Dialysis Care Outcomes

Gillian Keegan Excerpts

Thursday 19th May 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a great pleasure to serve under your chairmanship, Sir George. I would like to begin by thanking the hon. Member for Strangford (Jim Shannon) for securing a debate on this important issue and for his kind words.

I heard his impassioned case for improving outcomes for patients receiving kidney dialysis treatment. I also appreciate how kidney health is an issue of personal importance to the hon. Gentleman. It was very moving to hear the story of his nephew, Peter, who required a kidney transplant and happily got one when he was 16, after being born with posterior urethral valves. The hon. Member for East Lothian (Kenny MacAskill) mentioned how important it is in this place to share those stories. It really brings the debate to life. It shows why we are here, and why this matters.

We heard other moving stories from across the House. We heard about the stresses and strains that chronic kidney disease and dialysis treatment put on lives. We heard about Billy McIlroy and David Johnson from the hon. Member for Strangford, and about Dale and Tejal from the hon. Member for Enfield North (Feryal Clark). They spoke about the impact the treatment has on the lives of those around the patients. I would like to thank all Members for giving those patients a voice and making their stories real to us all.

I also recognise the fantastic work being done by charities, including Kidney Care UK, Kidney Research, the National Kidney Federation and the Polycystic Kidney Disease Charity, on behalf of people living with chronic kidney disease and their families. They are ensuring that issues such as those covered today are kept at the forefront of our thinking. That is why such debates are so important. I would particularly like to commend those charities for their recent work supporting World Kidney Day, which raised awareness of the issues faced by those with chronic kidney disease. I also commend Kidney Care UK’s campaign on the impact of the rise in energy costs on those who undergo dialysis at home. It is a very important matter.

I would like to reassure the hon. Member for Strangford that the Government remain absolutely committed to improving both access to and the quality of dialysis treatment that many kidney patients across the UK depend on, in particular to ensure that treatment at home is available to those for whom it is suitable, which we heard about today. The Government are working closely with NHS England to implement the renal services transformation programme, which was commissioned in September 2021, following specific recommendations published in Getting It Right First Time’s national report on renal medicine mentioned by the hon. Member for Strangford.

The aims are to reduce unwarranted variation in both the quality and accessibility of renal care, which the hon. Gentleman mentioned. One of the key priorities of the transformation programme is to increase the provision of home dialysis, with the aim of increasing the percentage of patients per renal centre receiving home therapies to 20% in each renal centre. That target of 20%, which was mentioned, is still in place, but several centres have actually exceeded that target and gone beyond 30%.

However, the Government acknowledge that there is a concentrated drive within the renal community for increasing access to at-home dialysis treatment, and for good reason. We heard some of those reasons. Home dialysis has the potential to deliver significant benefits for patient experience and outcomes, giving patients both flexibility and autonomy in their treatment. By investing in home dialysis so that patients do not need to make long and disruptive trips to hospital for regular treatment, local systems will be able to deliver better experiences and outcomes for patients and reduce spending on the transportation of patients to hospital dialysis centres. That makes sense, and we will of course ensure that those services are available to all people from all backgrounds. It is very important that they are equally available across the country.

A range of guidance, produced by the National Institute for Health and Care Excellence, is available for commissioners and clinicians to support patients’ access to home dialysis treatments when appropriate for the individual. Patients and their family members or carers should be involved in the decision-making process, alongside healthcare teams, when considering treatment options, and should be offered regular opportunities to review their treatment and discuss any concerns or changes in preferences. That includes a choice of at-home or in-centre dialysis modalities to ensure that the decision is informed by both clinical considerations and patient preferences.

In support of that, NHS England has set up 11 renal clinical networks, which are working closely with integrated care systems to determine local priorities. Providers of renal services, ICSs and regional commissioners will continue to monitor uptake of home dialysis via the UK renal registry and NHS England renal datasets. The transformation programme has also appointed a national clinical adviser specifically for dialysis, to develop and share best practice. The programme will provide recommendations to all renal services to support achieving the 20% prevalence rate.

The Government know that the impact of rising energy costs is a concern for many. I share the concern, raised in today’s debate and by patient charities, that those undergoing dialysis treatment at home may be particularly vulnerable to the impact of rising costs due to the high energy consumption of the dialysis machines that they rely on for their treatment.

I am pleased to be able to provide reassurance, as the Prime Minister did in PMQs yesterday, that provisions are already in place for patients receiving haemodialysis treatment at home to be reimbursed for additional direct energy costs as a result of their treatment. The arrangements are outlined in the “Haemodialysis to treat established renal failure performed in a patient’s home” service specification, and the NHS meets those additional direct utility costs through the payment of the national tariff to the patient’s usual dialysis provider.

There is no national policy on determining the amount to be reimbursed to patients, with costs to be agreed between the provider and the individual based on the amount of energy used and charged. However, the amount reimbursed is expected to match increases in the patient’s utility tariff. We fully expect providers of at-home dialysis services to inform patients about that financial support available to them, and I have asked my officials to keep me informed about rates of reimbursement over the coming months, to ensure that the policy is working well. I would also be delighted to meet with the APPG, where we can discuss this further and ensure that that progress is being made.

NHS England is working closely with renal networks to support consistency of approach regarding the reimbursement arrangements. That work has already commenced, with NHS England providing clinical networks with examples of formulas to calculate electrical outputs from dialysis machines to support that reimbursement for patients. Examples of good practice in supporting utility costs from dialysis centres have also been shared across renal networks during April 2022, so very recently.

NHS England has also agreed to communicate directly to all commissioned providers of home dialysis, and renal clinical networks, to remind them of the reimbursement arrangements within the adult service specification and that they should proactively alert eligible patients to the arrangements.

The hon. Member for Strangford also mentioned support for children on home haemodialysis.

[Feryal Clark]

I thank the Minister for giving way. The issue with a lot of the reimbursements is that renal patients are having to wait months—three or four months, in some cases—for that reimbursement. They are being treated as if they are a company that has put in a claim to the trust. Will the Minister ask NHS England to look into that and see if it can reduce that wait, or have a set time, so that people are not having to wait three or four months to be reimbursed? In this cost of living crisis, they need the cash back in their pockets quickly.

[Gillian Keegan]

The hon. Lady makes an important point. Hopefully the best shared practice includes that reimbursement should be paid very quickly. Clearly, the billing systems that are in place across the various providers will differ. It is important to state that best practice when it comes to reimbursement is to do it as quickly as possible.

We were talking about home hemodialysis support for children. That applies to about 20 children, as of February 2022, and it is currently at the discretion of individual providers. However, the renal service clinical reference group has begun an urgent review of the reimbursement process for children. Hopefully that will give some comfort to the hon. Member for Strangford.

If people with chronic kidney disease and their families need further information, there are a range of resources available on the excellent Kidney Care UK and National Kidney Federation websites, including information on treatment options, financial support and other support services to help people live well. NHS England will continue its work with those charities and others to engage their support in promoting awareness of reimbursement options available for those on home hemodialysis. In terms of wider ambitions, the renal services transformation programme is developing optimal pathways, tools and resources that will transform the delivery of renal services across England. That will support better healthcare outcomes for patients undergoing dialysis treatment, and provide integrated care systems with a whole-patient pathway approach to commissioning renal services.

The hon. Members for Rutherglen and Hamilton West and for Enfield North both mentioned the importance of providing suitable mental health support for dialysis patients. The Government acknowledge that this is very important. There can be a detrimental impact on an individual’s mental health when undergoing complex dialysis treatment. To address that, the national adult renal services transformation programme has identified psychosocial support in renal services as a key theme for improvement. Work is being taken forward with clinicians, patient representatives and other subject matter experts to identify best practices that can support patients’ psychosocial needs, as well as the steps that are needed to spread those best practices. Those suffering with renal issues can also access mental health support via self-referral to Improving Access to Psychological Therapies, which the Government have invested £110 million in to expand access.

As the hon. Member for Strangford is aware, health policy is a devolved matter, and I understand that there are different arrangements for Northern Ireland, although commissioners and trusts remain equally committed to excellent care and better outcomes. The transformation programme has established a multi-agency programme board with representation from key stakeholders, including regional commissioners, patient charities and relevant national bodies, to ensure that a full range of views are considered. It has also established five expert-led multi-disciplinary clinical workstreams, including work- streams on improving access, identifying best practice and developing solutions in chronic kidney disease. All transformation programme workstreams intend to make key deliverables available by April 2023. That will include documentation outlining best practice, a data dashboard outlining key metrics to support better decision making, and support for the review of the renal service specification led by NHS England’s renal clinical reference group.

