Chronic Obstructive Pulmonary Disease

Gillian Keegan Excerpts

Wednesday 17th November 2021 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Nokes, for the first time. I add my thanks and congratulations to the hon. Member for Weaver Vale (Mike Amesbury) on securing this debate, particularly on World COPD Day. We very much appreciate his support for the taskforce for improving lung health. It was also a pleasure to hear hon. Members’ contributions to the debate, and I will try my best to answer their questions.

The Government are dedicated to supporting those with chronic obstructive pulmonary disease, or COPD, which is a lot easier to say. In the last 10 years, we have rolled out guidance and initiatives to support and improve this area.

In 2011, a Department of Health outcomes strategy for COPD and asthma set out a proactive approach to early identification, diagnosis, intervention, proactive care and management at all stages of the disease. A wrong diagnosis will result in patients not getting the care they need, as a number of Members mentioned. That is why in 2013 a guide to performing quality-assured diagnostic spirometry was produced by the NHS, with several charities and other stakeholders. The guide was published to support accurate diagnosis of respiratory conditions and tackle the effects of misdiagnosis.

The national asthma and COPD audit programme was launched in March 2018. Led by the Royal College of Physicians, it aims to improve quality of care, services and clinical outcomes for patients with asthma and COPD by collecting and providing data on a range of indicators. As part of the national COPD audit programme, NHS England and NHS Improvement have developed a best practice tariff for COPD. The tariff is applicable to hospital trusts, in order to promote best practice and ensure improvements in care. Best practice will be considered to have been achieved when 60% of patients admitted for an exacerbation of COPD receive specialist input to their care within 24 hours of admission, and where COPD patients receive a discharge bundle before actually being discharged.

The NHS long-term plan sets out the NHS ambition to improve access to treatments for COPD patients. A date was requested by the hon. Member for Strangford (Jim Shannon). As part of the long-term plan, access to pulmonary rehabilitation will be expanded by 2028. Pulmonary rehabilitation, an exercise and education programme, is one of the most effective treatments for COPD, with 90% of patients who complete the programme experiencing improved exercise capacity or increased quality of life. By expanding pulmonary rehabilitation services over 10 years, 500,000 exacerbations can be prevented and 80,000 admissions avoided.

[Ruth Jones]

I take the Minister’s point about pulmonary rehabilitation being so important—an integral part of the management of these long-term chronic conditions—but 10 years is a long time. People need help now, so what is she thinking in terms of immediately putting into place the extra staff and resources required for pulmonary rehab?

[Gillian Keegan]

I will come to that, and I will also come to the questions about recovery and catch-up, which a number of people mentioned.

To increase access to pulmonary rehabilitation, a population management approach will be used in primary care to find eligible patients from existing COPD registers who have not previously been referred to rehabilitation. New models of providing rehabilitation to those with mild COPD, including digital tools, will be offered to give support to a wider group of patients with rehabilitation and self-management support.

The use of COPD discharge bundles, where appropriate, will also help to increase referrals to pulmonary rehabilitation, and the NHS long-term plan will build on a range of existing national initiatives focused on respiratory disease. The quality and outcomes framework, or QOF, ensures that all GP practices establish and maintain a register of patients with a COPD diagnosis, and the QOF for 2021-22 includes the improved respiratory indicator, including the recording of the number of exacerbations and assessments of breathlessness, and an offer of referral to PR.

NICE quality standards have been published, with the aim of raising the standard of care that those with COPD receive. The NHS RightCare Pathway for COPD is being rolled out nationally. This pathway defines the core components of an optimal service for people with COPD, and it includes timely access to PR as part of the optimal treatment pathway. It provides resources to support local health economies, and the pathway also concentrates improvement efforts on addressing variation and population health.

At the beginning of the pandemic, NICE published rapid guidance on COPD, which outlines how to communicate with, treat and care for patients suffering from COPD. It also outlines how healthcare workers should modify their usual care and service delivery during the pandemic.

[Derek Twigg]

I am listening carefully to what the Minister is saying, but one of the problems that I referred to briefly in my speech is that of being able to see a GP—not necessarily just for diagnosis, but when someone becomes ill. I wonder how she can square that circle in terms of what has been put in place, if people cannot get to see a GP in person in the first place.

[Gillian Keegan]

Of course, access to GPs’ services is a concern that all Members will have heard a number of their constituents raise. That is why we put in place £250 million to increase access to face-to-face GP appointments as part of the recovery plans, which are quite extensive for the NHS.

The guidelines I was talking about aim to highlight ways to support people with COPD, such as signposting charities and support groups for better health and wellbeing. They recommend using technology to reduce some in-person appointments, while making sure not to provide a service that would increase health inequalities through a lack of digital access—it is additional, not instead of—as well as offering advice on how to modify care during the pandemic.

A number of questions were raised about the recovery plan, and how to restore services for patients and restore the diagnostics to pre-pandemic levels, or above them. The 2021-22 priorities and operational planning guidance set the priorities for NHS England and NHS Improvement, and includes tackling the backlog for non-urgent treatment such as services for lung disease patients. That plan aims to stabilise total waiting lists, and eliminate waiting times of two years or more and the increase in waiting times of more than one year. We have made £1.5 billion available to assist local teams to increase their capacity and invest in other measures to achieve those priorities, and the 2021 spending review announced £2.3 billion to increase the volume of diagnostic activity and open community diagnostic centres to provide more clinical tests, including for patients with lung disease.

Targeted lung health checks are running in the parts of the country with the highest rates of mortality from lung cancer. However, those projects will not just identify more cancers, but pick up a range of other health conditions, including COPD. People aged between 55 and 74 who have ever smoked are now offered a free lung health check closer to where they live. They may then have a lung cancer screen scan if that check shows that they need one. A review undertaken by Professor Sir Mike Richards highlighted that patients with respiratory symptoms would benefit from community diagnostic centres, due to the number of diagnostic tests that will be made available. As well as supporting patients with COPD, the Government are committed to strategies that will help to prevent that condition, as a number of Members have mentioned.

