Transforming Care Programme

Debate between Caroline Dinenage and Cheryl Gillan

Thursday 5th July 2018 Commons Chamber

[Caroline Dinenage]

Absolutely, it should be 0%. As the right hon. Gentleman knows, that is what we are working towards.

[Dame Cheryl Gillan]

I appreciate that this is quite a complex area, but I have looked at some of the transition times. Dimensions—I mentioned it earlier—has estimated that its average transition time per patient is 12.5 months, which I believe is below the usual transition time. Does the Minister feel that this length of time will inhibit her from reaching her targets in 2019? Is there anything we can do to reduce the time, or does that length of time need to be taken?

[Caroline Dinenage]

My right hon. Friend makes an excellent point. NHS England says it is confident of hitting these targets and it will be doing all it can to ensure that that happens, but that must not be at the cost of treating people with the right levels of care or of having the right provision in place. This is also about keeping people out of the hospital setting in the first place.

The number of people receiving community or pre-admission care, education and treatment reviews also continues to improve, with 42% more undertaken in 2017-18 than in the previous year, of which 79% led to a decision not to admit somebody to in-patient care.

[Dame Cheryl Gillan]

I do not know whether the Minister will accept this, but I would have thought that everybody involved in this debate actually preferred us not to aim for a target that might not be reachable, because it is the quality of the outcomes and successful transitions that we are looking for. Will she be flexible enough to say, on looking at this again, that if we cannot achieve the targets by 2019, she will allow the timeframe to drop out of the picture? It is more important to have a successful transition, with the right length of time for somebody to transition, than to hit what might be an unattainable target.

--- Later in debate ---

[Caroline Dinenage]

We can certainly look at what the hon. Lady suggests. I am pleased that the operational delivery group, which I just mentioned, allows stakeholders to shape policy and it is really good news that Isabelle Garnett, Matthew’s mum, is a major contributor to this and liaises with NHS England directly on its programme around children either in hospital or at risk of being admitted.

The right hon. Member for North Norfolk asked why the evaluation was cancelled. As he knows, an evaluation sponsored by NHS England is already under way, and the Department, having invited bids for its evaluation, was not satisfied that the proposals received were what was needed. That does not mean that we are not absolutely determined to critically review progress, particularly working with stakeholders and users.

The right hon. Gentleman spoke about the “No voice unheard, no right ignored” Green Paper. Although I am always ready to bow to his incredible knowledge in this field, it is not entirely true to say that the Green Paper went unheeded. Some of the recommendations were overtaken by changes in Government policy, and indeed, in Governments, but we have taken forward work such as the named social worker pilot and a review of the Mental Health Act. We have asked Professor Sir Simon Wessely, the chair of the independent review, to listen to people with direct experience of the Mental Health Act and this, of course, includes autistic people and their carers. He published his interim report to update the Government on his progress, which sets out specific issues that we must explore to look at how we can improve the scope of the Act.

The hon. Member for Dulwich and West Norwood also spoke about training for teachers in autism. The Department for Education has funded training and support for teachers through the Autism Education Trust. That is in early years, schools and further education, and so far, 175,000 staff have been trained.

[Dame Cheryl Gillan]

Does my hon. Friend also welcome the fact that from September this year in initial teacher training, the possibility of having a module on autism will now be included? It is something that we worked very hard for and the Department for Education responded. This is about not just the historical training, which is so important, but the future training that is coming on-stream from September this year.

[Caroline Dinenage]

My right hon. Friend is absolutely right to raise that, and I am sure that its introduction is in no small part down to her incredible work.

Society has failed people with learning disabilities for too many years. Our aim is to put things right. People are at the heart of the transforming care delivery programme. The priority is to provide safe, high-quality care that is appropriate for everyone. We will continue to work with our partners to ensure that people with learning disabilities have the opportunity to live as full and independent lives as possible.

Oral Answers to Questions

Debate between Caroline Dinenage and Cheryl Gillan

Tuesday 19th June 2018 Commons Chamber

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

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

[The Minister for Care (Caroline Dinenage)]

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

[Dame Cheryl Gillan]

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

[Caroline Dinenage]

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

Learning Disabilities Mortality Review

Debate between Caroline Dinenage and Cheryl Gillan

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

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

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

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

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

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

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

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

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

[Caroline Dinenage]

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

Social Care Provision and the NHS

Debate between Caroline Dinenage and Cheryl Gillan

Thursday 3rd May 2018 Westminster Hall

[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.

Autism

Debate between Caroline Dinenage and Cheryl Gillan

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.

Support for Care Leavers

Debate between Caroline Dinenage and Cheryl Gillan

Thursday 16th November 2017 Westminster Hall

[Caroline Dinenage]

The hon. Gentleman is right to remind me about the sanctions—I pulled that little bit of paper out, but had forgotten to pick it up—but I think that I covered applications in advance of the 18th birthday earlier in my speech.

With regard to sanctions, I would like to stress that the Department for Work and Pensions recognises the unique set of circumstances faced by care leavers. Therefore, we allow care leavers to apply for hardship payments of 60% of their normal benefit payment from day one of the sanctions. Sanctions are used in a very small minority of cases, when people fail to meet each of the requirements that they agreed in their claimant commitment without good reason. That said, conditionality and sanctions are part of a fair and effective system that supports and encourages claimants to move into work, towards work or to improve their earnings. Work coaches are very well trained to deal with vulnerable claimants, and have the flexibility to tailor the requirements according to each individual’s circumstances, and that includes the needs of care leavers.

We do not impose sanctions lightly. Claimants are given every opportunity to explain why they failed to meet their agreed conditionality requirements before a decision is made. A well-established system of hardship payments is available as a safeguard if a claimant demonstrates that they cannot meet their immediate and most essential needs, including accommodation, heating, food and hygiene, as a result of their sanction. UC claimants are able to apply for a hardship payment from the first accounting period in which the sanction reduction is applied.

I have spoken to care leavers, and we do not do them any favours by insulating them from the challenges of the day-to-day reality and responsibilities that their peers face. The care leavers I have spoken to tell me that they do not want to be wrapped in cotton wool. They want a little extra support and help, but they do not want to be entirely insulated from the challenges and responsibilities that their peers face.

I am pleased to have been able to put on the record our commitment to supporting care leavers and the action we are taking, but I hope I have made it clear that we are not complacent. I am passionate about improving the lives of care leavers. We are determined to ensure that the welfare system in general and universal credit in particular help care leavers make a successful transition to independent living and working life, and that we support them as best as we can.

[Mrs Cheryl Gillan (in the Chair)]

I call Alex Burghart to wind up.