know that there are challenges and that is why we need to ensure that they are supported to deliver the best-quality care now and in the future. Part of that endeavour involves respecting not only the compassion and dedication of care workers but the vast range of skills they have. Alongside social workers, occupational therapists and nurses, we have many care workers who could benefit from or be inspired by new career progression ladders. We need to ensure that we have enough people within all those skilled roles to support individuals and families in living their best possible lives. That means ensuring that new routes into social care professions have as much variety and value as those developed by the NHS. Apprenticeships are part of that story. I am proud that in 2016-17 more than 90,000 social care apprentices began their training. That is up more than 40,000 compared with in 2010.

Of course, pay remains a constant and often emotive issue. Care workers deserve a wage that reflects the true value of their work. The national living wage is, in part, a reaction to that and the average salary for a care worker in the independent sector has gone up by 4%, with those full-time staff on the minimum wage seeing a pay rise of up to £2,000 since 2015. We are not complacent about the economic pressures faced by many in the system, but that is a good place to start.

A couple of hon. Members have spoken about sleep-ins and they are absolutely right to raise that. The Government are committed to creating an economy that works for everyone, ensuring that workers are paid fairly according to the law, including through the national minimum wage, but we recognise the pressure that has been placed on the sleep-in sector by historic liabilities for back pay. We are carefully exploring options to minimise any impact on the sector caused by this and have been engaging with the European Commission to ensure that any response would be legal. The Government will continue to work with representatives of the social care sector to strengthen the evidence base, building on the work we began over the summer. I will, of course, keep the House informed when we have made progress.

There are thousands of care workers in England, and we need many more, but it is true that we already have hundreds of thousands of carers out there—the unpaid hidden army of family, friends and community volunteers without whom the system would simply grind to a halt. We know that about 60% of us are likely to become carers at some stage in our lives. As it is today, one in eight of the adult population is a carer. That is why carers will be a fundamental part of the Green Paper. A sustainable settlement for social care will simply not be possible without focusing on the support we provide to them. Ahead of the Green Paper’s publication, we will shortly publish an action plan on carers, setting out a cross-Government programme of targeted work to support carers over the next couple of years.

Another principle that the Secretary of State has spoken about in the context of the Green Paper is control. We know that the greater control people have over their care, the better the outcomes. The only people who have a specific right to have a personal health budget are adults in receipt of NHS continuing healthcare or children receiving continuing care, which is why earlier this month we launched a consultation on extending the right to personal health budgets and integrated personal budgets to achieve better outcomes for those with the greatest ongoing social care needs as well as health needs. Those are some of the principles that are guiding the Green Paper. The goal is that, whatever a person’s age, they can be confident in our care and support system, not just for their own health and care needs but for those of the people close to them.

[Karin Smyth]

The 2015 Tory manifesto was very clear on the commitment and the assurances about the cap. The 2017 manifesto abandoned that. I think the Minister said earlier that it is still part of the Government’s considerations. Will she clarify from the Dispatch Box today what we are to expect in the Green Paper with regard to the cap?

[Caroline Dinenage]

The Prime Minister said last year in the general election that we would be consulting on the cap in due course and that will be part of the Green Paper. Building a sustainable care and support system will require some big decisions, but getting this right promises a better system in which everyone can have confidence, where people understand their responsibilities, can prepare for their future and know that the care that they receive will be to a high standard and help them to maintain their independence and well-being. The paper will set out options to put the social care system on a more secure footing and address issues to improve the quality of care and reduce the variation in practice.

[Several hon. Members rose—]

Autism

Caroline Dinenage Excerpts

Thursday 29th March 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I will start by heaping praise on my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) for securing this important debate and her incredible work over many years to raise the awareness of autism both within and outside this place. It is thanks to her ground-breaking private Member’s Bill on autism that we now have an adult autism strategy. Next year, it will be 10 years since her Bill became the Autism Act 2009, transforming services for autistic adults and having a huge impact on public awareness of autism. That is entirely down to her.

[Dame Cheryl Gillan]

Will the Minister give way?

[Caroline Dinenage]

I am not going to give way too much because I have a lot to get through, but I will definitely give way to my right hon. Friend.

[Dame Cheryl Gillan]

I thank the Minister and other Members who have acknowledged that I have had a part to play in this. She is sitting next to my hon. and learned Friend the Member for South Swindon (Robert Buckland); he and Members of all parties have contributed to this work. I assure the Minister that no one MP can do this on her own. My tribute is to all those people who have done the hard work and the heavy lifting.

[Caroline Dinenage]

My right hon. Friend is as honourable and modest as ever. I also want to thank all the other Members who have worked long and hard on this over a number of years, and those who have contributed so beautifully today. This high-quality debate has included strong personal stories and great examples of fantastic constituency work.

I thank the Backbench Business Committee for enabling this debate to happen during World Autism Awareness Week. It has given us the opportunity to draw much-needed attention to the challenges that autistic people, and their families and carers, face on a daily basis. Members who have spoken are absolutely right to say that we need to understand more about autism across all sectors of society and in all parts of government. I share their determination to address this important issue.

Since the introduction of the autism strategy in 2010, it has done much to improve the lives of those living with autism, but we know that there is still much to be done. As hon. Members may be aware, we have recently put in place revised governance arrangements to continue taking forward the strategy. On Monday I had the pleasure of chairing the first annual accountability meeting, where I heard from key stakeholders, self-advocates and partners about the challenges facing autistic adults across England and how we can keep making progress in realising the ambitious autism strategy.

[Mr Sheerman]

Will the Minister give way?

[Caroline Dinenage]

May I make a little bit of progress? I will take questions if I manage to get through this wad of paper.

In reference to a point made by the hon. Members for Huddersfield (Mr Sheerman) and for Cardiff West (Kevin Brennan), there were representatives at that meeting from all the other Government Departments, including the Department for Transport, the Department for Work and Pensions, the Department for Education and the Home Office. The hon. Gentlemen were absolutely right to point out that this subject reaches all Government Departments. It was clear that the complexity of autism and the multifaceted nature of the needs of those on the spectrum pose particularly challenging questions. Frequently this results in regional disparities that are far too wide in autism diagnosis waiting times and in the services someone can access once they have a diagnosis. Some areas are doing well, but others are not, and we need to ensure that good practice is identified and shared across all areas.