[Jim Shannon]

Just for clarification, following on from the question that the hon. Member for Halton (Derek Twigg) has asked, does the Department of Health proactively—perhaps even aggressively—contact smokers to follow through, rather than those smokers contacting the health service? I am not sure whether that would always happen. What is the Government’s policy on that?

[Gillian Keegan]

Obviously, there would be a relationship between the GP and the smoker, but that can go either way. Anybody who is in those age groups needs to be made aware that they are entitled to this free lung health check, and it is the responsibility of us all to make sure those checks are available. I am sure we will all ensure that that is understood.

In 2019, 85% of deaths due to COPD were attributable to smoking, and in 2019-20, 84% of hospital admissions with COPD were attributable to smoking. The proportion and the number have remained quite similar over the past five years, and as has been mentioned by a number of hon. Members, smoking is a key factor in many cases of COPD. This Government are committed to reducing the harms caused by tobacco, and have made good long-term progress in reducing smoking rates, which are currently 13.9%, the lowest on record. However, with 6.1 million smokers in England, tobacco is still the single largest cause of preventable mortality, and a radical new approach is needed to address the stark health disparities associated with tobacco use. As such, we have set out the bold ambition for England to be smoke free by 2030. To support that ambition, we have announced the publication of a new tobacco control plan, which will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda.

The NHS long-term plan commits to delivering NHS-funded tobacco treatment services to all inpatients, pregnant women and people accessing long-term mental health and learning disability services by 2024. COPD is responsible for around 33% of annual deaths from respiratory diseases and is the single largest cause of occupational lung disease. There are an estimated 17,000 annual new cases of self-reported, work-related breathing or lung problems, which is why our colleagues in the Department for Work and Pensions are also helping to tackle the causes of COPD in the workplace.

[Liz Twist]

I thank the Minister for recognising that a proportion of COPD cases are caused by work-related issues, which will of course affect the north and the north-east most of all because of their industrial heritage. I assume she will tell us what steps the Department will be taking to pursue that.

--- Later in debate ---

[Gillian Keegan]

Yes, indeed. In fact, one of my own family members—my uncle—has COPD and has never smoked. As we are from the north-west, it is likely to be due to his workplace conditions.

Tackling occupational respiratory disease remains one of the Health and Safety Executive’s health priorities, and the aim is to reduce the number of new cases of occupational-related lung disease. To help achieve that, HSE focuses its inspection and enforcement activity where it can have the most effect. It continues to work with a broad range of partners to extend its reach and raise awareness of the need to prevent exposure. HSE’s WorkRight campaign, which includes occupational lung disease, uses communication and social media channels to promote the benefits of good health and safety, and a range of initiatives are being undertaken to support reducing mortality rates among patients with lung disease—for example, HSE undertook interventions in 2019-20 to address the carcinogenic risks from welding fume exposure.

I hope that what I have set out answers the many questions that right hon. and hon. Members had, but clearly it is work in progress. We are working hard to ensure that COPD care improves for all, as outlined in the NHS long-term plan, and that people have access to the very best care available.

Social Care Update

Gillian Keegan Excerpts

Wednesday 17th November 2021 Written Statements

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

On 7 September 2021, my right hon. Friend the Prime Minister set out the Government’s new plan for adult social care reform in England. This included a lifetime cap on the amount anyone in England will need to spend on their personal care, alongside a more generous means test for local authority financial support.



Today we are publishing a technical note to complement the announcement, which:



provides further detail of the new charging reform framework and confirms key policy details, including the standard level at which ‘daily living costs’, will initially be set.

marks the start of a period of co-production of the statutory guidance with the sector, with the intention to publish a public consultation in the new year, and lay regulations and publish updated statutory guidance in spring 2022.

The key policy details that the technical note confirm are that:



from October 2023 both new entrants and existing social care users will be able to progress towards the cap.

the increase in the Upper Capital Limit of £100,000 will apply universally, irrespective of an individual’s care setting or circumstances.

between the Upper and Lower Capital limits, if individuals are not able to pay for their care from their income, they will be expected to contribute up to one in every £250 from their chargeable assets towards the cost of their care.

the notional level of ‘daily living costs’, a key concept of the reforms, will be set at £200 per week.

for individuals who receive financial support for their care costs from their local authority, it is the amount that the individual contributes towards these costs that will count towards the cap on care costs.

This last point requires an amendment to section 15 of the Care Act 2014. For this reason, the Government will bring forward an amendment for the purposes of introducing a clause into the current Health and Care Bill. This clause will seek to amend section 15 of the Care Act 2014 such that individual contributions—based on local authority rates—will count toward the cap.



This change will reduce complexity; it will ensure individuals receive the support they need through the means test but are not unfairly reaching the cap at an artificially faster rate than what they contribute.



I have ensured a copy of the technical note will be deposited in the Libraries of both Houses.

[HCWS399]

Autism and Neurodiversity Research Funding

Gillian Keegan Excerpts

Tuesday 16th November 2021 Commons Chamber

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

I thank my right hon. and learned Friend the Member for South Swindon (Robert Buckland) for securing this important debate on funding for autism and neurodiversity research and for such a wonderful, heartfelt speech. It is truly my honour to respond. I commend him on the incredible work that he has done throughout his career to improve the lives of the nearly 560,000 autistic people and about 5 million neurodivergent people across the country. In his previous roles as Lord Chancellor and chair of the all-party parliamentary group on autism, he has been instrumental in driving improved awareness and understanding of autism across Government.

We know that too many autistic people and neurodivergent people more generally are ending up in the criminal justice system and that much more needs to be done to improve people’s experiences. The review that my right hon. and learned Friend commissioned as Lord Chancellor in 2020 looked at this important issue and, as a direct result of his contribution, I expect our newly published national autism strategy will make a big difference to the lives of autistic and neurodivergent people who come into contact with the criminal and youth justice systems. We know that the strategy needs to improve autistic people’s lives. It was informed by a national call for evidence and incorporated the views of more than 2,700 autistic people, their families and carers. It is underpinned by an implementation plan for year one—that is 2021-22—and backed by over £74 million for the first year alone. It sets out our vision for what we want autistic people’s lives to be like by 2026. Over the next five years, we will improve understanding in society, reduce diagnosis waiting times and improve access to high quality health and social care for autistic people.

