Mental Health: Social Work
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Baroness Tyler of Enfield
To ask Her Majesty’s Government what plans they have to improve the provision of mental health social work, given the incidence of mental health problems among the population.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, the Government recognise that improving mental health services remains a significant challenge. Social workers play a vital role in delivering high-quality mental health services, and the Chief Social Worker for Adults is taking forward a number of initiatives with the sector to help address these challenges. Along with the College of Social Work, we recently launched The Role of the Social Worker in Adult Mental Health Services.
Baroness Tyler of Enfield (LD)
I thank my noble friend for his Answer. Does he share my concern about the shortage of good social workers who are able to work effectively in mental health settings in many places in the country? What further steps are the Government taking to address this? What specific plans do they have to ensure that social workers working in integrated health and social care teams feel valued by their medical colleagues and that their professionalism is indeed recognised?
Earl Howe
My noble friend makes some excellent points, and I acknowledge her role as a member of the programme board for the Think Ahead programme, which is designed to attract, in particular, new graduates into social work, and specifically into mental health social work. Good-quality social work can transform the lives of people with mental health conditions. It is an essential part of multidisciplinary and multiagency working. As we move forward into new ways of working, particularly in the context of integrating care, my noble friend’s point about other professionals understanding and appreciating the value that mental health social workers can give will be key, not just in terms of earlier intervention but by building resilience, reducing and delaying dependency and ensuring that people have all the information and enabling support that they need to look after themselves better.
Lord Bradley (Lab)
My Lords, I note my health interests. What is the Government’s assessment of the scale of shortages of mental health social workers? In particular, what assessment has been made of the capacity to respond to requirements under the Mental Health Act, particularly Section 135, for approved social workers?
Earl Howe
My Lords, we need more social workers, particularly in mental health. The Think Ahead programme is certainly one way in which we hope to improve the numbers. Social work is not always seen as an attractive career option. We know that there is a growing appetite among graduates to work in mental health; unfortunately that enthusiasm has not filtered through to the social work profession. We need to focus on that. Much will depend also on finding a greater number of placements in social work, particularly relevant to mental health, so that there is on-the-job training for those trainees.
Lord Laming (CB)
My Lords, does the noble Earl agree that the very least we must do for social workers operating in this very complex area of work is to ensure that they all have the appropriate training, which is not just about classic mental health problems but about the abuse of drugs and alcohol, and indeed now extends into the great impact that dementia has on patients and their relatives?
Earl Howe
The noble Lord is quite right. The importance of mental health knowledge across social work in its entirety—adults, children, adolescents and families—is vital. Mental health is a key factor for people with substance abuse problems and other complex social and health needs that defy neat categorisation. The Chief Social Worker for Adults, Lyn Romeo, is working with the Chief Social Worker for Children and Families, Isabelle Trowler, to produce a statement of the knowledge and skills required across children’s and adult services and the need for students and qualified social workers to be able to work with mental health issues in all contexts.
Baroness Trumpington (Con)
My Lords, what is the Minister’s solution to the situation that arises when a social worker moves from one district to another without necessarily taking their portfolio of work with them? I speak having been a Minister when a social worker was murdered when the person who killed her had changed district but the social worker had not been informed of the move.
Earl Howe
My noble friend makes an extremely important point about continuity of care. Not only is this important in terms of sheer administration; it is vital for the health of the service user or patient, as the social worker is very often the key point of contact for vulnerable people living at home and maybe on the brink of being admitted to NHS in-patient care. My noble friend makes a very good point. If I can amplify those remarks in any way I will write to her.
Baroness Farrington of Ribbleton (Lab)
My Lords, will the noble Earl join me in saying that, important though they are, it is not only patients with mental health issues who need help and support? Many young people in particular live at home with people who previously may have been inside a hospital and now quite rightly are being treated in the community. Those children and young people are in many cases coping with circumstances where adults would find it impossible to work. Will the noble Earl ensure that, in looking at this, the needs of those young people are borne in mind, not least because many of them fail in school because of the pressure they are under at home?
Earl Howe
The noble Baroness makes a series of extremely well put points. That is why we are looking at a number of ways to bolster the services that children receive from mental health services and professionals. We have the Children and Young People’s Improving Access to Psychological Therapies programme, as she knows. We are taking forward options for a new survey on how many children and young people have mental health problems, which is of course important for planning. New guidance published last week by the Government will help teachers to better identify underlying mental health problems in young people, and NHS England is currently reviewing children and young people’s in-patient mental health services so that we can see where there are pressures in the system and how money is being spent.
Mental Health: Parity of Esteem
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Lord Patel of Bradford
To ask Her Majesty’s Government what assessment they have made to measure the success of their policy No Health Without Mental Health, which undertook to give mental health “parity of esteem” with physical health within the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, our commitment to parity of esteem is explicit in the Health and Social Care Act 2012. As stewards of the system, we hold the NHS to account for the quality of services and outcomes for patients through our mandate to NHS England and the NHS outcomes framework.
Lord Patel of Bradford (Lab)
My Lords, I think that the picture is fairly gloomy. There has been a real-terms 1% drop in investment in mental health services for adults of working age, and mental health trusts have reported a real-terms reduction of 2.36% over the past two years. Investment across the three priority areas—crisis resolution, early intervention and assertive outreach—has seen a £30 million drop for the first time. Funding for older people in mental health services has seen a 1% real cash-terms drop, and 67% of councils have stopped child and adolescent mental health services funding. These cuts have come in at a time when more people—almost 8 million—are experiencing mental health problems. In addition, 30% are suffering from a long-term physical health problem, the number of deaths by suicide is increasing and mental health ward occupancy levels are at over 100%. This Government promised parity of esteem and we were assured that that would be in the Health and Social Care Act. Does the Minister agree that we are far from meeting our obligations on this simply because of the cuts and what has happened to these vulnerable people?
Earl Howe
My Lords, mental health and mental well-being are priorities for the Government; I want to make that clear to the noble Lord. We have legislated for parity of esteem between mental and physical health, and we mean business on this. Our new mental health action plan, which has been well received, sets out our priorities for essential change. We have the Crisis Care Concordat, which guarantees that no one experiencing a mental health crisis should ever be turned away. We are rolling out choice in mental health, which is an extremely important step forward, and a whole range of other measures, including IAPT and the children’s mental health measures that I outlined a moment ago. I hear what the noble Lord says about funding. We have debated that matter in the House before. We are currently scrutinising local CCG spending plans to make sure that mental health gets the priority that it needs.
Baroness Howe of Idlicote (CB)
My Lords, I am sure that everyone welcomes the fact that mental health has emerged at last to receive the attention that it should be getting. However, will the Minister confirm that the Government are paying particular attention to the number of women in prison with a mental health problem? In previous decades, that was not addressed at all.
