Winterbourne View

Norman Lamb Excerpts

Thursday 29th January 2015 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

The Government’s review Transforming Care: A national response to “Winterbourne View Hospital: Department of Health Final Report (2012)” looked at why Winterbourne View happened and set out a programme of work to take every step we can, to ensure this does not happen again. The Government committed in Transforming Care to produce a report two years on to account for progress. This report is a collective account from partners across the health and care system to reflect the cross-system effort that has continued over the past year to tackle the root causes of the abuse and treatment of people at Winterbourne View.

The report sets out what has been done, providing an update in the annex of all the original actions in Transforming Care and what has been completed or is continuing. A significant number of the recommendations have been achieved. We now know how many people are in in-patient settings, where they are and who is responsible for them. NHS England has introduced care and treatment reviews for everyone in in-patient settings, with a multi-disciplinary team from health and social care, alongside experts by experience. One hundred and eighty one people are benefiting from £7 million DH capital funding to support people inappropriately placed in in-patient settings to move to more suitable housing. We have strengthened the accountability and corporate responsibility arrangements to assure the quality and safety of care services. A duty of candour which requires providers to inform service users where there are failings in care came into force for NHS providers last November, and will be extended to all other providers registered with the Care Quality Commission in this April. A fit and proper person’s test which requires providers to ensure that directors are fit to carry out their role came into force last November for NHS providers in NHS trusts, foundation trusts and special health authorities. All other providers will be required to comply by this April. The introduction of the forthcoming statutory offences of ill-treatment or wilful neglect will also send a clear message throughout the health and care system that intentionally poor care will never be tolerated. We have new guidance on minimising restrictive interventions and work is underway to improve data about the use of restraint. A more rigorous registration, assessment and inspection approach is in place for learning disability services. The Care Act 2014 enshrines new principles for adult social care including the principle of individual well-being which encompasses people having control of their day to day life, suitable accommodation and being able to contribute to society. The Act requires local authorities to consider people’s views, wishes and beliefs and focuses on the outcomes people themselves want to achieve. The Act also underpins and reinforces the importance of good quality, independent advocacy and will support people, their families and carers to raise concerns.

The report is also clear, however, that we have not made nearly enough progress to transform services. This cannot be tolerated. We recognise that there is still much more to do to reduce the need for in-patient care. There are many people with very complex needs, in many different types of in-patient settings and we need to ensure the right decisions are made about their care, listening to individuals, their families and carers. All partners involved in Transforming Care have agreed the need for a single programme to collectively drive forward the changes needed. A strengthened programme will be put in place, which takes into consideration the recommendations of Winterbourne View—A Time to for Change (2014) by Sir Stephen Bubb, and will drive a better co-ordinated approach to achieve faster and sustainable progress. The details of this approach can be accessed at: http://www.england.nhs.uk/ourwork/gual- clin- lead/ld/transform-care/.

Partnership working is essential. We are clear that this cannot all be done from Whitehall. There has to be a change in culture and behaviour in local areas. We understand that this is not easy which is why, building on learning from work over the past two years, we are determined to make a difference for people and their families in the decisions about admission and discharge from hospitals. We are looking to consult on a range of potential future measures to strengthen people’s rights in the health and care system. This is likely to include options for ensuring people’s individual well-being is at the heart of decisions in both health and social care, and issues around how the Mental Health Act is applied.

Copies of the Winterbourne View Two Years On report have been placed in the House Library. It can also be accessed at:

http://www.gov.uk/government/publications/Winterbourne-View-2-years-on.

[HCWS231]

National Health Service

Norman Lamb Excerpts

Wednesday 21st January 2015 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

My hon. Friend mentioned Professor Allyson Pollock. Is he aware that she particularly highlighted the extraordinary amount of money spent under the previous Government on the private finance initiative, mortgaging the future of the NHS to the tune of more than £80 billion? In the course of the next Parliament, that will cost more than £11 billion.

[David T. C. Davies]

I commend the professor’s book, and I hope Labour Members read it, as well as looking at the NHS comparators between England and Wales, which they obviously have not done so far. I would like Labour Members to tell us whether—if they ever are in government; I hope they will not be—they will guarantee to continue with the cancer drugs fund, which has allowed thousands of people in England to live longer and more productive lives than they otherwise would have.

The situation is not the same in Wales, where these cancer drugs are routinely denied to people. I am talking about people such as my constituent Ann Wilkinson, who is also trying to care for a very ill husband but who has been denied Avastin. She has had to find other means to get it, and other seriously ill people in Wales have had to move to England or find people’s spare rooms to sleep in.

We heard something about cuts, but the reality is that we have guaranteed the NHS budget in England while it has been cut by about 8% in Wales. Thousands of people are members of Action for our Health, a group comprising people campaigning in Wales to be treated in England. Some people say that the NHS is the envy of the world, and perhaps it is, but the NHS in England is very much the envy of Wales. To see that we need only ask the thousands of people—ordinary patients—in a campaign group who want to be treated by the NHS that is run by this coalition Government and not by the NHS that is run by Labour.

I wish to finish by saying to my right hon. Friend the Minister that I congratulate him on the better ambulance response times he is delivering in England than Labour is delivering in Wales; on the better accident and emergency turnaround times he is delivering in England than Labour is delivering in Wales; on the shorter waiting lists in England than people face in Wales; and on the cancer drugs fund, allowing people to live longer in England than they otherwise would in Wales. Most of all, I congratulate him on protecting that NHS budget—on standing up for the NHS instead of cutting the budget, as the Labour party has done in Wales. I very much hope that he is able to continue with that good work in years to come.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

The NHS across the UK, including urgent and emergency care services, is facing enormous challenges. By the end of this Parliament, there will be nearly 1 million more over-65s than there were at its start, which means substantially more patients with more complex health needs, but such pressures are not unique to England. All hon. Members need to think very carefully about how we pursue the debate on the challenges and pressures that the NHS is facing. Patients and the NHS do not need or want cynicism and party point scoring. My right hon. Friend the Member for Chelmsford (Mr Burns) and my hon. Friend the Member for Cambridge (Dr Huppert) were absolutely correct to make that point.

[Sarah Newton]

Does my right hon. Friend agree that the pioneer programme in Cornwall is really leading the way, with the provisional results showing a 41% reduction in A and E and in-patient visits?

[Norman Lamb]

My hon. Friend makes a very good point. The Cornwall pioneer programme is doing the most amazing work making innovative change, involving Age UK alongside local doctors, and it is delivering real results.

Why does the Labour party make constant claims that the NHS in England is in crisis, when the position is so much worse in Wales, where Labour is in power?

[Ian Austin]

Will the Minister give way?

[Norman Lamb]

In a moment.

Why does the Labour party claim that the reforms are to blame when there has been no reform in Wales, yet the position there is worse? What people need and want is an open and honest debate about what should be done to secure the future of the NHS. The motion is about the pursuit of votes, not the interests of patients. If Labour Members—

[Several hon. Members]

rose—

[Norman Lamb]

Let me make this point.

If Labour Members are concerned about the interests of patients, why do they not agree to the suggestion by Professor Bruce Keogh, a respected clinician, for an investigation into safety in the Welsh NHS? Why do they remain silent?

[Andy Burnham]

The Minister accuses us of bringing politics into the NHS, but did not he and his colleagues put politics at its heart when they signed up to a Tory agenda to put market forces at the heart of the national health service?

[Norman Lamb]

That is absolute rubbish. Indeed, one of the right hon. Gentleman’s predecessors, the right hon. Member for Hull West and somewhere—

[Mr Speaker]

The right hon. Member for Kingston upon Hull West and Hessle, rather than “somewhere”.

[Norman Lamb]

I apologise, Mr Speaker. The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) spoke very candidly about the role of the private sector under the previous Labour Government, which the shadow Secretary of State constantly seeks to deny.

[Ian Austin]

Will the Minister give way?

[Norman Lamb]

No. I need to make progress, and I have very little time.

In a Guardian debate yesterday, in which I took part, Peter Carter, the respected chief executive of the Royal College of Nursing, spoke of the need for political consensus

“so that we stop this ridiculous points-scoring”,

which

“frankly is destructive and does nothing to enhance the quality of the debate.”

Let us take his plea on board. I have argued for a non-partisan review of NHS and care budgets this year —whoever is in power—which would engage the public. We should all commit to that.