My right hon. and learned Friend mentioned social care, and that will be a key part of the White Paper along with the social care needs of working-age adults. We will also publish further implementation plans for year two and beyond that will build on our actions this year. They will set out how we will drive improvements across health and care, employment, education and the criminal justice system.

We have made important strides across England in the last decade since the introduction of the landmark Autism Act 2009. I pay tribute to our friend Dame Cheryl Gillan for all her work in this area. The Act includes improvements in public awareness of autism and the availability of diagnostic services. To date, we remain one of the only countries in the world to have such legislation—I know that we are proud of that—but we know that we still need to do more to ensure that autistic people have equal access to services across their lives.

One of the biggest challenges that we face is, as my right hon. and learned Friend outlined, gaps in our evidence about what services and support work best for autistic people. I saw the real-life impact of that recently when I was interviewed by an impressive young woman called Immie. She told me about her struggle and how long it took her to get diagnosed with autism as well as the struggles faced by women and girls in getting the right support due to under-diagnosis. While we know that that is an issue and are taking action to address it, we need better evidence about the effects of masking and under-diagnosis of autism for women and girls.

When I was the Apprenticeships and Skills Minister, I met many young autistic people who told me they struggled to find and get into work. Recently, at the start of UK Parliament Week, I visited Littlegreen Academy in my constituency, which specialises in providing education to boys aged seven to 16 with autism. Pretty much every single one of them asked whether I would help them to get some work experience, to help them get on the ladder towards employment. Like my right hon. Friend the Member for Tunbridge Wells (Greg Clark), I took that as my action from the meeting.

Through our new autism strategy we are strengthening and promoting pathways to employment, such as supported internships, traineeships and apprenticeships, but to make further headway on closing the unacceptable autism employment gap we need to better understand the barriers to employment and the other barriers faced by people with autism.

We know that we have not reduced fast enough the number of people with an autism diagnosis in in-patient care, which is important, as my right hon. and learned Friend the Member for South Swindon said. There are many reasons for that number, but a main reason is that people are being diagnosed as autistic after they are admitted. We need to make sure the number of autistic people in such settings is reduced, as in many cases they are not the right settings. We set up a delivery board across Government and across system partners to make sure we monitor progress, identify blockers and propose actions so that people are better supported in their community, not in inappropriate in-patient care.

Many hon. Members mentioned the lack of understanding, and it is so important that we have more general understanding. I am sure many hon. Members remember the autism training that MPs and their offices received, again at the behest of Dame Cheryl Gillan, who pushed and encouraged us all to do that. I certainly learned a lot.

As set out in the “Right to be heard” publication in 2019, we are also trialling the Oliver McGowan mandatory training in learning disability and autism for all health and social care staff, backed by £1.4 million of funding. The trials are under way, and three providers are currently delivering the training. Hundreds of staff have already been trained. There will be a final evaluation report, which is due in the spring, and the outcomes will inform the wider roll-out of the Oliver McGowan mandatory training. We are working with his parents, Paula and Tom, to introduce the training.

As part of our new autism strategy, we will publish a cross-Government research action plan that lays out the steps we will take to improve and embed a culture of autism research by 2026. We know that we need a strategic approach to ensure that areas currently receiving less research investment, such as care and support—my right hon. and learned Friend mentioned the postcode lottery—are prioritised in future. We also need to make sure we are prioritising the right areas for research and that the research delivers the right change.

We will work with autistic people and their families, the research and voluntary sectors and NHS England to carry out this research action plan, which will ensure that we are building on the important work already happening in autism research. For example, we have already provided £81 million for autism and neurodiversity research in the past five years, which includes funding for a study on the impact of covid-19 on autistic people, a project to improve the accuracy of adult autism assessments and a systematic review to understand what mental health support works for autistic people.

In addition, we were delighted to announce this year a three-year partnership between the National Institute for Health Research and the UK’s leading autism research charity Autistica—which my right hon. and learned Friend mentioned—to fund research into the social care that works for autistic people. The partnership will encourage and support more research applications in this important subject area and we encourage many people to make such applications. I am glad we have had the opportunity today to hear about Autistica’s fantastic work and to welcome its new support plan. I am due to meet Autistica next week—that gives me some time to read the report—and I look forward to working with it on the development of our research action plan to transform the autism research funding landscape over the next few years.

I again thank my right hon. and learned Friend for securing this important debate and all Members for their contributions. I recognise that we must ensure that the actions we take to support and improve the lives of autistic people and their families are grounded in evidence. Through our new autism strategy and research action plan, we will level up support for autistic people throughout the country. I look forward to working with my right hon. and learned Friend and other Members to make that happen.

Question put and agreed to.

Adult Social Care: Winter Plan

Gillian Keegan Excerpts

Wednesday 3rd November 2021 Written Statements

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

On 3 November 2021, the Department of Health and Social Care will be publishing the “Adult Social Care: Winter Plan 2021 to 2022.” This plan has been developed in conjunction with the NHS and social care sector stakeholders, drawing on the recommendations of Sir David Pearson’s review of last year’s adult social care winter plan; advice from SAGE and UKHSA; and extensively on lessons learned so far in the pandemic.

The adult social care winter plan 2021-22 will set out the actions that national Government will be taking to support the sector, along with the steps that local authorities, the NHS, and care providers should take to prevent and control covid-19 outbreaks. The plan focuses not just on covid-19, but also on other viruses such as flu and norovirus, to ensure that those who receive social care are protected this winter.

Thanks to the huge success of the UK’s vaccine rollout, we are in a favourable position as we approach this winter, and I am determined to ensure that those in all social care settings remain protected while maintaining their quality of life. The UK Government have already set out a comprehensive package of measures to support the adult social care sector throughout the winter. These are:

£388 million in further funding to support infection prevention control, testing and vaccination uptake in adult social care settings. This is in addition to a further £478 million to continue enhanced hospital discharge support until March 2022.

