In-patient Abuse: Autistic People and People with Learning Disabilities

Maria Caulfield Excerpts

Tuesday 18th April 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing an Adjournment debate on this really important issue. I hope she will see from my response that we are by no means complacent about it. It is appalling to see reports of the care and treatment that some autistic people have experienced, and we absolutely take them very seriously.

As the Minister responsible for patient safety, I have made it clear to the House that everyone in an in-patient mental health facility is entitled to high-quality care and treatment and should be safe from harm. These are very vulnerable people who should feel safe and looked after in any in-patient setting: that applies to all patients admitted, but particularly to people with a learning disability and autistic people.

When in-patient care is absolutely necessary, it needs to provide a therapeutic benefit. It should be high quality, it should be close to home, and it should be as unrestrictive and for as short a time as possible—we have been very clear about that. Abuse cannot and will not be tolerated. That is why we are committed to taking steps at a national level to prevent the abuse and poor treatment of people with a learning disability and of autistic people in in-patient settings.

As we announced in January, the Government have commissioned a rapid review, independently chaired by Dr Geraldine Strathdee, of mental health in-patient settings. The review is focusing on how we use data and evidence, on how we respond to complaints, on how we listen to feedback and on how whistleblowers can raise the alert to identify risks to safety in in-patient settings.

I have met many Members across the House with concerns about in-patient care in their constituency. We absolutely take the issue seriously. We want to ensure that the right people get the right information, so patients get the care and support they deserve, and to ensure that if there are concerns, we can identify them as early as possible.

[Barbara Keeley]

There is obviously a considerable amount of detail in both what the Minister is saying and what I covered in my speech. However, the Breightmet Centre in Bolton, where Amy was detained, has been in and out of special measures, and it is inadequate. Amy was sent back to the unit and abused further, although the centre had been declared inadequate across all its settings. I am therefore finding it difficult to align what the Minister is saying with the actual situation. The list of scandals that have emerged since Winterbourne View extends across the country. We keep finding extra hospitals in which people have been abused, including Littlebrook Hospital in Kent. The CQC is taking some action, but these places are still open, they still have patients, and patients are being abused. How does what the Minister is saying line up with the reality out there?

[Maria Caulfield]

As I have said, we instigated a rapid review in January to examine the national picture across England because we wanted to see what was being done in in-patient settings. This will include looking at the data concerning the use of restraints, the safety of patients, how concerns are flagged and how many patients are being treated out of area, because that does increase the risk. However, the review—which will report very soon—does not prevent us from investigating further particular concerns about particular in-patient units, and once it has been published we will come to the House to update Members in response to many of the points that the hon. Lady has raised about specific in-patient settings.

[Barbara Keeley]

As I have said, there has already been a review. NHS England published a report on the 1,770 individual reviews of the care of autistic people and people with learning disabilities, including children, who had been detained. As I also said, that report was commissioned following the tragic deaths at Cawston Park, and revealed that there were high levels of restrictive practice and that 41% of people did not need to be in hospital at all but could not be discharged.

Does the Minister not accept that things are going seriously wrong, and that there is not the necessary provision in the community or the necessary training of staff to work with people? I cited the case of Danielle, and I hope the Minister will look at that case, along with the hon. Member for Maidstone and The Weald (Mrs Grant), because it is an example of someone being moved around for 13 years of her life, from one inappropriate facility to another. We are destroying lives, in many cases young people’s lives, because this often starts with children and teenagers.

[Maria Caulfield]

I will come on to what we are doing to try to keep people out of hospital, and to get others discharged. We fully recognise that there are too many people in in-patient settings at present, but we also want to ensure that when people are in an in-patient setting and need to be there, the service is safe and they do not come to harm.

NHS England has established a three-year quality improvement programme which seeks to tackle the root causes of unsafe, poor-quality inpatient care. We all acknowledge that there has been practice that has caused harm to patients. We want to see the picture across the country, and then look at specific trusts that are not providing the standard of care that patients and their families expect. Baroness Hollins is overseeing independent care and treatment reviews relating to people in long-term segregation, and a senior intervener pilot has been undertaken to help individuals in the most restrictive settings to be moved towards discharge. Work is being done to examine the specific units about which we have concerns.

The CQC, which the hon. Lady mentioned, has a central role in identifying cases of poor in-patient care and taking immediate action when that is necessary. We acknowledge that some settings are not delivering the high quality of care that everyone deserves, and we want to ensure that we are setting standards so that units, integrated care boards and commissioners are aware of the standards that should be expected and can raise concerns when they are not being met.

[Barbara Keeley]

As I said towards the end of my speech, around one in 12 of the 2,000 autistic people and people with learning disabilities being held in these inappropriate units are being held in units rated by the CQC as inadequate. The Breightmet Centre in Bolton, run by ASC Healthcare, has been in and out of special measures and is rated inadequate. Why is the Minister allowing people to be held in those units? She is talking about setting standards, but that is not an adequate standard. Would it not be a good place to start to say that no one with autism or learning disabilities can be held in a unit that is rated inadequate? That is an incredibly low bar.

[Maria Caulfield]

Admissions to services that are rated inadequate are an absolute last resort, and they should be being done with patients and their families being consulted and consenting to being placed in those units. We are minimising the number of new admissions to a unit that has been rated inadequate and we are working with the CQC to see how those units can be better supported to improve the quality of the service they offer.

The hon. Lady touched on funding. We are investing £121 million in this financial year across community support for people with learning abilities and autistic people as part of the NHS long-term plan. We are recruiting 27,000 mental health workers and we are on track to meet that target to increase the support available in the community. It is absolutely the solution to look after people in their communities with the care that they need so that admission to hospital—which, as she points out, is often not just for days or weeks or even months—is the absolute last resort.

The hon. Lady touched on the Building the Right Support action plan. We are drilling down on implementing the actions. We have short-term and long-term actions, and some of the work has had an effect already. At the end of February this year, the number of people with learning disabilities and autistic people in a mental health in-patient setting was 2,045, so we are seeing a reduction. That is a net decrease of 860 people, or 30%, since March 2015. Unlike someone with a physical health need, which can be quite complex in terms of planning their discharge, it is not just a case of finding people homes; they often have to have the right support in those homes. It is not just a case of providing them with support, because they often need complex support. The in-patients who still need to be discharged are the more complex cases, who, as the hon. Lady has pointed out, have often been in hospital for years. Adapting to moving back into the community is not an easy process for them, and that is why it is taking time to get them the packages of care that they need.

[Barbara Keeley]

I just wonder how the Minister can reconcile the figures as if they were increasing when I have told her that we found, through written parliamentary questions trying to get to the financial picture, that the investment in community services actually fell between 2021-22 and 2022-23, from £62 million to £51 million. With rocketing inflation and soaring costs to providers, that funding needs to increase.

I recommend that the Minister consider the issue of dowries, as was suggested in the Health and Social Care Committee’s report on this issue a few years ago. Time and again we find situations where a county council or urban council responsible for social care does not have the funding to provide that support. Millions and millions are being spent. We do not even know how much these placements cost, but some of them are very expensive. I am sure the Minister is aware of how expensive they can be. Decades ago, when we discharged people from long-term psychiatric institutions, a dowry accompanied them. We talked about Danielle’s case. If there were a system of dowries, Kent County Council could have the funding to provide her with housing and support. I have never understood why such a system has not been brought in. We included that in our Select Committee report. Cost-shunting is really a factor here. Local authorities do not have to fund an NHS England place, and that is part of the problem, yet we never get around to tackling that.

[Maria Caulfield]

The hon. Lady is right; a number of organisations are responsible for caring for people in the community, and it is often about pulling those organisations together. That is why we have the integrated care boards, which now have responsibility for looking after people with learning disabilities or autism and helping with their discharge.

[Barbara Keeley]

It is not just about responsibilities; it is also about the budget to go with those responsibilities. If the budgets were transferred from NHS England, which is shelling out millions for these inappropriate units, to the ICBs, I could see it working. It certainly worked all those years ago for discharges into the community. I was a councillor and vice-chair of social services in Trafford, and we might get a dowry of £1 million to settle someone from a long-term psychiatric hospital. That is the sort of funding we need to be thinking about, and it does not happen.

[Maria Caulfield]

A key reason why we sometimes find it hard to discharge someone from an in-patient setting is the housing element. We have capital funding available. I recently met ICB chairs and chief executives to encourage them to ask their local councils—particularly district councils, which do the planning element—to consider the funding that is available. The county councils, the upper-tier authorities, are often responsible for care, so it is about joining up the funding, but we are not building the right type of housing to support people back into the community. The capital funding is there. Sometimes one of the frustrations is making sure that the money flows with the patient so that they are able to get the care they need, but sometimes the money is there and it is about joining up the services to make it happen.