Labour claims that it will increase funding, but its proposed way of doing so appears to be unravelling before our eyes. Lord Mandelson has described the mansion tax as “sort of crude” and “sort of short-termist”. In the debate, the hon. Member for Hackney North and Stoke Newington (Ms Abbott) cast doubt on how much the policy would raise.

Before I address the main issues, I want to pick up the remarks made by the right hon. Member for Kingston upon Hull West and Hessle, who raised important issues about mental health. He talked about the case of his constituent, Beth. It is intolerable that she has been shunted around the country. I have met the right hon. Gentleman, and I am happy to engage with him again. It is unacceptable for this to continue to happen. That is why there is an urgent need for children’s mental health services to be reformed, and our taskforce will soon report on the essential changes that are necessary.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

I do not have time.

I am pleased that the right hon. Member for Kingston upon Hull West and Hessle endorsed the case for access and waiting times standards in mental health, which I think will have the same transformative effect as they had in cancer care when his party was in government. As my hon. Friend the Member for Norwich North (Chloe Smith) said, why is mental health not in the motion? It certainly ought to be.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

Let me make this point.

I acknowledge that several Members, including the hon. Members for Penistone and Stocksbridge (Angela Smith) and for Barrow and Furness (John Woodcock), raised distressing cases. I offer my personal sympathies to everyone who has been let down by the system. Such cases should motivate us all to strive to do everything that we can to improve how our NHS operates and to address the areas where it falls short.

The Opposition claim that the move from NHS Direct to NHS 111 has increased the demand faced by accident and emergency departments. There is no evidence to support that claim. Only 8% of calls result in a recommendation to go to A and E, and 30% of callers say that they would have gone to A and E if NHS 111 had not been available.

An accusation has been made about the impact of local authority cuts on social care. I remind the Labour party that the Government were faced with a £160 billion black hole in the public finances and had to act to sort that out. There is still no proposal from the Labour party to increase the funding for social care. The claims that it makes are hollow, without the money to go with them.

Let us look at one of the key indicators: delayed discharges from hospital. From August 2010 to November 2014, delayed days attributable solely to social care decreased from 38,324 to 37,000. The position is not as simple as some people suggest. Social care is performing incredibly well under difficult circumstances. In Cambridgeshire, there is the brilliant development of a service for older people to address their needs in innovative ways.

It has been claimed that the closure of walk-in centres has led to the current pressures on A and E. Again, we need to look at the evidence. A report by Monitor found that the reasons why local commissioners decided to close walk-in centres included that they were replacing them with urgent care centres co-located with A and E departments or other models of integrating primary care staff in A and E departments. The situation is not as simple as is suggested by the claim that walk-in centres have been closed and A and E has been left to pick up the burden.

The Opposition have said that the ambulance service is failing. In fact, ambulance services nationally are delivering nearly 2,000 more emergency journeys every day than in 2010. Ambulances respond to the majority of life-threatening cases in less than eight minutes. The Government have provided an additional £50 million to support ambulance services through this winter. It is right to take clinical advice to ensure that target response times are clinically based to avoid the unintended consequences of ambulance crews being driven crazy in the pursuit of targets, when it is patient safety that should be prioritised.

I come to the solution. In the short term, the Government have made an additional £700 million available to the NHS to cope with the pressures this winter. The right hon. Member for Tottenham (Mr Lammy) did at least acknowledge that. In the longer term, we need to focus on stopping the crises from occurring in the first place. We need a much greater focus on prevention, better integration of health and social care, and the implementation of Simon Stevens’s forward view.

I thank NHS staff for the amazing work that they do, often under great pressure, and the tremendous commitment that they make. We owe it to them and to the public to ensure that our NHS is protected and enhanced. Most people who use urgent and emergency care services receive effective, timely treatment. That is as it should be. Patients and their families should get the right advice and should get a response when they need it. We set the toughest standards in the world, and rightly so. We all know that those standards are under pressure across the UK, so let us be open and honest about that.

[Mr Alan Campbell (Tynemouth) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.

Code of Practice: Mental Health Act 1983

Norman Lamb Excerpts

Thursday 15th January 2015 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

Following a public consultation, the Government have today laid a revised Code of Practice: Mental Health Act 1983 before Parliament. We intend that the revised code becomes effective from 1 April 2015.

The code, which applies in England, is important because it underpins the Mental Health Act 1983 which affects the lives and liberty of many people with a mental disorder, impacting upon them and their families, friends and carers. In 2013-14, there were more than 53,000 detentions in hospital in England under the Act. The revised code does not include any changes to primary legislation.

The code routinely informs the practice of health and social care professionals: it helps to safeguard patients’ rights and ensures compliance with the law. The code can help make sure that anyone experiencing mental disorder and being treated under the Act gets the right care, treatment and support, knows what their rights are, what they can expect in certain situations and what to do if things are not done correctly.

Since the code was last published in 2008, there have been substantial changes and updates in legislation, policy, case law, and professional practice. The revised code now reflects and embeds developments since 2008 in areas including the use of restrictive interventions; use of police powers to detain people in places of safety; and the use of community treatment orders.

When we published “Transforming care: A national response to Winterbourne View Hospital and Closing the Gap: Priorities for Essential Change in Mental Health”, we committed to improving mental health services. “Closing the Gap” set out 25 priority actions to improve the provision of mental health care, promote recovery and the experience of patients, their families and carers. “Transforming Care” also committed the Department to review and consult on a revised code to address the need to improve the quality of care received by patients detained under the Act.

We remain committed to ensuring that high quality care is always provided for all patients treated under the Act. Care should always be a means to promote recovery, be of the shortest duration, be as least restrictive as possible and keep the patient and other people safe.

The revised is available in the Library of the House. It can also be found on the gov.uk website at: https://www. gov.uk/government/publications/code-of-practice-mental-health-act-1983

[HCWS195]

NHS Specialised Services

Norman Lamb Excerpts

Thursday 15th January 2015 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Bone. Your arrival has removed the opportunity for me to be accused of sycophancy along with everyone else who has commended your predecessor in the Chair on his knighthood. None the less, I join in congratulating him, even in his absence. It is good to see you this afternoon.

I congratulate my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) on securing this debate. His speech was impressive and compelling in making his case, and I hope that I can go some way towards reassuring him. However, I am happy to discuss with him further the concerns that he rightly raised, to ensure that commissioning is done in the best possible way.

Various hon. Members said that any change should be based only on improving care, not simply on cutting cost. Of course, everyone needs to be engaged in the debate about how we make the most effective use of money in the NHS, but we should not do things that damage care, simply to cut cost.

Before I go into the detail of my response to my hon. Friend, let me respond to some of the points made by other hon. Members. I will write to all hon. Members who have participated in the debate to deal with all the points of substance that have been made. The hon. Member for Bristol East (Kerry McCarthy), for example, made a number of key points at the end of her contribution. Hon. Members have had a good opportunity to raise concerns about specific conditions and patient groups, and they have done so constructively.

The hon. Member for Blaydon (Mr Anderson) raised important concerns about neuromuscular care and mentioned the Newcastle centre, and I would be happy to see him at one of my Monday evening MP advice sessions to discuss his concerns further. He also raised concerns about the drug Translarna. My colleague, the Under-Secretary of State for Business, Innovation and Skills, the hon. Member for Mid Norfolk (George Freeman), who is responsible for life sciences, has committed to convene further meetings to seek a resolution of the dispute, and I hope that goes some way towards reassuring the hon. Gentleman.

The hon. Member for Congleton (Fiona Bruce) highlighted the brilliant work of the RSA—an organisation based in her constituency. She said that it had raised millions of pounds for treatments and research and that it was important that such groups have a voice and are heard. I completely accept that, and I hope to provide further reassurance in due course.

A number of concerns were raised by the hon. Member for Poplar and Limehouse (Jim Fitzpatrick)—or is he a right hon. Member? [Interruption.] I think that he deserves to be called right honourable. He referred to sickle cell disease—an important condition that was mentioned by the right hon. Member for Wolverhampton South East (Mr McFadden)—or is he an hon. Member? [Interruption.] He certainly deserves to be called right honourable, and he has clearly been rewarded. He highlighted the need to improve the care and treatment of people who suffer from sickle cell disease.

The hon. Member for Poplar and Limehouse also referred to headache disorders. My wife is one of the many people across our country who suffer from headaches and migraines, so I very much understand their impact on well-being. The hon. Gentleman asked specifically about the possibility of a meeting. Again, I would be happy to see him at one of my Monday evening sessions, but I would also be happy to make sure he and his group are put in touch with officials. I am conscious that the Department’s diary up to the end of March is chock-a-block, but I am sure he could meet officials to take the matter further, as well as meeting me on a Monday evening. I hope that is some reassurance.