A new £162.5 million workforce recruitment and retention fund to bolster the dedicated care workforce. This funding will support local authorities, working with providers, to recruit staff and retain the existing workforce—through a range of measures which could include local recruitment activity, the creation of staff banks, additional overtime hours and payments to incentivise joiners and recognise loyalty—to ensure the right number of staff with the skills to deliver high quality care to meet increasing demands.

Free flu vaccination for eligible frontline social care workers and carers and ensuring pharmacists can vaccinate staff and recipients of care in care homes.

Covid-19 booster vaccinations to those in JCVI cohorts 1-9 that received their second dose more than six months ago. Older adult care home residents and staff will receive covid-19 boosters within their home.

Continuing the designated settings scheme, in order to provide appropriate care for in a covid-secure environment for those likely to be infectious with covid-19 who are discharged from hospital. The designated settings indemnity support has also been extended to cover the winter period until 31 March 2022, in order to maintain the current level of support for these vital settings.

Continuing to provide free PPE for covid-19 needs to the adult social care sector until the end of March 2022, with sufficient stock to cope throughout winter. Regular asymptomatic covid-19 testing will be maintained, with the availability of more intense testing regimes for higher risk settings.

We are also publishing the evaluation from the workforce capacity fund. The fund which saw £120 million support provided to the sector in January 2021, helped the sector to deal with the challenges of covid-19 last winter, delivered 7.3 million additional hours with over 39,000 new recruits. It was deemed, by the overwhelming majority of LAs, as either “somewhat” or “very” effective in supporting them to strengthen workforce capacity last winter.

The Department of Health and Social Care has worked closely with the NHS to ensure the adult social care winter plan is co-ordinated and integrated with their planning. NHS England and NHS Improvement’s winter planning guidance is already available at: NHS England » 2021/22 priorities and operational planning guidance: October 2021 – March 2022. The adult social care plan and NHSEI’s planning guidance enable the providers of care across both sectors to prepare for winter.

[HCWS371]

NHS Efficiency

Gillian Keegan Excerpts

Tuesday 2nd November 2021 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Gary.

I welcome the idea and the timeliness of this debate. My hon. Friend the Member for Peterborough (Paul Bristow) has raised an important issue, and I know many hon. Members present have great experience of various parts of the NHS, including my hon. Friends the Members for Watford (Dean Russell), for Bosworth (Dr Evans) and for Central Suffolk and North Ipswich (Dr Poulter). I thank them for their contributions to the debate.

We all have a responsibility to taxpayers to make sure that the NHS uses its resources as effectively as possible. To do that, we need to ensure that productivity grows every year, which is why the NHS long-term plan includes financial test 2:

“The NHS will achieve cash-releasing productivity growth of at least 1.1% per year.”

I make it clear that increasing productivity does not mean making staff work harder or making cuts. It means getting the most out of every £1 the NHS spends, and making sure that as much as possible is spent on frontline care. It means doctors and nurses doing the tasks they are trained to do and that nobody else can do. It means buying the right drugs at the right price. It means more patients getting the right treatment in the right place at the right time. That is good for patients, good for clinicians and good for the taxpayer.

Thanks to the hard work and innovative mindset of many NHS staff, the NHS is regularly recognised as one of the world’s most efficient health systems, although I take the point made by my hon. Friend the Member for Watford that there are different ways of measuring efficiency globally. In fact, in the decade before the pandemic, productivity growth in the NHS was faster than in the wider economy, as was independently verified by the Office for National Statistics.

Furthermore, the UK spends only around 2% of healthcare expenditure on administration—we spend a lot on the NHS, but only 2% of it on administration—and managers make up only 2.6% of the NHS workforce of 1.35 million. They might be an easy target for criticism, but good managers are of course essential to making services work, and many of us will have had experience of that throughout our various careers. If there were no managers, clinicians would have to manage their own workforce, logistics, finances and websites, and spend less time with patients. None the less, we want to improve the quality of management further, which is why we have asked General Sir Gordon Messenger to lead a review of leadership in health and social care.

[Dr Poulter]

I refer to my earlier declaration about my entry in the Register of Members’ Financial Interests, as a practising NHS doctor. On the point that the Minister just made, of course we want to promote clinical leadership in the NHS in senior management positions, because we know that that benefits patients and leads to efficiencies, but we also need to consider the fact that although there are many good NHS managers, a lot of them have never had experience of life outside the NHS. I wonder whether my hon. Friend the Minister could briefly say how we can draw in better business experience and other experience, so that NHS managers have broader experience, and can bring that benefit to the NHS and drive efficiencies.

--- Later in debate ---

[Gillian Keegan]

I have heard exactly the same point being applied to many different industries, even politics—how many people come from business into politics, or go from politics to business? That crossover between the public sector and the private sector, including bringing particular skills and learning from one to the other, is not done nearly enough, which is why I spend a lot of my time trying to get more business people involved in politics. However, I am sure that it is a challenge for people to do that, because I guess that people tend to get stuck in the way that they know and go up the career ladder in the world that they know, so there is too little crossover. I guess that the recruitment companies have something to answer for here. They look for square pegs for square holes—namely, people to do what they have already done, so that there is a natural progression.

Nevertheless, we need to encourage that crossover. If we put out a call to say, “Actually, we really do want businesspeople to join us and help us,” I am sure that many businesspeople would be interested in having a second career in public service, as we ourselves are all doing here in Parliament.

As I was saying, General Sir Gordon Messenger will review leadership; the terms of reference for that review are being developed right now.

There is no doubt that covid has had a severe impact on NHS productivity. Covid significantly increased costs for the NHS, while we also had to stop some regular activity, so productivity was obviously much lower than it would have been otherwise; indeed, many patients did not even wish to attend in-hospital services. Of course, covid made more stringent infection prevention and control measures necessary. Those measures, such has having to put on and take off personal protective equipment, slow staff down and limit the number of patients they can see, and will probably continue to hold down productivity in the immediate future. We know that that has happened, with the existence of green zones and red zones, and other new processes to try and control infection during this period.