Earl Howe
My Lords, yes, we are doing so. We are paying attention not just to women in prison but to women and men in prison and in the criminal justice system more generally. We have committed £25 million to introduce a new liaison and diversion scheme in England to identify and assess the health issues and vulnerabilities of all offenders when they first enter the criminal justice system, which I think is the crucial moment. We are building on liaison and diversion services to improve the quality of those services and their coverage across England, and we are trialling a core model in more than 20 areas over the next two years with the aim of moving towards comprehensive rollout by 2017.
Baroness Brinton (LD)
My Lords, is the Minister aware that one in 10 children between the ages of five and 16 has a mental health problem and may continue to have problems into adulthood? What are the Government doing to ensure that child and adolescent mental health services are properly funded by NHS England and CCGs?
Earl Howe
My Lords, we are investing £54 million over the four-year period from 2011 to 2015 in the Children and Young People’s Improving Access to Psychological Therapies, CYP IAPT, programme. That, along with the measures that I referred to earlier, will, I hope, give a sense of the priority that we attach to children and young people’s mental health services.
Lord Winston (Lab)
My Lords, the Minister gave us a long list of things that the Government are doing. However, he does not mention research into mental health. Is not one of the key problems that clinicians are never able to identify the disease phenotype, and that makes further and better treatments impossible? Should there not be much more emphasis on the need to research mental ill health throughout the country?
Lord Rooker (Lab)
My Lords, will the Minister do what he can in government to lock in the policy of the programme that he has announced today? I remind him that—I think it was in 2004—the former Social Exclusion Unit published a seminal report on mental health and social exclusion, with 27 action programme recommendations. As Ministers come and go and as civil servants get recycled, things go off the boil and we have to start doing it all over again. That does not serve the citizens of the country on an issue such as this, which transcends all our other divisions. We need to concentrate on it so that we do not lose it as people come and go.
Earl Howe
The noble Lord is right and I can say to him that the coalition Government have tried as far as possible to continue the good work on mental health of the previous Administration. One has to keep renewing the momentum on this. Situations do not stand still, and that is why our new mental health action plan Closing the Gap reminds everyone in the system of the most important gains to be made in 25 areas where people can expect to see and experience the fastest changes. I am glad to say that that document has been well received by all stakeholders.
National Health Service
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I am delighted that the noble Lord, Lord Crisp, has raised this important topic for debate this afternoon. I would like to thank him for sharing the report on patient empowerment by the six all-party parliamentary groups to which he referred, which I read with great interest.
Giving patients more power in the NHS involves concerted effort at every level: national, regional and local and, perhaps most importantly of all, in the consulting room itself, in the one-to-one conversations between clinician and patient. As the noble Baroness, Lady Pitkeathley, pointed out, the terrible events at Mid Staffordshire show what can happen when patients have no power at all. The deeply unfortunate experience of the noble Baroness, Lady Wilkins, as recounted by the noble Baroness, Lady Masham, is a further example. As a Government, we are committed to putting patients genuinely at the heart of the NHS, to giving them the information, tools, support and care to help them get well and stay well and to give real life to the commitment in the NHS constitution on that theme.
Involving patients and the public in health matters is something that the Government, my department and our partner organisations are firmly committed to. Indeed, there is a general consensus that patients should be at the heart of the health system and that putting the patient first needs to be made a reality.
Ensuring that patients have more say in how their care is delivered and embedding choice are key themes in the Health and Social Care Act 2012, to ensure that we genuinely put the patient first and drive improvements in quality. As part of that, involving patients and ensuring that there is “no decision about me without me” needs to become the norm, not the exception. The same applies to the very apt question, “What matters to you?”
We are passionate about ensuring that people have every opportunity to have their voices heard; that people have the opportunity to shape the services that affect them and their families; and that they are empowered to make decisions about their own healthcare and management. That is why we want everyone to be able to make informed choices about health and social care.
The noble Lord, Lord Crisp, asked me to endorse the principle of patient empowerment, which I readily do. We know that empowering patients and citizens is key to ensuring that health services meet people’s needs, that people have a better experience of care and are able to take better care of themselves; all of which—as the noble Baroness, Lady Pitkeathley, pointed out—will help to sustain the system itself, a system in which we all place so much value.
My noble friend Lady Brinton referred to the need to measure the patient experience, not just patient outcomes, and of course she is right about that. There are a number of measures for collecting information about different aspects of patients’ experience. One way of doing that, which is supported by various parts of the health system, is a validated measure devised by Warwick University.
To do all this it is vital that we understand what patients want from their care. There are a number of ways in which we do that. One in particular can be mentioned; namely, that we have received over 2.5 million responses to the Friends and Family Test in inpatient and A&E settings. That is proving to be a really useful tool in shining a light in almost real time on patient experience.
Patients must be given the chance to be as involved in their decisions about their care as they wish to be. We know that there is an appetite among many people to be more involved in their care than they currently are. Involved patients are in a far stronger position to manage their own healthcare, resulting in improved patient outcomes, a reduction in unnecessary consultations, improved patient experience and better use of resources. This is not a new agenda, and already a lot of progress has been made.
The noble Lord, Lord Crisp, asked about patient decision aids. NHS England is updating the patient decision aids as part of its work to establish a sustainable model of PDA which is underpinned by clinical leadership and partnership with organisations that can stimulate patient use and clinical buying in. Research shows that the tools need to sit within a wider system amenable to partnership, with patients and shared decision-making with clinicians as the norm. Patient decision aids comprise a shared decision-making website. That allows patients to plan their healthcare pathway. As for NHS England, the NHS Citizen programme seeks to put the patient voice at the heart of the decision-making that NHS England itself undertakes. That is a commitment from NHS England.
I am struck by how much engagement has taken place throughout the healthcare system in the past year, with a diverse range of people and organisations: patients, carers, the public, the voluntary sector, social enterprises and the community sector. It is important that we get this right, and we must engage the support of the public and other stakeholders in doing so.
The noble Baroness, Lady Pitkeathley, referred to carers as citizens, and of course I agree fully with her. It is important to gather the views of carers through a number of feedback mechanisms, including the Friends and Family Test and the GP Patient Survey. We have to understand the particular needs of carers to ensure that we can tailor the support that is required. NHS England will be publishing commitment to carers this year.
Of course, if we are serious about putting the patient first, that involves much more than giving patients and the public a chance to shape the services, although that issue should not be overlooked. The noble Lord, Lord Hunt, asked whether Healthwatch England was making a difference. We can now see the role of Healthwatch England making itself felt, ensuring that people’s experiences and views about their care and treatment are listened to and acted on. It is providing worthwhile leadership, support and advice to the local Healthwatch network, which is promoting a local consumer voice.