[Barbara Keeley]

Is the Minister saying that there is unspent money that could be used or transferred to local authorities? If so, how much is available? I have asked written questions about this, but it seems to me that the money has tailed off. Whether it is money to help pay for housing or money to pay for workforce improvements, the Government have halved the funding. People need housing and they need support, and those elements have been cut back.

--- Later in debate ---

[Maria Caulfield]

There is capital funding available to build supported housing for people with a learning disability or autism, which is why I recently encouraged a number of ICBs to make bids for funding at a local level.

We have made good progress on reducing the number of people with a learning disability in mental health hospitals. We are not where we want to be. Of course, we want every person who is able to be discharged to be either at home or in the community. I recognise that there is work to be done, but the number of in-patients with a single diagnosis of a learning disability and the number of in-patients with both a learning disability and autism are down from March 2015.

I am very happy to keep the hon. Lady updated on the work we are doing. We will be meeting the Building the Right Support team again very soon for an update on progress, but I recognise her point. The two elements for me are that we need to get more people out of hospital, whether by providing the care and support they need through the 27,000 extra mental health staff and by focusing on building resilience in the community, or, when someone needs to be an in-patient, by making the experience as safe and as therapeutic as possible. I have previously made it clear from the Dispatch Box that we will not accept poor care in in-patient settings. Once the independent rapid review reports back very soon, we will set out the next steps to improve safety in such settings.

[Barbara Keeley]

The Minister has mentioned the Building the Right Support delivery board, and I have said that I see it and the plan as vacuous and unambitious. It has been derided by the organisations in the sector that work with it. There is not a lot of confidence in it. I have also quoted to her something that we found out by asking questions about it: the delivery board, which is meant to be driving cross-departmental Government action on this important area to those 2,000 people and their families, has met for only six hours in the 22 months since it was established. How is that enough? It is not exactly a powerhouse is it, with six hours of meetings in all that time?

[Maria Caulfield]

The work goes on in between the meetings. The meeting reports back to update members of the board on specific areas, but the work is happening on a daily basis to both improve the safety and quality of the care that patients are receiving, and to get patients home where they are able to be discharged. That is our absolute focus. I will be able to update the hon. Lady further once the rapid review is completed very soon, and I absolutely take her points on board.

I do not want anyone to be in an in-patient setting unless they absolutely have to be, and if they are in such a setting they should be receiving good-quality, safe care, so that family members and friends can be reassured that their loved one is being looked after well. No one wants that more than me.

Question put and agreed to.

Covid-19 Vaccine Update

Maria Caulfield Excerpts

Monday 17th April 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

His Majesty’s Government (HMG) are committed to protecting people most vulnerable to covid-19 through vaccination as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI).

On 6 April 2023, HMG accepted advice from the JCVI that clinically vulnerable children in England aged 6 months to 4 years should be offered a covid-19 vaccine. I am informed that all four parts of the UK intend to follow the JCVI’s advice.

Although young children are generally at low risk of developing severe illness from covid-19, infants and young children who have underlying medical conditions are over seven times more likely to be admitted to paediatric intensive care units compared to those without underlying medical conditions.

Over 1 million children aged 6 months to 4 years in the US have received at least one dose of the Pfizer-BioNTech covid-19 vaccine since June 2022. Data from the US showed no new safety concerns and the most common side effects reported were similar to those seen with other vaccines given in this age group, such as irritability or crying, sleepiness, and fever.

The UK’s independent medicines regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), approved the Pfizer-BioNTech infant vaccine for children aged 6 months to 4 years on 6 December 2022 after assessing the safety, quality, and effectiveness of the vaccine against MHRA’s robust standards.

Following this authorisation, the JCVI advised that children aged 6 months to 4 years who are in a clinical risk group (as defined in the UK Health Security Agency Green Book, which sets out information for public health professionals on immunisation) should be offered the vaccine. The JCVI does not currently advise offering covid-19 vaccination to children aged 6 months to 4 years who are not in a clinical risk group.

The JCVI has advised that eligible children should be offered two doses of the vaccine, with an interval of 8 to 12 weeks between the first and second doses. The NHS in England will begin offering vaccinations to those eligible in England from mid-June.

I am now updating the House on the liabilities HMG have taken on in relation to further vaccine deployment via this statement and accompanying departmental minutes laid in Parliament containing a description of the liability undertaken. The agreement to provide indemnity with deployment of further doses increases the contingent liability of the covid-19 vaccination programme.

The extension to this cohort of children aged 6 months to 4 years creates a new contingent liability under the indemnities in the existing vaccine supply agreement between HMG and Pfizer.

Deployment of effective vaccines to eligible groups has been and remains a key part of the Government strategy to manage covid-19. Given the terms on which developers have been willing to supply a covid-19 vaccine, we, along with other nations have taken a broad approach to indemnification proportionate to the situation we are in.

Even though the covid-19 vaccines have been developed at pace, at no point and at no stage of development has safety been bypassed. These vaccines have satisfied, in full, all the necessary requirements for safety, effectiveness, and quality.

We are providing indemnities in the very unexpected event of any adverse reactions that could not have been foreseen through the robust checks and procedures that have been put in place.

I will update the House in a similar manner as and when other covid-19 vaccines or additional doses of vaccines already in use in the UK are deployed.

[HCWS708]

Maternity Investigation: Programme Transition

Maria Caulfield Excerpts

Thursday 30th March 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

This statement updates Members on the transition of the Healthcare Safety Investigation Branch’s (HSIB’s) maternity investigation programmes.

On 26 January 2022, Official Report, 25WS, by way of a written ministerial statement, the Department of Health and Social Care announced that a separate Special Health Authority would be established to continue the independent maternity investigation programme, which is currently overseen by the Healthcare Safety Investigation Branch.

The Department is committed to ensuring the continuation of independent, standardised maternity investigations that provide learning to the system and contribute to the Government’s ambition to halve the 2010 rates of stillbirths, neonatal and maternal deaths and brain injuries in babies occurring during or soon after birth by 2025.

Following careful consideration, the Department has determined that the most appropriate and streamlined mechanism for delivering the valued and independent maternity investigations is for the function to be hosted within the Care Quality Commission. The purposes of the maternity investigation programme remain as set out last January: to provide independent, standardised and family-focused investigations of maternity cases for families: to provide learning to the health system via reports at local, regional and national level; analyse data to identify key trends and provide system wide learning; be a system expert in standards for maternity investigations; and collaborate with system partners to escalate safety concerns.

We will now work with the CQC and the HSIB to complete the transition of the maternity investigation programme to the CQC by October 2023.

As announced in the written ministerial statement of 9 February 2023, Official Report, 40WS, the establishment of the new HSSIB will take place in October 2023, to enable all the necessary work to be completed to ensure a smooth transition of these investigation programmes.

[HCWS698]

Approach to Managing Covid-19

Maria Caulfield Excerpts

Thursday 30th March 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

On 21 February 2022, the Government published, “Covid-19 Response: Living with Covid-19” which set out the plan for living with covid-19. This response has enabled the country to manage covid-19 like other respiratory illnesses, largely due to the continued effectiveness of vaccines and improved treatments. Our approach to managing covid-19 from April 2023 continues this important work.

The overwhelming majority of people in the UK now have some protection against covid-19 through vaccination and/or previous infection, but the virus will continue to evolve and variants which are immune-evading may still occur. The Government will therefore maintain a range of capabilities to protect those at higher risk of severe illness. It will also retain proportionate situational awareness through surveillance, and maintain proportionate critical resilience for the future, for example a holding of lateral flow tests, should a dangerous new wave or variant emerge.

Proportionate scale back of testing

Appropriate levels of testing will remain to support diagnosis for clinical care and treatment and to protect very high-risk individuals and settings. Lateral flow device (LFD) testing continues to be effective in detecting positive results, including of new variants, providing better value for money than polymerase chain reaction (PCR) testing at this stage of the pandemic as well as rapid results. LFDs will be used except where there is a specific clinical or epidemiological need to use a PCR test.

From April 2023 the Government will continue to fund and provide diagnostic PCR testing as part of the standard clinical management of individuals requiring covid-19 treatment (similar to other respiratory viruses) and LFD testing in the following situations:

Adult social care settings and hospices: symptomatic testing of care home residents to support access to therapeutics and for specific clinical need, symptomatic testing for staff working in hospices (which care for individuals unlikely to respond to vaccination), and outbreak testing for care homes and similar settings.

NHS settings: symptomatic testing for staff on wards caring for patients at the highest risk from covid-19 (who are least likely to mount an immune response to vaccination due to their current condition or treatment), symptomatic testing of some patients in hospital where needed to inform decisions such as ward transfers, outbreak testing and testing of all patients on discharge not care settings as appropriate.

People who are eligible for covid-19 treatments in the community: to enable access to antiviral treatments.

Individuals who live in high-risk closed settings: highly targeted outbreak testing and testing to support clinical care in settings such as prisons (and other places of detention), and homelessness, domestic abuse refuge and asylum seeker accommodation.