We do not yet know what impact covid has had on NHS productivity, but we expect that it will turn out to be large and negative. The ONS estimated that public service productivity as a whole fell by 22.4% between July 2020 and September 2020, compared with the same quarter a year earlier. Even as productivity recovered, it was still 9.8% lower in the first quarter of 2021 compared with Q1 in 2019. Covid has definitely had a massive impact on productivity, and it is reasonable to expect that the impact on NHS productivity will be similar.

At the same time, however, the pandemic has been a spur for innovation. Across the NHS, clinicians said that the pandemic offered an opportunity to cut through bureaucracy and try new ways of working and new ways of partnering with local services. In London, the hospitals worked together and, as my hon. Friend the Member for Peterborough mentioned, their Getting It Right First Time programme will pilot a new approach to high-volume, low-complexity surgery. That is now being rolled out across the NHS. My hon. Friend also mentioned budget numbers, but it is not easy to compare like with like, because that programme has been integrated into the NHS Improvement budget and is now embedded within the plan for elective recovery, so that is where the finances are coming from.

Trusts will be benchmarked against the programme standards for surgical productivity through the model hospital system, and NHS England and NHS Improvement have set up a beneficial changes network to collect evidence of innovation during the pandemic. The network has distilled 3,000 submissions and 700 examples of recognised beneficial changes into 12 high-impact change areas, which will now be rolled out to the NHS. That is something good that has come out of the pandemic through the need to work together to face challenges.

As the NHS begins to recover, increasing productivity is more important than ever. Many patients could not receive the care they needed during the pandemic, and the NHS faces unprecedented waiting lists. We owe an immense debt of gratitude to NHS staff, who have worked so hard to care for patients throughout the pandemic, but the NHS now needs to use the investment that we have provided to deliver more care more effectively and to remove the burden from staff. This year, we are providing £2 billion through the elective recovery fund to increase activity levels, and £700 million through the targeted investment fund to fund improvements in surgical productivity and digital productivity tools. Digital will be a big feature—we have all learned a lot during the pandemic.

We have announced a further £1.5 billion to build surgical hubs across the country in order to develop new models of care and increase productivity, which is being piloted by GIRFT and the London region. Some £2.3 billion has been allocated to transform diagnostics by rolling out at least 100 community diagnostic hubs and investing in digital diagnostics that will deliver 10% higher productivity. Another £2.1 billion has been allocated to digitise frontline services and free staff from admin tasks, so that they can spend more time with patients—something that was mentioned by my hon. Friend the Member for Bosworth.

Our aim is to return productivity to an ambitious trajectory, so that we can deliver on our ambitious plan to build back better and to clear the waiting list, but also to build an NHS that is fit and able to cope with the demands of the future. Of course, we have more work to do on integrating social care and developing best practice so that the systems work well together. It is not over and we have a lot of work to do, but I am sure that with all the measures that we have put in place, my hon. Friend the Member for Peterborough will feel satisfied that the NHS is continuously looking at continuous improvement.

NHS Allergy Services

Gillian Keegan Excerpts

Friday 29th October 2021 Commons Chamber

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

I thank the hon. Member for Dagenham and Rainham (Jon Cruddas) not only for securing this debate on this important issue but for arranging for me to meet, on Wednesday, the wonderful APPG to receive a copy of its report in person.

The Government recognise the challenges faced by people with allergies and are taking a number of actions to further support them. Allergies affect around 20 million people in the UK. For most, they are mild, but for some they are severe and can be fatal. That was the case for 15-year-old Natasha Ednan-Laperouse, who sadly passed away in 2016. Thanks to the tireless work by Natasha’s parents, Tanya and Nadim, and their charity, the Natasha Allergy Research Foundation, Natasha’s law came into force in October this year. That milestone legislation sets out the legal requirement for all food retailers and operators to display full ingredient and allergen labelling information on every food item they sell pre-packed for direct sale. This will give the millions throughout the UK who are living with food allergies and intolerances better protection and more confidence in the food they buy.

We know how important it is that healthcare professionals, people with allergies and those close to them have the information that they need about the safe and effective use of adrenaline auto-injectors—AAIs—when they are administered in an emergency situation. That is why the Medicines and Healthcare Products Regulatory Agency is developing a communications campaign to convey key messages to improve the safe and effective use of AAIs, including the need to carry two AAIs at all times.

People with allergies continue to be supported through locally commissioned services but, to support patients with more complex conditions, NHS England and NHS Improvement also directly commission some specialised services such as specialist allergy clinics.

As with all conditions, we acknowledge that we need to have the right professional support in place for people living with allergies, including national clinical leadership. We have already established a clinical reference group for specialised allergy and immunology services, chaired by Dr Tomaz Garcez, a consultant immunologist. Membership includes clinicians, commissioners, public health experts, patients and carers. They use their combined knowledge and expertise to advise NHS England on the best ways to provide those specialist services. To support clinicians in the implementation of clear care pathways, the NICE website has guidance to support diagnosis and treatment of a range of allergy conditions, including how to identify allergies, when to refer to specialist care, and how to ensure allergies are recorded in people’s medical records.

The importance of getting that right was emphasised to me when I had the privilege of meeting people on Wednesday, when the all-party group shared its report. In particular, I was personally touched by the story of the two young boys I met, Arlo and Monty, who suffer from serious allergies. The report rightly emphasises the need and the importance of having a highly skilled workforce educated in allergy diagnosis and treatment to ensure that they can appropriately support people in managing their conditions. I have agreed to meet the hon. Gentleman and other representatives from the group to discuss that important issue further. I also plan to arrange a roundtable meeting in due course, so we can understand what additional help is required.

On ensuring we have the right workforce in place, there has been some encouraging progress. However, we know that more can be done. We are working with HEE to increase the uptake in available training places. The latest figures to June 2021 show that the number of doctors, and doctors in training, in specialist allergy and immunology has increased. I know there are already many dedicated medical professionals working in allergy and immunology specialisms.