The noble Baroness, Lady Pitkeathley, referred to the patient leaders concept. The Care Quality Commission aims to involve people who use health and social care services in everything it does. For example, Experts by Experience takes part in inspections of health and social care services and visits to monitor the use of the Mental Health Act. Furthermore, NHS England has invested a significant amount of effort to improve the way in which it supports people to manage their own care. There is a number of core programmes, such as personalised care and support planning, so that people with long-term conditions and disabilities can work together with their health and social care professionals. Personal health budgets will give people more choice and control, and sites have now been chosen for piloting personal health budgets for people with mental health conditions.
The noble Lord, Lord Crisp, referred to the benefit of empowering patients to ask more questions. The key to giving patients more power in the NHS is the provision of high quality and accessible health information. Already, NHS Choices helps to put people in charge of their healthcare. The noble Lord, Lord Hunt, and the noble Baroness, Lady Murphy, referred to technology. NHS Choices also includes a health apps library spanning a whole range of lifestyle and clinical conditions to help people choose apps that are safe to use. As part of NHS England’s work to give patients access to their records, the Patient Online programme’s accelerator sites will be testing how that is impacting on patients and clinicians. That represents a real shift in emphasis and the relationship between patients and professionals, so it is important that we test it out first. It is about doctors trusting patients to use information responsibly. Having said that we need to test it, the principle of giving patients practical ownership of their records is surely right, and I think that that work will provide the foundation for that. Of course, we would like to move faster with this critical agenda, but it is important that we do this at an appropriate pace to bring people with us and to learn lessons from trying out new ideas.
Let me pick up the theme that my noble friend Lady Brinton spoke to so powerfully. We must not forget the importance of supporting the workforce. Some are already doing an excellent job in involving patients in their care. But more widely, the right medical education and clinical training needs to be in place, because by empowering health professionals we can empower patients. The NICE standard on patient experience defines best practice in this area and provides evidence-based statements for commissioners to support a cultural shift towards a truly patient-centred service.
I am pleased that NHS England together with other organisations across the health, social care and voluntary sectors has formed a coalition, the Coalition for Collaborative Care, to make person-centred care a reality for people living with long-term conditions. Furthermore, a key part of increasing the involvement of patients in their own care is being able to measure the skills, knowledge and confidence that people have that predispose them to be able to manage their own conditions better. As the noble Lord, Lord Crisp, said, diabetes is an excellent example but we must also think in terms of more complex conditions, as the noble Lord, Lord Hunt, rightly pointed out. Working in partnership with the Health Foundation and the King’s Fund, NHS England is piloting the patient activation measure in five CCGs and the renal registry. This is an exciting development. It is a score based on patients’ responses to 13 questions that include measures of an individual’s knowledge, beliefs, confidence and self efficacy. It has the potential to drive real improvements in participation.
Finally and importantly, the move to a new health system, including the transfer of the public health function to local government, has created the potential for action on health and health inequalities to be centred on people and places. I am delighted to see how Public Health England and NHS England are working in partnership. With Healthwatch championing the needs of children, young people and adults, the health and care system as a whole is working together to make things better for everyone, especially the most vulnerable in our communities.
There are a number of points that I feel I should pick up, but in view of the time I hope that noble Lords will allow me to write to them on those points. In saying that, I would like to thank all speakers for their contributions to what has been a very fruitful debate.
National Health Service: Nursing Staff
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Baroness Kennedy of Cradley
To ask Her Majesty’s Government why there has been a reduction in the number of senior nurses in the National Health Service since 2010.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, local NHS organisations are best placed to determine the skill mix of their workforce and must have the freedom to deploy staff in ways appropriate for their locality. Some organisations have reviewed their nursing staff structures to ensure that they are delivering quality of care for patients. This has resulted in a decrease of some senior posts. However, there has been an overall increase in nursing numbers, with over 3,300 more nurses, midwives and health visitors since 2010.
Baroness Kennedy of Cradley (Lab)
I thank the Minister for that reply, but since 2010 there has been a decrease of 4,000 senior nursing posts—modern matrons, ward sisters and specialist nurses, which we all recognise, as indeed do the Government, as being universally critical to patient care. Are the Government not worried about the fact that, on the one hand, trusts are saving money by decreasing these senior nursing posts yet, on the other hand, they are spending money by increasing the pay of executive directors by 6%? What are they going to do about reversing this worrying trend, and how are they going to tackle this dangerous loss of experience and skill in our NHS?
Earl Howe
My Lords, the figure that I have is in fact a decrease of just over 3,000 nurses in senior positions at bands 7 and 8, but that is more than made up for by the increase of over 7,500 nurses at bands 5 and 6 on the front line. On the noble Baroness’s second point, the figures that I saw emanating from the Royal College of Nursing should be looked at with some caution; the RCN has included exit packages for executive directors but not for nurses. In fact, the latest independent evidence shows that for the third year running there was no increase in median executive board pay. It is important to compare like with like there, and the figure of 6.1% as a rise for executive directors is not one that we recognise.
Baroness Cumberlege (Con)
My Lords, does my noble friend agree that one of the most encouraging aspects of the nursing profession is the number of senior nurses who have gone on to be chief executives and board members in the NHS, bringing all the skills of nursing to the leadership of hospital trusts and clinical commissioning groups?
Earl Howe
I agree with my noble friend. To ensure that nurses have the leadership skills, styles and behaviours that our healthcare system needs, the NHS Leadership Academy has launched the largest and most comprehensive approach to leadership development ever undertaken. More than £46 million has been invested in core programmes that will map to foundation-level, mid-level and executive-level leadership development, with two programmes specifically for nurses and midwives that started in March last year.
Lord Hunt of Kings Heath (Lab)
My Lords, given the answer that the Minister has just given to his noble friend, surely it is ironic that throughout the NHS the number of senior posts is actually being squeezed. Would he not agree that that runs counter to what Francis said post-Mid Staffordshire about the need for highly effective quality supervisory nurses? Is the reason why this is happening not that the NHS cannot afford to increase its nurse staffing levels with the amount of money that it has been given by the Government? Something has gone, and unfortunately it is these crucial posts that seem to be having to give way.
Earl Howe
My Lords, I do not agree with that because nursing numbers are now at a record high, which cannot indicate that hospitals are being starved of resources for their nurses. I do not see it as ironic that some senior posts have been reduced, bearing in mind the effect of Robert Francis’s report which has caused hospitals to increase the number of nurses on the wards. By and large, nurses at grades 7, 8 and 9 are in managerial positions and not in front-line posts.