In line with this stage of the pandemic, routine asymptomatic and symptomatic staff testing in all settings will end. Individuals will follow the standard guidance for the population based on illness severity and symptoms. The guidance is available here:

https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19

Surveillance

The Government will maintain essential covid-19 surveillance activities in the community, primary and secondary care, and in high-risk settings, which will enable the evaluation of the effectiveness of vaccination against a range of clinical outcomes, to inform vaccine deployment, and appropriate disease management. This will be underpinned by the continuation of genomic sequencing to detect and assess severity and vaccine effectiveness against new variants in surveillance studies and where PCR testing has been performed in secondary care on a proportionate basis.

Contingency

The Government will retain proportionate capability for testing use in the event of a covid-19 wave or variant that results in a significant increase in pressure on the NHS. Laboratory infrastructure and a stock of LFDs will be maintained to provide resilience to respond, allowing for a period of additional testing for individuals at higher risk of severe respiratory illness across the NHS and the care sector. A more comprehensive response can be scaled up, should this be needed.

Guidance

Guidance published on 1 April 2022 for individuals in the community with symptoms of covid-19 or respiratory illness continues to set out the actions we can all take to help reduce the risk of catching covid-19 and passing it on to others.

Guidance on covid-19 specific testing regimes for the NHS, adult social care and other high-risk settings will be updated to reflect the latest advice from public health experts. This guidance will be published for settings to implement from 1 April 2023.

Vaccines

The covid-19 vaccination programme continues to reduce severe disease across the population, while helping to protect the NHS. Covid-19 vaccines remain available to eligible groups, and the Government will continue to consider the advice of the Joint Committee on Vaccination and Immunisation (JCVI) on future vaccine selection and booster programmes for those at greatest risk.

Devolved Governments

UKHSA is committed to work with devolved Governments to take forward the testing programme in each nation from April 2023. While UKHSA will procure and distribute tests on behalf of devolved Governments, it will continue to be up to each nation to decide their own testing policy.

Conclusion

The Government will continue to work together with our partners to keep all these measures under review.

[HCWS702]

Vaccine Damage Payments Act 1979

Maria Caulfield Excerpts

Friday 24th March 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my hon. Friend the Member for Christchurch (Sir Christopher Chope) for securing this important debate. I met him earlier to listen to many of his concerns on the issue. We know that, unfortunately, there have been some rare instances in which individuals have suffered possible harm following a covid-19 vaccination. Of course, my sympathy goes out to them and their families. The Government are keen to help those who feel that they have been affected by this issue; that is why I have agreed to meet the all-party parliamentary group and Members from across the House who have concerns on the issue.

The vaccine damage payment is a one-off, tax-free payment to individuals who have been found, on the balance of probabilities, to have been harmed by any vaccine, including covid vaccines. It was established over 40 years ago, and provides support to those who have experienced severe disablement that could have been, on the balance of probabilities, caused by a vaccine against one of the conditions listed in the legislation. The NHS Business Services Authority took over the scheme in November 2021 to try to improve the process, and speed up the response to and assessment of applicants. Assessments are done on a case-by-case basis by experienced, independent medical assessors, who have undertaken specialised training in vaccine damage and disability assessment. That is partly why the process can take so long. I will touch on the other reasons.

My hon. Friend raised concern about the payment of £120,000. I have listened to his point; indeed, it was raised at Prime Minister’s questions this week. It is important to note that the amount is a one-off, lump-sum payment. It is not designed to cover lifetime costs for those impacted. It is in addition to other support packages, such as statutory sick pay, universal credit, employment and support allowance, attendance allowance and personal independence payments. Also, it has increased since the scheme was put in place; it was just £10,000 in 1979. The amount has been raised several times, the current level having been set in 2007. The amount will be kept under review. I will take away the points that my hon. Friend made in this debate and in our meeting beforehand. As he is aware, a successful claim under the scheme does not preclude individuals from bringing a claim for damages through the courts. There are a number of claims under way, and I cannot comment on those specifically.

My hon. Friend also touched on the 60% disability threshold, which was lowered from the initial 80% threshold in 2002, to remain aligned with the definition of severe disablement set out by the industrial injuries disablement benefit, so that there is consistency across the board. Only 67 of more than 4,000 rejected claims were rejected as not being eligible for the scheme, on the basis of not meeting the 60% disability threshold. Claims are usually rejected for other reasons, so the threshold is not affecting a significant number of claims. We do not see the threshold as a big barrier to those who want to make a claim but, of course, we will keep it under review as the scheme progresses.

The BSA took over the scheme in November 2021, because we found that claims were taking a while. A key issue was getting access to patient records. NHS BSA has done a huge amount of work in that short space of time. On average, it is now taking around six months to process a claim, whereas it was previously taking significantly longer. The BSA has put in place digital modernisation processes that allow for a quicker, easier and faster application process. It has also put in place a strategic research agreement so that patients who make a claim can give consent on application, which enables the team to request the patient’s records from hospitals, GPs and other organisations to be able to determine the claim.

While the new process has bedded in, NHS BSA has introduced quality standards. Although everyone has the right of appeal if their claim is rejected, we want to get it right first time. Making sure those quality assurance processes are in place means that we determine eligible claims first time. The last thing we want is for people to have to appeal because the initial assessment was not correct.

We have also increased staff numbers. The scheme had four members of staff when it sat with the Department for Work and Pensions but, because of the sheer number of claims, more than 80 people are now taking part in the process to assess claims quicker.

I hope I have been able to reassure my hon. Friend, but I will touch on some of the issues around vaccine safety in my remaining couple of minutes. I recognise that he has concerns about the vaccine, and that is why we have instigated further research. There is £110 million going into the National Institute for Health and Care Research to fund covid vaccine research, and that includes vaccine safety and the robust monitoring of adverse events. We have also allocated £1.6 million to researchers at the University of Liverpool, to understand the rare condition of blood clotting with low platelets following vaccination.

[Andrew Bridgen]

Will the Minister answer the question I asked in the Chamber last week? Why has the Medicines and Healthcare products Regulatory Agency decided to stop publishing updates to the yellow card scheme relating to covid-19 injuries?

[Maria Caulfield]

I am happy to write to the MHRA to get a response for the hon. Gentleman on that point, but I hope he will be reassured that the Government are investing in research on vaccine safety both at the University of Liverpool and at the National Institute for Health and Care Research, because we want to reassure people about the safety of vaccines.

On the VDPS, I want to reassure those making claims that the Government want to support them through the process. I have not touched on it much in my response, but I am keen to reassure those who feel they have suffered and who are struggling to get healthcare for their symptoms that we are looking at this.

[Sir Christopher Chope]

As I understand it, the Minister’s time will be up at eight minutes past 3, so can she now explain whether the Government will accept that post-vaccine syndrome is clinically recognised? Will she divert resources specifically to that issue?

[Maria Caulfield]

I am not going to commit to that specific point on the Floor of the House, but I will commit to this: if people who feel that they have symptoms from the vaccine—that includes a range of symptoms—are struggling to get the healthcare they need, when I come to the APPG I will want to look at the sort of symptoms they are experiencing and help them to get the care and support that they are struggling to get at the moment. It is the same with long covid: there is such a range of symptoms. What we have found in setting up specific long covid clinics is that they have not always been able to cover the wide range of symptoms that people have had. I am very happy to discuss that further with my hon. Friend at the APPG.

[Sir Christopher Chope]

My hon. Friend refers to long covid clinics, but people who are suffering from the consequences of vaccine damage feel that they are being treated differentially and in an inferior way. If we have clinics for long covid, why do we not have clinics for post-vaccine syndrome?

[Maria Caulfield]

I thank my hon. Friend. The point I was trying to make is that we have set up long covid clinics, but they have not always addressed the needs of those who are suffering long covid, because they have such a wide variety of symptoms. What I can say to those who feel that they have experienced side effects from the vaccine is that I am very happy to meet them, hear about those symptoms and see what more we can do to support them in getting the care and services that they find they are struggling to access at the moment. I just want to reassure my hon. Friend that I have taken his points seriously—we do not have our head in the sand. I am very happy to meet the all-party parliamentary group and those who are concerned about their experience.

We will continue to prioritise improving the operations of the VDPS: six months is the average time taken, but ideally we want to make it quicker and more efficient for those who put in a claim. We are working alongside the BSA team, who are doing an amazing job to turn around so many claims as quickly as possible within the limits of getting notes and access to information from a variety of sources. That is often challenging, particularly when there are different computer systems and some paper notes are still in operation across healthcare settings. They have a very tough job, but they are trying to do it as speedily as possible by modernising and scaling up operations to improve the experience for those who are claiming, as well as helping those who want to make a claim.

Question put and agreed to.