I was asked earlier what the Government are doing to fund research into kidney conditions and their treatment. We are committed to supporting research and funding it through the National Institute for Health and Care Research. For the financial years 2016-17 to 2020-21, the NIHR spent £113.2 million on kidney research. That research includes kidney disease, but also explored why people with kidney disease are at an increased risk of death and disability following a heart attack, the relationship between covid-19 and kidney disease and whether aspirin reduces the risk of major vascular events in patients. There is a full research programme ongoing.

Once again, I extend my continued gratitude to all charities working to support improved outcomes for people with chronic kidney disease. We are very happy to continue to work with them; we all have the same objective.

Finally, I thank the hon. Member for Strangford for securing the debate and giving me the opportunity to promote the vital schemes that are available to support patients with chronic kidney disease, to make sure people know what is coming next and are aware of the financial support available to them, and to outline the strong programme of work we are undertaking across the country to transform these services. I urge all patients receiving dialysis at home to speak to their provider so that they receive the full NHS support they are entitled to through their care.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 19th April 2022 Commons Chamber

[Ms Anum Qaisar (Airdrie and Shotts) (SNP)]

10. What recent discussions he has had with Cabinet colleagues on the adequacy of mental health support for veterans and military charities.

[The Minister for Care and Mental Health (Gillian Keegan)]

NHS England has several bespoke services for veterans, including Op Courage, the veterans’ mental health and wellbeing service, which provides a complete mental health care pathway for veterans. Veterans can benefit from personalised care plans, ensuring that they can access support and treatment both in and out of hours. As part of the care and support available to veterans, Op Courage works with military charities and local organisations to provide healthcare and address wider health and wellbeing needs, including for drug and alcohol addiction.

[Ms Qaisar]

My constituency of Airdrie and Shotts has a long military history, with many people having previously served in the armed forces. When I meet veterans from my constituency, we often discuss the mental health of veterans. The war in Ukraine will undoubtedly have an immediate and lasting impact on the mental health of veterans, as they may be reminded of their experiences of war. To help support our veterans, will the Department come forward with a package of emergency funding for armed forces mental health charities?

[Gillian Keegan]

The hon. Lady raises a very good question. Last year, we committed an additional £2.7 million to further expand Op Courage following the recent events in Afghanistan, and NHS England has put in place several bespoke services and initiatives to meet the needs of our armed forces community. In addition to Op Courage, there is the veterans trauma network, the veterans prosthetic panel and the veteran-friendly GP accreditation scheme, but given ongoing events in Ukraine, we will of course keep everything under review. I am very happy to meet the hon. Lady to discuss further what may be required.

[Mr Speaker]

We now come to the shadow Minister, Dr Rosena Allin-Khan.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Our veterans have risked their lives for our country and deserve excellent mental health support. We must go even further: from the military frontline to frontline workers who have kept us safe, everyone deserves proper mental health provision. People have stepped up to protect our country and save lives during the pandemic, so is it any wonder that teachers and NHS staff are so furious with the comments made by the hon. Member for Lichfield (Michael Fabricant), about how they would go back to the staffroom and have a “quiet drink”, in an attempt to justify the indefensible actions of the Prime Minister? What does this say about the effect of mental health on our frontline staff? Will the Minister please condemn those comments and apologise for the hurt caused by those remarks?

[Gillian Keegan]

I am very happy to say that we of course thank very much all the staff who have been on the frontline, whether veterans or teachers, and involved in everything that kept us going throughout the pandemic. We are of course very much aware of the impact of those stresses and strains on mental health. There is additional support for mental health, and there will continue to be additional support for young people’s mental health and for adult mental health. That is one reason why I launched a call for evidence last week to inform a new 10-year cross-departmental mental health vision, and I urge everybody to input into that process before it closes on 5 July.

[Kirsty Blackman (Aberdeen North) (SNP)]

11. What recent progress his Department has made on NHS (a) short-term and (b) long-term workforce planning.

--- Later in debate ---

[Bell Ribeiro-Addy (Streatham) (Lab)]

T5. Since February 2020 my local borough of Lambeth has seen a 14% drop in dementia diagnosis. That means people are not getting the support that comes from diagnosis. We also know that so far none of the announced £8 billion backlog funding has been dedicated to addressing the stagnation of diagnosis rates. Can the Secretary of State explain what exactly he is going to do to make sure that people get diagnosed on time?

[The Minister for Care and Mental Health (Gillian Keegan)]

The hon. Lady raises a very important question. We want a society in which every person with dementia and their families and carers receive high-quality, compassionate care from diagnosis through to end of life. We have provided £17 million this financial year to NHS England and NHS Improvement to increase the number of diagnoses. That funding was spent in a range of ways, including investing in the workforce to increase capacity in memory assessment services.

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[Helen Hayes (Dulwich and West Norwood) (Lab)]

T10. A survey by the charity stem4 has found that 95% of GPs believe that children and adolescent mental health services are in crisis, with children and young people waiting up to two years for treatment after referral. Will the Secretary of State stop treating children as an afterthought and act to provide open access mental health hubs for young people in every community, to put an end to these agonising waits?

[Gillian Keegan]

The hon. Lady raises a very important point. I know that children’s mental health services are treating more young people than ever. However, the demand has quadrupled since the pandemic and that is why we have invested £79 million in these services. By 2023-24, an extra 345,000 more young people will be accessing support. I mentioned the call for evidence. It is important that we work through our vision for our 10-year plan. We are also introducing mental health support teams in schools, which will help, plus access to community and mental health hubs, and more young people will have access to eating disorder services, but there is a lot of work ongoing.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I know from discussions with constituents that needle phobias are a real thing. Will my right hon. Friend therefore tell the House what support the Government are giving to intranasal vaccine delivery systems to ensure that the maximum number of people take up the vaccine?

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Those providing social care often work long hours and are a real lifeline for the most vulnerable. Will the Minister act to ensure that those in social care are paid properly with a real living wage, as Citizens UK is campaigning for?

[Gillian Keegan]

Actually, according to Skills for Care data from 2020-21, the majority of care workers were paid above the national living wage in that year. Most care workers are employed by private sector providers who set their terms and conditions. However, we have committed £1.36 billion to the market sustainability and fair cost fund, which will support local authorities to move towards paying providers a fair cost of care. We hope that will lead to better sustainability and better staff.

[Simon Jupp (East Devon) (Con)]

At Prime Minister’s questions, I raised a local campaign for a specialist menopause clinic in Devon. I am pleased the Minister agreed to meet me. Will my hon. Friend encourage local NHS leaders to fund specialist menopause centres?

--- Later in debate ---

[Gillian Keegan]

I thank the hon. Lady for her question and of course we have a great deal of gratitude for every unpaid carer. Around 360,000 carer households on universal credit can receive an additional £2,000 a year through the carer element. The weekly rate of carer’s allowance increased to £69.70 in April 2022. Also, real-terms expenditure on carer’s allowance is forecast to increase by around £1.3 billion. In addition, there is a big focus, in our reforms and in the White Paper, on what more we need to do to support unpaid carers.

Covid-19: Impact on Social Work

Gillian Keegan Excerpts

Wednesday 23rd March 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Lancaster and Fleetwood (Cat Smith) for securing the debate so close to World Social Work Day, and for using her excellent speech to highlight the excellent and varied work that social workers do day in, day out. I had the pleasure of attending the world social worker of the year award ceremony, which was held here in Parliament on World Social Work Day. I know that many Members from both sides of the House enjoyed going along, meeting their local nominees and celebrating the fantastic work of social workers, as well as congratulating the winners of the awards.

Social work is a highly valued vocational profession and we thank all social workers for their important work to support those who are hardest hit, especially during the pandemic when we really relied on their support. Social workers provide a critical model of practice for the health and social care sector. They undertake relationship-based engagement with individuals, their families and communities, and combine emotional support with practical help at a time of great need. Their strengths-based personalised approach in understanding what matters enables them to shape people’s care and support so that they can have the best possible lives. I pay tribute to them all, including the hon. Lady’s father, who obviously contributed to changing many lives during his career.