Many Members have highlighted particular challenges that autistic children face in school. My hon. Friend the Member for Henley (John Howell) explained exactly why it is important that autistic children are well supported in their education if we are to raise their attainment and improve their life chances. The Government congratulate the all-party group on autism on its report about education in England, which was published in November. It is really important that support for young people with autism is targeted where it will be most effective. The recommendations of that report are being considered by the Department for Education and will be key to its plans. As my hon. Friend said, all teachers are now trained to help children with conditions such as autism as part of their teacher training. Since 2011, we have funded the Autism Education Trust to provide autism awareness training for more than 150,000 education staff—not just headteachers, teachers and teaching assistants, but support staff such as receptionists and dinner ladies, thereby encouraging a whole-school approach to supporting children.

Exclusions were mentioned by a number of Members, including my hon. Friend the Member for Henley, my right hon. Friend the Member for Harlow (Robert Halfon), my hon. Friend the Member for Cleethorpes (Martin Vickers) and the hon. Members for Cardiff West and for Bedford (Mohammad Yasin). We are funding work via the Autism Education Trust to provide advice to parents and professionals on trying to cut down the number of exclusions. We have introduced the biggest reforms to special educational needs and disability support in a generation; introduced education, health and care plans that are tailored to a child’s needs; and given councils £223 million extra funding to help them to introduce these significant reforms.

Diagnosis was mentioned by many hon. Members. Adults and children should not have to face long waiting times for autism diagnosis. We will continue to work with partners to try to address these long waiting times. This is also a key part of the task and finish group that is being led by NHS England. We have included autism indicators in the mental health services dataset, with data beginning to be collected from 1 April this year. This is a real step forward. We need such robust, comparable data to be regularly collected and monitored so that we can be certain of the true extent of the problems not just on waiting times for diagnosis, but on post-diagnostic outcomes. In the Think Autism strategy, we are clear that there should be a pathway to diagnosis, care and support in every local area so that we improve recognition, speed up the process of diagnosis, and meet individuals’ advice and support needs.

I have previously described my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) as a force of nature, and today we saw another example of that. She spoke about regional centres of excellence—a fabulous idea—and said that there is nothing wrong with people with autism; they are just different. I had the pleasure of meeting her different and fabulous son James for an evening in Edinburgh last summer. I would hate to be on the receiving end as somebody she encountered in a shop giving her fine young gentleman a hard time.

[Mr Sheerman]

Will the Minister give way before she concludes, as she said she would?

[Caroline Dinenage]

If you will give me a little extra time to complete my remarks, Madam Deputy Speaker, yes.

[Mr Sheerman]

I am grateful to the Minister, who is making an excellent speech. I just wanted to get her to say something about the report we launched yesterday—I know she could not make the event—about people selling harmful interventions to individuals on the autism spectrum. Does she believe that that is a problem?

[Caroline Dinenage]

The hon. Gentleman is absolutely right to raise this; I know that he has done so at Health questions in the past. The Department of Health and Social Care does not in any way condone any of the so-called cures or remedial substances that are being proffered. We do not think that any of them are any good whatsoever.

Last year, NICE’s indicator advisory committee recommended including autism diagnosis in a menu of GP indicators. A review of the quality and outcomes framework is being undertaken by NHS England, and it will conclude later this spring. NHS England has confirmed that the GP autism register will be considered in the context of this work.

We know that there are sometimes issues with the health gap. The hon. Member for Dulwich and West Norwood (Helen Hayes) raised the case of her constituent, Matthew, which shows how horrible things can be when they do go wrong. I will be very happy to meet her to ensure that Matthew’s experience is not in vain.

Many Members raised issues around employment. We know that having a job is not just about earning a living, as it also contributes to people’s wellbeing, gives them a sense of belonging and purpose, and builds self-confidence and self-esteem. Through the Disability Confident scheme, the Department for Work and Pensions is engaging with employers and helping to promote the skills, talents, abilities and value of people with autism. Additionally, Access to Work has a hidden impairment support team that gives advice and guidance to help employers to support employees with conditions such as autism, to offer eligible people an assessment to find out their needs at work, and to help to develop a support plan.

My right hon. Friend the Member for Harlow, the brilliant Chair of the Education Committee, who is passionate about apprenticeships, made a brilliant point about the need for more focus on ensuring that children do not drop off the edge when they leave school. We will certainly take that forward. In December, the DWP published “Improving Lives: The Future of Work, Health and Disability”, which set out how it will deliver on its ambitious plan to help 1 million more people with a range of disabilities into work.

On the civil service becoming an autism-friendly employer, we have committed to support the autism exchange programme, and the civil service is working with Ambitious about Autism to provide work placement opportunities for young people.

On access to democracy, under Representation of the People Acts, polling stations must be as accessible as possible to disabled voters. We recognise that there might be specific challenges, and we will explore with the Electoral Commission what further adjustments can be made.

A few Members talked about the criminal justice system. The Ministry of Justice is working with the Home Office and the Crown Prosecution Service to develop a guide to help officers to identify people with autism. That is now included as part of all police training. NHS England has also issued a revised liaison and diversion specification, which includes autism. To date, eight prisons and young offenders institutions, including Feltham, where the programme started, are part of the criminal justice accreditation scheme, and another 35 are currently looking at the process.

I am really disappointed to hear examples from Members across the House of bad experiences with jobcentre staff, PIP, work capability assessments and so on. All healthcare professionals conducting work capability assessments and other things receive extensive training regarding autism spectrum disorder as part of their new entrant training. All work coaches in jobcentres receive the same training, but I will pass those comments on to the Department for Work and Pensions.

The hon. Member for Bristol West (Thangam Debbonaire) is clearly a true champion for autism in her local area, and I give her massive credit for what she does. She mentioned loneliness. I will be working closely with the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), in developing the cross-Government strategy on loneliness, which is supported by the Prime Minister.

We have heard wonderful examples of great community projects offering fantastic support in different Members’ local areas, and I should give a shout-out to the incredible Marvels and Meltdowns in my constituency—a blatant plug.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) mentioned poor mental health. Obviously that is not an inevitable consequence of autism, but if someone has autism and a mental health problem, it is essential that they can get the appropriate help and support.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) highlighted worrying figures about suicide. We are committed to tackling suicide in every community and for everyone who is at risk, and we updated the national suicide prevention strategy last year to strengthen delivery on key areas.

I want to join the hon. Member for Dewsbury (Paula Sherriff) in paying tribute to the National Autistic Society and its Too Much Information campaign, Autism Alliance, Autistica and various other charities throughout the country that do fantastic work to raise awareness and offer support.

We all want to live in a world and in a country where autism is never a barrier to the opportunity afforded to others. World Autism Awareness Week enables us to continue keeping this issue high on the agenda and in the minds of policy makers, professionals and members of the public alike, which is where it should be.

Question put and agreed to.