World Down Syndrome Day

Maria Caulfield Excerpts

Thursday 23rd March 2023 Commons Chamber

[Liz Kendall]

The right hon. Gentleman must have read the next line in my speech. Of course, it is not only an issue of staff shortages and vacancies. I think that the real issue, which the right hon. Gentleman mentioned earlier, is training. If people are not trained to understand an issue and to understand its manifestations, they will not be able to put it right. In some other areas, I have seen medical schools and universities pioneering new forms of training, in which those who have a condition and their families become part of the training module to explain what the implications are. I hope that the Minister will tell us what action the Government are taking in this regard, and whether the guidance that will be issued will involve changes within medical schools or for nurses and other healthcare professionals.

The second area in which progress is needed is social care. It is, I believe, the biggest area in which the right support for people with Down syndrome is too often lacking. Whatever Conservative Members may say, I think it is important to understand the context in which the Down Syndrome Act will be working, and to take into account the difficult situation relating to social care. Just last week, research from the learning disability charity HfT revealed that nearly half the social care providers in England have been forced to close part of their organisations or hand back contracts to councils as a result of cost pressures in the last year. More than half a million people are awaiting a social care assessment, a review, or the start of a service or direct payment, and a survey conducted by the Down’s Syndrome Association found that 43% of family carers said their adult child was in need of an assessment, with some waiting as long as two years for that basic service.

What all this means, of course, is that families tend to be left to pick up the slack, often having to leave their own jobs or reduce their hours because they cannot obtain the help that they need to look after their loved ones. The fact that there are 165,000 vacancies in the social care workforce is having an impact on the support that is available to families with Down syndrome. We need to address both the issue of the care workforce and wider reforms.

Last week, the Health Service Journal reported that there are due to be cuts in the money announced for social care reform in the 2021 White Paper. A sum of £500 million was set aside to improve the training and career progression of the care workforce, but the Health Service Journal said that that is going to be cut by half. It also said that the £300 million to better integrate housing, health and care is set to be cut, with cuts to the budgets for unpaid carers and the use of technology.

This is really important, because unless we join up services and support, people with Down syndrome will not be able to live the lives they choose. The issue of housing is critical. Just 28% of people with learning disabilities live in supported housing, yet we know that 70% of people with a learning disability want to change their current housing arrangements to give them greater independence. Will the Minister confirm whether those reports are true? Are the Government going to cut £250 million for improving the training of the social care workforce and £300 million from the budget to better integrate health, care and housing? [Interruption.] It is not a disrespectful question; it is a question that has a direct impact on the lives—

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I said it was disappointing.

[Liz Kendall]

It is not disappointing; it is my job to hold the Government to account. I would like the Minister to answer that question.

The hon. Member for Southend West (Anna Firth) mentioned help to work, which I am passionate about. Work gives purpose, independence and dignity, but only 5.5% of adults with a learning disability in England were in paid employment as of 2020, yet 65% of people with learning disabilities say they want to go out and work. The hon. Member asked about what was happening in her constituency. I recently visited the Leicester Royal Infirmary, which is doing pioneering work with Ellesmere College, a college for students with special educational needs, to give them the skills and experience they need to get to work, with pioneering apprenticeships. I visited a young woman who was working in the hospital café. I asked her what she thought, and she said that her ambition now was to set up her own café and employ others. I think that shows that if people are given the chance and the support, real progress can be made.

The Down Syndrome Act presents a real opportunity for change. It creates a duty on the Secretary of State to issue guidance to relevant authorities on how to meet the specific needs of people with Down syndrome. That will cover many of the issues I have outlined, and I hope the Minister will update us on when it will start to make an impact on the ground. I understand that the call for evidence on the Act closed in November. When will we see the Government’s response? We need to act quickly to make real progress to transform the lives of people with Down syndrome and ensure they can live the life they choose.

I would argue that wider action is needed to support the NHS and social care so that we have the investment and reform we need to improve lives, but I hope the Minister will address in detail my questions about the reports. I understand that the Government will produce an update on social care, possibly next week. Will the Minister answer my question and say whether the funds the Government promised will be available?

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my right hon. Friend the Member for North Somerset (Dr Fox) for securing the debate and for all his hard work over the years campaigning and supporting people with Down syndrome. I, too, attended the reception on the Terrace earlier this week. I met lots of people from around the country, some with Down syndrome, but with campaigners, supporters, friends and family. In particular, I pay tribute to the National Down Syndrome Policy Group and its founders, Ken and Rachael Ross, who are in the Public Gallery.

I had the pleasure of meeting the advisory team this morning in No. 10, where we held a roundtable with young people with Down syndrome. They certainly put my feet to the fire with their questions and the progress they want to see. They have joined us this afternoon, too. Florence, Harshi, Ed, Max, Fionn, Tommy, Charlotte, James, Heidi and Rula asked extremely difficult questions, and I have promised to update them on progress. That just shows the strength of feeling and the range of support from people around the country.

[Selaine Saxby (North Devon) (Con)]

As we celebrate World Down Syndrome Day and the achievement of those who suffer with Down syndrome, will the Minister join me in congratulating my constituent Jade Kingdom, who is now a Guinness world record holder as the first person with Down syndrome to complete a sprint triathlon. She overcame her health conditions to achieve this and raised £30,000 for the North Devon Hospice.

[Maria Caulfield]

That is a fantastic achievement, and I congratulate Jade on her amazing ability. I wish I could do something similar.

Tuesday marked the 12th World Down Syndrome Day. My right hon. Friend the Member for North Somerset was not able to join us on the day because he was at the UN in New York to showcase the work done in this Parliament. Many countries are now looking to us as they try to do something similar. He has not only changed the lives of people with Down syndrome in this country; he is making a difference globally, too.

As part of the World Down Syndrome Day celebrations, I am wearing my different socks to showcase the three strands of chromosome 21, which apparently look like socks and are the cause of Down syndrome. The socks highlight Down syndrome and the amazing contribution that the incredible people with Down syndrome make to our communities and society.

The hon. Member for Glasgow South West (Chris Stephens) spoke about his constituent Danielle, her son Steven and the very real issues of diagnostic overshadowing. My hon. Friend the Member for Stoke-on-Trent Central (Jo Gideon) spoke about her uncle Donald and how difficult it was for her family. She also spoke about what life was like in the past for people with Down syndrome.

My hon. Friend the Member for Ashfield (Lee Anderson) spoke about Jossie, who I am sure has a wonderful future ahead of her. My hon. Friend the Member for Southend West (Anna Firth) spoke about David Stanley and the Music Man team, who cheer us up with their wonderful performances.

My hon. Friend the Member for Hendon (Dr Offord) spoke about the dancing ability of his constituent Michael. He also spoke about Liam. I am a “Coronation Street” fan, and Liam is not currently at Roy’s Rolls, but I look forward to his next episodes because he has a good sense of humour.

It is important to celebrate people with Down syndrome and to recognise the barriers they face. It was wonderful to see the actor James Martin win an Oscar for his brilliant performance, but we must not forget why we are here today.

The Down Syndrome Act became law in April 2022, and I will now update the House on its progress. My right hon. Friend the Member for North Somerset and the Education Secretary, my right hon. Friend the Member for Chichester (Gillian Keegan), ensured the passage of the Act. We all have a responsibility to make sure it is not the end of the story by implementing the Act and getting the guidance out.

At Downing Street this morning, the young people asked when we will see those changes. We will deliver guidance for professionals working in health, social care, education and housing, to try to bring together support for people with Down syndrome. The guidance will set out tangible, practical steps that organisations should take to meet the needs of people with Down syndrome. It will raise awareness of the specific needs of people with Down syndrome, and it will bring them together with the relevant authorities to make support more easily accessible.

We launched our national call for evidence in July 2022, in the spirit of “With Us Not For Us,” and we heard from hundreds of people across the country. We had more than 1,000 responses on the needs and asks of the various communities. I thank everyone who responded or participated in the focus groups. It is thanks to them that we received so much evidence, which officials are now going through to analyse the data. We will shortly provide a summary of the key findings.

It is essential that people’s lived experience informs the development of the guidance, and that people with Down syndrome are involved at every stage. We will shortly set up a working group to oversee the development of the guidance. Once drafted, the guidance will be subject to further public consultation to make sure we have it absolutely right.

My right hon. Friend the Member for North Somerset asked some practical questions about the guidance, and we recognise that the issues and the services supporting people with Down syndrome sometimes overlap with the issues and the services supporting other people with learning disabilities and learning difficulties, which we need to consider. But I am absolutely clear that this guidance is about people with Down syndrome, because we want to help as many people as possible, to make it feasible for relevant authorities to implement this guidance in practice and to ensure that there will be oversight of it in Parliament.

We are committed to considering the inclusion of employment and other public services through the call for evidence. We heard that best practice in supporting employment and benefits services is also going to be included in the guidance. We know that employment can have a significant benefit in terms of living independently and participating fully. That is why it is so important that the Minister for Disabled People, Health and Work, my hon. Friend the Member for Corby (Tom Pursglove), has sat through this afternoon’s debate. He was also at the reception earlier in the week, along with the Education Secretary. This is a cross-Government approach, and we cannot act just with one Department on its own. That shows that the full strength of the Government is behind these changes. We will also be looking at transport and leisure facilities, and removing some of the barriers to enable people with Down syndrome to be able to fully participate in the activities that they want to do. We will be working with other Departments to consider how to best incorporate those areas into the guidance.