Relevant training is the responsibility of the Royal College of Physicians, with a certificate of completion of training in allergy and immunology available to support specialist allergy care. The RCP also runs an accreditation scheme, improving quality in allergy services. Currently, there are seven accredited NHS trusts in England: North Bristol NHS Trust; Nottingham University Hospitals NHS Trust; Royal Brompton and Harefield Hospital NHS Foundation Trust; University Hospitals of North Midlands NHS Trust; University Hospitals Birmingham NHS Foundation Trust; University Hospitals of Leicester NHS Trust; and University Hospitals Plymouth NHS Trust. A further 22 trusts across the UK are working towards accreditation. In addition, the British Society for Allergy and Clinical Immunology provides training for primary care staff across the country through workshops and education. The Royal College of General Practitioners has developed an allergy e-learning online resource to support CPD and revalidation, which aims to educate GPs about the various presentations of allergic disease, how to access an atopic patient, and when to investigate in primary care or refer to secondary care.

Looking to the future, we continue to invest in research to improve the health outcomes of those living with allergies. Over the past five years, the Department of Health and Social Care has awarded the National Institute for Health Research over £2 million for research into food allergies. It is currently funding two trials investigating food allergy using oral immunotherapy, including one that compares two treatments for an allergy to cows’ milk in babies and another which seeks to overcome severe allergic reactions to peanuts in adults.

This is a very important debate, and I genuinely thank the hon. Gentleman for bringing it forward. I look forward to working with him to improve services. The NHS works really hard to care for all its patients, including those suffering from allergies, mild or severe. I want to ensure that all adults and children, like Monty and Arlo, living with allergies continue to receive the best care possible and feel safe and confident in the care that they receive. We will continue to work with our delivery partners and stakeholders to ensure that we have the workforce, clinical leadership and expert guidance in place to best support those living with allergies.

Finally, I want to say a special thank you to Arlo and Monty. On Wednesday, during half-term, they gave up their time and, when most other children were out and about enjoying activities, they got here early with their parents to present the report to me. They looked fantastic and spoke very wisely. That really brought home to me the maturity of young children who have to live with allergies, with all the things they need to know and all the personal responsibility they need to take. I will do all that I can to make life better for them and others like them.

Question put and agreed to.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 19th October 2021 Commons Chamber

[Caroline Dinenage (Gosport) (Con)]

3. What steps the Government is taking to improve health outcomes for people with learning disabilities and autism.

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

I thank my hon. Friend for her work as the Minister for Care and particularly for starting the work on the Oliver McGowan mandatory training. We are currently trialling the training to improve awareness and understanding of learning disability and autism for all health and care staff. The improvement of health outcomes for people with learning disability was also championed by our dear friend Sir David Amess; I shall think of him every day in this role and try my very best to live up to his expectations.

[Caroline Dinenage]

I warmly welcome the Minister to her role, which I know she will do with great care. Will she expand a little on the roll-out of the mandatory training for all health and care professionals working in learning disability and autism, which is, as she knows, named in honour of Oliver McGowan? Will she say when it is likely to be rolled out nationwide and what sort of funding will be attached to it? Will she also say when the annual GP health checks for people with learning disability or autism are likely to be rolled out throughout the country on a face-to-face basis post covid?

[Gillian Keegan]

We have started the trials and they are well under way. We are using three trial providers. Our final evaluation report is due in spring 2022 and I would be very happy to share that with my hon. Friend. The outcomes of this trial and the evaluation will inform the plans for the roll-out across the country. I am working closely with Paula and Tom, Oliver McGowan’s parents, who, incidentally, grew up in the same place that I did—in fact, two streets away. They are key stakeholders and, obviously, we will make sure that we set out the detailed plans for roll-out as soon as possible. I thank my hon. Friend and Paula and Tom for all the work that they have done in this area; it really is remarkable and will make a massive difference. On the annual health checks for people with learning disabilities, the NHS has already met its target two years ahead of time for 75% of people on the GP learning disability register to receive an annual health check. I would urge anybody to come forward to make sure that they take advantage of that very important step.

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

The Government have not responded to the report of the Health and Social Care Committee on the treatment of autistic people and people with learning disabilities and that response is now well overdue. Sadly, there is continued evidence of ongoing abuse of people with learning disabilities and autistic people. I point the Minister to the deaths reported at Cawston Park. There was a terrible report on that recently. This needs immediate and assertive action. Autistic people and people with learning disabilities are often trapped in inappropriate units for six years on average. By delaying their response, the Government are demonstrating apathy with regard to the terrible treatment in places such as Cawston Park and other units. When will the Government respond and act?

[Gillian Keegan]

I share the hon. Lady’s concerns; it simply is not good enough. The events at Cawston Park—my first response as a Minister to an Adjournment debate was on that subject—were unbelievable and deeply traumatic. My deepest condolences are with the families of Ben, Joanna and Jon. I have committed to meeting with the families at the earliest opportunity so that I can understand their experiences directly. This is currently being arranged by officials and the Norfolk Safeguarding Adults Board. The Department continues to work at pace through the delivery board of cross-Government and cross-system partners to drive progress on implementing the Building the Right Support national plan, which is ultimately the answer to have much better support in the community. We will publish an action plan, outlining all of the plans that we have, how we will improve outcomes and how we will enable people to live well in our communities.

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

First, let me welcome my hon. Friend to her position. As chair of the all-party group on learning disability, I look forward to working with her.

On the point that the hon. Member for Worsley and Eccles South (Barbara Keeley) raised, the Government have a plan to reduce the number of people in in-patient units—the assessment and treatment units—like the one at Winterbourne View, which delivered completely inappropriate treatment. When will that delivery plan be published? Her predecessor committed to doing it four months ago; she said that there was work to be done. Can my hon. Friend set out when it will be published so that we can press the Government on delivering those ambitious goals?

[Gillian Keegan]

I look forward to working with my right hon. Friend. I have been along to the first board, although I have not yet chaired it. But we will be developing that action plan. I cannot commit to the date but I will let him know as soon as I can when we will publish the plan. We will be publishing a winter plan for the NHS, which will include lots of different support, in the next couple of weeks.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her response. Given recent statistics that show that one in 20 schoolchildren in Northern Ireland has an autism diagnosis, may I ask her what steps have been taken here on the mainland to ensure that children with learning disabilities or autism have guidance in their health journey and are never left overwhelmed without specialised support at those very necessary appointments?