Importantly, social workers work across agencies and connect people to the resources and the services that they need. They span the boundaries of our health and care workforce, ensuring that people’s human rights are protected and that the individual’s choice and control of their care and support is respected at all times. The pandemic has taught us that co-operation and collaboration across the health and care sectors are absolutely critical, and social workers are central to embedding that way of working. They co-ordinate health and care planning and make vital links to ensure that people with care and support needs do not slip through the gaps in provision.

We have never needed the expertise and insights of social workers more than we do now. As we emerge from the pandemic—into fresh anxieties and tragedies born from the war of Ukraine, the cost of living crisis and other things that we will have to deal with—we will turn to the social work profession for advice, guidance, leadership and support. Covid-19 had a significant impact on health and social care services, including social work, and the response of our workforce was one of dedication and commitment to the people whom they support. Those were unprecedented and challenging circumstances and we stand by the entire workforce and thank them for their vital work to make a difference to people’s lives.

Our focus has always been on ensuring that the adult social care sector has the resources that it needs to respond to covid-19. Throughout the pandemic, we have made available more than £2.9 billion in specific covid support funding for adult social care, including £1.81 billion for infection prevention and control, £523 million for testing, and £583 million for workforce capacity—recruitment and retention—as we know that there are shortages across the sector.

The infection control and testing fund and the workforce recruitment and retention fund supported the care sector to prevent the transmission of covid and to support local authorities in working with providers to boost staffing and support existing care workers until 31 March of this year. Some of that funding helped to enable local authorities to provide continuous support to those in need of social care, including by delivering social work appointments virtually, as well as in person where it was appropriate and safe to do so.

Social workers went above and beyond during the pandemic and they deserve huge thanks for their tireless work. That is why continuing to help social workers manage their mental health and wellbeing remains a priority for the Government. We are determined that everyone working in social care should feel they have someone to talk to or somewhere to turn when they find things difficult. As many hon. Members have said, they deal with the most complex and difficult cases. We are committed to supporting social workers to recover from their extraordinary role in helping our country through the pandemic. We will deliver a listening service to help relieve immediate pressures, as well as talking therapies and coaching sessions for those with more intensive needs.

The chief social worker for adults, Lyn Romeo, has implemented a range of measures during the pandemic, including partnering with Tavistock and Portman NHS Foundation Trust to issue guidance to support the wellbeing of adult social workers and social care professionals. She meets regularly with the principal social workers in each local authority and NHS trust, advising and supporting them on practice and workforce support for their staff during the pandemic.

We have invested in increasing the number of social workers completing their approved mental health professional qualification for local authorities to increase their capacity in responding to the needs of people with mental ill health. An additional 228 social workers will be supported to complete their training. Social workers have been supported to improve their knowledge and skills in working with people with learning disabilities and autism.

My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) mentioned the vital work that social workers do to support people with learning disabilities. The chief social worker for adults commissioned the British Association of Social Workers to develop a capability statement for social workers working with adults with a learning disability in 2019. That supports best practice in this important area, especially considering the impact of the pandemic on those with learning disabilities and/or autism.

As well as our focus on wellbeing, we know the importance of building and strengthening our social care workforce. A number of hon. Members mentioned that it is vital to strengthen the social care workforce so that we can meet demand now and in the future. It is encouraging to note that the number of child and family social workers in the workforce is increasing every year, up from 28,500 in 2017 to 32,500 in 2021. That is 2% more than in 2020 and 14% more than in 2017.

The hon. Member for Strangford (Jim Shannon) rightly focused on recruitment and strengthening the workforce. The Government invest over £130 million a year on recruiting, training and developing social workers to ensure the social care workforce has the values, capacity, skills and knowledge to perform its roles. This includes investments in bursaries for undergraduate and postgraduate social work degrees. A new and very popular addition, which I am very proud of, because I worked on it in my last role, is degree apprenticeships.

We have education support grants to support practice placements in organisations delivering social work services. That is vital to build that experience that was mentioned by the hon. Member for Strangford and the hon. Member for Glasgow East (David Linden). We also have a range of postgraduate fast-track training programmes for those wanting to work in children and family social work or mental health social work. Our attention is not just on training our social workers of the future; we also invest a significant amount in leadership and development programmes for qualified social workers. That includes leadership programmes for social workers and the assessed and supported year in employment for newly qualified social workers. That provides high-quality support for every newly qualified social worker by sharing best practice and quality-assuring provision.

We have announced record investment in developing the social care workforce. In our recent White Paper, “People at the Heart of Care”, we set out our workforce development strategy and plans for the investment of £500 million over the next three years. I am sure we will be discussing that many times as we develop those plans. The investment will help us to realise our vision for a workforce of people experiencing rewarding careers with opportunities to develop and progress in the future. That includes a focus on how we can develop new training routes for people who want to become social workers.

We will also work with the adult social care sector, including providers and the workforce, to co-develop a universal knowledge and skills framework and careers structure. As well as supporting the development of our care workforce, we will help those wanting to progress into regulated professions such as social work. I am also delighted that the number of people taking part in the new social worker degree apprenticeship programme continues to increase, with 660 starts in 2019-20 alone. That is only the second year for which it has been available, so that is phenomenal growth.

Looking forward, we have commissioned Health Education England to work with partners to develop a robust long-term strategic framework for workforce planning. For the first time ever, the framework will include regulated professions working in social care, such as nurses, social workers and occupational therapists. That work will look at the key drivers of workforce supply and demand as well as careers, as has been mentioned, and will inform the direction of the health and care system over the next 15 years.

The framework will help identify the main strategic choices facing us, develop a shared and explicit set of planning assumptions and identify the actions required at all levels of using all our system levers. That will ensure that we can plan for a workforce that is skilled, confident and equipped with the right support to deliver the highest quality health and social care in the future. It will also form the basis of our next phase of work to develop a long-term workforce strategy, led by NHS England and NHS Improvement in partnership with Health Education England and the Department of Health and Social Care.

[David Simmonds]

I very much welcome what the Minister is sharing with us today. Does she agree that it would be worth considering how to develop the finance function of health and social care? The recent Competition and Markets Authority report highlighted that a lot of the provision the private sector has brought into the care market, both in children’s homes and adult social care, is, frankly, quite an astonishing rip-off for the taxpayer. Profit margins of 30% and more are not unusual and these are complex structures that are extracting resources that could be spent on care. Does she agree that there is an opportunity both strategically and in developing the skills of social workers and others involved in those decisions locally to bring more focus to the issue so that we can ensure we procure the best possible care with an eye to value for money for the taxpayer?

[Gillian Keegan]

My hon. Friend raises an important point that we will address as part of the White Paper, “People at the Heart of Care”. It is important that we equip local authorities with the skills and tools they need to commission well in the market and to get the balance right between paying a fair cost for care while making sure that they get value for money for taxpayers.

[Cat Smith]

I welcome quite a lot of what the Minister is saying, and I hope that I am not straying beyond her brief. The complex issue with social work, of course, is that it crosses many Government Departments. While she is talking about the recruitment and retention of social workers, I would like to invite her to put on record her thoughts about why, particularly in child protection, a social worker tends to burn out a lot faster. People tend to go into child protection and then progress to different parts of social work. Would she share her thoughts on why child protection in particular seems to lead to such quick burnout for social workers?

[Gillian Keegan]

The hon. Lady makes an excellent point. Anyone who has met social workers doing that vital job, particularly in child protection, has nothing but admiration for the job they do. It is an incredibly difficult job with incredibly difficult choices that are highly complex and have a massive impact on families and individuals. It is a highly stressful job, but we need to do more to support people in the workplace so that they can deal with their mental health, talk to people and share their experiences. There is no doubt that it is an incredibly difficult job and one that is done very well, but every day they face enormous challenges and big decisions.

Finally, last November we announced a review of leadership in health and social care, led by Sir Gordon Messenger. The review will report in early 2022 and is considering how to foster and replicate the best examples of leadership. Strong leadership in health and social care will help to ensure the best outcomes for our key priorities, including, most importantly, improved care for patients and service users. The review aims to ensure that the necessary leadership behaviours, strategies and qualities are developed to maximise these efforts. We all know that leadership is vital in these key professions.