To ensure that the guidance is implemented in practice, every integrated care board will be required to have a named lead for Down syndrome. As my right hon. Friend the Member for North Somerset said, we want there to be a clear person accountable. The named lead will be responsible for ensuring that the Down Syndrome Act is implemented in practice. NHS England is currently developing its statutory guidance for ICBs, including for the Down syndrome lead role. Having a named lead for Down syndrome will help to ensure that the specific needs of people with Down syndrome are considered when services are designed and commissioned. One speaker this afternoon said that that would open the floodgates for change, but we absolutely need change to happen, so I do not necessarily have a problem with that. My right hon. Friend also touched on the school census. I wish to reassure him that although we have missed the deadline for 2023-24, we are looking at 2024-25 for this. We will be discussing that with the Education Secretary, because we recognise the importance of the school census and gathering that information.

I thank everyone who has taken part in the debate. It has been a consensual debate and it shows Parliament at its best when we work together to deal with these challenges. I pay tribute to the families, carers, organisations and professionals who work tirelessly on behalf of people with Down syndrome, but I pay a particular tribute to those with Down syndrome themselves. It is indeed “With Us Not For Us”—I absolutely get that message. That is why we are here today. I also want to pay tribute to the officials at the Department of Health and Social Care—David Nuttall and his team—who have got that message loudly too and are working with the community to make sure that the Act and the guidance address their needs. Next year, I am sure that we will update the House further on the progress that has been made.

Mental Health and Wellbeing Plan

Maria Caulfield Excerpts

Wednesday 15th March 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the right hon. Member for North Durham (Mr Jones) for bringing forward the debate and for all his work in this space. He is absolutely right that mental health affects us all, and for those who have a poor experience with mental health the impacts can be life-changing. He is also right that debates in this place have broken taboos and challenged stigmas around mental health, and have helped with the national conversation about mental health and why it is so important. In one sense, I violently agree with all that he said. The difference is about how we get to that place where we are looking at mental health, rather than just mental illness, and treating people sooner when they need help and support.

I believe that in the last 10 years we have seen a seismic shift in the way that we look at mental health—a shift to parity with physical health, and towards early intervention and community support, rather than waiting for someone to reach a crisis and then intervening. It has been a shift to look at mental health as well as mental illness; the two are very different, but support each other. If we get mental health right, we are much more likely to deal better with mental illness. Parity between mental health and physical health is why the major conditions strategy has mental health in it.

Huge progress is being made. We have committed to funding increases each year, from almost £11 billion in 2015 to £15 billion in the current financial year. Such a level of funding has not been seen in mental health services before, and it is making a difference. The additional £2.3 billion a year to transform mental health services in England has the aim of getting in as early as possible when people need help, and moving to community mental health services as the first port of call for people who need support.

I have seen in practice the difference that the funding and change of emphasis are making. I recently visited Hammersmith and Fulham Mental Health Unit, where community and in-patient mental health teams are working together. If someone is struggling in the community they get input from the in-patient setting, and, when someone is an in-patient, the community team are making sure they are getting the help and support they need for discharge. It is working extremely well.

I have met with police chiefs and talked about the Humberside model, which means that patients are not being taken to A&E or police cells as a first point of refuge, but are instead seen by community support teams. That frees up police time, and is a better experience for patients to quickly receive more appropriate care. That would not have been possible 10 years ago. Of course, there is work to be done, and we get huge numbers of patients who need services and want referrals, but a huge amount of progress has been made.

We recently announced £150 million to support crisis centres in local communities up and down England, so that someone who is not well has easier access to teams and support. Up to 90 mental health ambulances are being rolled out, which means that if someone is going into crisis, it is a mental health support team that responds to them, and not necessarily a paramedic, who would normally be the first responder. That is making a difference, keeping people out of hospital and making sure they are getting the right support as quickly as possible.

[Daniel Kawczynski]

The Minister will recall a conversation we had some time ago, when I was very keen for her to meet a constituent of mine from Shrewsbury who has a daughter experiencing mental health problems. They are not happy with the level of service we receive in Shropshire. I hope the Minister will commit to meet my constituent.

--- Later in debate ---

[Maria Caulfield]

I am happy to meet my hon. Friend’s constituent.

Record numbers of patients are coming forward, both through referrals and via GPs. The consequence of breaking stigmas and taboos and encouraging people to come forward early is that more people want to use the system, so it is taking longer than we would hope for them to be seen. The situation is the same in Scotland, Wales and Northern Ireland; it is not just something that England faces, which is why we are focused on increasing funding and resources. We are recruiting 27,000 additional mental health staff, and we are on track to deliver much of that in terms of support staff that are already in place.

We are also putting mental health support teams in schools. There are 287 mental health teams in place, covering 4,700 schools and colleges. They are not only helping young people who are struggling, but normalising mental health and making it as important as physical health. We teach young people about their physical health in schools—how to look after it and look for signs and symptoms of concern—but we have not done that in the past with mental health. Mental health support teams will normalise the idea that mental health wellbeing is as important as physical health wellbeing.

It is an achievement that in the major conditions strategy, mental health is on a par with other major conditions in the strategy. We cannot see patients just as people who have mental health needs, or who are suffering with a mental health illness. More than one in four patients who have mental health conditions have two or more long-term conditions, and 30% of people with a long-term physical health issue will also have a mental health problem. We cannot treat problems in isolation—seeing the individual as a cancer patient, a heart disease patient or a mental health patient. People are complex and have multiple issues.

By putting mental health in the major conditions strategy, we are matching what NHS England is doing with its Core20PLUS5 strategy. The right hon. Member for North Durham talked about inequalities. That is exactly what Core20PLUS5 does: it looks at the 20% of the population who are the most deprived and struggling the most with all their health needs, both physical and mental, and drills down into the five conditions that drive those inequalities, of which mental health is one. The major conditions strategy will mirror exactly what NHS England is doing.

[Mr Kevan Jones]

Will the Minister comment on the 5,200 responses to the discussion paper and the issue that was raised by my hon. Friend the Member for Blaydon (Liz Twist) about groups that fed into the discussion paper? How will that work, and how will charities and people in the sector be able to feed into the new strategy?

--- Later in debate ---

[Maria Caulfield]

I am not one for reinventing the wheel. Consultation work has been done, and we received a significant response. The hon. Member for Blaydon is right to point out groups such as YoungMinds, who will be in Parliament next week—I hope to meet them to follow up discussions. We will publish the previous call for evidence this spring, because we want to use that work to navigate and develop the mental health part of the major conditions strategy. This is not about undoing the work that was done before; it is about including it with physical illness. Over a third of people with severe symptoms of common mental health disorders also report a chronic physical condition, compared with a quarter of those with no or fewer symptoms of a common mental health disorder. Physical and mental health are very much interlinked, and to address one without the other would be to do a disservice to those patients.

[Rachael Maskell]

I am glad that the Minister has talked about parity of esteem, but only 8.6% of the health budget is spent on mental health. I hope that we will see a real uplift in funding for and investment in people’s mental health. Will the Minister set out the timeline for the publication of the strategy? It feels like the can is being kicked down the road.

[Maria Caulfield]

For the mental health perspective, which is the area that I work on, we will publish the previous consultation responses this spring—in the forthcoming weeks. That will feed into the development of the mental health aspect of the major conditions strategy, which we want to publish very soon. We also have the suicide prevention strategy, which will be a stand-alone strategy that will dovetail into that as well. There are record levels of funding for mental health. I am sure that more will be required, but it is not just about the amount of money; it is about how we spend it. We want to deliver on mental health ambulances, crisis centres and community support. We want to get in as early as possible.

I hope that I have been able to reassure hon. and right hon. Members that, just because this is not a standalone mental health strategy, that does not mean that we are reducing elements of the work that has gone before. It is so important to include it with those other major conditions, which is exactly what NHS England is doing with its Core20PLUS5 strategy to reduce inequalities. We hope to do the same with our strategy.

Question put and agreed to.

Health and Social Care

Maria Caulfield Excerpts

Tuesday 14th March 2023 Ministerial Corrections

The following are extracts from the debate on Autism and ADHD Assessments in Westminster Hall on 6 February 2023.

[Maria Caulfield]

NICE has a recommendation that autism assessments should be done within 13 weeks of referral and we know that in many cases that recommendation is not being met.

[Official Report, 6 February 2023, Vol. 727, c. 242WH.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield):

An error has been identified in the speech I gave.

The correct statement should have been:

[Maria Caulfield]

NICE has a recommendation that autism assessments should begin within 13 weeks of referral and we know that in many cases that recommendation is not being met.