[Gillian Keegan]

I thank the hon. Gentleman for his question. He is right to identify this concern. Compared with the general population, people with learning disabilities are three times more likely to die from an avoidable medical cause of death. That is why these annual health checks to ensure that we get early diagnoses for these people are so important. That is why I am delighted that many people are coming forward and that the NHS is two years ahead of its plan here in England. Hopefully, others will follow that lead.

[Nick Fletcher (Don Valley) (Con)]

4. What plans his Department has to build a new hospital in Doncaster.

--- Later in debate ---

[Damian Green (Ashford) (Con)]

7. What steps he is taking to provide a long-term solution to social care.

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

Last month the Prime Minister announced an unprecedented investment in social care to support our own futures and those of our loved ones and our growing ageing population. This investment of £5.4 billion will support the wellbeing of the 1.5 million-strong workforce, offer professionalisation and provide hundreds of thousands of training places. It will also fund supported housing, better advice and capped care costs at £86,000, removing the fear of spiralling care bills.

[Damian Green]

I am grateful for my hon. Friend’s answer, but she will acknowledge that even the promised better integration of health and social care, although very welcome, will not be enough. We need a long-term plan covering workforce issues, the use of technology, and provision whereby people can live in their own home for longer if we are to achieve ultimate success. If we do not solve all those issues, then I am afraid we will not have fixed social care.

[Gillian Keegan]

I agree with my right hon. Friend. The forthcoming White Paper on adult social care reform, which we will publish before the end of the year, will set out our vision for the sector. It will cover issues that affect care users, including housing and innovation within our housing models, access to information and advice, and funding for the workforce. I am very happy to be meeting him on 4 November in his role as chair of the all-party parliamentary group on adult social care to ensure that his insight and all the work that he and the APPG have done in this area are carefully considered.

[Liz Kendall (Leicester West) (Lab)]

I welcome the hon. Lady to her post. I listened carefully to what she said about the Government’s recent announcement. However, is not the reality, as the Association of Directors of Adult Social Services says, that all the additional money announced is going to the NHS in the first three years and little, if any, will ever make it to social care; there is nothing to deal with the overwhelming workforce pressures and increased levels of need we are experiencing right here, right now; and we will not see a single extra minute of care and support or an improved quality of life for older and disabled people or family carers? On top of this, at £86,000 the cap on care costs will not even stop people having to sell their homes to pay for care, and the vast majority of people will be dead before they ever reach the cap because it does not cover the costs of accommodation or food. How is this a long-term solution to social care, and is the Chancellor finally going to fill these gaping omissions in his Budget and spending review next week?

[Gillian Keegan]

I am sure the hon. Lady is in fact delighted that finally a Government have come forward with a plan for social care. In addition to that, this Government have spent an extra £34 billion this year in the NHS and we have raised the levy, which, as she says, will fund both the electives and the catch-up from the pandemic—we all know that many of our constituents need this—but there is also the £5.4 billion that is the biggest investment we have had in social care in this country. As things stand, one in seven adults over 65 face care costs of over £100,000 in their lifetime. Nobody will be forced to sell their home, as people will now have a very clear cap of £86,000 that will give families peace of mind that their assets will not be wiped out, and people can already take a deferred payment agreement so that their payments can be deducted from their estate after they die. Most people I have spoken to truly welcome this announcement and are absolutely convinced that this Government will introduce it.

[Siobhan Baillie (Stroud) (Con)]

We all know that when the care sector is struggling, the NHS feels the pressure, and that is certainly the case in Gloucestershire at the moment. The demand for adult social care is increasing for us locally by 4% year on year, which is higher than the average, and the huge number of requests for new care packages means that there are now delays for domiciliary care, as the market cannot respond to demand. Will the Minister, who I welcome to her new post, tell the House and the Gloucestershire care sector that the Government are working to support us? Will she meet the six Gloucestershire MPs and the leader of the council to discuss this matter?

[Gillian Keegan]

This is absolutely vital. The recent announcement of £500 million over three years to fund social care professionalisation is very warmly welcomed by the sector. It is a sector that employs 1.54 million people. It is larger than the NHS, construction, transport or food and drink. I am of course happy to meet my hon. Friend and other Gloucestershire MPs. I know this issue is a challenge. We have some short-term actions, and it is a key pillar of our long-term reform.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

With the Government introducing a health and social care levy, will the Minister ensure that social care is not at the back of the queue for spending? Can she provide clarity about every penny of Barnett consequentials that will be given to the devolved nations?

[Gillian Keegan]

I am sure that the Chancellor will be setting out what will happen with the Barnett consequentials. Yes, this issue is important. The most important thing to say is that this is the start—we have £5.4 billion over the next three years for us to embed some of the changes we need in the system, but this levy will continue, and social care will be a big part of and a big beneficiary from that levy in the future.

[Mr Peter Bone (Wellingborough) (Con)]

Will the Minister recommend what North Northamptonshire Council has just done, which is to pay its social care workers as a minimum the real living wage and to backdate that to April this year? That would be a small step in helping with this situation.

[Gillian Keegan]

Yes, I completely agree. Some 95% of the jobs are with private providers, so it is important that they take care of their workforce. There is a lot of competition for labour and a lot of skills shortages in our country. Most workers are on just above the national living wage, but it worries me that a third are on zero-hours contracts, so there is a lot we can do to improve the terms and conditions of the social care workforce. My hon. Friend raises a good leadership example.

[Sarah Olney (Richmond Park) (LD)]

8. If he will make it his policy to keep prescriptions free for people aged over 60.

Cawston Park Hospital: Norfolk Safeguarding Adults Board Review

Gillian Keegan Excerpts

Tuesday 21st September 2021 Commons Chamber

[The Minister for Care (Gillian Keegan)]

I thank my hon. Friend the Member for Broadland (Jerome Mayhew) for securing this debate on this deeply disturbing, upsetting and important topic, and for his continued work on exposing the failings at Cawston Park.