Baroness Manzoor (LD)
My Lords, can the Minister say if an impact assessment has been undertaken on losing senior nurses from the NHS and the impact it has on service standards? The noble Lord, Lord Hunt, has already made the connection with the Francis report. Can the Minister also say whether an exit strategy has been undertaken to see why senior nurses are leaving?
Earl Howe
My general answer to my noble friend is that it is not for the Government to decide how many nurses hospitals should employ. We have not done an impact assessment. That is a matter for local hospitals to judge. They are in the best position to do that, based on the needs of their patients and local communities. What the Government should do, and are doing, is to ensure that staffing levels are available for public scrutiny and comparison on a patient safety website. That work is currently in train. It will now be much more evident to patients and the public what their local hospital is doing in terms of safe staffing ratios.
Baroness Finlay of Llandaff (CB)
My Lords, before seven-day working comes in, are the Government ensuring that senior nurses are also taking part in the seven-day rota to ensure that their expertise is available both in hospitals and in the community to support other nurses at more junior grades?
Earl Howe
My Lords, the work going on on seven-day working certainly includes the nursing workforce. However, I repeat that it is not for the Government to mandate what each and every hospital should be doing in terms of deploying their senior nursing staff. It is a judgment for the board of that hospital.
Lord Warner (Lab)
My Lords, the Minister is very proud of the increase in the number of nurses on the front line. Can he confirm that all these nurses are actually in hospitals? What is the comparable figure for nurses working in the community? I believe the Government’s policy is supposed to be to have more care in the community.
Earl Howe
The noble Lord is right. The Government recognise the very important contribution that community nurses make in providing high-quality care to people within community settings. I think we have seen a reaction, as I have said, to the Francis report. Lots of hospitals say that they are going to employ more nurses on the wards. We now need to ensure that staffing levels are safe across the NHS and the community, and the Chief Nursing Officer has set up a working group which is looking specifically at what we can do to increase the number of community nurses, which we certainly need to do.
Baroness Masham of Ilton (CB)
My Lords, does the Minister agree that specialist nurses are not being replaced when they retire and that there is great concern about this as they do such valuable work for many specialties?
Earl Howe
I acknowledge the valuable role played by specialist nurses in a number of disciplines but, once again, it is up to employers to exercise their responsibility to manage turnover, retention, recruitment and skill mix to ensure that they have sufficient workforce supply to meet the levels of staffing that the hospital or organisation needs. Here again, patient safety is paramount.
Health: Rheumatoid Arthritis
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Baroness Brinton
To ask Her Majesty’s Government what steps they are taking to ensure that general practitioners are trained to recognise potential rheumatoid arthritis symptoms, and refer such patients immediately to rheumatologists.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, the Government’s mandate to Health Education England includes a commitment that it will ensure that general practitioner training produces GPs with the required competencies to practice in the NHS. The content and standard of medical training is the responsibility of the General Medical Council. The current GP curriculum requires trainees to successfully complete training on care of people with musculoskeletal problems, which includes rheumatoid arthritis.
Baroness Brinton (LD)
My Lords, I thank my noble friend for his helpful Answer. However, the reality is that too many GPs do not recognise the symptoms. A new report published today by the National Rheumatoid Arthritis Society shows that a shocking 25% of patients have to stop work within the first year of diagnosis, and with the delays their clinical outcomes are poorer and it costs the NHS much more. What will the Government do to raise awareness of symptoms, particularly among GPs?
Earl Howe
My Lords, I pay tribute to the National Rheumatoid Arthritis Society, which is organising Rheumatoid Arthritis Awareness Week this week, between 16 and 22 June. I am aware that Public Health England has run early diagnosis campaigns, which up to now have focused largely on cancer. However, I understand that a broader focus on earlier diagnosis is currently being considered. What might be done to tackle other conditions or symptoms has yet to be decided, but I will keep the noble Baroness informed of developments.
Lord Turnberg (Lab)
My Lords, one of the problems is that there are still far too many single-handed general practices, which have great difficulty providing a full range of services. Are the Government doing anything to try to bring them into bigger groupings?
Earl Howe
My Lords, we are encouraging single-handed practices not to disband but to federate themselves—if that is a good word—with other practices in the area, and certainly to seek the support of their clinical commissioning group. That would ensure that the range of professional training available is utilised and that there is peer support where appropriate. Therefore, while many single-handed practices do a very fine job, there is scope for them to collaborate with their colleagues in the local area.
Baroness Howarth of Breckland (CB)
My Lords, I am sure that the noble Earl will tell me that it is the responsibility of either NHS England or the local health commissions, but is he not alarmed by the number of GP practices being suggested for closure at the moment, and by the long waiting times that patients have to endure in many areas? In some country areas you cannot see your GP for four weeks. Should the Government not have at least some concerns on that?
Earl Howe
My Lords, we are concerned by reports of patients having difficulty accessing their GPs. That is why a whole range of work is currently going on in NHS England to look at the issue, to see how general practices can be helped and to enable them to see more patients. However, more generally, we in the Government have amended the GP contract to free up GPs’ working time. We have abolished well over a third of the QOF indicators precisely to do that. The Prime Minister’s Challenge Fund—£50 million-worth of funding—enables GPs to open up different ways of working; for example, consulting patients on Skype and working hours other than nine to five.
Baroness Gardner of Parkes (Con)
My Lords, although it is very important for GPs and even patients to be aware of early symptoms, does the Minister acknowledge that the real answer as to how to deal with this condition will be in research? Can he tell us whether the Government are supporting such research?
Earl Howe
I am grateful to my noble friend. Expenditure on musculoskeletal disease research by the National Institute for Health Research has increased from £15.5 million in 2009-10 to £23.1 million in 2012-13. The NIHR is investing over £21 million over five years in three biomedical research units in musculoskeletal disease. They are all carrying out vital research on rheumatoid arthritis. The NIHR is currently investing £2 million in a programme of research on treatment intensities and targets in rheumatoid arthritis therapy.
Baroness Wheeler (Lab)
My Lords, can the Minister tell the House what impact the very worrying reported shortage in take-up of family doctor training places is likely to have on the ability of GPs to support patients with potential rheumatoid arthritis symptoms? A recent survey by Pulse found that only 7% of the funding for medical schools goes into teaching general practice. Does this not augur badly for the future of primary care?
Earl Howe
My Lords, we of course recognise the very hard work that GPs do. Despite a decrease in headcount, there has in fact been a 1.2% increase in full-time GPs since 2012 and the number of practice nurses and practice staff has also grown. However, we also recognise that the workforce needs to grow to meet rising demand. That is why our mandate to Health Education England requires it to ensure that 50% of trainee doctors enter GP training programmes by 2016. Generally, we will work with NHS England to consider how to improve recruitment, retention and return to practice in primary and community care.