[Maria Caulfield]

NHS England has developed a framework that is transforming learning from autism and ADHD pilot schemes into scalable action, which will improve support and care for people across the country.

[Official Report, 6 February 2023, Vol. 727, c. 243WH.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield):

An error has been identified in the speech I gave.

The correct statement should have been:

[Maria Caulfield]

NHS England has developed a framework that is transforming learning from autism pilot schemes into scalable action, which will improve support and care for people across the country.

[Maria Caulfield]

That is making a difference by supporting young people with mental health issues, but it is also about identifying whether they could have an ADHD or autism diagnosis and getting them into the system much more quickly.

[Official Report, 6 February 2023, Vol. 727, c. 243WH.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield):

An error has been identified in the speech I gave.

The correct statement should have been:

[Maria Caulfield]

That is making a difference by supporting young people with mental health issues, but might also include identifying whether they could have an ADHD or autism diagnosis and working as part of an integrated referral system by getting them into the system much more quickly.

[Maria Caulfield]

I will touch on a final point, raised by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), which was that ADHD is under-diagnosed in women and girls. She is absolutely right, and that is because the symptoms and signs are very different in girls as opposed to boys and men. We are looking at that in the women’s health strategy.

[Official Report, 6 February 2023, Vol. 727, c. 244WH.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield):

An error has been identified in the speech I gave.

The correct statement should have been:

[Maria Caulfield]

I will touch on a final point, raised by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), which was that ADHD is under-diagnosed in women and girls. She is absolutely right, and that is because the symptoms and signs are very different in girls as opposed to boys and men. We are looking at sex-differences in health conditions in the women’s health strategy.

International Women’s Day

Maria Caulfield Excerpts

Thursday 9th March 2023 Commons Chamber

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

It is always an honour to speak in this debate and celebrate the wonderful achievements of women. I thank the right hon. Member for Basingstoke (Dame Maria Miller) for proposing the debate and the Backbench Business Committee for securing it. I associate myself with her remarks celebrating women in this place for all of their achievements. So many trailblazers have been mentioned: Betty Boothroyd, my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), Barbara Castle, Maureen Colquhoun and many more. But we need many more. As my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) said, on the Opposition Benches we are proud of the fact that more than half of our representation is female. We need to see that change across all parties and extending away from this place into local government. It was wonderful to hear many Bristolian examples from my hon. Friend the Member for Bristol South (Karin Smyth), and from right across the country, of women in local government, but we need many more.

I thank everyone who has spoken in this debate, and above all my hon. Friend the Member for Birmingham, Yardley (Jess Phillips). She delivered, yet again, her powerful memorialisation of the women killed over the past year. It was an honour, yet again, to have some members of the families of those individuals join us in the Public Gallery. There can be no starker or more sobering illustration that so many women still lose their lives to male violence and far too many others are still living in fear of it. Let us compare our situation in safety here to the situation that those women remain in right now, in our country, in their homes, in their workplaces and on the street.

I am grateful to my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) for speaking so authoritatively about the behaviour of male perpetrators and the need to end their impunity, including when they commit gateway offences such as exposure. I am also grateful to my hon. Friend the Member for Vauxhall (Florence Eshalomi), who was absolutely right that we should call a spade a spade, and a murderer a murderer. As the hon. Member for Thurrock (Jackie Doyle-Price) rightly said, these are not soap operas but despicable crimes and despicable criminals. That must always be the case in the broadcast and print media, as my hon. Friend the Member for Brent Central (Dawn Butler) so powerfully set out in her contribution. That must also be the case on social media, and I associate myself with the remarks from my hon. Friend the Member for Erith and Thamesmead.

We need stronger action against violent misogyny online. I am afraid that the Online Safety Bill is simply not tough enough to deal with that cancer in our society. We need more action on policing and in other areas on criminal justice, too. Police-recorded rape and sexual offences are at record highs, but just 1.5% of recorded rapes lead to convictions. More than two thirds of women have experienced some form of sexual harassment in a public space, and 86% of 18 to 24-year-olds.

The criminal justice system is in disarray, I am afraid to say; we all know that, because as constituency MPs we see it in our casework every single day. Women’s refuges—those that are still open—are full. Women and girls are being put at risk. Many of us will question, as hon. Members have done today, why there was no mention of making Britain safer for all in the Prime Minister’s five key priorities.

No one believes that ending violence against women and girls will be easy, but we certainly cannot do it with short-term, sticking-plaster solutions. We need a comprehensive approach. That is why Labour’s cross-cutting Green Paper “Ending Violence Against Women and Girls” sets out our plan to embed action across every Department. It includes proposals for a new street harassment law, tougher sentences for rapists and whole-life tariffs for those who rape, abduct and murder. It includes having domestic violence specialists in every 999 control centre. It includes making misogyny a hate crime. It would ensure the compulsory vetting of police officers in every police force. We would give victims access to the justice that they deserve. We really cannot delay.

Nor can we delay in other areas that are critical to women’s lives. Previous Labour Governments did not delay: they introduced the Equal Pay Act 1970, the Sex Discrimination Act 1975 and of course the Equality Act 2010. We are determined to go further. We will match that record and go beyond it by putting women’s equality at the heart of everything we do, and we will start by taking action on the gender pay gap. It is disturbing that that gap has increased by 12% in the past two years alone.

[The Minister for Women (Maria Caulfield)]

indicated dissent.

[Anneliese Dodds]

Those are ONS statistics. We need proper action to eliminate that inequality for women, so I am delighted to be working with my right hon. Friend the Member for Leeds West (Rachel Reeves) and with Frances O’Grady to review how we can go further and faster to close the gap. We also need action so that flexibility for women in the workplace is not just in the hands of employers. We need equal pay comparisons between employers, not just within a single employer. We need a modern childcare system, as my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) has ably set out.

As I have the floor for a few more moments, I want to talk about a group of women who rarely get a hearing in this place. I am talking about midlife women: women in their 40s, 50s and 60s. They experience a series of immense pressures—they are often expected to hold down a job, care for elderly parents and support older children—but when we look at how they are faring economically, we can see that over recent years things have moved backwards for them. In the past decade, women in their 40s and 50s have seen their real wages fall by almost £1,000 a year. Since the pandemic, 185,000 women between 50 and 64 have left the workforce at a cost of up to £7 billion to the British economy.

--- Later in debate ---

[The Minister for Women (Maria Caulfield)]

May I thank right hon. and hon. Members for their contributions this afternoon? I particularly thank my right hon. Friend the Member for Basingstoke (Dame Maria Miller) for securing this debate and for her work every day of the year on championing women’s rights. I thank all hon. Members who have spoken so passionately today about the issues on which they are campaigning on behalf of women up and down the country.

As my right hon. Friend pointed out, many women who have gone before us have led the way to our being here today. The hon. Member for Erith and Thamesmead (Abena Oppong-Asare) mentioned Baroness Boothroyd, but there have also been women such as Margaret Thatcher, the first female Prime Minister, who broke that glass ceiling. Unlike the shadow Minister, the hon. Member for Oxford East (Anneliese Dodds), I am not afraid to compliment and pay tribute to female Members on the other side of the House. A personal heroine for me was Mo Mowlam. The hon. Member for Bristol South (Karin Smyth) spoke about how women have been erased from photos and others have often taken the credit for their hard work; Mo Mowlam was instrumental in delivering peace for Northern Ireland, but she is very often forgotten when we talk about issues around the Northern Ireland protocol. However, she is very much remembered for the work that she did.

My right hon. Friend the Member for Chelmsford (Vicky Ford) said that there is a special place in heaven for men who stand up for women. Today I want to remember Sir David Amess, who usually spoke in these debates; I think particularly of his work on endometriosis. I am sure that he would be very pleased to see his successor, my hon. Friend the Member for Southend West (Anna Firth), taking part in this debate. It has also been great to see my hon. Friend the Member for Worthing West (Sir Peter Bottomley) spending most of the afternoon in this Chamber to listen to women speak about the issues that we face. We are very lucky to have such a Father of the House who respects female Members.

On International Women’s Day yesterday, I was particularly pleased that so many Departments were able to showcase the work that has been done and make announcements on tackling the issues that women face, many of which have been raised today. The Foreign, Commonwealth and Development Office launched its first international women and girls strategy yesterday, which highlights the work being done globally to tackle threats to gender equality across the world. From climate change and crisis to conflicts and coronavirus, those threats disproportionately affect many women in certain countries; hon. Members have spoken particularly about Iran and Afghanistan today. Significant work is going on to support women across the world.

I want to touch in particular on the issues facing the women of Ukraine. I had the great pleasure and honour of meeting the First Lady, Mrs Zelenska, this year. While of course planes, weapons and resources are important, her plea to us in this place was to make people aware of how rape is being used as a weapon of war against women in Ukraine—there are young girls, women, older women and elderly women who are being raped as part of the war against Ukraine.