My hon. Friend the Member for Colchester (Sir Bob Russell) raised the issue of prescription charges. He is right that there are anomalies—there is no point denying that—and they have existed for a long time. The previous Government looked at the issue, but they did not quite get round to doing anything in relation to long-term conditions, and this Government have also not acted. The constant problem is the pressure on resources in the NHS. People on low incomes are, of course, protected, but he made a valid and legitimate point, and the debate is, rightly, bound to continue. The other point that he made, by analogy, is that any move NHS England makes on this front must not do more damage to people with long-term conditions. I hope to reassure him that that will not happen.

[Sir Bob Russell]

Will the Minister explain what possible justification there can be for somebody with cystic fibrosis having to pay a prescription charge, when they would not have to do so if they had diabetes and cystic fibrosis?

[Norman Lamb]

My hon. Friend makes a legitimate challenge. These anomalies have not been addressed so far, but they need to be at some point. I do not seek to deny his point.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) highlighted the work of Headway, which provides incredible support for people with brain injuries and their families. She mentioned the helpline and the emergency fund, which will be of enormous help to families in the incredibly difficult circumstances they face.

The hon. Member for Bristol East mentioned the Cystic Fibrosis Trust—another amazing patient organisation that does extraordinarily important work. She talked about the importance of equity of access, and it is incredibly important that that principle is maintained in any changes that take place. We do not want to return to the postcode lottery that existed in the past. Again, I am happy to try to provide responses to the questions she asked at the end of her speech.

The hon. Member for Walsall South (Valerie Vaz) was incredibly generous in her remarks about the shadow Minister, and I feel the same about him—let us be blunt about that. I appreciate her kind remarks about me—indeed, the feeling is entirely mutual. She made some really important points about epilepsy and Epilepsy Action. She highlighted concerns about many CCGs and health and wellbeing boards not yet engaging fully in work on epilepsy. That critical issue goes beyond this debate, but I completely take the point that there needs to be a lot more understanding and recognition of the importance of good epilepsy care that follows good practice and addresses the awful problem of so many people losing their lives unnecessarily to this condition.

[Valerie Vaz]

The issue is actually within the scope of the debate. We are talking about co-commissioning, but CCGs are not ready.

[Norman Lamb]

I totally accept the point. Again, I hope to reassure the hon. Lady.

The hon. Member for Luton North (Kelvin Hopkins) referred to robotic assistive surgery. I do not want to give him any particular hope, but it is always possible for new procedures to be added to the list of those that come within specialised commissioning. The prescribed specialist services advisory group keeps the list under review. Just as there are proposals to remove procedures, there is always the possibility, if the case is made and the four conditions that need to be taken into account are met, that additional areas can be included.

[Kelvin Hopkins]

I should have mentioned that robotics make possible an increase in non-invasive surgery, which is not only better for the patient, but much cheaper for the NHS, because there is less recovery time and so on.

[Norman Lamb]

I totally take that point. The hon. Gentleman is absolutely right that the NHS must be, as he put it, at the cutting edge of new technologies and new ways to reduce the invasiveness of procedures, although I add that having things in specialised commissioning is not the only way for the NHS to do so.

The hon. Gentleman was at risk of going into too much detail when he started talking about various procedures. Despite being a Health Minister, I am at risk of passing out on such occasions, so I was glad that he stopped when he did.

[Kelvin Hopkins]

rose—

[Hon. Members]

No!

[Norman Lamb]

I have hon. Members pleading with me not to give way, but if the hon. Gentleman insists, I will. No—that comes as an enormous relief to everyone.

The hon. Member for Alyn and Deeside (Mark Tami) made some important points about blood cancers and bone marrow transplants. I was interested in his point about the need for more joined-up approaches and services, not only within health, but between health and education. At its best, the proposition being put forward has the potential to achieve that, but I am with him on the ambition for much more integration between public services.

I want now to respond to some key points made by my hon. Friend the Member for St Austell and Newquay. NHS England is responsible for commissioning 147 prescribed medical services on a national basis. Those are specialised services for rare and complex conditions. The services are set out in legislation and commissioned directly by NHS England, through 10 area teams. By commissioning those services nationally, NHS England can commission each service to a single national standard, with single national access criteria, and ensure that patients have the same access to specialised services regardless of where they live in England.

The specialised services that NHS England commissions provide for people with rare or very rare conditions. Therefore, it is necessary to commission those services across a wider population than most CCGs cover—for example, in excess of 1 million people. Specialised services tend to be provided by larger hospitals that are able to recruit and retain clinical and support staff with sufficient specialised knowledge, expertise and leadership. That maximises the provision and co-ordination of care for the relevant patients. The list of prescribed specialised services is kept under review and therefore has the flexibility to change with advances in technology and treatment—such as those that the hon. Member for Luton North referred to.

It is for Ministers to take the final decision on which services should be included on the prescribed specialised services list in legislation and therefore which services are directly commissioned by NHS England. Those decisions are not taken lightly. Expert advice is provided by the prescribed specialised services advisory group—a Department of Health-appointed expert committee established in 2013. NHS England established a specialised commissioning taskforce in April 2014, which my hon. Friend the Member for St Austell and Newquay referred to, to make some immediate improvements to the way in which it commissioned specialised services and to put commissioning arrangements on a stronger footing for the long term. Of course, as I think everyone recognises, such services must be sustainable.

The taskforce aims to improve ways of working and to ensure that the commissioning of specialised services is undertaken in the most efficient and effective way possible. Additional resource from within NHS England has been diverted to the taskforce to ensure that it has the right mix of skills and expertise to enable it to meet its objectives.

[Stephen Gilbert]

As my right hon. Friend will be aware, the taskforce has just suggested that renal dialysis and morbid obesity should come off the list of prescribed specialised services. The decision has been taken over a short period and is due for implementation before the general election, on 1 April. Will he speak to his officials and NHS England about whether further consultation is needed on the decision and whether it could be delayed?

[Norman Lamb]

I take the concerns seriously. My hon. Friend discussed the need for more time in his speech. I will put his representations to officials and NHS England. I cannot go further than that, but I recognise the importance of the issues that he raises and I pay tribute to the work of his constituent Nicola Hawkins in collecting many names on her petition.

Following the work of the taskforce and conversations with key stakeholders last year—from individual patients and patient groups to CCG leaders, area teams and providers of services—NHS England has identified opportunities for improvement. That will affect both what is commissioned and how the services are commissioned.

The NHS England taskforce has identified two areas where there is potential for improvement, and that must be what the process is about. First, it has identified commonly-delivered services that it may be appropriate to devolve to CCGs for local commissioning. Formal responsibility for commissioning those services would be transferred to CCGs. Secondly, in line with the vision of the five-year forward view, NHS England proposes a more collaborative approach to commissioning specialised services, whereby it jointly commissions services with CCGs. That is not a transfer to CCGs—it is joint commissioning. While some highly specialised services will continue to be commissioned entirely nationally, CCGs will be invited to have a greater say over the commissioning of the majority of specialised services.

My hon. Friend intervened on the transfer of commissioning responsibility. The PSSAG met and formulated its recommendations on 30 September. Following proposals from NHS England, it concluded that renal dialysis services and morbid obesity bariatric surgery services did not meet the four statutory requirements—debated in Parliament—for commissioning nationally as part of the prescribed specialised services list, and that therefore commissioning responsibility should be devolved to CCGs. Ministers were minded to accept its advice on changes to the list of prescribed specialised services. Given the changes involved, they felt it was important to engage with stakeholders on the practicalities of transferring the commissioning responsibilities.

The Department of Health launched a public consultation on the logistics and timing of the transfer, which ran from November to 9 January. The consultation asked respondents to consider how a transfer of commissioning responsibility from NHS England to local CCGs could take place, and what would need to happen to ensure a smooth transition while service standards and patient safety were maintained.

We are carefully considering all responses to the consultation, and will respond in due course. NHS England has assured me that it is absolutely committed to issuing guidance to ensure the safe transfer of commissioning responsibility from nationally commissioned services to locally commissioned services, where that is recommended by the PSSAG. It is anticipated that a range of products would make up that commissioning guidance, including national service specifications, national standards and contracting information.