Lord Warner (Lab)
My Lords, is not the current model of general practice in this country bust? Is it not time that the Government started to think about setting out the requirements that all GPs who offer services to NHS patients ought to make available? If that means them working in bigger practices then so be it, because that is in the interest of patients.
Earl Howe
My Lords, the noble Lord is right that there is scope to examine different ways of working in primary care. I would have to think about whether I would go quite as far as he has, but the point of principle he makes is a very sound one. That is why the Prime Minister’s Challenge Fund is encouraging GPs to think out of the box in the way they make themselves accessible to patients.
People with Learning Disabilities
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I begin by expressing my gratitude to the noble Baroness, Lady Hollins, for her huge contribution in the fields of learning disability and mental health, her tireless efforts in championing the rights of individuals and families, and for the very real difference the breadth of her work has made to the life chances of so many people.
It is nearly a year since the noble Baroness convened a debate on action to address the health inequalities identified by the government-commissioned Confidential Inquiry into Premature Deaths of People with Learning Disabilities, and I welcome the opportunity to bring those issues to the fore again. Since the government response was published in July last year, we have published our call to action, setting the aspiration to make the UK among the best nation states in Europe at reducing premature and avoidable deaths.
In April, working with partners and stakeholders, we published Living Well for Longer: National Support for Local Action to Reduce Premature Avoidable Mortality, which recognised the need for a targeted approach for people with learning disability. This national partnership, and the focus and momentum it has engendered, creates a vital opportunity to make a difference in our collective fight to reduce avoidable mortality. At the same time, by creating both the evidence base and a system-wide work programme, the confidential inquiry and the Government’s response have provided a powerful tool to turn that opportunity into action.
We have the policy framework in place and have reflected health inequalities across the NHS, public health and adult social care outcomes frameworks. There are specific measures on preventing people with learning disabilities dying prematurely and greater focus on empowering people to have greater choice and control. The mandate to NHS England for 2014-15 allows us to hold the system to account and gives us the basis for measuring progress. Reducing differences in life expectancy and health expectancy are key measures across the system.
NHS England is committed to establishing a learning disability mortality review function by March 2015, as set out in its business plan, Putting Patients First. A project group is overseeing this development, with representation from Mencap, PHE and the Department of Health. I am delighted that the noble Baroness has also been invited to lend her expertise.
The Government’s response to the confidential inquiry included a commitment from NHS England to an assessment of costs and benefits by March 2014. NHS England, together with the inquiry team and other partners, undertook a robust assessment, and resources have been allocated through the priority-setting processes. This is now a commitment in its business plan and strategic objectives, and we all wish to see this work proceeded with rapidly. As regards funding, I am sure that NHS England, in establishing the review function and beyond, will be giving full consideration to funding issues through its business planning and resource allocation processes.
The noble Baroness, Lady Hollins, highlighted the issue of data linkage. Work is under way with NHS England, the Health and Social Care Information Centre and Public Health England to provide standardised mortality data for people with learning disabilities to underpin the NHS outcomes framework and the mortality review function. However, I hope she will appreciate that in taking that work forward, we must also take account of wider cross-system discussions about the collection and sharing of patient data, which will inevitably have implications for this work. Nevertheless we are working closely with partners and will certainly act to secure the prioritisation of this work through all appropriate mechanisms.
The noble Baronesses, Lady Hollins and Lady Andrews, both emphasised the importance of integrated care for those with learning disabilities and getting the whole system engaged. NHS England is looking at ways to establish care co-ordination and risk stratification for people with learning disabilities as normal practice. We will underline the importance of prioritising this with NHS England.
Following the passing of the Children and Families Act, new arrangements will be introduced from September 2014 for joint assessment, planning and commissioning of health, social care and education services for children and young people with special educational needs up to 25 years old. A single education, health and care plan will set out meaningful objectives which will make a difference to the life of the young person, including supporting their transition to adulthood and independent living. The right reverend Prelate stressed the importance of advocacy for people with learning disability. He is right. Several actions arising from the Winterbourne View programme are intended to improve the quality and availability of good advocacy, working with a range of key stakeholders.
As the noble Baroness, Lady Hollins, emphasised, as did the right reverend Prelate, we need a system for identifying those with learning disabilities. The GP register of people with a learning disability from this year onwards is an all-age register, so will include children and young people with a learning disability. GPs are incentivised to construct this register as part of the quality and outcomes framework.
I can tell the noble Lords, Lord Wigley and Lord Hunt, that the NHS standard contract for 2014-15 now includes a requirement for providers to undertake an annual audit of reasonable adjustments. There is already a system within all NHS foundation trusts to provide board-approved risk assessments to Monitor about six specific areas of good-quality care for people with learning disabilities. On the back of this already-established standard, Professor Sir Mike Richards has agreed that four additional questions will be trialled in the inspection of acute hospitals, concerning numbers of people with learning disabilities in hospital, reasonable adjustments, specialist learning disability nurses and care audits. In addition, Professor Steve Field is exploring the data that can be used for intelligent monitoring purposes, in preparation for inspection of primary care providers and how they meet the needs of people with learning disabilities in a primary care setting.
The CQC will, from the autumn, be inspecting services around its preparedness and plans for children and young people with learning disabilities transitioning into adult services. To answer a point raised by the noble Baronesses, Lady Andrews and Lady Warwick, that better transition planning also feeds into the new enhanced services for learning disability annual health checks, which are starting from the age of 14 from this year onwards. They include a requirement for health action plans, and I can tell both noble Baronesses that NHS England is looking at the variation in uptake and the quality of health checks, with the aim of improving both.
I return to the issue of patient identification. In the last year, Public Health England has been involved with the Health and Social Care Information Centre in the development of information standards to improve the identification of people with learning disabilities in healthcare records. Public Health England’s Learning Disabilities Observatory maintains a national register of examples of reasonable adjustments made by hospital and other health service providers to help ensure that people with learning disabilities can benefit as much from available care as other people.
On health checks, as my noble friend Lord Ribeiro mentioned, Public Health England has produced leaflets specifically designed with and for people with learning difficulties, which explain the invitation and screening process for cancer and cervical screening programmes. It also has guidance for professionals on access to screening, and on informed consent and best interests decision-making. NHS England is also looking very carefully at that. In recognition of the very poor uptake of flu immunisation by people with learning disability, this year’s annual flu immunisation letter asks GP practices to prioritise vaccine uptake in people with learning disabilities.
Education and training in this field is vital. My noble friend Lord Ribeiro stressed the importance of compassion and good clinical practice. The noble Baroness, Lady Andrews, referred rightly to a need for cultural change, as did the noble Lord, Lord Rix. Health Education England’s mandate includes an objective to improve the skills and capability of the workforce to respond to the needs of people with learning disabilities and behaviour that challenges. The Department of Health has commissioned a consortium, led by the Royal College of Paediatrics and Child Health, to develop Disability Matters, an e-learning portal for those who work with children, young people and adults with a disability. The Care Quality Commission is raising awareness among its inspectors.