I am pleased that the UK has cemented its position as a leading global actor standing up for women who are under attack. We know the scale and severity of gender-based violence at times of conflict and insecurity. I am proud that the UK is recognised internationally for the preventing sexual violence in conflict initiative, committing £60 million to preventing and responding to conflict-related sexual violence since 2012. Last November the UK hosted the PSVI international conference in London, with more than 1,000 delegates, and secured new political declarations with 53 countries and 40 national communities. That is incredible work.

However, this debate has mainly focused on the domestic issue of the gender-based violence that women and girls are experiencing up and down the country. We heard a very moving speech from the hon. Member for Birmingham, Yardley (Jess Phillips), who highlighted the sheer scale of the women who have been murdered in the past year. The right hon. Member for Kingston upon Hull North (Dame Diana Johnson) described the terrible, tragic case of Libby Squire, and the hon. Member for Livingston (Hannah Bardell) told us Wendy’s story about her daughter Aimee. Members cannot have failed to be moved by that.

Of course we are doing great work in improving the experience of women. We have announced the awarding of grants to rape crisis centres in England and Wales to set up a national telephone support line, open 24/7, which was launched on 7 December, and we are providing £27 million to recruit more independent sexual and domestic violence advisers. Despite all that, however, there is clearly a significant problem. Violence against women and girls was included in the women’s health strategy because it is not just a criminal issue or a justice issue. I was pleased to see both my right hon. Friend the Member for Charnwood (Edward Argar), the Minister for Victims and Sentencing, and the Under-Secretary of State for the Home Department, my hon. Friend the Member for Derbyshire Dales (Miss Dines), in the Chamber earlier to hear about this staggering problem.

[Sarah Owen (Luton North) (Lab)]

I have listened intently to the debate, and it is an honour to be able serve alongside such fantastic female representatives on both sides of the House. The Minister is talking about eradicating sexual and domestic violence from society. Does she agree that we should not be rewarding, in any way, any perpetrators of that sort of abuse and violence?

[Maria Caulfield]

I absolutely agree. As I have said, that is why we included violence against women and girls in the women’s health strategy, and as we approach the first anniversary of the strategy, I am keen for us to move towards making that our priority for the second year, working across Government. I am happy to work across parties as well, because this is such an important issue. Despite all the strategies, plans and—let us be fair—significant funding, we are still not making progress in the areas in which we want to make it. We have been presented with many images, but I was particularly struck by what was said by the hon. Member for Brent Central (Dawn Butler) about the way in which language is used to describe both female victims and their perpetrators, which suggests that an offence of that kind can be justified—that it simply happened, that it was a mistake, and that it was not all that significant. That has to change, which means changing the culture as well as creating the infrastructure to support it. I am keen for us to make progress on that in the next 12 months.

[Jackie Doyle-Price (Thurrock) (Con)]

I am very interested by what my hon. Friend has just said. She referred earlier to putting violence against women and girls at the heart of the health strategy. If we are serious about increasing the rate of convictions for rape and sexual violence, and indeed domestic violence, we should bear in mind that women report being treated like pieces of evidence. What we need is wraparound therapeutic support for victims, so they are not re-traumatised every time they try to obtain justice. Will that be a large part of what my hon. Friend is doing?

[Maria Caulfield]

Absolutely. We do need to look at how we support women, and that includes female MPs. I am thinking of Rosie Cooper, who simply left the House of Commons because of what she had experienced. She has gone on record as saying that she did not feel safe continuing.

[Wera Hobhouse]

Will the Minister give way?

[Maria Caulfield]

I do not have a huge amount of time, but I will give way a couple more times.

[Wera Hobhouse]

I will be very quick. The police are saying that they need to move away from viewing the victim as a credible witness, and move on to the perpetrator. Too often, the perpetrator gets away while the police are investigating the victim.

[Maria Caulfield]

I entirely agree. This is about changing culture as much as about changing the structure of services: we have seen plenty of evidence of that. Let me also pay tribute to the hon. Lady for her private Member’s Bill, which will tackle sexual harassment in the workplace. She has done tremendous work on the Bill, and we hope that it will make swift progress in the other place.

[Vicky Ford]

The issue of spiking has, unfortunately, been coming up in my constituency. If the perpetrators are to be caught, it is important for victims to come forward quickly and provide physical evidence, such as a urine sample, within 24 hours. I wonder whether there is more that my hon. Friend could do, using her own voice, to get that message out to victims.

[Maria Caulfield]

Yes, absolutely. That is why we need a cross-Government approach. We need to work with the Home Office and the Ministry of Justice team so that we have a united voice.

[Abena Oppong-Asare]

Will the Minister give way?

[Maria Caulfield]

I will give way one more time.

[Abena Oppong-Asare]

I appreciate the Minister’s generosity. I just want to put on record the work that Sistah Space has done—particularly in relation to Valerie’s law—for victims of abuse, especially black victims. The Minister’s predecessor started to do some work with me and with Sistah Space before the change of Government. Will she please continue that work?

[Maria Caulfield]

I shall be happy to do that, and we can certainly arrange to meet following this debate.

The shadow Minister was slightly dismissive of the groundbreaking Online Safety Bill. However, my right hon. Friend the Member for Chelmsford has reported that the UN special rapporteur on violence against women and girls has described it as world- leading. Many other countries are following our progress, and, indeed, may adopt similar legislation. The Bill will tackle criminal activity online. It will protect children from harmful and inappropriate content, and it aims to stop the rise of online misogyny. Several Members have mentioned the importance of that.

Let me say something about business. The UK is now successfully including gender provision in all the free trade agreements that we have made since leaving the EU. Our trade agreements with Australia and New Zealand, for instance, contain dedicated trade and gender equality chapters. That too is groundbreaking work. As for our domestic business focus, our taskforce on women-led high- growth enterprise was established last summer. I want to pay tribute to my hon. Friend the Member for Meon Valley (Mrs Drummond) for her work in the all-party parliamentary group on women and work, not just her work in pushing science, technology, engineering and maths for women, but the high-growth sector work she is doing. If we deliver more women with ambition, we will improve growth in our economy and also improve the outcome for those women as they thrive in the workplace.

We know that childcare is an issue. That is why we have spent more than £3.5 billion over the last three years on early education entitlement, and have increased the funding for local authorities to £160 million this year, £180 million next year and £170 million thereafter, to allow them to increase their payments to local childcare providers. I recognise the challenges and the cost that childcare imposes on families, but I also know how difficult it is for the providers to sustain their business model.

Turning briefly to women’s health, I am proud that in the past year we have published the first women’s health strategy for England. The hon. Member for Vauxhall (Florence Eshalomi) mentioned that in particular, and I am very keen that we make progress in that space, especially on maternity disparities. We have appointed Dame Lesley Regan as the first women’s health ambassador to lead that work. We announced yesterday that we are investing £25 million to roll out women’s health hubs across the country, providing a one-stop shop for women’s healthcare needs.

We will also level up IVF access to same-sex couples and across the board, ensuring consistent provision across the country, which does not currently exist. The HRT prepayment certificate will be launched from 1 April, cutting the cost of HRT by hundreds of pounds. We also aim to announce our pregnancy loss certificate later this summer, so that babies born before 24 weeks can be registered—an important issue for those parents who have lost babies. The major conditions strategy will look at long-term conditions such as heart disease, musculoskeletal conditions and dementia, the leading cause of death in women, which for too long have been ignored.

Finally, I want to touch on girls’ education, which it is a top priority for us in both our international commitment—we want 12 years of quality education for every girl, which is the best way to get girls and women out of poverty—and our domestic commitments. The Prime Minister in his first speech set out his ambition to ensure that all school pupils in England study some form of maths to the age of 18. My hon. Friend the Member for Thurrock (Jackie Doyle-Price) raised the issue of teaching materials in schools; the Prime Minister yesterday committed to a review of those and we will look forward to what that shows.

We need to get more women and girls into science, because, as my right hon. Friend the Member for Basingstoke said, despite getting more girls into STEM A-levels and on to undergraduate courses, we only see women making up 29.4% of the STEM workforce. That is why we are running our STEM Returners pilot; there are 75,000 people, mainly women, with experience and qualifications in STEM who are not working in the sector and who we want to see return to practice.

I hope that that showcases some of the work we are doing across the board. There are many challenges—we do not deny or shirk that fact—but we are making significant progress. In particular, domestically, on violence against women and girls, I hope that this time next year we will have a better story to tell.

Oral Answers to Questions

Maria Caulfield Excerpts

Wednesday 8th March 2023 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

1. What recent assessment she has made of the implications for her policies of the gender pay gap.

[The Minister for Women (Maria Caulfield)]

Gender pay gap reporting continues to motivate employers to look at their pay data and improve workplace gender equality, and huge progress is being made. The gender pay gap has fallen by approximately a quarter in the past decade, but of course, there is more work to be done.