Concerns have been raised and views expressed today and through the consultation about the transfer of renal dialysis services, which I think are the subject of the petition that my hon. Friend referred to. I assure hon. Members that NHS England is in dialogue with stakeholders about both the opportunities and the challenges of transferring responsibility for renal services. Indeed, Dr Paul Watson, the specialised services taskforce lead in NHS England, met stakeholders from renal service representative groups on 18 November to hear their concerns. My noble Friend Lord Howe, an Under-Secretary of State, also recently met all-party kidney group. I repeat that I will relay my hon. Friend’s plea for more time and of course respond to him and other hon. Members.

In addition to the proposals for formal transfer of commissioning responsibilities, NHS England is currently exploring collaborative commissioning—which is what most of this afternoon’s speeches have been about—between NHS England and CCGs, for most specialised services. NHS England has identified the fact that some services will always need to be commissioned on a national basis, including, for example, services that were under the previous arrangements commissioned as highly specialised services. However, a number of services on the current list could potentially benefit from being commissioned on a smaller footprint with greater local involvement, to make joined-up services possible across the care pathway, while maintaining national standards.

One faces a danger when separating off some procedures for national commissioning if other parts of the pathway are commissioned at a local level; that is the case with obesity services, because preventive services are commissioned locally whereas bariatric surgery is commissioned nationally. The danger is that one creates false or artificial divides in the patient pathway, which can damage patient care and create perverse incentives. We have to be cognisant of that and see whether there are better ways of doing things.

NHS England is looking to provide an opportunity for CCGs to begin collaboratively commissioning a number of services in the prescribed specialised services list from April. The approach being taken is a deliberative one that does not impose things on the tight time scale that my hon. Friend was concerned about. Collaborative commissioning would likely be carried out through joint NHS England and CCG committees. It would maintain the expertise—the specialism—but there would be the potential to spread that expertise and build capacity at a local level, which could be in the interests of everyone.

NHS England is aware of several CCGs that would welcome the opportunity to become involved in specialised commissioning, but it is equally aware that many CCGs will not be in a position to take on such increased commitments from 2015-16. There is therefore no question of a return to the previous arrangements.

[Stephen Gilbert]

I remain grateful to my right hon. Friend for giving way, and to other colleagues; this is the last time that I will intervene. I hear what my right hon. Friend is saying. It is reassuring that he is using language about improvements to patient care and the benefits that patients will feel, because there is a danger—I think it is felt by all the patient groups that we have talked about this afternoon—that collaboration becomes buck-passing. I would be reassured if he was giving the undertaking that NHS England will continue to engage with those groups that feel they have not been engaged with already and that improvement to the patient experience is the bottom line in relation to some of these changes.

[Norman Lamb]

I can reassure my hon. Friend on both those points. Openness, transparency and engagement with patient groups are incredibly important, and I would always argue the case for them.

Collaborative commissioning would be an open offer; it would be an opportunity to keep up momentum for high-performing CCGs that are keen to deliver more for their local communities. NHS England is looking to pilot or trial these innovative arrangements in 2015-16—nothing more than that.

NHS England has established a specialised commissioning co-design group, including members of the NHS commissioning assembly, with advice coming from clinical and patient experts, to develop further the details of the collaborative commissioning approach. NHS England will also support CCGs to ensure that the commissioning system remains stable during the transition to any new arrangements.

NHS England is now embarking on a comprehensive programme of patient and stakeholder engagement to support the implementation of these changes; I think the hon. Member for Mitcham and Morden made a plea for that engagement to happen.

[Mark Tami]

It all sounds very good; localism is always thrown around as being a positive thing. My concern is that it still creates uncertainty. From the patient’s point of view, the uncertainty must be whether they will be able to access the treatment they need where they live.

[Norman Lamb]

That is a legitimate concern and fear, but the arrangements have the potential to avoid that risk, so that those concerns and fears are not realised; I will expand on that in a moment.

Guidance will be issued later this month setting out the detail of the proposed changes, alongside the criteria that determines which service is commissioned at which level. The engagement programme will include a number of patient and public engagement events and workshops in February, led by regional and area teams, to help to co-design the process for implementing the changes with CCGs. I encourage involvement with that programme, and as part of it NHS England will seek views on the criteria to decide which service is best commissioned at which level.

NHS England acknowledges that people are concerned about the re-emergence of a “postcode lottery”—the hon. Member for Alyn and Deeside specifically mentioned that point—as a result of a more collaborative approach. In particular, people are concerned that specialised services could once again be commissioned in a variety of ways across the country, resulting in patients experiencing difficulties in accessing services.

I totally understand why people have that anxiety, but let me be clear that NHS England would remain the accountable commissioner for any services commissioned collaboratively with CCGs. My hon. Friend the Member for St Austell and Newquay referred to the Health Committee’s concerns about the previous arrangements. However, because NHS England would remain the accountable commissioner and because commissioning would be done collaboratively, I think that concern has been sufficiently addressed.

Since April 2013, NHS England has achieved significant progress in developing a set of nationally consistent service standards and commissioning policies, which have been widely welcomed. They ensure equity of access to high quality services; the point about access was referred to by a number of hon. Members. These standards and policies will still apply for specialised services that are jointly commissioned by NHS England and CCGs, and NHS England will continue to improve on those in the years to come. I think that the shadow Minister, the hon. Member for Copeland (Mr Reed), also raised concerns about access and I hope that he finds what I have said about it reassuring.

For any services that are fully devolved to CCGs, allocations will be made on the basis of activity. Data from NHS England area teams would be used to trace historical activity levels and CCG funding allocations would be based on those, with adequate adjustments for population increase.

The purpose of the move to collaborative commissioning is to support more effective joint working and to allow discussions about service redesign to take place across the local health economy, engaging both national level and local level to try to build capacity.

In the short term, patients should not notice any difference to the service they receive, and in the medium to long term NHS England is confident that these changes should result in improvements, rather than a deterioration—including improved outcomes for patients, more integrated pathways and a better patient experience. We continue to work closely with NHS England as it develops these proposals and engages with all those involved in the commissioning of specialised services, including CCGs, individual patients and—critically—patient groups, area team commissioners and providers of services.

I thank all hon. Members and the sole right hon. Member here today, the right hon. Member for Wolverhampton South East, for contributing to this debate in a constructive way. The issues that have been discussed are of real concern, and it is right that they should have been raised. However, I think we have the potential to improve the way in which the system operates.

[Mr Peter Bone (in the Chair)]

I thank all right hon. and hon. Members for this excellent debate.

Question put and agreed to.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

7. With reference to his Department’s publication “Transforming care: A national response to Winterbourne View Hospital”, published in December 2012, if he will take steps to ensure that the statutory guidance implementing the adult autism strategy uses clear language and is mandatory.

[The Minister of State, Department of Health (Norman Lamb)]

The revised autism statutory guidance will be written in clear and accessible language. It will include existing obligations from the 2010 strategy and recent legislation such as the Care Act 2014. Local authorities and NHS bodies are required to take the guidance into account, or provide a good reason for not doing so.

[Mr Clarke]

The Minister will be aware that, under the Mental Health Act 1983, people with autism can be compulsorily detained for assessment and treatment although there is no evidence of mental illness. Will he join the National Autistic Society and others in endorsing the Justice for LB Bill campaign and seeking to end that wholly unacceptable practice?

[Norman Lamb]

The right hon. Gentleman has raised an incredibly important point. I, too, pay tribute to the campaigning of Justice for LB. We are strengthening the guidance relating to the code of practice under the Mental Health Act, and that strengthened guidance will be published shortly. We are considering whether amendments to the Act are needed, and we are also drafting a Green Paper. I should be happy to discuss the issue further with the right hon. Gentleman, and to have further meetings with campaigners.

[Mr Speaker]

The hon. Gentleman’s question is quite a long way from the statutory guidance, but it can be given a brief reply.

[Norman Lamb]

I have to say that I was not aware of the information provided by the hon. Gentleman. I should be happy for him to send me more information, but I make the general point that it is always important for us to base our decisions and expenditure on evidence.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Would the Minister be prepared to discuss with his counterparts in the devolved regions the need to ensure that clear language is considered essential, and that best practice is replicated throughout the United Kingdom?