Resolved,

That this House notes that World Autism Awareness Week 2018 runs from 26 March to 2 April; believes that there is a lack of understanding of the needs of autistic people and their families; and calls on the Government to improve the support provided to autistic children in school and to autistic adults in or seeking employment, to reduce waiting times for autism diagnosis, and to promote a public awareness campaign so people can make the changes necessary for the UK to become autism-friendly.

Patient Safety

Caroline Dinenage Excerpts

Wednesday 28th March 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I wish to start by congratulating my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing this really important debate on patient safety. All patients have a right to expect care that is compassionate, effective and safe. The courageous testimonies of individuals such as Julie Bailey, who exposed the scandalous failings at Mid Staffordshire NHS Foundation Trust, and Sara Ryan, who campaigned fearlessly following the death of her son, Connor Sparrowhawk, while in the so-called care of Southern Health, show that safer care starts with listening to patients and their families.

It is important that we recognise that there are many victims when care fails—the families and the loved ones, of course, but also the healthcare professionals who carry the burden of their mistakes. The great majority of NHS patients receive effective and successful care. However, according to international studies, levels of healthcare harm range from 1% for the most “negligent” adverse events, to 8% to 9% for preventable adverse events. We are clear that any level of harm over 0% is unacceptable, and we believe that the route to a safer NHS is through transparency, learning and action. What is most frustrating is when harm persists, despite our having the knowledge and wherewithal to prevent it. There are approximately nine “never events” in the NHS every week—avoidable harms such as wrong-site surgery or foreign objects left after an operation.

Thirty years ago, the aviation industry stood at a similar crossroads. Since then, there has been a massive reduction in fatal accidents every decade, despite a huge increase in the number of passengers. According to the Civil Aviation Authority, there is an average of one fatality for every 287 million passengers carried by UK operators. Compare that with the 150 avoidable deaths every week across the NHS. That rate would potentially equate to the loss of 52 airliners per year.

How has the airline industry transformed its safety record so successfully? The key has been a “just culture” that recognises honest human error, but continues to hold people to account for criminal acts or wilful negligence. Creating a safe space that protects the evidence provided by pilots and air traffic controllers when there is an investigation is a cornerstone of the approach. It helps to create a culture in which people can be open about their errors and a system of learning from one’s mistakes, rather than blaming individuals.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Sleaford and North Hykeham (Dr Johnson) on securing this debate on an important matter. NHS staff are greatly restricted by their work and the long hours they do. We all know that and pay tribute to them. Sometimes, however, we have to look at better ways of keeping records and at innovations to streamline things to make sure that the real focus of NHS staff is on the work that they do. Has the Minister looked at streamlining and innovations to take away the red tape that restricts the caring job that NHS staff do?

[Caroline Dinenage]

The hon. Gentleman is absolutely right. The more we can innovate and put in place the technology that helps to streamline day-to-day processes, the more that will help NHS staff, who do such a marvellous job, to do their job even more effectively and efficiently.

As my hon. Friend the Member for Sleaford and North Hykeham rightly said, to err is human. I am told that every year, 30,000 motorists put diesel fuel into their petrol cars—that is around 15 every hour. Those people are not intentionally destructive or feckless, they are human. Of course, I am not making an analogy with medical mistakes, which can be significantly more damaging and life-changing than the need to get a new engine, but in the same sort of way we need to move away from a blame culture in health—away from investigations that single out one individual rather than seeing their actions in the context of a complex overarching system.

[Rachael Maskell]

Robert Francis’s report included 290 recommendations to address these issues, not the least the duty of candour. However, people are still fearful to report—why is that?

[Caroline Dinenage]

I think it is for a variety of reasons. The hon. Lady is absolutely right to raise that issue; if she bears with me, I shall come to it a little later.

A first step in our new direction, based on an aviation model, is the Healthcare Safety Investigation Branch, which became fully operational in April last year and will independently investigate some of the most serious patient safety incidents every year. It is the first investigatory body of its kind in the world and demonstrates our commitment to learning and innovation. As part of the Government’s drive to make the NHS the safest place in the world to give birth, HSIB will standardise investigations of cases of unexplained severe brain injury, intrapartum stillbirths, early neonatal deaths and maternal deaths in England.

As an MP who represents a constituency in the area served by Southern Health, I am particularly aware that tragedy can spiral when an organisation loses sight of systematic problems in its provision of care. Our Learning from Deaths programme is a direct response to such events. Trusts are now expected to have proper arrangements for learning from the deaths of patients and are subject to new reporting arrangements, including evidence of learning and improvements. I should add that we are one of the first countries in the world to measure deaths in this way. Through Learning from Deaths, NHS England is supporting improved engagement across the NHS with bereaved families and carers.

As my hon. Friend the Member for Sleaford and North Hykeham rightly says, healthcare professionals need to feel safe to speak out about problems in the workplace. To support that, we have introduced an independent national officer for whistleblowing, and new regulations to prevent discrimination against whistleblowers who move jobs. Recent commentary in the media and among professionals has highlighted a possible brake on openness and transparency arising from high profile convictions of healthcare professionals for gross negligence manslaughter, which is exactly the same example as the one that she cited. That is why the Secretary of State for Health and Social Care announced in February that he was asking Professor Sir Norman Williams, former President of the Royal College of Surgeons, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.

Absorbing the review’s recommendations into our healthcare system will be crucial to ensure that our healthcare professionals feel valued and secure, and that includes the GMC. The deadline for submitting evidence is April, and I encourage patients, families and professionals to contribute.

It is essential that infants have the best possible start in life, and the safety of mothers and their babies is a fundamental starting point for safer care. In November 2017, the Secretary of State announced his intention to bring forward the ambition to halve the rate of maternal deaths, neonatal deaths, birth-related brain injuries and stillbirths by 2025—a full five years ahead of our previous target. Pre-term birth is a major health inequality with mothers, and the Secretary of State has set an ambitious target to reduce the national rate of pre-term births from 8% to 6%.

Continuity of care is a key factor in a healthy pregnancy. Evidence shows that women who continue to receive care from the same midwives are 19% less likely to miscarry, and 16% less likely to lose their baby. That is why, yesterday, the Secretary of State announced important steps towards ensuring that the majority of women receive care from the same small team of midwives throughout their pregnancy, labour and birth by 2021. That announcement includes 650 new training places for midwives in 2019, which represents a 25% increase in the number of midwives in the UK.

We can never be complacent. Zero harm might sound impossible to achieve, but it should always be our aim. By learning lessons when things go wrong, listening to patients and their families, and working across the whole system to create a genuine culture of improvement, this Government are making a significant and lasting contribution to patient safety.