On the issue of the Mental Capacity Act, raised by the noble Lord, Lord Patel of Bradford, the Government’s response to the House of Lords report on the Mental Capacity Act was published this week. It sets out a system-wide programme of action to address low levels of awareness of the Act among professionals. Health Education England is reviewing all education and training programmes to determine compliance with the principles of the Act. It will also look at including MCA compliance in the standard contract with education providers.
The noble Lord, Lord Rix, and the noble Baronesses, Lady Hollins and Lady Andrews, expressed disappointment that the department had not published a one-year-on report. We undertook to keep the Learning Disability Programme Board informed of progress. At a conference organised by the department on 28 March, the confidential inquiry team was able to share information and best practice on national, regional and local work to address the recommendations. That was followed by a meeting with members of the Learning Disability Programme Board in April.
We now need to step up the pace and make a concerted national effort to see more equitable access and outcomes for people with learning disabilities. A report setting out progress to date will be presented to the Learning Disability Programme Board in July, a year on from the Government’s response to the confidential inquiry. That will be published online.
The noble Baroness, Lady Hollins, asked whether we would embed the learning from the confidential inquiry into other policies. Most certainly yes: we have already committed to link the learning recommendations from the inquiry to other policies and programmes—for example, the Winterbourne View programme, the Mental Capacity Act and, indeed, end of life care.
The noble Baroness, Lady Warwick, expressed her concern over what she saw as the Government’s lack of action. I hope I have demonstrated that there has been extensive action, but of course there is more to do. I believe that collaboration nationally and locally on this challenging issue will give us the best chance of delivering equitable health outcomes across our nation. I would say to the noble Lords, Lord Adebowale and Lord Hunt, that the Government, as steward of the health and care system, are taking responsibility for delivering their commitments in response to the confidential inquiry’s recommendations. In doing so, we are ensuring that all key delivery partners across the health and care system play their rightful part as well.
Health: Transition to Adult Health Services
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government what action they are taking to ensure the continuity of standards of care for teenagers with long-term health conditions who transfer to adult NHS services, as recommended in the Care Quality Commission report From the Pond into the Sea.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, our 2013 pledge to improve health outcomes for children and young people included the ambition to co-ordinate care around the individual young person with complex needs to deliver the best experience of transition to adult services. The partners to the pledge—including NHS England and Health Education England—are working to deliver this. Our mandate to NHS England calls for improvements in the way that care supports smooth transitions between children’s and adult services.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the noble Earl. He will know that this is a worrying report and that it would appear that young people with long-term health conditions often fall through the net when they transfer to adult services. He said that the mandate to NHS England requires it to do something about this, but can we be confident that NHS England actually will take note of what Ministers ask for? I would just refer him to the inability of NHS England to implement the Winterbourne recommendations and its failure to fund mental health services in accordance with parity of esteem. Does the mandate amount to anything at all? Too often Ministers have come to this House and said that something would be done, but nothing has actually happened.
Earl Howe
I think that I can reassure the noble Lord on this point. NHS England is currently developing service specifications across the range of commissioning models: specialised commissioning, CCG secondary and primary care commissioning, adolescent mental health and special educational needs, and learning disability. Those will translate examples of best practice and published outcomes into specifications for commissioning to hold providers to account for the delivery of robust transition services with measurable quality standards attached to them.
Baroness Butler-Sloss (CB)
My Lords, there is a particular problem with young people who have not only physical problems but very considerable mental health problems. Is a priority being given to help that group of children?
Earl Howe
The noble and learned Baroness is quite right, and as she well knows, this has been a long-standing issue. Our document, Closing the Gap: Priorities for Essential Change in Mental Health, which we published recently, identifies the transition from child and adolescent mental health services into adult services as a priority for action. We are supporting the work of NHS England to develop the service specification which I have just referred to. CCGs and local authorities will be able to use that specification to build excellent person-centred services that take into account the developmental needs of the young person, as well as the need for age-appropriate services.
Baroness Pitkeathley (Lab)
My Lords, problems arising at the transition stage are often reported by the parents of these young people because they are their carers. Does the Minister agree that standards of care must include support for those much-needed parent carers?
Earl Howe
I fully agree. I think that much of this will succeed only if services work together around the needs of young people as well as their families and carers, and if the families and the young people themselves feel involved in the way in which their care is being organised and planned.
Baroness Howarth of Breckland (CB)
My Lords, in terms of developing the specification, can the noble Earl tell us how stakeholders are to be involved? In particular, will the young people themselves now have a voice? I declare an interest as the president of Little Hearts Matter, which deals with children with single-ventricle problems.
Earl Howe
I think that we can pay considerable tribute to the Children and Young People’s Health Outcomes Forum. It is one of the bodies that have highlighted the need for more effective transitions and for new outcomes indicators to measure them. Its framework for this year includes a proposal that, where possible, all data should be presented in single-year or five-year age bands up to the age of 25 to support better monitoring. Moreover, the forum asked the National Network of Parent Carer Forums to develop a narrative of what good integrated care looks like in transition. The CQC report has drawn quite heavily on that report in its conclusions.
Baroness Barker (LD)
My Lords, the Teenage Cancer Trust had to battle for years to get NHS commissioners to understand that age-specific rather than gender-specific wards are better for young people. It is a good organisation, but it has been a hard job to change the mindset of the NHS. Can he help organisations such as the Teenage Cancer Trust to find ways in which to influence commissioners far more quickly than they have been able to do in the past?
Earl Howe
My noble friend raises another extremely important point which applies not only to cancer, but also particularly to mental health settings. We have had many debates in this Chamber about age-appropriate settings. I will take her point back with me and find out where we are in our dialogue with stakeholder groups.
Baroness Uddin (Non-Afl)
My Lords, can the noble Earl tell the House whether the commissioning will specify autism in the service specifications? Further, will the NHS England staff who are responsible for implementing these measures be trained to deal with the issue of autism?
Earl Howe
The noble Baroness raises an important point and I can reassure her that we are addressing the full range of complex needs in children and young people. She may also be interested to know that Health Education England will be working with the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health to develop a training course that will allow GPs to develop a specialist interest in the care of young people with long-term conditions. The aim is to introduce the course in September 2015. It will include a particular emphasis on the transition from childhood.
Baroness Finlay of Llandaff (CB)
Do the Government recognise the need for a champion, such as we have had with Dr Lidstone in Wales, who has completely transformed the transition for children with life-limiting illness?