[Norman Lamb]

I am happy to make sure that we liaise properly with the devolved Administrations and it is important for officials on both sides to ensure that the language is as clear as possible across the United Kingdom.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

8. What the clinical reasons are for plans to close Calderdale Royal hospital A and E department.

--- Later in debate ---

[Robert Jenrick (Newark) (Con)]

11. What proportion of 111 calls resulted in an ambulance being called in the most recent period for which figures are available.

[The Minister of State, Department of Health (Norman Lamb)]

There were just short of 882,000 calls triaged by the NHS 111 service in England in November 2014, and 99,808 of the calls—11.3%—had an ambulance dispatched.

[Robert Jenrick]

I thank the Minister for that response, and I am grateful for the earlier response to my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), which is very reassuring. Any Member who has spent time with paramedics, as I have in Newark, knows that this is a hot topic for them. So we would appreciate any extra reassurance the Minister can give that the algorithms that lie behind the 111 service, and the level of clinical involvement in it, can be improved, with experience, to create a sensible number of cases going to accident and emergency.

[Norman Lamb]

I pay enormous tribute to the paramedics, who are working under a lot of pressure. The survey results, which showed that about 27% of people who have used 111 say that they would have gone to A and E had it not been available, are a considerable reassurance. However, we need constantly to seek to improve the service, and the urgent and emergency care review pointed to refining the 111 service so that, ultimately, people could get access through to a GP, doctor or nurse, to ensure that they receive the right guidance at the right time.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Public Accounts Committee examined this service in Devon and Cornwall and discovered, as it has in other inquiries, a lot of issues associated with cost shunting, because it does not cost 111 when it tells someone they need to go to hospital in an ambulance. So there have been “impressive figures” on the number of people who did not go to A and E as a result of their call, but is the Department monitoring the number of people who are sent to A and E by 111 but should not have been?

[Norman Lamb]

As I said in response to the previous question, there is a real case for constantly seeking to refine the way the service works. The urgent and emergency care review pointed to ways in which we could do that to ensure that, in appropriate cases, people could get through to a doctor or a nurse to give them the right advice. That, in turn, would reduce the number of people turning up at A and E.

[Andrew George (St Ives) (LD)]

Further to the previous question, will the Minister urgently review the operation of NHS 111, as not only did it experience meltdown over the Christmas period in my area, but it is run from a call centre in Newport, 200 miles away, and it uses algorithms that involved staff asking a patient in my constituency, “Are you conscious?”?

[Norman Lamb]

Call volumes doubled over the Christmas period compared with those a year ago, so the system was certainly under enormous pressure. As I say, the survey results show that a lot of people were diverted away from A and E, but there is absolutely a case for seeking to improve 111.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State earlier complacently claimed that England has the best A and E service in the United Kingdom, but last week 86 hospital trusts in England operated below the Wales average. Suzanne Mason, professor of emergency medicine at the university of Sheffield, said that ambulance services in some parts of the country have been “brought to their knees” by 111. Does the Minister now think it was a mistake to scrap the nurse-led NHS Direct service? Will he urgently implement Labour’s proposal to get more nurses answering 111 calls, to relieve pressure on our chronically overstretched A and E departments?

[Norman Lamb]

I understand that about 22% of callers do get to speak to a clinician and, as I have already said, we are seeking to develop the service so that there are more referrals to an appropriate clinician. Let me again repeat the fact that the performances of A and E, ambulances and people waiting for hospital are considerably better in England than they are in Wales, and the Opposition need to recognise that.

[Derek Twigg (Halton) (Lab)]

12. What recent assessment he has made of the reasons for increased attendances at A and E departments in 2014.

[The Minister of State, Department of Health (Norman Lamb)]

A range of factors is contributing to increased attendances. The ageing population means that, by the end of this Parliament, there will be nearly 1 million more over-65s than at the start. The urgent and emergency care review cited pressure on GP appointments and availability or awareness of alternatives as factors that might affect A and E attendances.

[Derek Twigg]

NHS Providers, which represents 94% of NHS foundation trusts, says that national tariff proposals that have forced hospital trusts to find efficiencies of 3.8% are excessive and, taken with other cost pressures, undeliverable. It will take £1.2 billion out of budgets from front-line NHS services. Do the Secretary of State and his Ministers understand the implications of that proposal, and will they act to stop it given the pressures on the NHS, especially on A and E departments?

[Norman Lamb]

The Nicholson challenge, which was published in the last year of the Labour Government, recognised that the whole system had to deliver efficiency savings, and I think that everyone understands that. But the answer to all of this is a significant shift of emphasis towards preventing ill health and preventing crises from occurring. Under the better care fund the NHS and the care system are for the first time being properly joined together.

[Mr Philip Hollobone (Kettering) (Con)]

The Northamptonshire clinical commissioning groups and Kettering general hospital are agreed that Kettering’s A and E department is too small and outdated and needs to be replaced with an urgent care hub in line with the NHS five-year forward view. Given that the three local MPs on a cross-party basis refused to treat our local A and E as a political football, will the Minister of State encourage his colleague, the hospitals Minister, to consider that proposal seriously when we come to see him this afternoon?

[Norman Lamb]

I understand that a meeting will take place very soon, and I certainly encourage my hon. Friend the hospitals Minister to ensure that he listens to the case being put by the hon. Gentleman and his colleagues this afternoon.

[Liz Kendall (Leicester West) (Lab)]

Ministers have been repeatedly warned about the impact that their social care cuts are having on elderly people and that that is a key cause of pressures on A and E. Today it has been revealed that public health officials have issued an alert about a statistically significant and “sustained” decline in life expectancy in parts of the north-west. They say it is extremely unusual and that

“central government driven reductions in adult social care budgets”

are a possible cause. Will the Minister confirm that alert, say whether life expectancy is declining elsewhere, guarantee that Public Health England will urgently investigate the matter and promise that its findings will be published in full?

[Norman Lamb]

Although there was a fall in life expectancy for those aged 85 in 2012, preliminary analysis shows that there was no further drop in 2013. Incidentally, let me pay tribute to the people who work in social care. The system has performed remarkably well. Statistics on delayed discharges due to social care show that the number of delayed days is almost exactly the same this year as it was in 2010—a remarkable performance.

[Heidi Alexander (Lewisham East) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Mr Jim Cunningham (Coventry South) (Lab)]

T7. Government-inflicted cuts on local government funding and subsequent reductions in adult social care services have increased the pressures of bed-blocking at University hospital Coventry, with a number of patients unable to be discharged as they wait for a nursing home place or a package of care in their own home. Does the Minister agree that this is a problem, and what steps has his Department taken to remedy it? Will he not do the Pontius Pilate act but take responsibility for his actions?

[The Minister of State, Department of Health (Norman Lamb)]

The hon. Gentleman is absolutely right that what happens in social care has an impact on the health service, and the answer has to be to stop seeing them as two separate systems and to look at the whole health and care system. That is why the better care fund is such an incredibly important initiative, pooling a substantial sum of health and care funds, and it must go further so that we end up pooling the entire resource.

[Sir Bob Russell (Colchester) (LD)]

T6. The last Government abolished community health councils, a truly independent health watchdog and voice for patients. Their replacement, the patient advice and liaison service, is not independent. Does the Minister agree that PALS must be made independent?

[Norman Lamb]

PALS was not the direct replacement of community health councils; a different scheme was set up for the patient and public voice independent of hospitals. My hon. Friend raises important concerns about PALS and the Government are intent on looking at the service to ensure that it performs effectively for patients.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

T8. My constituent Mr Offord waited 22 minutes after a 999 call for a double-crewed ambulance, and his death was referred by the South Yorkshire coroner to Ministers because of a concern that he might have survived if he had received medical help sooner. The Yorkshire ambulance service has just settled the case brought by Mr Offord’s family out of court. When will the Secretary of State recognise the growing crisis in ambulance services and support my right hon. Friend the shadow Secretary of State’s call for an investigation?

Mental Health and Policing

Norman Lamb Excerpts

Thursday 18th December 2014 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

The Government have today published the report of the Government’s review of the operation of sections 135 and 136 of the Mental Health Act 1983. This has been an important piece of work, conducted jointly by the Home Office and the Department of Health.

It is our overarching objective for all public services to respond at the right time to the needs of people experiencing mental health crises. We also need to improve the outcomes for people experiencing mental health crises when they come in to contact with the police. This review showed that there are areas where this is working well and areas where there is still room for improvement.