The hon. Member for Lancaster and Fleetwood mentioned the work of the British Association of Social Workers and the “Homes not Hospitals” campaign to help more people to get the support that they need in their community, so that they can leave hospital. I completely agree with the desire to get more people out of hospital and getting the right care in the community. Indeed, we have an action plan, “Building the right support”, which we will be publishing in the not-too-distant future. I will be delighted to meet with representatives of the British Association of Social Workers to discuss this further.

Once again, I thank all hon. Members who have provided valuable contributions and insights today. It is important for the sector that we have this debate. We know, in our role as Members of Parliament, the work that we can do to highlight the fabulous work that people are doing. That does not always get highlighted, so this is a fantastic opportunity to highlight the complexity of the social work role and the variety of the role—the many different areas in which social workers provide vital support and the link to ensure that people get the right services from a load of different public services and get the wraparound care necessary for them.

The measures that I have set out today show that the Government are fully committed to supporting and developing the social work workforce—it is vital, and recognised as vital—as well as the wider health and social care sector. I thank everybody for their contributions and I look forward to continuing to work to celebrate this fantastic profession.

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[Cat Smith]

Thank you, Mr Robertson. I had actually forgotten that I would get to wind up, but I will take the opportunity to thank all hon. Members for taking part in this important debate. I know that it will be reported on in various publications and read by social workers across the four nations of the United Kingdom, and I think that the contributions by the Members present will be appreciated. It is fair to say that social workers often feel invisible or unrecognised and that the only time they get the spotlight is when, sadly, things have gone horribly and tragically wrong. However, this has been an opportunity, so close to World Social Work Day, to highlight the good work that social workers do.

I thank the Minister for agreeing to meet with the “Homes not Hospitals” team at BASW. If she would not mind, I would be delighted if I could join her at that meeting.

[Gillian Keegan]

indicated assent.

[Cat Smith]

There has been such a lot of agreement and consensus in this debate, and it has been an absolute pleasure to hear so many positive things said about social workers right across the United Kingdom.

Question put and agreed to.

Resolved,

That this House has considered the impact of the covid-19 outbreak on social work.

Liberty Protection Safeguards and Mental Capacity Act Code of Practice

Gillian Keegan Excerpts

Thursday 17th March 2022 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

This is a joint statement with the Parliamentary Under-Secretary of State for of Justice.

Today, the Department of Health and Social Care, and the Ministry of Justice have launched a joint public consultation on an updated statutory code of practice for the Mental Capacity Act and on proposals for the implementation of liberty protection safeguards. The Mental Capacity Act 2005 provides an empowering legal framework for people who cannot make certain, specific decisions about their own lives. This includes some people with dementia, learning disabilities and autism.

The liberty protection safeguards were introduced in the Mental Capacity (Amendment) Act 2019. They will protect people aged 16 and above who are, or who need to be, deprived of their liberty to enable their care or treatment and who lack the mental capacity to consent to these arrangements. When a person needs to be deprived of their liberty, this must be done with the greatest of care and respect for that person and their rights. It is the Government’s intention that the liberty protection safeguards will replace the deprivation of liberty safeguards and will provide specific protections when people are deprived of liberty in any setting, in England and Wales.

In 2019, MoJ also announced a review of the Mental Capacity Act code to reflect changes in law and practice since its publication in 2007. We undertook a call for evidence to help us decide which aspects of the code needed updating or improving. Acting on feedback from stakeholders, we have decided to merge the Mental Capacity Act code with guidance on the liberty protection safeguards. Liberty protection safeguards implementation and practice will therefore be fully informed by the important principles of the Mental Capacity Act.

The elements of the new code that do not directly concern the liberty protection safeguards do not contain new policy or legislation, but rather reflect recent changes in related legislation, organisational structures, good practice and terminology. Following the call for evidence, officials at the Department of Health and Social Care and the Ministry of Justice have worked in partnership with experts to co-produce the new code. This has involved substantively revising and adding new illustrative scenarios to make the code more accessible. It is important that the new code is informed by, and useful for, people who work with the Act and those who are affected by it.

Alongside the new code, we are also publishing additional draft documents, which set out, in detail, how we think the liberty protection safeguards should be implemented and operate. This includes six sets of regulations, information about workforce training, a proposed data specification for national reporting, and an updated impact assessment. We welcome views from everyone with an interest in the liberty protection safeguards on the plans set out in these documents.

Once we have carefully considered feedback to the consultation, we will publish the Government response and the final drafts of the code and liberty protection safeguards regulations. The code and regulations will then be laid in Parliament. People who work with the Act and those who are affected by it will need sufficient time following the publication of those final documents, to prepare for the implementation of liberty protection safeguards.

We had hoped to be able to fully implement the liberty protection safeguards by April 2022. Given the impact of the pandemic on the sectors and professionals who will be called upon to implement these important reforms, we have had to reconsider this aim.

We have committed to an inclusive public consultation lasting 16 weeks from 17 March to 7 July. We expect that responses will be very detailed and will take time to work through to get the liberty protection safeguards right. We are going to set a new fixed date for liberty protection safeguards implementation post consultation to ensure that there is adequate time for implementation.

We look forward to the consultation ahead and will update Parliament when we publish our consultation response.

[HCWS694]

Hymenoplasty

Gillian Keegan Excerpts

Wednesday 16th March 2022 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

On 23 December 2021, as part of the “Vision for the Women’s Health Strategy in England” publication, the Government announced its intention to ban the hymenoplasty procedure in the United Kingdom at the earliest opportunity:

Our Vision for the Women’s Health Strategy for England - GOV.UK (www.gov.uk)

We are already working to ban virginity testing and introduced a Government amendment to the Health and Care Bill in November to do so. Banning hymenoplasty is another important milestone in the Government’s ongoing mission to tackle violence against women and girls.

Hymenoplasty, a procedure which involves reconstructing the hymen, is a tool of honour-based abuse and, like virginity testing, is used to oppress vulnerable women and girls.

The Government’s decision to ban hymenoplasty followed the recommendations of an independent expert panel (the panel), that was established to look at the clinical and ethical implications of banning the procedure. The panel was made up of clinicians, ethicists, and subject matter experts and I would like to place on record my thanks to all members of the panel for their input in this process.

The panel made a suite of recommendations in their final report: Expert panel on hymenoplasty - GOV.UK (www.gov.uk), which we are accepting in full. This includes introducing legislation to create a criminal offence of hymenoplasty alongside the prohibition of virginity testing; ensuring there are no medical exemptions including for victims of rape; issuing guidance to support healthcare professionals to carry out risk assessments when hymenoplasty is requested; and providing adequate resources for community engagement.

Our work to ban the harmful practice of virginity testing and our commitment to banning the hymenoplasty procedure demonstrate that the safety of women and girls is at the forefront of this Government’s agenda.

By banning both procedures this Government will ensure the United Kingdom is a safer place for women and girls.

[HCWS690]

Physical Activity and Health Outcomes

Gillian Keegan Excerpts

Tuesday 15th March 2022 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on bringing forward today’s debate on this important topic. In his excellent speech, he has outlined the many benefits of physical activity, and I am grateful for his challenge on what more the Government need to do to address the critical health issues of inactivity, poor diet and obesity. I would like to put on record my thanks to all those who work in our local authorities, in the NHS, in our schools, in voluntary and community organisations and in the fitness and leisure sector for their efforts in supporting people of all ages and abilities to stay active, particularly during the pandemic, which as we know, was very challenging.

As my hon. Friend so eloquently outlined, physical activity can contribute to reducing the risk of many chronic health diseases, including some cancers, heart disease and type 2 diabetes. Being physically active can also help to improve our mental health and wellbeing and help to keep people, friends and communities connected. Before the pandemic there were disparities in physical activity levels, but we were seeing some improvements. Those gains have diminished. The people most impacted by the pandemic were those we most need to support, including older adults, those in more deprived areas, those with a disability, those with long-term health conditions, those who were asked to shield and those from black, Asian and minority ethnic groups. We need to do more to achieve a level playing field and to create local places where everybody, no matter their age or circumstances, can find safe, accessible ways to be active every day and to stay fit and strong. Indeed, active travel is an important part of that.