Question put and agreed to.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

2. What support his Department is providing to children who need sports prostheses.

[The Minister for Care (Caroline Dinenage)]

Since 2016, the Government have invested £750,000 to fund the provision of sports and activity prostheses for children and young people on the NHS. We have also invested a further £750,000 in a new National Institute for Health Research child prostheses research collaboration to drive improvements in technology. I can confirm that that funding will continue, and we will announce more details shortly.

[Mr Francois]

I thank the Minister for that reply. The centre at Headley Court provides world-class support for our servicemen who unfortunately lost limbs in Iraq or Afghanistan. It does incredible work. What lessons have we learned from Headley Court that we are able to transfer into the NHS?

[Caroline Dinenage]

My hon. Friend speaks about this with great knowledge. He was an outstanding Defence Minister and understands this subject better than almost anybody. He will be pleased to learn that, following the incredible progress that we have seen with adult prostheses through places such as Headley Court, we are now seeing the same technology in the development of children’s sports and activity prostheses, using the same manufacturers. The research collaboration will also enable us to invest in future studies, including in the development of some exciting technologies, such as myoelectrical bionic upper-limb prostheses for children.

[Richard Graham (Gloucester) (Con)]

3. What steps his Department is taking to ensure that NHS primary care infrastructure meets the demands of an ageing population.

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

Over the last three years, about 65% of social care service users have been extremely or very satisfied with their care and support in England, and 81% of adult social care providers are rated good or outstanding.

[Dan Carden]

Since 2010, Government funding for Liverpool City Council has been cut by 64%, or £444 million in real terms and, given that 90% of properties are in bands A to C, our ability to raise money locally through council tax is at the bottom end of the UK average. We need integrated health and social care, but a departmental name change will not do it; we need the money locally. When will we see proper reform and proper funding to plug the gap in our most deprived areas?

[Caroline Dinenage]

The hon. Gentleman is right to say that the integration of health and social care is vital, and I think that the renaming of the Department is a symbol of how seriously the Government take our commitment to it. I am keen to talk to him about funding, given that the figures for Liverpool show that it is raising £7.4 million from the social care precept and has received approximately £21 million in grant from the Government.

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

I agree that the social care system needs more funds. In recent Budgets, the Chancellor of the Exchequer has found those funds and put them into the system. May I urge my hon. Friend, as she looks at the Government’s proposals in the Green Paper, to ensure that the Dilnot proposals are included? Those proposals, for which we have already legislated, will give us the best chance of a sustainable system in the current Parliament.

[Caroline Dinenage]

The Secretary of State was with Andrew Dilnot yesterday, and we are looking carefully at his proposals. My right hon. Friend is right: although 81% of adult social care providers are registered as good or outstanding, it is unacceptable for levels of care to fall below the standards that we would expect, and in preparing the Green Paper, we will look closely at how we can improve the system.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

19. According to recent polling by the Alzheimer’s Society, public concern about the social care system is growing, and it is clear that action is needed now to fix the crisis. Why will the Government not heed the will of Parliament and commit themselves to closing the social care funding gap, as agreed in the vote on our Opposition day motion last October?

[Caroline Dinenage]

I do not entirely agree with what the hon. Gentleman has said. We provided an extra £2 billion in last year’s Budget to help councils to commission care services that are sustainable, high-quality and diverse. In the Green Paper, which will be published this summer, we will consider how we can future-proof the system.

[Mr Philip Hollobone (Kettering) (Con)]

The Government inspector for Northamptonshire County Council has recommended that, because of misgovernance over the last five years, the council should be abolished. Will my hon. Friend and her colleagues work with the new successor authorities to ensure that a successful social care system is established in the county?

[Caroline Dinenage]

The Secretary of State has already had conversations with councillors about this matter, but my hon. Friend is absolutely right to raise it. The Care Act 2014 placed a duty on local authorities in England to promote diverse, sustainable, high-quality care, and it is important for them to continue to do that.

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

The National Audit Office says that our care system is not “sustainably funded”, the Care Quality Commission says that one quarter of care facilities are not safe enough, and care providers cherry-pick to whom they will give care places, and even evict people with advanced dementia on cost grounds. What is the Care Minister doing to address those issues and the sharp decline in public satisfaction with the social care system?

[Caroline Dinenage]

We know that the sector is under pressure because of the ageing population, but the Government have given councils access to £9.4 billion more dedicated funding over three years. The hon. Lady is right to emphasise the importance of putting power back in the hands of residents and their families, which is why we published a package of measures to ensure and protect consumer protections in the social care sector, and we will continue to look at that very closely.

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

6. What progress his Department is making on reforming the provision of social care.

--- Later in debate ---

[Nigel Mills (Amber Valley) (Con)]

9. What progress Public Health England has made on implementing his Department’s policy of publishing data on hand gel usage in NHS trusts as an indicator of hand hygiene compliance.

[The Minister for Care (Caroline Dinenage)]

Patient safety, and particularly infection prevention, are among the Government’s key priorities. Public Health England has carried out some initial analysis of available data. However, currently the data is incomplete and would not give a true reflection of the usage of hand gel. We are working with Public Health England to explore how we can improve that data.

[Nigel Mills]

I am sure the Minister will agree that it is a matter of real importance that all NHS staff wash their hands at all the required five moments of patient contact. Does she agree that it is disappointing that we have not quite got that data published yet, and will she set a date when we will be able to see that data for each trust?

[Caroline Dinenage]

As I have said, we will continue to look at that, but, as my hon. Friend knows, the Department has a really strong track record of tackling infection. Incidents of MRSA are down 54% on 2010. We have published a revised code of practice on hand hygiene and we are working with partners across health and social care to ensure that this remains a focus.

[Stephen Pound (Ealing North) (Lab)]

There has been some excellent work on extending hand gel usage throughout the NHS, and the decline in MRSA is, I think, indicative of that. However, there is a glaring prejudice, certainly in my part of the world, amongst people who think that these gels contain alcohol, and will not use them for that reason. Is it possible to instigate some form of signalling or marking to prove and to state that there is no alcohol within these hand gels, because we do not want to see people prevented from using them?

[Caroline Dinenage]

The hon. Gentleman makes an excellent point, and it is certainly something that we can look at more closely.

[Theresa Villiers (Chipping Barnet) (Con)]

Will the Minister explain the work that the Government are doing with Public Health England to raise awareness of sepsis infections, and do urgent work to tackle that potential killer?

[Caroline Dinenage]

This is a massive priority for the Government, and we are about to start a public information campaign. Sepsis is a killer—one that deserves to be given the utmost importance, and one that we will be seeking to tackle in every way that we can.