We have been fortunate that this review took place alongside both the Home Affairs Select Committee’s inquiry into policing and mental health and the Health Select Committee’s report into child and adolescent mental health services. This work rightly highlighted the unacceptable state of affairs when a vulnerable child can be held in a police cell at the point of mental health crisis. Police stations must only be used in genuinely exceptional circumstances and never for a child or young person aged under 18. We therefore propose amending legislation to this effect subject to the next Parliament.

The review makes a number of other recommendations. It points out that making better use of alternative places of safety would be advantageous as we recognise that there is not one solution which is appropriate for all people at all times. There was a clear consensus that a maximum period of detention under these sections is too long at 72 hours, and the review therefore proposes reducing this to 24 hours, while still emphasising the need to complete assessments as soon as possible.

Although there is no space remaining in this Parliament to make these changes, I believe there is a general consensus that these issues must be addressed. Therefore I hope that in the next Parliament the momentum that has been generated will be maintained.

The following documents are available as attachments online at: http://www.parliament.uk/writtenstatements, and copies have been placed in the Library of the House.

Review of the operation of Sections 135 and 136 of the Mental Health Act 1983: Review Report and Recommendations;

Review of the operation of Sections 135 and 136 of the Mental Health Act 1983: A Summary of the Evidence;

Review of the operation of Sections 135 and 136 of the Mental Health Act 1983: A Literature Review,

The Centre for Mental Health’s report, Review of Sections 135 & 136 of the Mental Health Act: The views of professionals, service users and carers on the codes of practice and legislation.

Gosport Independent Panel

Norman Lamb Excerpts

Tuesday 9th December 2014 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

On 10 July, Official Report, column 33WS, I announced the establishment of the Gosport independent panel, chaired by Bishop James Jones, set up to review documentary evidence held across a range of organisations concerning the initial care of families’ relatives and the subsequent investigations into their deaths in Gosport War Memorial hospital.

Since then, the Bishop has begun working with affected families to ensure their views are taken into account in shaping the terms of reference.

I can now announce the Gosport independent panel’s agreed terms of reference and the appointment of four further members of the panel.

In summary, the remit of the Gosport independent panel will be to:

Consult with the families of the deceased and of those treated to ensure that the views of those affected are taken into consideration;

Obtain, examine and analyse documentation from all relevant organisations and individuals—governmental and non-governmental.

Produce a report which will provide an overview of the information reviewed by the panel and will illustrate how the information disclosed adds to public understanding of these events and their aftermath.

The four additional panel members I have appointed are:

Dr Bill Kirkup, CBE, former member of the Hillsborough independent panel and currently the chair of an independent investigation into neonatal and maternal deaths at Morecambe Bay hospital. Dr Kirkup will finish this work before taking up his place on the Gosport panel substantively.

Dr Colin Currie, as a geriatrician, has wide experience in the care of older people in acute, rehabilitation and respite settings; and also has expertise in clinical governance, hip fracture care, and policy on the integration of health and social care.

David Hencke is an investigative journalist and writer.

Duncan Jarrett, OBE, is a former Scotland Yard commander and an experienced mediator.

Christine Gifford is a recognised expert in the field of access to information. She joined the panel in July, and has started work to ensure maximum possible disclosure of the documentary evidence to the panel.

I am making these appointments in view of the skill set required for the panel’s work. The new panel members are experts in their respective fields and I am grateful to each of them for agreeing to take on this task. Other panel members may be appointed at a later date. I will announce any future appointments through a press release.

This announcement marks the beginning of very important work for the independent panel members, relevant organisations and individuals in addressing the concerns and questions raised by family members over the years.

The review by the independent panel is expected to complete by the end of 2017. The Secretary of State for Health will make arrangements for publication of the final report to Parliament.

A copy of the detailed terms of reference has been placed in the Libraries of both Houses. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. It is also available online at: http://www.parliament.uk/ writtenstatements

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 25th November 2014 Commons Chamber

[Andrew Bridgen (North West Leicestershire) (Con)]

1. What steps he is taking to deliver parity of esteem for mental health services.

[The Minister of State, Department of Health (Norman Lamb)]

Parity of esteem has been set out in law, and we are delivering it for people. More than 2.6 million people have entered talking therapy treatment through the Improving Access to Psychological Therapies programme since 2008, and we have secured an additional £120 million over 2014-15 and 2015-16 to support the introduction of the first ever waiting time standards in mental health services.

[Andrew Bridgen]

According to the recent chief medical officer’s report, mental illness is responsible for 70 million sick days a year, at an estimated cost to the economy of around £100 billion a year, so parity of esteem is essential. What more can be done through early intervention to help people with mental health illness by preventing their chronic problems from becoming acute?

[Norman Lamb]

My hon. Friend is absolutely right about the importance of early interventions. Next year, we are introducing for the first time a six-week maximum waiting time standard for access to psychological therapies to start treatment for conditions such as anxiety and depression, and a two-week standard for starting treatment for those suffering a first episode of psychosis. I am also calling on every FTSE 100 company to sign up to Time to Change, so that they can show leadership in how they deal with their employees.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

It is one thing to say it, but completely another to do it. I am sure that the whole House will recognise improvements that happen, but does the Minister understand the scale of the crisis, not simply in the NHS but in the education system where more and more young people are increasingly finding that they simply cannot get anything like the support they need at increasingly difficult points in their lives?

[Norman Lamb]

I completely agree with the hon. Gentleman about the importance of children and young people being able to access treatment and support. If the truth be known, it has always been like this. It has always been the Cinderella of the Cinderella service, which is why we established a taskforce this summer, bringing in a whole load of experts and, importantly, consulting children and young people so that we can develop a modern health service for the mental health problems of children and young people. We hope to report early next year.

[Dr Sarah Wollaston (Totnes) (Con)]

19. As the Cabinet taskforce sets out on this important work, will the Minister reassure me that it will bear in mind the important finding of the Health Committee’s inquiry into CAMHS—Child and Adolescent Mental Health Services—that it is the tier 1 and tier 2 services that really make the difference in preventing the need to access the service when children are much more unwell?

[Norman Lamb]

I very much appreciated and supported the findings of the Health Select Committee report into children and young people’s mental health services. The hon. Lady is absolutely right that we need to focus far more on preventing ill health and preventing a deterioration of it. If we can get into schools and work much better at maintaining people’s mental well-being, we can achieve much better results.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Despite what the Minister says, in South Shields, financial challenges have contributed to the closure of Bede wing mental health ward. This means that acute in-patient services are no longer provided in our borough. Can the Minister explain why mental health services are, in fact, being eroded under this Government?

[Norman Lamb]

Over the past decade and a half, there has been a very substantial reduction in bed numbers, and it is a trend that we should thoroughly support because we want to move away from institutional care towards supporting people at home in their communities. With children’s mental health, we have invested an extra £7 million this year to ensure that children get access to beds close to home when they need them.

[Paul Burstow (Sutton and Cheam) (LD)]

Will the Minister ensure that the taskforce he mentioned considers the evidence that one in five mothers suffers from mental health problems during pregnancy or within a year of giving birth because the costs of that to society are massive and three quarters of those costs are borne by the child and subsequent generations? Is it not time to make sure that we focus on perinatal mental health because it can make such a big difference?

[Norman Lamb]

I very much agree with my right hon. Friend. Accompanied by my hon. Friend the Member for Torbay (Mr Sanders), I visited a brilliant perinatal mental health service in Torbay recently. My right hon. Friend is absolutely right. The London School of Economics has done a lot of work, showing evidence that if we invest in perinatal mental health, we get a return on the investment, but most importantly, we change people’s lives. I am determined to pursue that.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The Minister talks about parity of esteem, but it is under this Government that mental health budgets have been unfairly cut, and 1,500 beds and 3,300 nurses have been lost. He has already received a damning Select Committee report on child and adolescent mental health services. Ill people are being locked in police cells, or are travelling hundreds of miles to find a bed. The Minister could not have brought about more disparity if he had tried—and now we hear that there is to be yet another review. He is the Minister in charge. I ask him again: what action is he going to take today?

[Norman Lamb]

Inexplicably, when the last Labour Government introduced access and waiting time standards, they left out mental health. That was an extraordinary decision, and it drives where the money goes. The introduction of mental health waiting time standards next year, for the first time ever, will help to achieve equality for mental health. We have also published a vision of the next five years explaining how we will secure genuine equality for mental health, which is something that the last Labour Government did not achieve.