I will shortly reflect on some of what the Government are doing to help, but first I stress that scientific evidence underpins what we and the NHS are doing to support and promote a more active nation, and advice from the UK chief medical officers is at the heart of our physical activity policies. The guidelines published in 2019 set out the types and levels of activity that are most likely to provide physical and mental health benefits for children, young people, adults, older adults, disabled adults, disabled children, disabled young people, and women during pregnancy and after birth.

As my hon. Friend knows, the Government are supporting primary schools with £320 million a year through the physical education and sport premium. We have also funded the school games network. This enables schools, through the school sport and activity action plan, to deliver a whole-school approach to physical activity, and many of us have seen the successful daily mile programme in our schools on our Friday constituency visits.

The plan, first published in 2019, is a joined-up approach by the Department for Education, the Department of Health and Social Care and the Department for Digital, Culture, Media and Sport, and it has provided the blueprint for cross-Government working on physical activity. This plan has enabled a range of non-competitive opportunities to engage the least active groups. To tackle gender disparities, the plan has enabled nearly 9,000 girls to take part in competitive sport.

Our work to promote physical activity does not stop at the school gates. Through the world-beating “Better Health” social-marketing campaign, we will continue to provide digital resources, such as the popular Couch to 5k and Active 10 applications, and to signpost people to local opportunities to get active. Our commitment to exploring new ways to help people get active is demonstrated through the health incentives pilot, which will take place in Wolverhampton with the support of the local authority, the NHS and the local community.

Birmingham will host the Commonwealth games in summer 2022. Such sporting events provide moments of inspiration, and the Government, Birmingham City Council and others are investing in providing local communities with opportunities to participate in sporting activities.

My hon. Friend rightly mentioned the contribution that an active, fitter nation could make to helping to protect the NHS and social care. The Department, through the work of the Office for Health Improvement and Disparities and in partnership with Sport England, has been working across the NHS to deliver the moving healthcare professionals programme. This work enables healthcare professionals to increase their awareness, knowledge and skills in promoting physical activity to patients, managing ill health and reducing inactivity.

The Government’s health promotion taskforce is bringing Departments together to develop actions that will deliver on our ambition to get the nation more active and provide equitable opportunities to those who will benefit most. The Government are absolutely committed to ensuring that everybody can lead more active lives, and my hon. Friend mentioned the work of my colleagues in the Department for Transport and their vision for active travel. There is unequivocal evidence that physical activity has a role to play in enabling people to live healthier, longer lives. As the Minister responsible for dementia and the dementia strategy, I know how critical physical activity is to diseases that people might not imagine have a link to it. It really is the answer to almost any health question.

As I mentioned, we remain committed to introducing actions that will help current and future generations to access, participate in and enjoy all forms of activity, play and sport and, as my hon. Friend said, to integrate them into their daily life. We understand there is still a lot of work to do to create equal access for everybody and to address disparities. We will need the help of every single local authority, school and community and a truly collaborative cross-Government and NHS approach. I genuinely believe that, by working together, we can make a huge difference to the health of our nation.

Once again, I thank my hon. Friend for securing this debate on such a vital issue.

Question put and agreed to.

Covid-19: Deteriorating Long-Term Health Conditions

Gillian Keegan Excerpts

Thursday 10th March 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a real pleasure to serve under your chairmanship, Mrs Cummins, and to follow the hon. Member for Denton and Reddish (Andrew Gwynne), who showed no symptoms of brain fog in his eloquent speech. He has my personal assurance that we will definitely focus on both research into long covid and its treatment.

I thank my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) for raising this very important issue, and for his proud advocacy for patients with many different long-term conditions who rely on NHS services, particularly those who have had a stroke. I extend my best wishes to my hon. Friend’s wife, Ann-Louise, who I am sure informed much of his powerful speech. Many of the experiences we have heard about will resonate with many of us. My father had a stroke a couple of years ago, and rehabilitation has been vital to his recovery, which is a long road that he is still on.

I was deeply moved to hear of the difficulties that the pandemic has caused people with deteriorating long-term conditions, many of which have been outlined. I want to reassure all hon. Members that we remain committed to making sure that everyone has access to the care and support that they need and deserve. We know we have to catch up after the impact of the pandemic.

My hon. Friend the Member for Bromley and Chislehurst mentioned spinal cord injury. I attended the all-party parliamentary group on spinal cord injury yesterday to hear about the concerns and the impact that the pandemic has had on people with the condition, and what more we need to do to respond to it.

We know that covid has had a significant impact on the health and care system, including on rehabilitation services. It has had a real and profound impact on people with rehabilitation needs and their treatment. I am very sorry for any undue suffering that that has caused. We remain committed to making sure that everyone has access to the care and support that they need and deserve. Throughout the pandemic, we have worked to maintain access to health services in what has been an extremely challenging environment, but we recognise that getting that support at the right time is vital for people’s health. That is why we protected priority services across England during the pandemic, which included rehabilitation and post-acute services, for people who had survived a stroke, and their families and carers.

Continued service delivery was in part supported by innovative methods of care—we have talked about a few of them—throughout the pandemic. NHS England and Improvement supported people with long-term conditions by providing safe and person-centred assessments and diagnosis via remote methods, or in face-to-face consultations when appropriate. Providers innovated and rolled out remote consultations using video, telephone, email and text message services, and health services implemented new models of care with effective triage processes to make sure that patients received the care appropriate to them and in outpatient settings closer to home.

Clinical teams used and will continue to use virtual rehabilitation services alongside face-to-face contact to ensure that every patient gets the treatment and support that they need. Almost half of stroke survivors have received virtual care since the pandemic began, transforming their experience of the health system. Over 80% reported positive or very positive experiences, as my hon. Friend the Member for Bromley and Chislehurst outlined, but we know that remote consultations are not suitable for everyone or for every situation, as eloquently outlined by the hon. Member for York Central (Rachael Maskell), who has experience in this matter. We will continue working to make sure services are suitably tailored to meet patients’ often complex needs.

For example, NHSE&I has worked with memory assessment clinics to capture best practice on remote consultation and virtual diagnosis of dementia, which is vital, as mentioned by my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn), to promote its use. It has published guidance to help enhance best practice in dementia assessment and diagnosis, and to support a personalised approach with choice over the delivery of remote consultation and diagnosis.

There has been further guidance for a range of conditions to help health systems adapt to the challenges of the pandemic, including the National Institute for Health and Care Excellence guidance on chronic obstructive pulmonary disease and the Association of British Neurologists guidance to help healthcare professionals prioritise neurological services.

People with different long-term conditions may also need emotional and psychological support, as has been mentioned by many hon. Members, and that is why NHS mental health services stayed open throughout the pandemic, and why local areas continued to offer talking therapies—remotely in many cases—with a face-to-face option if appropriate. We are investing in a mental health recovery action plan, which will help us to provide more appointments, which, sadly, were missed during the pandemic. That will help us catch up.

We are committed to ensuring that those who need it are given outstanding and tailored care with choice, control and the support that they need to enable them to live independent lives, and we are committed to ensuring that people find adult social care fair and accessible. A lot of reforms are coming forward in this area. We recently introduced our strategy for the social care workforce in our “People at the Heart of Care” White Paper, which is supported by at least £500 million to develop and support the workforce over the next three years.

As highlighted by the “Moving forward stronger” report, rehabilitation services were particularly affected by the pandemic. The health system has long recognised the importance of rehabilitation. Many hon. Members mentioned how important that is to lifelong conditions and how important it is to enable people to avoid more acute illness later on, requiring more services from the health service. Specific commitments are set out in the long-term plan, which include the expansion of pulmonary rehabilitation services over 10 years from 2019, new and higher-intensity care models in respect of stroke rehabilitation, and the scaling up of cardiac rehabilitation to prevent up to 23,000 premature deaths.

Following the publication of the national stroke service model in May 2021, NHS England and NHS Improvement have committed to creating integrated stroke delivery networks across England, bringing together health and care services across the whole stroke pathway, from prevention to rehabilitation. As my hon. Friend the Member for Bromley and Chislehurst mentioned, linking those services is vital. More than 20 integrated stroke delivery networks are now operational, bringing together health and care services across the whole stroke pathway. Over £3.3 million has been dedicated to the establishment and ongoing delivery of those networks, which have already brought about some improvements to the co-ordination and direction of how the stroke care pathways across England are delivered.