[Anna Turley (Redcar) (Lab/Co-op)]

10. What estimate he has made of the number of young people who have not had access to child and adolescent mental health services after a referral in the last 12 months.

--- Later in debate ---

[Edward Argar (Charnwood) (Con)]

12. What steps the Government are taking to support Dementia Awareness Week.

[The Minister for Care (Caroline Dinenage)]

Dementia Awareness Week runs from 21 to 27 May, and the Department of Health and Social Care is expecting to participate fully in a range of activities that week, working with partner organisations and the voluntary sector.

[Edward Argar]

Alongside the work of Governments of both parties to improve dementia research, care and awareness—Dementia Awareness Week is a key part of that—the role of voluntary organisations and dedicated volunteers around the country is vital. Will the Minister join me in paying tribute to the fantastic work of specialist dementia care Admiral Nurses and in backing Leicestershire Dementia UK volunteers in their campaign, which is well on track, to raise the £50,000 needed for an Admiral Nurse for our county?

[Caroline Dinenage]

First, I pay tribute to my hon. Friend for the sterling work he does as co-chair of the all-party group on dementia. He is absolutely right to say that Admiral Nurses do fantastic work in many parts of the country, helping people with dementia to maintain their independence, and improve their quality of life and that of their families. I very much support all the fundraising activities going on in his local area.

[Stephen McPartland (Stevenage) (Con)]

13. Whether he has plans to establish a satellite radiotherapy unit in Stevenage.

Deprivation of Liberty Safeguards and Mental Capacity

Caroline Dinenage Excerpts

Wednesday 14th March 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

Subject to the written ministerial statement HCWS202 made on 30 October 2017, I am today announcing the publication of the Government’s final response to the Law Commission’s report on mental capacity and deprivation of liberty safeguards (DoLS), a copy of which is attached.

I welcome the publication of the Law Commission’s report and thank them for their careful, comprehensive and considered work. This Government are committed to take action to reform mental health, and transform care for people with learning difficulties and/or autism. Taking action to reform the current DoLS regime is an important contribution towards achieving these aims and providing greater protection for some of the most vulnerable people in our society.

We have set out in detail our provisional view of each individual proposal in our response, and we broadly agree with the liberty protection safeguards model. As the Government have commissioned a review into the Mental Health Act, proposals that relate to the interface between the Mental Health Act and Mental Capacity Act will be considered as part of that review. We also want to ensure that liberty protection safeguards fit with the conditions and future direction of the health and social care sector, so we will continue to work through the detail of the recommendations and engage further with stakeholders particularly on implementation. We will bring forward legislation to implement the model when parliamentary time allows.

Attachments can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-03-14/HCWS542/

[HCWS542]

Respite Care for Vulnerable Adults: Teesside

Caroline Dinenage Excerpts

Monday 12th March 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I am grateful to the hon. Member for Stockton North (Alex Cunningham) for raising his concerns this evening, and indeed to his colleagues, the hon. Members for Stockton South (Dr Williams) and for Redcar (Anna Turley). They have stated the justifiable concerns of their constituents powerfully and articulately. Whenever change is afoot, people have a tendency to feel concerned, and it is absolutely right that those concerns are articulated.

Supporting the most vulnerable in our society—those with complex needs, those with autism and those with learning disabilities—is one of the most important but exacting tasks that health and social care commissioners face. It is a task that must be undertaken with a genuine desire to get the very best outcomes not only for those who need support, but for those who care for them.

It is important to remember that many of the services that we are discussing today are focused on people with autism and learning disabilities—conditions that can manifest with very different requirements. They may need care and help ranging from routine, occasional help in the home to full-time personal support, with perhaps two or more people at a time providing that personal assistance.

Our mandate to NHS England includes a clear objective to improve outcomes for people with autism or learning disabilities. That means making sure that they are fully supported in the community, that hospital admissions are reduced and that they have the opportunity to live an ordinary life. Building the right support is our plan to use concerted local action to deliver that community support and to reduce the number of in-patients by March 2019.

We know that respite services are extremely important and a significant element of community-based support. They benefit not only the individual receiving that care, but their family and carers. Members have spoken very powerfully about that tonight. The hon. Member for Stockton North rightly points out that family carers in particular play an invaluable role—a role that is often unsung and undervalued. Often, they do so not out of a sense of duty or compassion, but out of pure love, and they deserve nothing other than our unbridled respect and our thanks. He asked me about the work that we are doing to support carers. They will of course be an integral part of our thinking in the Government Green Paper on social care that will be produced later in the year. In the interim period, we have a carers’ action plan, which I care passionately about and which will set out some short-term steps that we want to introduce to support carers and their valuable work more fully.

[Alex Cunningham]

It is very clear that the Minister gets this, and I admire the way in which she is putting her argument across, but this is also about resource. I am very concerned about the current problem on Teesside, but in the longer term young people in their 20s are coming through the system and approaching 30. These are children who in a previous generation would never have survived, and they are going to need more and more services. More children are becoming adults who will require more provision. What are the Government doing in terms of longer-term planning?

[Caroline Dinenage]

The hon. Gentleman articulates a real issue with which we have to contend. That is why we have increased NHS spending every single year since 2010, so that our NHS now has about £13 billion more to spend on caring for people than it had in 2010. That goes to the heart of the issue that he has identified. We need to ensure that care, particularly respite care, is responsive to the needs of individuals. That implies both a need to assess and determine the right kind of support, and a need for flexibility to allow for personal choice, as I believe is being looked at in Teesside.

Some needs may be best met through a stay in a suitable service that provides overnight beds, with appropriately trained staff to support people’s individual care needs, but that may not be true for everybody. Those with less severe physical or learning disabilities may find that action in the community is more desirable and appropriate for them—for example a visit, leisure activity or even visiting family members with the right personal support. We do not want those opportunities to be written off for them because we have a very restrictive system, which is why it is right that commissioners have the means to seek new approaches and to be flexible in how they meet people’s needs. I understand that the intention in North Tees is exactly that, but it must be based on suitable engagement, as the hon. Gentleman said, to assess people’s individual needs.

Having listened to hon. Members’ comments, I understand their concern that not everyone can currently access respite services and that these services may not be flexible enough. Local commissioners are rightly looking to change respite provision. The hon. Gentleman will understand that it is not customary for a Minister to comment in detail on specific commissioning decisions or on the extent to which there was appropriate consultation, unless that is part of a formal review process. I understand that the local CCG has consulted on the proposals for 10 weeks and is now in the process of designing the service.

[Alex Cunningham]

Does the Minister recognise that the CCG has acknowledged that it will have to get more people into the system, so the service will be diluted? Having recognised that, what can she do about it?