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

The Minister will know that the statutory guidance of the adult autism strategy in England is the keystone of the provision of services under the Autism Act 2009. The updating of that guidance is now imminent, and concern has been expressed to me about the draft wording produced by the Department. Can the Minister assure me that the Department does not intend to weaken the requirements for local authorities to provide services for people with autism and their families?

[Norman Lamb]

I am delighted that my right hon. Friend has become chair of the all-party parliamentary group on autism. She has fought for many years to secure a fair deal for people with autism. I am grateful to her for alerting me to the issue that she has raised, and I shall be sure to look at the guidance. It is absolutely not the intention to water down guidance for local authorities in any way.

[Kerry McCarthy (Bristol East) (Lab)]

2. What recent assessment he has made of the adequacy of provision of student health services.

--- Later in debate ---

[Hugh Bayley (York Central) (Lab)]

T4. Patients with mental health problems who are referred for psychological therapies wait, on average, less than 40 days for treatment, but in York the wait is 125 days. My constituent, Laura Goodacre, has now waited nearly 350 days. Will the Minister look at this worrying case and the need for our mental health trusts in York to reduce waiting times?

[The Minister of State, Department of Health (Norman Lamb)]

I will absolutely look at that case, and I am happy to talk to the hon. Gentleman about it. This is precisely why we are introducing, for the first time ever, an access standard—a maximum waiting time of six weeks for access to psychological therapies from next April.

[Charlie Elphicke (Dover) (Con)]

T8. After all the cover-ups of the past, what is being done to ensure that the culture of the NHS is always improving, particularly in that patients are treated with dignity and respect and always have the highest standards of safety?

Christina Edkins

Norman Lamb Excerpts

Monday 17th November 2014 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on securing this debate on this incredibly important and difficult issue. He asked some specific questions. First, he talked about the failure of organisations to share information, and I will develop my thoughts on that in due course. He made a particular point about the role of the Care Quality Commission. Under the new inspection regime, the CQC will undertake much more detailed inspections of providers than has been the case in the past, and it will be able to take into account issues such as the importance of sharing information to ensure good care. I will make sure it receives the Hansard report of this debate, so it can take on board the specific points he makes.

My hon. Friend talked about the importance of a more systematic and standardised assessment of risk. That is one of the points the Government need to respond to in terms of the report. At the end of his speech he asked about the status of the report. It is clear that the report raises issues of both local and national significance. It is incredibly important that the Government recognise that and seek to address and respond to the concerns identified. I am happy to write to him to pursue that further, but I am intent on ensuring that we respond as soon as possible where it is clear that there are national lessons to be learned. This tragic case raises issues that have been raised before—they are not new. It is imperative for all of us to seek to address the issues identified in the report.

My hon. Friend raised a concern about individuals who do not hit the threshold for admission to secondary care. He also asked whether I would be prepared to review child and adolescent mental health services. I am pleased to say that in the summer I announced a taskforce to review the way in which CAMHS operate. I do not think that the way we commission or organise CAMHS is fit for purpose. There is a need for a fundamental review of how the services are organised and commissioned. The findings of the report can absolutely feed into that taskforce.

I would just like to dwell on some of the issues we need to look at in the taskforce process. At the moment, four organisations are involved in the commissioning of services for children and young people: local authorities, schools, clinical commissioning groups and NHS England. The fragmented arrangement for commissioning care does not lead to the best chance of joined-up services and that fundamentally needs to change. We recognise that it is very clear that only a minority of youngsters who have mental health problems receive access to any service at all. That has been the case for a very long time, but it does not make it right.

It is clear that many interventions deployed with youngsters have a very strong evidence base. For example, early intervention in psychosis—after the first episode of psychosis—can stop deterioration occurring. However, around the country the position is variable. In some areas there is access to good services, but in other areas there is either no service at all or people have to wait a very long time. I am therefore very pleased that the Prime Minister announced in October the introduction, for the first time, of an access waiting time standard of two weeks for early intervention in psychosis. We start with 50% of everyone who experiences an episode of psychosis. In future years, the aim would be to raise that percentage so that as many people as possible have access to support as fast as possible, and access to a service that is evidence-based, NICE-based and approved.

That is a breakthrough and a watershed moment for mental health services, but another area that the CAMHS taskforce wants to look at is how to improve access more generally. In Australia there is something called Headspace, which involves non-stigmatised access to services often provided by third sector consortia. There are local Headspace centres around the country, and a telephone service and an online service. That means that far more youngsters can receive access to some support at a much earlier stage than is the case in this country—and was the case in Australia before it introduced Headspace. We can learn lessons from the way services are commissioned and provided, and there is a lot we can do to improve access to support in those earlier years.

Moving on from the specific points my hon. Friend raised, I should put on the record my horror at Christina’s murder. I share his sentiments and wish to extend my personal sympathies to the family. What they must have been through is unimaginable, and my heart goes out to them. Christina Edkins was a happy, well-loved teenager with a bright future ahead of her. She was doing well academically, she played netball for the school team and enjoyed writing. She had ambitions to become a midwife and was already working with young children in a nursery school. Her death was tragic. We should all be able to go about our daily lives without fear of violence.

As Dr Reed’s report says, the attack was random and unprovoked. The question is whether it was preventable. As my hon. Friend made clear, Phillip Simelane’s mother tried for many years to get him the help she knew he needed. The system has let down that family as well as the victim’s family, and one’s heart goes out to his mother for what she must have gone through, having tried so hard to get help over many years. She herself suffered a number of attacks by Phillip, and she knew that his mental state was deteriorating and tried to get help. We cannot say what would have happened had she been successful, but it could hardly have been worse than what took place in March 2013. I am sure I speak for everyone here when I say that my heartfelt sympathies go out to the families of both Christina Edkins and Phillip Simelane.

Nothing we can do can return Christina to her family, but as my hon. Friend said, we can ensure that lessons are learned and that appropriate action is taken to prevent, as far as is humanly possible, any similar event from happening again. This afternoon, I met Dr Reed, who wrote the homicide report into Christina’s death, and discussed with her at length both her report and the importance of responding to the recommendations raised in it. Lessons can be learned from this tragic incident, both locally and nationally, and we are considering the national recommendations in the report. As well as explaining some of the actions today, I would be happy to write to my hon. Friend setting out in more detail what action the Government are taking to address the recommendations. I want us to be clear about the time scale for responding more fully and about what actions might follow a formal written response.

Before I turn to the specifics of the report, I would first like to touch on the importance of parity of esteem for mental health, which has long been a personal priority of mine and of my hon. Friend. The Government are clear that mental health care is as important as physical health care. It is unacceptable that in this time of modern medicine three out of four people with common mental health problems receive no treatment. If three out of four people with diabetes, for example, received no treatment, we would all be completely outraged. Mental health problems can have a huge impact on the quality of life of individuals and their families and friends and should be taken as seriously as physical health problems. I think that this simple principle of equality is starting to be accepted, but there remains a big and frustrating time lag when it comes to translating it into practice in terms of the responsiveness of services on the ground.

It is clear from the homicide investigation report that Phillip Simelane did not receive the treatment he needed for his mental health conditions. His mother repeatedly attempted to get appropriate treatment for her son from the time he was 14. The report found that there were multiple opportunities for Mr Simelane to be given access to mental health interventions or treatment, but many opportunities were missed. In some cases, Mr Simelane did not meet the provider’s criteria for specific services—a point made by my hon. Friend—such as admission to a psychiatric intensive care unit. In others, he was not able or willing to engage with services. During this time, his behaviour deteriorated and his mother became increasingly concerned and at risk. One can only begin to imagine how hard it must have been for her to see the deterioration happening before her eyes, to be at risk herself yet to have no proper response from the authorities, who ought to have been safeguarding her and ensuring that others were safeguarded from the actions of someone whose condition was deteriorating.

In total, Mr Simelane was reviewed or formally assessed for mental health conditions 17 times by four different organisations between April 2009 and December 2012. Quite a lot of effort and time were put into assessing him, but there was precious little action or support. None of this resulted in him getting the help he actually needed.

The 2014-15 mandate to the NHS sets out an explicit target for NHS England to make measurable progress to ensure that

“everyone who needs it has timely access to evidence-based services”,

whether it be for mental health or physical health. We have identified £40 million of additional spending to kick-start change in mental health services in the current year, and a further £80 million for 2015-16. As I said, this will for the first time enable the setting of access and waiting time standards in mental health services. This will include 75% of people referred to the improving access to psychological therapies programme being treated within six weeks of referral, and 95% being treated within 18 weeks of referral as a backstop. At last, people with a mental health condition—depression, anxiety or a condition such as obsessive-compulsive disorder—will have an entitlement, just like those with a physical health problem, to access treatment on a timely basis. Furthermore, at least 50% of patients experiencing a first episode of psychosis will be treated with a NICE-approved care package within two weeks of referral, while £30 million-worth of targeted investment from within the total £80 million envelope will be spent on effective models of liaison psychiatry in more acute hospitals.