National Health Service: Hospital Beds
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Lord Kennedy of Southwark
To ask Her Majesty’s Government what is their response to the Organisation for Economic Co-operation and Development’s report on the number of hospital beds per person in the United Kingdom in comparison to Europe.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, numbers of hospital beds per person do not provide meaningful comparisons of good-quality care. Our NHS is making efficient use of its beds by judging patient demand and managing bed numbers accordingly. In the NHS, as in Europe, the number of beds has reduced because progress in medical technology is enabling more patients to be treated and discharged on the same day, and average length of hospital stay has reduced over the past decade.
Lord Kennedy of Southwark (Lab)
My Lords, France has twice the number of beds we have here in the UK while Germany, I think, has nearly three times as many. We are now seeing dangerous levels of overcrowding, with greater risk of infection due to beds not being cleaned properly in time. Does the Minister not see that this is very reminiscent of the previous time his party was in office and that the NHS is just not safe in their hands?
Earl Howe
No, in a word. First of all, it is very important to compare like with like. A number of other health systems have completely different models from our own. For example, they still have large, long-stay hospitals for people with mental health problems and older people. The NHS has a strong primary care tradition and is committed to providing care in the community. Some of the statistics that have been collated by the OECD include systems in Europe where nursing home beds are included in the figures or indeed the private sector. We are seeing healthcare infections at their lowest ever levels. There have been dramatic falls in both MRSA and C. diff infections since 2010.
Lord Ribeiro (Con)
Would my noble friend like to ask the noble Lord, Lord Kennedy of Southwark, how funding is undertaken in Germany? German hospitals are funded on the basis of length of stay. In this country, we have demonstrated that we can get patients home much more quickly, particularly after surgery, with the use of day case surgery. Furthermore, Sweden has fewer beds than we do.
Lord Campbell-Savours (Lab)
My Lords, is there any linkage between hospital-acquired infections and the reduction in the number of beds?
Earl Howe
My Lords, no. By comparing the OECD bed-provision data and the 2011 joint prevalence survey, the available European data indicate that bed provision and healthcare-associated infection rates across countries are not correlated. Indeed, as I have said, we have seen a dramatic fall in the number of healthcare-associated infections in hospitals, combined with a rising level of demand for in-patient beds.
Baroness Brinton (LD)
My Lords, the noble Lord, Lord Kennedy, mentioned France. In France, most patients who have had a hip replacement spend a month in a convalescent hospital having in-house physiotherapy, whereas of course in the UK most people return home. I wonder whether my noble friend can tell us whether there are data to show how medical technology has improved both hospital care and community care, so that we can confirm the OECD report’s phrasing that the reduction in the number of hospital beds,
“has been driven … by progress in medical technology”.
Lord Turnberg (Lab)
My Lords, is the noble Earl aware that we have one of the highest rates of bed occupancy in the EU, approaching 90%, and yet we have the lowest average length of stay? All this makes it extremely difficult to think about reducing bed numbers still further.
Earl Howe
In fact, average annual bed occupancy rates have been stable at around 84% to 87% since 2000. Of course, that rate goes up and down. We know that winter sees greater pressure on bed occupancy, but the NHS has long experience in managing peaks in demand, particularly over the winter. We do not set optimum bed occupancy requirements on the NHS. As the noble Lord knows well, that is a matter for the local NHS to manage.
Lord Mawhinney (Con)
My Lords, does my noble friend recall that the previous Government did not run their NHS policy on the basis of the number of beds in the NHS, and rightly so? Will he continue robustly to reject the arguments of those who, using beds as a criterion, are so out of date with modern medicine delivery?
Earl Howe
My noble friend has encapsulated the point very well. One cannot correlate bed numbers as a stark statistic with the quality of care that a health system delivers. Our system is dependent not just on acute settings but on care in the community, and that is where the focus should rightly lie at the moment.
Lord Rooker (Lab)
Then can we look at outcomes rather than beds as far as the OECD figures are concerned? For the United Kingdom, I will take just three factors: infant mortality, cancer survival rates and obesity. We are beyond the 20 best performers in terms of outcomes—20 OECD countries do better than us. Why are we operating so poorly compared with these other countries?
Earl Howe
There are a number of issues there. The noble Lord is right to raise obesity, in particular, where only one solution is available to us, which is a public health policy which embraces all parts of the system and, indeed, individuals. The issues that he raises are too complex for me to encapsulate in a short answer but I will be happy to write to him about what we are doing in all three areas. He is of course absolutely right to raise them as very important issues for the health service.
Healthcare Professions: Regulation
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government what plans they have to modernise the regulatory framework for the healthcare professions.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, we asked the Law Commission to undertake a major review of professional regulatory legislation, which reported in April this year. The report is complex and needs thorough consideration, which we are currently undertaking. We are committed to legislating on this important issue when parliamentary time allows. In the mean time, we are already using secondary legislation to make urgent changes necessary to make sure that patients can continue to be confident they are receiving safe care.
Lord Hunt of Kings Heath (Lab)
My Lords, the noble Earl will recognise that the Law Commission work has been extremely valuable. The outcome is potential legislation to modernise all the regulatory bodies in the health service, which has the full support of all the regulatory bodies. The noble Earl cannot be serious in suggesting that a lack of time prevents Parliament considering that Bill. It was widely expected to be taken in this Session, and I am sure that we could come back a week or two earlier to help the noble Earl get this through. Is the real case not that the Government are so worried about their stewardship of the NHS that they dare not bring a Bill on healthcare in this Session?
Earl Howe
No, my Lords. We understand the frustration felt by the regulators that this has not been taken forward yet, but other government priorities have had to take precedence. That is the reality that we must accept. As I have said, we are committed to legislating on this important issue when time allows. With that in mind, we are currently working hard in consultation with key partners, including the professional regulators and patient and professional representatives, on our response to the Law Commission’s work. The complexity of that exercise cannot be overemphasised.
Lord Willis of Knaresborough (LD)
Would my noble friend agree that, after the very challenging Bills that went through the House in the first two Sessions, this Bill would have support right across the Chamber, across both Houses and across all the professions in terms of patient safety? Would my noble friend also agree that this would be a wonderful opportunity for us to tackle the appalling situation whereby 1.3 million healthcare support workers are not regulated and do not have standards, and no one can judge fitness to practise? A draft Bill would at least give us an opportunity to frame that legislation.
Earl Howe
My Lords, as my noble friend will know, we have debated the regulation of healthcare assistants on a number of occasions. The Government’s view is well known. However, I agree with him that the content of the Law Commission’s draft Bill is welcome to many parties—indeed, the Government are keen to see it progress. Much of the proposed legislation is already law in one form or another. The review is about pulling together all the different bits of legislation, introducing consistency across the professional regulators where practicable, making sure legislation is fit for purpose and, importantly, introducing flexibility for the regulators to respond to changing situations.