[Caroline Dinenage]

As I have already said, it is up to CCGs to commission the local services that they feel are appropriate in their local communities. It is not for the Government to force a top-down diktat on how they need to spend their resources. I understand that local councils are, quite rightly, scrutinising the proposals right now. This is an important means of quality assurance and is informed by local people with local knowledge. I hope that the hon. Gentleman will find some reassurance in that. However, although it is right that service reconfigurations are considered locally and are not driven from the top down, any significant changes to services are subject to the Government’s four tests. The changes should demonstrate support from clinical commissioners, strengthened public and patient engagement, clarity on the clinical evidence base, and support for patient choice.

There is a clear set of expectations in relation to the provision of respite care and the role of commissioners. Alongside provisions in the National Health Service Act 2006, all CCGs must secure services to meet the needs of their population to a reasonable extent. Respite care may be routinely commissioned or made available as part of a package of NHS continuing healthcare, and is often also provided as part of social care. The Care Act 2014 requires that where an adult or carer appears to have care and support needs, the local authority must carry out an assessment and meet any need where the person has met the eligibility criteria.

[Alex Cunningham]

The scrutiny groups on Teesside—at least some of them—are thinking of referring the matter to the Secretary of State. What happens when it is referred, and what can the Government do then?

--- Later in debate ---

[Caroline Dinenage]

That will of course be a matter for the Secretary of State, who will deal with it in the appropriate way.

The Care Act also requires local authorities to take a preventive approach to addressing people’s needs in taking steps to intervene early to prevent or delay any worsening of an adult’s need for care and support. This would of course include the carers about whom the hon. Gentleman and his colleagues care so passionately. It is really important to allow carers to take the respite that we have spoken about.

The hon. Gentleman might be interested to know that the Autism Act 2009 requires the Government to have a regularly reviewed autism strategy and to issue guidance to local authorities, NHS bodies, and foundation trusts. In addition, the Children and Families Act 2014 introduced a new statutory framework for children with special educational needs and disabilities. This gives commissioners very clear responsibilities towards those with learning disabilities and autism, including those who may be affected by the review on Teesside.

[Jim Shannon]

I think that everyone in this Chamber will have a knowledge of autism. The Minister will be aware that we have an excellent autism strategy in Northern Ireland, and there is also a very good strategy in Wales. Has she had a chance to check out both those strategies in order perhaps to introduce them, in full, to England?

--- Later in debate ---

[Caroline Dinenage]

I have not, but now that the hon. Gentleman has recommended that to me, I will certainly look into it.

It is really important that commissioners have the prerogative to make a local determination of what constitutes the right services. We have set clear expectations for how health and social care meets people’s need for support and families’ and carers’ needs for respite. We can close the gap between the outcomes for those who are most vulnerable and those without complex needs, but it has to be via a combination of setting national expectations alongside a local approach to delivering the necessary services. The NHS has a responsibility to ensure that people have access to the best and safest healthcare possible. This means that it must plan ahead and look at how best to secure safe and sustainable NHS healthcare provision, and provide flexible approaches to meet the widest range of needs.

That is what we hope to see in action in Teesside. I understand that any change to local services for vulnerable people must be viewed with a degree of apprehension. However, considering the assurances given locally by commissioners, the process they have undertaken, and the overall aim of providing a more flexible set of options for respite care that moves away from a very medical model, I am hopeful that these changes will be of benefit to the people who most need these services.

Question put and agreed to.

PACE Trial: People with ME

Caroline Dinenage Excerpts

Tuesday 20th February 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Mr Hollobone. I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing today’s debate. As she has articulated so beautifully, the situation is clearly very concerning. I know that she has done an enormous amount of work in this area, and has met people, both in her constituency and more widely, affected by the condition, and with expertise on the condition, to hear about its impact on individuals’ lives. As MPs, we all know people in our constituencies who are affected by the condition.

As we have heard, chronic fatigue syndrome, also known as myalgic encephalomyelitis or encephalopathy, is a debilitating and very poorly understood condition, which is estimated to affect more than 200,000 people in England. We do not understand the underlying causes of it, there is no one diagnostic test to identify it, and although patients can improve and recover, there is no cure for it. The condition, which for brevity and to avoid covering you in a thin layer of spittle, Mr Hollobone, I shall refer to in the abbreviated form CFS/ME, can stop a life in its tracks, leaving sufferers unable to carry out the most basic tasks. In the most serious cases, people can be bedbound for weeks at a time. It has a complex range of symptoms, including a very disabling, flu-like fatigue and malaise, and neurological problems. Of course, the impact on friends, families and carers can be significant as well.

It is also true that the difficulties in diagnosis mean that patients with CFS/ME often experience delays in getting the treatment and support that they need. In recognising the need for GPs to be aware of the condition, the Royal College of General Practitioners identified CFS/ME as a key area of technical knowledge that GPs should have as part of their qualifying exams, which answers a question raised by the hon. Lady.

The recommended treatments for CFS/ME, namely cognitive behavioural therapy, or CBT, and graded exercise therapy, or GET, and the evidence for them are the subject of today’s debate. Those treatments were first recommended for patients with mild or moderate CFS/ME in 2007 in the NICE guidance, in line with the best available evidence, which showed that the treatments offered benefits. The guidance sets out that there is no one form of treatment to suit every patient and that the personal needs and preferences of patients should be taken into account. Doctors should explain that no single strategy will be successful for all patients; that in common with all people receiving NHS care, CFS/ME patients have the right to refuse or withdraw from any part of their treatment; and that those with severe symptoms may require access to a wider range of support, managed by a CFS/ME specialist.

The results of the PACE trail, which examined pacing therapy, cognitive behavioural therapy, graded exercise and specialist medical care for chronic fatigue syndrome, were published four years after the NICE guidance. The trial ran from 2005 to 2011 and, contrary to what the hon. Lady said, was primarily funded by the Medical Research Council, not the DWP. Total funding was £5 million and the MRC contributed almost £3 million.

The study was undertaken by the Queen Mary University of London. It was the largest ever trial for CFS/ME, including more than 600 participants in England and Scotland. It sought to assess and compare the effectiveness of the four main treatments for CFS/ME—adaptive pacing therapy, CBT, GET and standardised specialist medical care.