The NHS is committed to delivering personalised, needs- based stroke rehabilitation to every stroke survivor who needs it, and we recognise the vital role of multidisciplinary teams, comprising occupational therapists, speech and language therapists and physiotherapists, in assessing, diagnosing and treating issues concerning different daily activities, speech and cognitive communication. Community rehabilitation services continue to benefit from extra investment, with £4.5 billion of investment in primary medical care and community health services by 2023-24 and productivity reforms set out in the long-term plan. The long-term plan committed to the rolling out by 2024 of new two-hour urgent community response and two-day reablement ambitions, which will improve the responsiveness of community health services to people’s needs across the country. We anticipate that the wider package of investment in community and intermediate healthcare will eventually free more than 1 million hospital beds, allowing health systems to better support those in need.

Underlining our commitment to improving rehabilitation services, the NHS has created the new role of national director for hospital discharge and rehabilitation, which was rightly called for. Jenny Keane, who was appointed to the post in December 2021 and started recently, will lead a team of 60 people responsible for hospital discharge and rehabilitation. Her team within NHSE is already taking forward important work in this area, including a programme to identify the optimum bed-to-home model of care for non-acute rehabilitation services. That will support the implementation of the discharge-to-assess policy, and improve the delivery of timely and high-quality care in home settings. Ultimately, that will empower more people to recover and maintain their independence following an unplanned event or a period of acute care.

The programme will estimate the capacity for bedded non-acute rehabilitation care that integrated care systems will require for their populations. Systems will be supported to shift towards new rehabilitation models through a range of guidance, frameworks and tools. I anticipate that rehabilitation will also benefit from the wider reforms set out in the Health and Care Bill, reorienting systems towards co-operation and strengthening NHS action to reduce health inequalities. Rehabilitation will also benefit from the plans that we have set out in the integration White Paper, under which patients will receive better, more joined-up care.

Looking ahead, the NHS published its delivery plan for tackling the covid-19 backlog of elective care last month. The plan sets out a clear vision for how the NHS will recover and expand elective services over the next three years, including how it will support patients. We plan to spend more than £8 billion between the next financial year and 2024-25. That is in addition to the £2 billion elective recovery fund and £700 million targeted investment fund already made available to systems this year to help to drive up and protect elective activity. However, my hon. Friend the Member for Bromley and Chislehurst is right that we must ensure that the voice of rehabilitation services does not get lost in that considerable investment.

That funding could deliver the equivalent of around 9 million more checks, scans and procedures, and it will mean that the NHS in England can aim to deliver around 30% more elective activity by 2024-25 than it was delivering before the pandemic. A significant part of that funding will be invested in staff, in terms of both capacity and skills. The delivery plan also contains some targets to ensure that by March 2025 people will not wait longer than a year for elective care.

[Jim Shannon]

I am finding the Minister’s response very helpful and supportive of what we are trying to do, but I asked a specific question in relation to those who are waiting for eyesight-saving operations. We need to ensure that they do not lose their eyesight because of the delays. If the Minister is able to give me a response today, that will be great, but if she cannot, I am happy for all of us to receive a response by letter.

--- Later in debate ---

[Gillian Keegan]

I thank the hon. Gentleman for his intervention and I am very happy to respond by letter. However, I do know—I have had conversations about it—that these prioritised electives will be prioritised. Somebody whose sight can be saved through an operation would, I imagine, be a key priority for our NHS colleagues.

At the October 2021 spending review, the Government announced a further £5.9 billion of capital funding to support elective recovery, diagnostics and technology. That funding will drive investment in technology to improve patient experiences of care and help patients manage their experience.

The NHS has been working on rolling out 44 community diagnostic centres, which will massively increase diagnostic activity. As we take the road to recovery, we are also reforming and transforming how care and health services are delivered for patients, including through dedicated surgical hubs and more convenient and efficient community diagnostic centres.

Finally, I want to thank hon. Members for the points that they have made in the debate.

[Sir Robert Neill]

I am very grateful for the Minister’s detailed response and for her commitment to trying to improve these matters. She referred to a delivery plan for recovery of elective services, but is not the logical thing to ensure that the voice of those with long-term needs and of rehabilitation is not lost, and that we also have a specific delivery plan for rehabilitation and for catching up on the backlog? I did not hear mention of that. Are we going to have that?

[Gillian Keegan]

I mentioned the work that Jenny Keane will be doing following her recent appointment. She will be responsible for work on rehabilitation and discharges, as well as other areas covered by NHS continuing healthcare and the better care fund. That work is ongoing but does not include a specific commitment at this point to a strategy, as outlined.

[Sir Robert Neill]

Can the Minister tell me why not?

[Gillian Keegan]

I think it is only fair to say that, obviously, Jenny Keane has just started her work in this area—it is very new—but I know that she will be dedicated to ensuring that we make progress on the plans that I have set out. I hope that they reassure hon. Members that we will continue to support people who are living with long-term conditions and, by learning the lessons from the pandemic, ensure that they have access to the right services, at the right time, to enable them to live the fullest and happiest life they can. A lot of work is ongoing. We need to get behind that work and, obviously, support the team who are looking to deliver it. I thank everybody very much for their contributions.

Allergy Research and Treatments: Government Support

Gillian Keegan Excerpts

Wednesday 9th March 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Sir Charles. I thank the hon. Member for City of Chester (Christian Matheson) for securing this debate on this important issue and the hon. Member for Dagenham and Rainham (Jon Cruddas) for his comments. In my short few months in this role, we have already talked about this important topic on a number of occasions. I take it very seriously and I appreciate the tone in which this debate is taking place.

Allergies affect around 20 million people in the UK. Thankfully, most allergic reactions are mild and people can manage their symptoms effectively. However, for some people, as we heard from the hon. Member for Bolton South East (Yasmin Qureshi) when she spoke about her niece, management of allergies can be complex and reactions to allergens can be severe and cause much distress, and can even, sadly, be fatal on some occasions.

For people living with allergies, everyday activities can be challenging and navigating the world can be an anxious experience. The Government recognise the challenges faced by people with allergies and are committed to ensuring that all children and adults living with allergies are well supported.

As has been mentioned, investing in research is a key component in supporting people living with allergies. It plays a vital role in providing those working in the NHS, public health and social care with the evidence they need to better support parents and families, and supports access to pioneering treatment, diagnostics and services.

The Department of Health and Social Care funds research through the National Institute for Health Research. In the past five years we have provided the NIHR with over £14.1 million in funding for research into allergies. We would welcome funding applications for research into allergies, including potentially into more unusual types of allergies, as more funding is available but on an application basis. There has been a wide breadth of research across the life course on a range of allergic conditions, from hay fever, eczema and allergic or atopic asthma, to food and drug allergies, which can cause severe anaphylaxis, as has been mentioned.

In addition to directly funded projects into allergies, the NIHR clinical research network also supported the recruitment of participants into 79 studies of allergies over the past five years. In 2020-21 alone, the NIHR biomedical research centres had 56 active projects related to allergies, and those projects can make a real difference to people’s lives.

One trial of a new peanut oral immunotherapy treatment in children showed a high rate of desensitisation, with many of the participants able to consume a very small quantity of peanuts following the treatment. The families involved in the trial said that oral immunotherapy had transformed their lives, reducing anxiety and allowing them more freedom in terms of food choice.

Further research is being carried out into the effectiveness and safety of immunotherapy to see whether it can be used to help others. For example, there is a project looking at peanut oral immunotherapy in adults and another investigating cow’s milk oral immunotherapy in babies. I know those will be welcomed by many people. I am very much struck by the stories of Monty and Arlo, which I took to heart, and by the anxiety felt by the children having to deal with this on a daily basis. I am also struck by the maturity with which they both approached it.

In terms of new treatments, in December last year NHS England announced that children in England will be the first in Europe to receive Palforzia, a life-changing treatment for peanut allergies, after NHS England secured the first deal of its kind in Europe. The National Institute for Health and Care Excellence published its final guidance on Palforzia in February 2022, so it is very recent. Up to 600 children aged four to 17 are expected to benefit from the treatment this year, with that number rising to as many as 2,000 in 2023.

It is important that, while we continue to look for treatments, we also consider how best we can support families living with allergies.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

My hon. Friend is right to highlight the advances in allergy treatment. I congratulate the hon. Member for City of Chester (Christian Matheson) on securing this debate and the hon. Member for Dagenham and Rainham (Jon Cruddas) on his work in this area over a number of years.