I would like to begin by expressing my sympathy for the families, friends and loved ones of Joanna, “Jon”, as he is referred to in reporting, and Ben. These are three people whose lives were cut short tragically and needlessly. The accounts of their experiences at Cawston Park Hospital, a place that should have been there to care for and support them, are heartbreaking. I can only imagine how distressing it would have been for their families and loved ones to read about the events leading up to their deaths. I send the families of Ben, Jon and Joanna my deep condolences, and I would like to invite them to meet me so that I can understand their experiences directly—I would be happy for my hon. Friend to join me in those meetings.

I would also like to thank those who have shared their experiences of the services and support at Cawston Park, and the Norfolk Safeguarding Adults Board for under-taking the review and preparing the final report. That is essential for shining a light on what has happened. I know that my officials are in dialogue with the board to identify how recommendations can be progressed as impactfully and as quickly as possible. I believe they met today.

The appalling care and practice uncovered at Cawston Park is completely unacceptable. Every person with a learning disability, and every autistic person who needs it, must receive safe and high-quality care, and they must be treated with dignity and respect. Both my hon. Friend and I have dearly loved family members who have Down’s syndrome and know many people with autism, and we are horrified to think that vulnerable people who put such trust in others for support would be treated in such an appalling way.

I recognise and acknowledge the frustration and strength of feeling about the issues raised today. The Department is working with the NHS, local government and the Care Quality Commission to ensure that we identify unacceptable care with urgency and take robust action immediately. I can confirm that Cawston Park closed in May, following action taken by the CQC, and all of the people who were in-patients at Cawston Park have moved either to a supported community setting or to an alternative hospital setting, where immediate discharge was not possible.

I appreciate that everyone listening will want assurance that anyone with a learning disability and any autistic person in one of those hospitals—any one of the 2,000 people he mentioned—is safe. NHS England’s reviews of each individual person’s care arrangements will ensure that there is a clear care plan in place with a clear path to discharge. Such treatment where there were no clear paths to discharge must not happen again.

More broadly, I welcome this opportunity to set out the work that is under way to eliminate poor-quality in-patient settings and properly invest in the community alternatives that people with a learning disability and people with autism deserve.

As the regulator for mental health hospitals, the CQC has a central role in identifying any cases of poor in- patient care and taking immediate action. The Department fully endorses the increased scrutiny by the CQC and its improved inspection approach, which includes spending more time with patients and their families to identify settings that are at risk of developing a closed culture. In particular, the CQC takes more account of what families have to say. The enhanced processes have revealed cases in which quality falls below the standards we expect. Where that is the case, robust regulatory action is being taken. We must not tolerate poor care and treatment, and any provider that cannot meet standards should be tackled immediately, including through closures.

In the report, families describe the excessive use of restraint and seclusion by unqualified staff. Any kind of restrictive practice or restraint should only ever be used as a last resort. The Department is taking action to increase the transparency and reporting of the use of restrictive practices, in response to the recommendations made by the CQC in its review of the use of restraint, seclusion and segregation. Increased transparency is a central aim of the Mental Health Units (Use of Force) Act 2018 statutory guidance, on which we have recently consulted. Work is now under way to commence the Act from November 2021.

As part our longer-term plans to limit the unnecessary detention of people with a learning disability and autistic people, we are seeking to implement once-in-a-generation reforms to the Mental Health Act. Under our proposed reforms, we will limit the scope to detain people with a learning disability or autism for treatment if there is no diagnosed mental health cause for distressed behaviour. To support that, the proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and that every local area understands and monitors the risk of crisis at an individual level. For those who continue to require in-patient care, we are clear that this should be for the shortest time possible, as close to home as possible and the least restrictive possible.

Alongside the longer-term plans to improve in-patient care and support, the situations outlined in the review of Cawston Park highlight the need for urgent action in quicker time. That will require cross-system, cross-Government action in a number of priority areas that have historically presented blockages to progress. The Government are taking action specifically to target such blockages, ranging from identifying best practice models in the community to ensuring that the right workforce with the right training is in place.

In closing, I thank Members for their contributions on this important topic and their commitment to ensuring that people with a learning disability and autistic people receive the high-quality care and support that they deserve. The CQC’s robust inspections are helping us to identify and prevent cases of unacceptable care, such as that of Cawston Park. It is our priority—and my personal priority—to reduce reliance on in-patient care. I have set out today the range of work that is under way not only to reduce in-patient numbers but to drive real change in the care that is available to people with learning disabilities and autistic people, to enable them to live fulfilling lives in the community, as we all want. All our actions will be shaped by the Norfolk Safeguarding Adults Board review report, to ensure that the experiences of Ben, Jon and Joanna are not repeated.

Question put and agreed to.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 5th May 2020 Commons Chamber

[Steve Double (St Austell and Newquay) (Con)]

What assessment he has made of the potential effect of the introduction of T-levels on the (a) quality and (b) recognition of technical education.

[The Parliamentary Under-Secretary of State for Education (Gillian Keegan)]

T-levels are based on the best international examples of technical education and, crucially, they are employer designed. They will help to raise the quality and prestige of technical education across the UK, with longer teaching hours and a meaningful industry placement. I am confident that they will provide a high-quality alternative to A-levels, giving technical education the status and recognition that it deserves.

[Steve Double [V]]

I thank the Minister for that answer. It is clear that T-levels will have a valuable part to play in ensuring that we have the workforce of the future across the economy, but the sector of the economy that is being most adversely affected by the current crisis is hospitality, and it is vital that that sector is able to access the workforce that it will need to recover, particularly in a post-Brexit world, so will the Minister please consider bringing forward a T-level in hospitality as soon as possible?

[Gillian Keegan]

I agree with my hon. Friend: equipping people with the skills that they need is crucial to our economic recovery, particularly in St Austell and Newquay. To support tourism and hospitality, which are important to his constituency, we will offer T-levels in cultural heritage and visitor attractions, catering, and management and administration. I hope that, with my hon. Friend’s support, T-levels will be available soon so that young people in St Austell and Newquay can benefit from a high-quality technical education.[Official Report, 1 July 2020, Vol. 678, c. 2MC.]

[Joanna Cherry (Edinburgh South West) (SNP)]

What discussions he has had with Cabinet colleagues on support for the further and higher education sectors during the covid-19 outbreak.