The peer-reviewed trial results published in The Lancet in 2011 found, as the hon. Lady said, that 60% of patients with CFS/ME benefited from CBT and GET when provided alongside specialist medical care. CBT and GET were found to be better than pacing therapy or specialist medical care alone in improving both symptoms and disability, and a follow-up study looking at recovery after one year further supported the benefits of interventions. The trial had ethical approval from the NHS research ethics committee and had ongoing oversight from an independent trial steering committee, which included patient representatives. Trial reports were regularly provided to a data monitoring and ethics committee that had the power to halt the trial if harm was indicated. NICE considered the PACE results in 2011 and concluded that they supported its existing recommendations on both CBT and GET.

The Government are aware that the use of CBT and GET in treating CFS/ME has long been a controversial issue for patient groups, charities and some clinicians. That began with the publication of the NICE guidance 10 years ago and continued with the PACE trial. Since 2011, PACE trial data has been shared with many independent scientists as part of normal research collaboration, including the internationally respected research organisation Cochrane, which independently validated the findings. However, in the last 18 months, the attention on the trial has increased substantially, following a tribunal ruling in August 2016 ordering the release of the trial data to a member of the public, which the hon. Lady referred to. The data has since been examined more widely and critics, including some clinical academics, have suggested that it shows that CBT and GET are not as effective as the trial results suggested.

[Nicky Morgan (Loughborough) (Con)]

This is clearly a very important debate. I think both the hon. Member for Glasgow North West and the Minister would agree that it is not possible to do justice to the concerns raised by all our constituents, and the 200,000 sufferers that the Minister has identified, in half an hour. Does the Minister agree that this is a subject worthy of wider debate in the House of Commons? Constituents such as Sarah Reed, who have written to me, say that because of the belief in CBT and GET, and because academics believe in the results, many other treatments have not been pursued. Does the Minister feel angry about that?

[Caroline Dinenage]

I thank my right hon. Friend for her intervention. As has already been said, it is important that we listen to patients. As I will go on to explain, NICE is now looking at reviewing its guidance on this and, in the light of that, it may well be worth discussing the issue more fully.

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

Does the Minister agree that believing patients is also important here? Patients with the condition are often not believed and concerns about the PACE trial have not been believed, and that has just loaded concerns on those individuals.

[Caroline Dinenage]

As I have already set out, sometimes it can take a really long time for this to be diagnosed. People have to keep going backwards and forwards to GPs and others with their symptoms. Many other potential conditions have to be discounted before it can be fully diagnosed, which often leaves people feeling that their symptoms are not being taken seriously or they are being dismissed. Obviously, that is massively concerning, which is why, as we have already said, it is important that patients are listened to and that clinical professionals are well-equipped to be able to recognise the symptoms and identify them.

As I said, the data has been examined more widely. Critics, including some clinical academics, have suggested that it shows CBT and GET are not as effective as the trial results suggested. In turn, the trial authors have defended their work. They have responded to criticisms in medical journals and the wider medical printed press. I know the hon. Member for Glasgow North West raised one such criticism at the oral evidence session of the Science and Technology Committee in January, concerning possible conflicts of interest of the PACE trial authors. On that point, in line with normal practice, all such conflicts were published with the trial protocol as well as the results. If she has evidence to the contrary, I would be very happy to discuss that with her afterwards.

[Carol Monaghan]

I thank the Minister for that. However, they were not disclosed to the PACE participants.

[Caroline Dinenage]

It is very important that the hon. Lady has raised that point, and I am sure it will be taken into consideration.

[Helen Whately]

ME sufferers in my constituency welcome that the NICE guidelines are being reviewed, but one problem is that when they find that the existing treatments do not work for them, there is a lack of alternatives. Does the Minister recognise that alternative treatments need to be looked into urgently and offered to patients?

[Caroline Dinenage]

I am sure that will be part of the NICE guidance. Where there is significant evidence that alternatives deserve greater investigation, I am sure NICE will look at that. I will talk about that a little more in a second.

On conflicts of interest, it is obviously important that researchers and scientists with particular expertise in one area will have worked and shared their expertise in related fields and industries, but transparency regarding conflicts of interests is vital to the integrity of the research. The NHS Health Research Authority already issues guidance on conflicting interests and I understand it will consider whether any further clarity is needed.

Clearly, the controversy around the trial is problematic for researchers, but it is most of all distressing for patients with CFS/ME, who deserve the most appropriate treatment from the NHS and to have confidence in the treatment that is being provided. That is why we welcome the NICE decision to undertake a full review of the guidance, which will examine the concerns around the PACE trial and any implications for its current recommendations. NICE develops its guidance independently to support NHS organisations and clinicians to deliver services in line with the best available evidence. It welcomes the input of stakeholders and more than 10 CFS/ME charities and organisations are already registered to support the guideline development process. All other parties who are interested can comment on the draft scope and draft guidelines at the appropriate time during the development process. Final guidance is expected in October 2020.

[Paul Blomfield (Sheffield Central) (Lab)]

The Minister makes the point that final guidance is expected in October 2020, but given the significant doubt over CBT and GET and their impact now, does she recognise the strong case for NICE to suspend the current guidance, which points people towards those potentially damaging treatments?

[Caroline Dinenage]

As an independent organisation, that will of course be a matter for NICE, taking into consideration the evidence.

I know it is a priority for the CFS/ME community that more research into identifying the underlying causes of the condition be undertaken. I would like to reassure those affected that both the MRC and the National Institute for Health Research welcome high-quality applications for research into CFS/ME, including studies to investigate its biological causes, and it will come as welcome news that the MRC is currently funding a project to examine the relationship between abnormal brain structures and symptoms of CFS/ME.

I again thank the hon. Member for Glasgow North West for raising this important issue on behalf of those affected by the condition in her own constituency and up and down the country. I hope the debate has been helpful.

Question put and agreed to.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 6th February 2018 Commons Chamber

[Luke Hall (Thornbury and Yate) (Con)]

3. What steps he is taking to integrate local health and social care services.

[The Minister of State, Department of Health and Social Care (Caroline Dinenage)]

The fact that the Department has been renamed the Department of Health and Social Care reflects both their interdependence and our commitment to achieve co-ordinated care tailored to individual needs. The better care fund is a national integration programme that helps the NHS and local government to deliver better, more joined-up services.

[Luke Hall]

I thank the Minister for that answer and welcome her to her place. The proposal to build a community health centre in Thornbury and Frenchay is an essential part of joining up health and social care in South Gloucestershire. Will the Minister join me in highlighting the importance of Thornbury health centre and in pressing South Gloucestershire clinical commissioning group to make progress with the project as quickly as possible, after years of unnecessary delays?