May I push the Minister on one point? The key challenge for many families is access to diagnostics and the link between primary and secondary care. As well as highlighting many of the successes, will she outline what more can be done to improve timely access to diagnostics for families?

[Gillian Keegan]

I appreciate my hon. Friend’s intervention and will go directly to that point. General practitioners are responsible for ensuring that their own clinical knowledge remains up to date and for identifying learning needs as part of their continuing professional development. I am sure he is aware of that. That activity should include taking into account new research and developments in guidance. All doctors are expected to meet those standards, and the Royal College of General Practitioners has developed an allergy e-learning online resource to support continuing professional development and revalidation, which aims to educate GPs about the various presentations of allergic disease to aid with diagnosis. We appreciate that that has to go through a large number of GPs.

I was talking about families living with allergies. Other NIHR-funded research at the University of East Anglia is developing a psychological toolkit that aims to help parents to learn skills to manage their own anxiety around their child’s food allergy, as well as addressing children’s anxiety. We know that people with allergies are often advised to avoid the substance that they are allergic to, but we also know that that is not always easy or practical, and we have seen tragic examples of where that has not been the case—indeed, Natasha was mentioned. The Government are taking steps to protect those with allergies and intolerances. That includes the introduction of Natasha’s law, named after that sad case, which came into force on 1 October 2021, making it a legal requirement for all food retailers and operators to display full ingredient and allergen labelling information on every food item they sell that is pre-packed for direct sale.

Additionally, food hypersensitivity, which includes food allergies, is a strategic priority for the Food Standards Agency. As an evidence-based organisation, the FSA has been at the forefront of world-leading research, which has had a significant impact on our understanding of food. The FSA is currently undertaking a programme of work to improve the quality of life for people living with food hypersensitivity and provide support to make safe, informed food choices to effectively manage risk. The Medicines and Healthcare products Regulatory Agency is also planning next steps to support the wider availability of adrenalin auto-injectors in public spaces. We have had debates on that here as well. That is a medicine used for the emergency treatment of severe acute allergic reactions. We know there is more to consider about how we might protect people further.

I know that this issue matters to many Members, and to many constituents. I thank all hon. Members for the points they have made and the continued discussion we have had on this topic. I hope they will accept that real progress is being made. I hope I have been able to assure them that we will continue to support people living with allergies through NIHR research and exploring and investing in new treatments. With the engagement and involvement of patients and the public across the country, I hope we can improve the lives and outcomes for everyone living with allergies and their families.

Question put and agreed to.

Prison-based Addiction Treatment Pathways

Gillian Keegan Excerpts

Wednesday 2nd March 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship for the first time, Dr Huq, and I look forward to doing so on many more occasions. I am grateful to the hon. Member for Liverpool, Walton (Dan Carden) for raising this important issue, which I know matters to us both. We come from a similar area and have seen similar challenges, which is probably one of the reasons why we are both here to try to help people live their best lives.

Addiction is a chronic condition with damaging and far-reaching consequences for individuals, their loved ones and wider society. A high proportion of the individuals who go into prison already have a substance misuse problem, but some may develop an addiction while in prison, as the hon. Member for Strangford (Jim Shannon) outlined. This Government are committed to ensuring that we take the opportunity while people are in prison to get them the treatment they need and to get them out of crime. However, tackling addictions in prison requires a collective effort at both national and local level. The Department of Health and Social Care is committed to working with partners across health and justice to ensure safe, timely and effective care that improves health outcomes and reduces health inequalities for prisoners, as well as reducing reoffending.

In prisons and in the community, the NHS is focusing on integrating substance misuse and mental health services, to ensure that we provide joined-up, trauma-informed care that addresses an individual’s complex and interrelated problems, as the hon. Member for Liverpool, Walton, pointed out so eloquently. This is an important blend—to ensure that the mental health services and support are there, as well as substance misuse support. Investment in those services in prisons has increased from £184 million in 2016-17 to £203 million in 2020-21, with NHS England and Improvement committing a further £21 million over the next three years.

The NHS has also just commenced the roll-out of something fundamental—the GP2GP functionality. This will ensure that 100% of GPs working in the adult prison estate will be able to transfer clinical records to and from GPs in the community, allowing greater continuity of care for people entering and leaving the prison estate, and safeguarding health gains made when people go to and from prison. Ensuring continuity of care is vital, but it does not happen well in all cases today. The roll-out is being made in six tranches, with all of the male prison estate to be completed by June 2022.

Providing appropriate intervention and treatment at the right time and in the right place is vital to improving outcomes for people with substance misuse and mental health problems. NHS liaison and diversion services work at police stations and criminal courts to identify and assess people with substance misuse issues so that they can be referred to appropriate services and, where appropriate, out of the justice system all together. We are working with health and justice partners to increase the use of community sentence treatment requirements, which can help to reduce reoffending and custodial sentences by offering drug or alcohol treatment as part of a sentence.

In February 2019, the Government commissioned Professor Dame Carol Black to conduct an independent review of the issues and challenges relating to drug misuse, which exposed the stark scale of the national challenge. The hon. Gentleman referred to that vital piece of work a lot. I thank Dame Carol for her thorough review and for championing this important agenda. The Government accepted all of her key recommendations and are committed to supporting individuals suffering from addictions in prison.

To that end, we recently announced a number of initiatives that focus on recovery and rehabilitation, some of which the hon. Gentleman mentioned. The new drugs strategy, “From harm to hope”, was published on 6 December 2021. It sets out how we will significantly increase the number of drug and alcohol treatment places, and therefore increase the number of people in long-term recovery from substance addiction. The strategy aims to reverse the upward trend in drug-related deaths and to bolster the crime prevention effort by reducing levels of offending associated with drug dependency. It is important work. The hon. Gentleman questioned whether the DHSC is in any way reluctant to carry out that work. Not at all; I am very committed to that outcome and, as far as I am aware, we are working well with partners across and in the community.

To deliver the strategy, we have made available an additional £780 million, which represents the largest ever single increase in treatment and recovery investment. Of the £780 million, £530 million will be spent on enhancing drug treatment services, while £120 million will be used to support offenders and ex-offenders to engage with the treatment that they need to turn their lives around. There is specific funding for that purpose.

The hon. Gentleman made a point about abstinence-based treatment versus methadone prescribing or other treatments. Both have their place. Not everyone’s addiction is the same and nor is their pathway to recovery. The clinical evidence guidelines—including National Institute for Health and Care Excellence guidance—and clinical consensus will support a balanced and integrated approach. Those bodies will be the ones deciding what is best for the individual concerned.

The prisons White Paper, which was published on 7 December 2021, has a specific focus on tackling barriers to rehabilitation and reform by deploying the full range of treatment options to support recovery from drug dependency. For example, we are exploring the benefits of making long-acting buprenorphine available to prisoners by assessing the impact on engagement with treatment, protection from overdose, and relapse after release. We are also supplying life-saving naloxone medication to staff in prisons and approved premises to prevent unnecessary deaths from opiate overdoses.

Crucially, we want continuity of treatment once an offender is released back into the community, so that they do not slip back into using drugs and into the life of crime that they have often followed. The NHS long-term plan introduced the NHS Reconnect service to work with individuals who would otherwise struggle to engage with community-based healthcare services. The service works with such individuals pre-release to ensure that there is no disruption to their care. Reconnect is the largest health and justice investment to be delivered by the NHS long-term plan, with an annual spend of £13.8 million in 2022-23, rising to £20 million in 2023-24.

As well providing health and care support, we need to tackle the wider issues that can hinder a person’s ability to recover and turn back the clock on their crime. Prison programmes for drug rehabilitation, skills and work will be more closely linked to the support services available in the community when offenders are released. We are working with the Department for Work and Pensions and the Ministry of Justice on that. Through those initiatives, we are ensuring that every day that an offender spends behind bars involves purposeful reform and rehabilitation to help them to recover and turn their life around, and to ensure that they have the building blocks in place to maintain that recovery and make a positive contribution to society after they leave prison.

Our focus on recovery is unprecedented in its ambition and in the level of funding backing that ambition, and it forms a key part of the Government’s plans to cut crime and make our communities safer as we build back better, stronger and fairer after the pandemic.