Lord Patel (CB)
Will the Minister confirm that the Department of Health intends to bring in an urgent amendment via a Section 60 order to allow the GMC to implement the urgent reforms that it needs to protect patients and bring doctors to account?
Earl Howe
Yes, my Lords, we are working with the GMC to develop secondary legislation that will strengthen and protect the separation of the GMC’s investigation and adjudication functions by establishing the Medical Practitioners Tribunal Service in statute, as well as modernising the adjudication procedures, and to address a number of lacunas in the legislative framework. We are seeking to have the Section 60 order on the GMC’s fitness-to-practise processes in place before the general election.
Baroness Pitkeathley
I declare an interest as chair of the Professional Standards Authority. The authority has already done preparatory work for the Department of Health on which changes to Section 60 orders would be in the interests of public protection and cost-effectiveness. Can the Minister say that the Government will take account of this work and the views of the regulators as they consider their next steps?
Lord Walton of Detchant
Yet again I shall declare an interest as a past president of the GMC from 1982 to 1989. To follow up a point made by my noble friend Lord Patel, I spoke recently to the current chair of the General Medical Council, Sir Peter Rubin. He and his colleagues are very concerned about the introduction of a number of important changes in the interests of improving medical treatment and medical education, and to protect patients, which will require amendment of the Medical Act. What are the prospects of seeing any such amendments introduced in this House and debated before the next election if the Bill introduced by the Law Commission is to be long delayed?
Earl Howe
My Lords, I have already said that we will introduce a Section 60 order amending the powers of the GMC, as it has requested and as we agree should happen. There is a range of changes that we hope to incorporate in that Section 60 order and I hope to have further news on that quite soon.
Lord Winston (Lab)
My Lords, I draw the Minister’s attention to the regulation provided by the Human Fertilisation and Embryology Authority, which is allowing entirely unvalidated experimental treatments, such as pre-implantation genetic screening, for patients who then have to pay to experiment on themselves. Many clinics are also advertising on the Underground and some have relationships to do work that is not allowed by British regulation in other clinics overseas. Is the noble Earl prepared to respond to that really burning issue and the exploitation of infertile women?
Baroness Masham of Ilton (CB)
My Lords, is the Minister aware that clinical physiologists desperately need full registration? They have had voluntary registration for some years and they say it does not work.
NHS: Clinical Commissioning Groups
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Baroness Wheeler
To ask Her Majesty’s Government how they will ensure Clinical Commissioning Groups’ strategies and implementation plans support carers and take account of their needs and aspirations.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, NHS England assures clinical commissioning groups’ plans to support and challenge them to meet the needs of their populations. This includes considering supporting carers, who are a hugely valuable asset for local communities. NHS England has published a commitment to a carers action plan. It will review the delivery of these commitments through feedback from carers and carers’ organisations and through progress towards the relevant outcomes indicators and mandate objectives.
Baroness Wheeler (Lab)
I thank the Minister for his response. At the start of national Carers Week, it is right for the whole House to pay tribute to our 1.5 million carers and the vital support that they provide in caring for their partners, friends or a family member. What is the Minister’s response to a recent Carers UK survey, which found that while GPs have implemented systems to identify those undertaking carers’ responsibilities, few are actually doing anything differently to accommodate them—for example, giving regular health checks or changing appointment systems to support getting somebody to the surgery who is in a wheelchair or caring for somebody with dementia? Does the Minister agree that the appointment of carers leads under CCG implementation plans is a key step in bringing about the major push that is needed to get GPs to up their game? How will the Government ensure that that happens?
Earl Howe
My Lords, I fully endorse the comments of the noble Baroness about the importance of carers. They play a crucial role as partners in care for the well-being of those they look after. I saw that report and of course it is important that GPs are aware of their role in supporting carers. We set out our vision for this in a document we published, Transforming Primary Care. That recognises the importance of involving and supporting carers. It sets out an expectation for GPs to identify carers as a matter of course. As I said in my original Answer, CCG plans will be assured by NHS England, including the important element of carers’ support and recognition.
Baroness Gardner of Parkes (Con)
My Lords, is the Minister aware that, at last, carers who work by going from one person to another will be paid for their travel time? I have drawn attention in this House before to the fact that people who were self-employed under such care systems were earning £2-something an hour. Does the Minister agree that that will be a great benefit to both the clients and, in particular, the carers who rely on that income?
Earl Howe
I do agree with my noble friend, but I would point out to her that the thrust of the noble Baroness’s Question is about unpaid carers, of whom there are 5.4 million in this country, 1.4 million of whom work more than 50 hours a week as unpaid carers. It is to support those people that the attention of NHS England is being rightly directed.
Baroness Pitkeathley (Lab)
I thank the Minister for pointing that out and saving me having to do so. We are talking about so-called informal, unpaid carers in this Question. My noble friend’s Question has underlined how much progress is still to be made in bringing the needs of carers to the attention of local CCGs and health professionals. Will future versions of the carers strategy action plan address that issue?
Earl Howe
My Lords, yes. The action plan will of course be reviewed, as it needs to be, at regular intervals. I am sure that the noble Baroness will know that the action plan needs to be informed by the various legislative changes that we have recently made through both the Care Act and the Children and Families Act, both of which immeasurably strengthen the rights of carers and what they can expect from the system.
Baroness Brinton (LD)
My Lords, given that the Francis report said that it was important that carers be involved and informed about the care of their family member but one study found that only one-third of those surveyed were told how to care for their relative or how to cope with dementia, what are the Government doing to make that a real priority for CCGs?
Earl Howe
My noble friend makes a crucial point. In the document Transforming Primary Care, we included a clear expectation for GPs to work with wider health and care professionals to involve people using services and their carers in identifying and planning for a person’s needs in the round. The plan sets out a clear expectation for GPs to identify as a matter of course whether a person is themselves a carer for another person, whether they have a carer or carers and to understand fully the contribution that carers make.
The Lord Bishop of Norwich
My Lords, the census revealed a substantial increase in young carers, some of whom may not even recognise the term but are simply doing what is expected in their family. Does the Minister agree that CCGs should consult and connect with schools to ensure that those noble but often vulnerable young adults get the support they deserve?
Earl Howe
I fully agree with the right reverend Prelate. The Government’s carers strategy sends out a strong message that education, health and young carer services should work together with families better to identify and support young carers to prevent them taking on harmful caring roles. Young carers’ education, development or employment opportunities should not be diminished because of their caring role, and the right reverend Prelate may like to note that one of the initiatives recently put in train has been to recruit school nurses who are reaching out to schools to ensure that young carers’ needs are recognised in schools.