[Caroline Dinenage]

I thank my hon. Friend for raising that important issue. He is right to do so, and proposals such as those for Thornbury health centre are crucial for ensuring that health and social care are truly integrated and centred around each individual in the community. I am advised that South Gloucestershire CCG remains committed to progressing those plans as soon as possible and that the local NHS expects to be able to provide an update on plans next month.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

The Minister will be aware of the situation surrounding pain infusion treatment for patients in Hull and East Riding. Many of the 86 patients who lose that treatment will require increasing levels of social care. Consultants have even written letters to the CCG to say that if that treatment is removed, there is an increased risk of mortality for those patients. Will the Minister meet me urgently to discuss that and write to the CCG to ask it to urgently review its decision in the light of the evidence from consultants?

[Caroline Dinenage]

Of course blanket bans on treatments are unacceptable, and decisions on treatments should always be made locally by doctors, based on clinical assessment. I understand that those patients will be offered an alternative, more rounded service and that the CCGs have arranged for each patient to meet their consultant to discuss their treatment. Where there is evidence of rationing, we expect NHS England to ensure that CCGs are not breaching their duties.

[Sir Nicholas Soames (Mid Sussex) (Con)]

Does my hon. Friend agree that the integration of health and social care is so important to the future success of the NHS that everything needs to be done to speed up the programme to integrate them better? Will she join me in encouraging a speedier approach to that method in Surrey, Sussex and Kent?

[Caroline Dinenage]

My right hon. Friend is absolutely right. The better care fund is already having a fantastic impact in the area. We are developing metrics for assessing progress on integration by local area, particularly at the interface of health and social care. We need to proceed with this as rapidly as possible, and I am sure that with his backing, that will happen in his local area.

[Derek Twigg (Halton) (Lab)]

It is of course very important that we see integration of the two services, but the fact remains that there is just not enough money. Over a year ago, one of the Minister’s predecessors praised my authority in Halton for the work it was doing in this area, but Halton is now on the brink in terms of the money it has and its ability to deliver its statutory duties. There is simply not enough money, and the Government keep trying to avoid that.

[Caroline Dinenage]

We have provided £2 billion of extra funding over the next three years to help councils commission high-quality services, in addition to giving councils access to up to £9.25 billion of dedicated social care funding by 2019-20.

[Andrew Selous (South West Bedfordshire) (Con)]

Will the Minister look at the benefits of independent living schemes such as Priory View, pioneered by Central Bedfordshire Council, which bring reduced hospital admissions and reduced demands on social care through greater socialisation and more use of exercise classes?

[Caroline Dinenage]

Independent living schemes can keep people living healthier, more independent lives for much longer and provide the comradeship and camaraderie that keep people active and healthier. My hon. Friend is right to raise their importance, and the Government very much support them.

[Stephen Lloyd (Eastbourne) (LD)]

With reference to the integration of health and social care, the Minister may be aware that I have two outstanding respite and rehab homes in Eastbourne called Milton Grange and Firwood House. They are both under threat of closure by the county council, which says that central Government are not giving it enough money. Those homes serve a crucial purpose in supporting the local hospital. Will the Minister agree to meet me and representatives from the county council to work out a way to find the funds to keep both those vital homes open?

[Caroline Dinenage]

The hon. Gentleman is absolutely right to stand up for the good-quality respite in his local area. The Care Act 2014 requires local authorities to shape local markets and ensure that they give a sustainable, high-quality local offer. I would be more than happy to meet him to discuss that further.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I welcome the Minister to her place. One model of integration that has aroused considerable concern is the so-called accountable care organisation model. Many are concerned that that means greater private sector involvement, and given legitimate worries about Carillion going bust, Capita not being able to support GPs and Virgin suing the NHS, those concerns are well founded. Can the Minister rule out any private sector involvement in ACOs? Will she also delay laying the relevant regulations to establish an ACO until after the two judicial reviews and the NHS England consultation?

[Caroline Dinenage]

The hon. Gentleman is right to raise this. NHS England is consulting on that at the moment, and I can confirm that no regulations will be laid until that consultation has been completed.

[Jonathan Ashworth]

I am extremely grateful to the Minister for offering us that clarification. May I therefore ask her about funding? The integration of health and social care needs more funding, yet the NHS is going through the biggest financial squeeze in its history and social care has been cut by billions since 2010. A few moments ago, the Minister said that the funding is adequate, but if the funding is adequate across health and social care, why are delayed discharges of care up 50%, and why did NHS England say on Friday that for the rest of this year the A&E target has in effect been abandoned?

[Caroline Dinenage]

We recognise that there are pressures on our social care as the population ages. In the short term, we have of course made the extra £2 billion of funding available to local authorities; in the medium term, we need to make sure that best practice is observed across all local authorities and NHS trusts; and in the long term, we will be coming forward with a Green Paper on social care later this year.

[Bim Afolami (Hitchin and Harpenden) (Con)]

4. What steps he is taking to broaden routes into nursing.

--- Later in debate ---

[Neil Parish (Tiverton and Honiton) (Con)]

10. If he will increase funding for the Food Standards Agency’s national food crime unit.

[The Minister of State, Department of Health and Social Care (Caroline Dinenage)]

The Food Standards Agency’s national food crime unit is crucial to protecting consumers from serious criminal activity that impacts on the safety of their food and drink. I understand that the FSA is exploring options for the unit’s future funding, and a decision is expected in late spring.

[Neil Parish]

The FSA is answerable to the Department of Health and Social Care for food safety, but there are a lot of assurance schemes that do not really answer to anybody and which the FSA needs to be able to bring together. That is where the crime unit could do a really good job, so anything the Minister can do to get that money and get the crime unit up and running would be very good.

[Caroline Dinenage]

I thank the Chair of the Environment, Food and Rural Affairs Select Committee for his advice. I know that he is keen and astute on this subject. Ensuring that food businesses meet their safety responsibilities is, of course, one of the FSA’s most important roles. It is developing a new regulatory model and actively engaging with third-party assurance scheme owners to determine how information and data can be shared and more effectively used by regulators.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I send a brief message of congratulation to the Secretary of State for his rapid response to President Trump’s remarks about the values of the NHS?

As chair of the Westminster Commission on Autism, let me now ask the Secretary of State a serious question. We are about to produce a report on the fake medicine that is sold to families with an autistic child. When the report is published, in the next few days, will the Secretary of State act very quickly to stop this dreadful trade?

--- Later in debate ---

[Mr Speaker]

Possibly. Anyway, it was a worthy effort, and I will give the hon. Gentleman the benefit of the doubt. Let us now hear from the Minister.

[Caroline Dinenage]

As the hon. Gentleman was so very charming to the Secretary of State, we will of course look into the issue.

[Julian Sturdy (York Outer) (Con)]

11. What recent progress he has made on improving the performance of hospitals in special measures.