Question put and agreed to.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 1st March 2022 Commons Chamber

[Mr Steve Baker (Wycombe) (Con)]

10. What his timescale is for awarding the £50 million funding for targeted motor neurone disease research through specific scientific programmes proposed by MND charities.

[The Minister for Care and Mental Health (Gillian Keegan)]

Researchers can apply right now to the National Institute for Health Research and UK Research and Innovation to access the £50 million of funding. The timescale for spending the money depends on the research applications received. The £50 million over five years is a minimum commitment, and we hope to spend much more than that on research in this vital area. We are working with the motor neurone community to help it effectively access the committed funding and to boost MND research even further.

[Mr Baker]

The Minister has made a positive announcement in the course of the last few months, and this is an important repetition, but there seems to be a slight miscommunication going on because organisations are telling me that they are not sure where the co-ordination is coming from. May I invite her to meet me and the coalition of patients and researchers to try to nail down exactly what is happening, in a spirit of good faith?

[Gillian Keegan]

I would be happy to meet my hon. Friend. I have also met some of the campaigners and researchers in this area, and the head of our research arm, so that we are clear. The support we are providing to the community includes a new £4 million MND partnership. That will bring the research community together so that they can pool resources and expertise to leverage that funding further, and ensure that they put forward strategic applications.

[Christine Jardine (Edinburgh West) (LD)]

11. If his Department will make an assessment of the long-term impacts of use of (a) benzodiazepines and (b) other opioids on children being treated for acute forms of epilepsy.

[The Minister for Care and Mental Health (Gillian Keegan)]

Benzodiazepines are an important medicine in the treatment of severe cases of certain types of epileptic conditions in children. The Medicines and Healthcare products Regulatory Agency continues to monitor the safety of treatment with benzodiazepines. Opioids are not authorised to treat children for acute forms of epilepsy.

[Christine Jardine]

Benzodiazepines are not appropriate for all children, and the Secretary of State has been instrumental in approving medicinal cannabis for use by children with epilepsy. I recently visited a medicinal cannabis farm in the borders of Scotland, which is poised to make an important contribution to the pharmaceutical industry in this country. Given the economic benefits, and the moral imperative of helping those children who can only benefit from medicinal cannabis, will the Minister say what steps the Government will take to make it available on NHS prescriptions?

[Gillian Keegan]

The National Institute for Health Research welcomes funding applications for research into any aspect of human health, including epilepsy, and we would welcome those pharmaceutical companies coming forward to partake in trials. The NIHR and the NHS will support a programme of two randomised control trials into epilepsy, which will compare medicines containing cannabidiol, and CBD plus tetrahydrocannabinol and a placebo. This is a pioneering area of research, and I am aware that NHS England and NIHR are working closely to get those trials started as soon as possible.

[Karl Turner (Kingston upon Hull East) (Lab)]

12. What steps his Department is taking to tackle regional health inequalities including waiting times for NHS treatment.

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[The Minister for Care and Mental Health (Gillian Keegan)]

NHS England and NHS Improvement have been field testing waiting time standards across 35 different local pilot initiatives. Through that clinically led review, we hope to understand the merits of introducing them. NHS England and NHS Improvement published the outcome of a consultation on those standards on 22 February, just over a week ago. We will work with them now on the next steps for the proposed measures.

[Sarah Champion]

I am very interested in what the Minister says, and I would be really interested to see the review, but in Rotherham the waiting time for children’s neurodevelopmental assessments is 200 weeks. That is almost four years of a young life. Consultant led NHS services are required to report waiting times against the 18 and 52 week standard, but neurodevelopmental assessments having no such requirements means that the political will is not there to challenge. Will the Minister please look into putting the resources necessary into children’s mental health so that no child, wherever they are, goes without that support?

[Gillian Keegan]

I thank the hon. Lady for her question. She raises an incredibly important point. As a Government, we are determined to tackle long autism diagnosis waiting times. We are investing £2.5 million as part of the NHS long-term plan to test and implement the most effective ways to reduce autism diagnosis waiting times for children and young people across England. That is vital, because we know that the earlier children get the support, the better the outcomes are for them. We are absolutely determined to work on this, but the diagnosis pathways are sometimes quite complex.

[Caroline Nokes (Romsey and Southampton North) (Con)]

16. What plans his Department has to take steps to permanently implement the telemedicine service for early medical abortion.

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[Mr Toby Perkins (Chesterfield) (Lab)]

17. What assessment he has made of the adequacy of child mental health in-patient provision in Derbyshire.

[The Minister for Care and Mental Health (Gillian Keegan)]

We want to ensure that more children and young people can access appropriate support in their community, and that those who require in-patient cases are treated as close to home as possible. The East Midlands Provider Collaborative is responsible for commissioning tasks for tier 4 in-patient children and adolescent mental health services, including for Derbyshire. It has implemented strategies to ensure the most efficient use of in-patient beds, including a review of the types of beds required by east midlands patients.

[Mr Perkins]

My constituent Stephen Jones wants what the Minister wants, but when his daughter required in-patient child mental health facilities she was forced to go to Stoke to receive them. He had a 70-mile journey every time he wanted to see her, which was obviously very expensive and also just impossible to do. It meant that his daughter’s mental health got worse, because she felt that she had been abandoned by her own family, putting the whole family under pressure. In addition, if people do not receive universal credit, they get no support with the financial impact. Will the Minister tell us more about how we can ensure that children’s mental health is not exacerbated by the inability to access services locally?

[Gillian Keegan]

The hon. Gentleman raises a very important point. Clearly, these are distressing enough times without having that commute and those travel arrangements on top of that, but sometimes the services are highly specialised. We are trying to get the right blend between access to highly specialised in-patient services and making sure that we increase community efforts. We have been working very hard to ensure that there are more community efforts, but we have also invested £10 million more in capital for more beds to make sure people can get treatment closer to home.

[Fleur Anderson (Putney) (Lab)]

18. What assessment the Government have made of the adequacy of support for young carers.

[The Minister for Care and Mental Health (Gillian Keegan)]

We have introduced significant changes to support for young carers, with statutory entitlements to young carers’ assessments from April 2015. Local authorities are held to account for such assessments and support through the social care inspection framework. Further, as we set out in our adult social care White Paper, we will amend the school census at the earliest opportunity to include young carers, allowing us to establish a wealth of evidence on this cohort.

[Fleur Anderson]

I welcome more information being found out about young carers, because this is a hidden health crisis. A constituent came to see me. She is a young person now and has been a young carer for many years. The impact on her educational attainment, physical health and mental health has been devastating. There are 800,000 young carers in the UK, with 800 of them in Wandsworth where support services have been slashed. Does the Minister recognise the impact of that unpaid child labour and does she have a plan to tackle it?

[Gillian Keegan]

Very much so. Young people should be protected from inappropriate and excessive caring responsibility, and adult and children’s services need to work together better. We recognise, though, the lack of hard data and evidence on outcomes for young carers. That is where we are and that is why we have made the commitment, with the Department for Education, to amend the school census. We intend to introduce that as early as 2022-23 and each year thereafter. The data will be collected at primary school and secondary school, so we will be able to look at all kinds of outcomes for this particular cohort and take actions.

[Mr Philip Hollobone (Kettering) (Con)]

19. If he will ensure that the NHS new hospital programme team complete approval processes by summer 2022 to allow the preparation of the full business case for the redevelopment of Kettering General Hospital by the local NHS trust.

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[Kim Leadbeater (Batley and Spen) (Lab)]

On the issue of children’s mental health, does the Minister agree that children with ADHD and autism have found the last two years even more stressful than usual? A cross-departmental approach is long overdue to ensure that their needs are adequately met.

[The Minister for Care and Mental Health (Gillian Keegan)]

The hon. Lady is absolutely right, which is why we are working cross-departmentally to bring forward a mental health strategy. It is also why we have put in place mental health recovery funding specifically for the recovery from the pandemic, which has had a terrible effect on children’s mental health.

[Ronnie Cowan (Inverclyde) (SNP)]

The Secretary of State is on record saying:

“Making medicinal cannabis available on prescription will benefit the lives of ill patients currently suffering in silence. There is nothing harder than seeing your loved ones in pain”.

Since he said that, there have been three prescriptions for medical cannabis on the NHS. They are important, because they set a legal and medical precedent that it can happen, and it can happen now. Currently, however, if I can afford it, I can buy it, but if I cannot, I cannot. When will he address that anomaly?