[Munira Wilson]

I thank the Minister for her response. An 18-year-old entering the workforce today will not see gender pay equality in her lifetime. With the national gender pay gap at 14% and growing, will the Minister commit this International Women’s Day to ending the motherhood penalty by fixing our broken childcare system and ensuring that every family can access affordable childcare?

[Maria Caulfield]

Absolutely. It is this Conservative Government who, in 2017, introduced the world-leading regulations that have ensured that we are able to record the gender pay gap and the progress that we are making. We are also committed to the childcare aspect, which is difficult for many women. That is why we have announced additional funding of £160 million this year, £180 million next year, and £170 million the year after for local authorities to increase the hourly rates to pay for childcare, which is so important to women.

[Mr Speaker]

I call the shadow Minister.

[Maria Caulfield]

I thank the shadow Minister for that question. It is disappointing that she cannot welcome the progress that has been made, and not just in terms of the gender pay gap: we are supporting pay transparency, which is equally important in making sure women are paid the same as men. We are launching a science, technology, engineering and maths returners pilot to enable 75,000 people to return to the STEM sector, mainly women. On carers’ leave, flexible working and shared parental leave, and through supporting the hon. Member for Bath (Wera Hobhouse) with her private Member’s Bill on harassment in the workplace, there is huge progress on supporting women in work.

[Anneliese Dodds]

No apology, then, for that increase in the gender pay gap over recent years, and no real action, it seems. Other figures from the Office for National Statistics show that the gender pay gap for women in their 50s and 60s is nearly four times higher than it is for those in their 30s. Some 185,000 women aged between 50 and 64 have also left the workforce since 2020, at a cost of £7 billion to our economy. Will the Minister back Labour’s proposal for larger companies to publish menopause action plans to support women to stay in work, boost productivity and grow our economy, or will that action to support working women again just be dismissed as left-wing?

[Maria Caulfield]

I am pleased that the Labour party is getting with the programme—that it can actually define what a woman is, for a start. We will not take any lectures from the Labour party; perhaps it needs to get its own house in order before lecturing the rest of the country, because according to The Daily Telegraph in January, the Labour party paid its black workers 9% less than its white workers. It absolutely needs to get its own house in order.

[Mr Speaker]

I call the shadow SNP spokesperson.

[Kirsten Oswald (East Renfrewshire) (SNP)]

As I highlighted to the Leader of the House last week, the gender pay gap between women and men currently sits at nearly 15%. We know that women are not a homogenous group, so that gap will vary further based on intersecting characteristics, including ethnicity and disability status. Will the Minister, in line with the theme for this International Women’s Day, embrace equity by mandating gender pay gap reporting and action plans for all employers, as well as introducing ethnicity and disability pay gap reporting requirements?

[Maria Caulfield]

As I set out, this Government in 2017 set out world-leading regulations requiring larger employers to publish their average salaries, but that does not stop other employers from doing the same. We would have to pass new regulations to reduce that threshold and change the Equality Act 2010, but we are seeing all employers wanting to reduce the gender pay gap, and we are leading the way in government, with the Department for Culture, Media and Sport and the Department for Work and Pensions having eliminated that gap in their Departments.

[Wera Hobhouse (Bath) (LD)]

2. What recent assessment the Government have made of the potential merits of making misogyny a hate crime.

--- Later in debate ---

[Sir James Duddridge (Rochford and Southend East) (Con)]

3. What recent progress the Government have made on tackling health disparities.

[The Minister for Women (Maria Caulfield)]

Health disparities exist across a wide variety of conditions, from cancer to mental health, and contribute to the unacceptable variation in health outcomes. The major conditions strategy that we are launching will therefore apply a geographical lens to end the disparities in health outcomes across England.

[Sir James Duddridge]

I thank the Minister for that reply, but what does she make of the interesting comments by Sir Chris Whitty about health inequalities in coastal areas, such as Southend, and what are the Government proposing to do about those inequalities?

[Maria Caulfield]

My hon. Friend is absolutely right that there are disparities. There is an eight-year difference in life expectancy between a woman born in Blackpool and a woman born in Woking, and we want to end that. That is why our major conditions strategy is in parallel with the work that NHS England is doing on its Core20PLUS5, where we are targeting the 20% most deprived populations and the five key health conditions that are making those disparities apparent today.

[Martin Docherty-Hughes (West Dunbartonshire) (SNP)]

The average life expectancy of a woman with a learning disability is around 18 years shorter than women in the general population, so on this International Women’s Day, what can the Minister say to women with learning disabilities about the disparity in their life expectancy in Britain?

[Maria Caulfield]

The hon. Gentleman makes a very good point and that is exactly why mental health is part of the major conditions strategy. People with mental health and learning disabilities do suffer from poorer physical health, and that is why it is crucial that we do not see—[Interruption.] If he listened to me, he would have heard that I said “learning disabilities”. It is crucial that we do not see people with a learning disability in isolation, and that we look after their physical health, as well as the conditions they suffer from.

[Mr Speaker]

I call the shadow Minister.

[Yasmin Qureshi (Bolton South East) (Lab)]

Pregnant women who live in the poorest areas of England are twice as likely to die than those living in the most affluent areas. Shockingly, black women are four times more likely to die during childbirth. This Government have had 13 years, but have failed to tackle maternal health inequalities. What action is the Minister taking to address these appalling disparities?

[Maria Caulfield]

This is why we have set up the maternity disparities taskforce. We are working with the chief midwife to drive down those disparities, and we are working with NHS England. Maternity is one of those Core20PLUS5 elements, because we recognise that there is huge disparity across the country, which we want to eliminate.

[Helen Morgan (North Shropshire) (LD)]

4. Whether she has had recent discussions with her Cabinet colleagues on the impact of energy bills on disabled people.

--- Later in debate ---

[Chris Stephens (Glasgow South West) (SNP)]

T1. If she will make a statement on her departmental responsibilities.

[The Minister for Women (Maria Caulfield)]

I wish everyone a happy International Women’s Day, when we celebrate 51% of the population. I am proud of this Government’s record on supporting women, whether that is young girls playing more sport in school or the first ever women’s health strategy, which this year will see the rolling out of the prepayment certificate for hormone replacement therapy, pregnancy loss certificates this summer, and the levelling up of IVF access. Today I am proud to announce £25 million to roll out women’s health hubs across England—the one-stop shop for all women’s health needs that will drastically improve women’s experience of healthcare in England.

[Chris Stephens]

The Minister will be aware—[Interruption.]

[Chris Stephens]

The Minister will be aware of a legal agreement under the Equalities Act between McDonald’s and the Equality and Human Rights Commission over the handling of complaints of sexual harassment. Does the Minister believe that that is solely an issue of a toxic culture at McDonald’s, and will she look at whether women working on zero-hours contracts across the economy are at increased risk of experiencing sexual harassment because of depending on male managers for future shifts?

[Maria Caulfield]

We take sexual harassment in the workplace very seriously—[Interruption.] Oh, to be shouted down for the entrance of a man.

[Mr Speaker]

Order. Minister, nobody was shouted down. It happens every time, and when the Prime Minister comes it will happen again. Don’t worry—come on.

[Maria Caulfield]

I will try again, Mr Speaker. Once again, the Government are keen to tackle sexual harassment in the workplace. That is why we are supporting the private Member’s Bill promoted by the hon. Member for Bath (Wera Hobhouse), the Worker Protection (Amendment of Equality Act 2010) Bill, because it is such a serious issue.

[Simon Jupp (East Devon) (Con)]

T2.   I am proudly backing a campaign to improve services for menopause sufferers in the county of Devon. In society and at work, stigma remains a barrier to many people getting the support they require. What steps are the Government taking to prevent menopause discrimination in the workplace?

--- Later in debate ---

[Sir James Duddridge (Rochford and Southend East) (Con)]

T5. Young men often struggle with their mental health, and particularly with suicidal thoughts that can hit like a heart attack. What more can the Government do—indeed, what more can each individual Member of the House do—to help those young men?

[Maria Caulfield]

Absolutely. That is why we are setting out the suicide prevention strategy and looking at high-risk groups such as men. The Home Office is also working to set up helplines for men. Some £200,000 is going into those helplines, and so far they have supported 10,000 men who needed support.

[Stephen Morgan (Portsmouth South) (Lab)]

T4. New businesses are almost three times as likely to be started by men as by women. Does the Minister agree with Labour’s plan to work with the British Business Bank to support female founders to achieve their ambitions?

[Maria Caulfield]

The Labour party is once again late to the party, because the Conservative Government are already delivering on this. We have set up the high-growth enterprise taskforce to get more women into setting up high-growth businesses and to end the disparity in venture capital whereby, for every pound that is given, 89p currently goes to men’s businesses and only a penny to women’s.

[Mr Speaker]

Before we come to Prime Minister’s questions, I would like to point out that live subtitles and a British Sign Language interpretation of proceedings are available to watch on parliamentlive.tv.