Crisis care is one area where the gap between the experience of those with physical and mental health problems is at its greatest. If someone suffers a physical health crisis, they will know what will happen—an ambulance will arrive and they will be taken to A and E. The system may be under pressure, but access will be granted to a specialist who can help with the particular condition. If someone suffers a mental health crisis, however, God knows what will happen. They may have a good service, but too often it falls short. Too often still, people end up in police cells when they are in the middle of a mental health crisis.

[James Morris]

One crucial aspect of this particular report is the interaction between crisis care services and the Prison Service. One of the big gaps revealed by the report relates to what happens when someone is released from prison with known mental health problems. In this case, nothing happened and the individual was lost to services. Will the Minister reflect a little on how we might be able to join the Prison Service and health services more closely?

[Norman Lamb]

I completely agree with my hon. Friend on that point. The first incredibly positive thing to say is that we have embarked on the national roll-out of a liaison and diversion service, the purpose of which is to ensure that when a person first appears in the criminal justice system—whether at a court or a police station—someone will be able to assess their mental health. If they have an identifiable mental health problem, they will be referred straight away for treatment and support. They may still go through the criminal justice system and may still end up in prison, but their condition will have been identified and they will have been referred for the treatment that may help them to address their offending behaviour.

So far we have spent £25 million in the current financial year. We have covered about 25% of the country, and next year we will cover more than 50%. Our aim is a national roll-out by 2017, subject to the making of a business case to the Treasury, and that in itself will make a dramatic difference. No other country in the world is pursuing this on such an industrial scale. Moreover, what we are doing is evidence-based, and as we build on the programme, we will develop the evidence and ensure that we apply it. There is also the issue of what happens to someone who is in the system and what happens when the person leaves prison, and I shall deal with that in a moment.

The Department has funded nine street triage pilots this year, in which police and mental health professionals have worked together to support people who are experiencing mental health crises. Perhaps most relevant to cases such as that of Mr Simelane is the £25 million to which I referred earlier, which constitutes the first stage of the roll-out of a national liaison and diversion service.

Before my hon. Friend intervened, I was talking about the unacceptable practice of allowing people who are in the middle of mental health crises to end up in police cells. It is good news that between the 2012-13 and 2013-14 financial years there was a 24% reduction in the use of police cells, and evidence suggests that that trend is continuing in the current year. Earlier this year we published the mental health crisis care concordat, in which more than 20 national organisations committed themselves to standards of care in mental health crisis for the first time. Our objectives were a 50% reduction in the use of police cells in the current financial year compared with two years ago, and a complete ending of the use of police cells for children. My right hon. Friend the Minister for Policing, Criminal Justice and Victims and I are currently writing to local authorities asking them to take seriously their responsibility to end that unacceptable practice. I think everyone would agree that the practice of allowing a child under the age of 18 to end up behind bars in a police station must be brought to an end.

A key finding of the homicide report was that information sharing within and between organisations involved in Mr Simelane’s case was not effective. The sharing of information between organisations that are responsible for the care of vulnerable people has many benefits, and all organisations of that kind should strive to communicate and share information effectively. Indeed, I believe that they have a duty to do so. At the heart of most of the scandals over the years when something dreadful has happened has been a failure to share information effectively, and that certainly includes the case of Mr Simelane.

I realise that, in practice, such information sharing is difficult to achieve, but it must be an absolute priority, and the organisations involved must actively seek solutions. We recently issued a simple one-page guide for practitioners working in the health system, which emphasised the importance of sharing information. We are right to focus on the importance of confidentiality, but, in doing so, we sometimes forget that need to share information to ensure that good care is provided.

Electronic patient records are becoming more prevalent and are making information sharing easier, but they are not foolproof, and there are still security and confidentiality issues that limit the sharing of some information. For the time being, such systems should be seen as adding an additional layer of patient safety, and it is important for all clinicians receiving a referred patient to satisfy themselves that they have a thorough understanding of the patient’s history. Clinicians also have the ability to request additional information from other clinicians or relevant professionals if they feel that such information would be beneficial in making an accurate assessment of the patient.

The Ministry of Justice is responsible for the management of offenders in the community. Care and supervision may be delivered by a number of agencies working together to share information, including health, social care, probation and other authorities. This enables appropriate action to be taken if an offender’s behaviour escalates to present a risk to the public, and that may include intervention by professionals or even recall to prison or to another appropriate facility.

We come back to the need for appropriate sharing of information among organisations. As I have said, this can in practice be complex and difficult to implement. However, organisations with a responsibility to care for vulnerable people and to protect the public must be able to work effectively together. Dr Reed’s report was only published in September and there will be no quick fixes for the organisations involved in this case. We expect NHS England to work with all the NHS providers involved to ensure that they address the recommendations in the report. This will require NHS providers to work with non-NHS organisations, including the Prison Service, to ensure that the lessons that need to be learned from this report are implemented across the board.

The issues identified in the report as essentially local will probably be common to many other organisations around the country, and we owe it to the families who have been devastated by this tragedy to ensure that those local lessons with wider applications and the issues identified as of national importance are all properly addressed, and I am happy to work with my hon. Friend to try to achieve that.

[James Morris]

On the specific point about the status of this report, I know that the Edkins family have written to NHS England expressing concerns about some of the findings in the report and asking whether there needs to be a further independent review. I think NHS England has promised to get back to them. Could the Minister use his good offices to communicate with NHS England to get back to the family?

[Norman Lamb]

I absolutely will communicate with NHS England and seek to ensure that the family get a response to that request.

As I said earlier, I shall write to my hon. Friend on all the issues that emanate from the report, and in doing so I will summarise the work being undertaken by the Government in response to this report. Work on this has already begun. The health care providers at HMP Hewell and HMP Birmingham have developed action plans in response to the recommendations in the report. NHS England’s Shropshire and Staffordshire area team is monitoring progress closely to make sure that all recommendations are met. The report also contained national recommendations for NHS England, and the Department of Health and the Ministry of Justice will work with partner organisation to address these recommendations.

Black Country Partnership NHS Foundation Trust has already implemented some changes in response to Christina’s death. It has phased out the use of “opt-in” letters, which my hon. Friend specifically referred to. Their use was an extraordinary practice when one thinks about it, given the nature of the condition that individuals such as Mr Simelane suffer from. Opt-in letters were previously used to invite patients to make an appointment, but they allowed someone to be discharged from secondary care if they did not respond. This practice has to end. The trust now proactively assesses all patients referred to it. That issue has wide application across the country.

The trust is working to improve the way its services join up with others, particularly those provided by external agencies, in the care of someone with severe mental illness. The trust will shortly be introducing electronic patient records which will enable teams across different parts of the service to access relevant patient information more quickly.

Birmingham and Solihull Mental Health NHS Foundation Trust has also implemented changes, including putting in place a robust escalation process for all cases in which disputes or concerns are raised about the outcome of a prison assessment, and ensuring that a full check is made on the HMP health care patient information recording system to identify any previous significant physical and/or mental health history.

The trust also has work under way. This includes changing psychiatric intensive care unit induction and training for doctors and nurses to include training on how to undertake prison assessments; introducing a review of all new prisoners by a nurse specialist within 24 hours when mental health concerns have been raised and, if recommended, by a psychiatrist within a maximum of five working days; and including in health screening on discharge cross-checking and reference between the health and prison records systems. The trust aims to have these and other changes in place by March 2015.

The investigation makes national recommendations, including the implementation of new supervision requirements for offenders who have served sentences of under 12 months, as was the case for Mr Simelane at the time of the incident. As part of the Transforming Rehabilitation programme, the National Offender Management Service is working with the NHS on through-the-prison-gate support for offenders serving sentences of under 12 months, including those offenders who are known to have mental health problems.

The Ministry of Justice is putting in place an unprecedented nationwide resettlement service, which will mean that most offenders are given continuous support by one provider from custody into the community. The Ministry will ensure that most offenders are held in a prison designated to their area for at least three months before release. This will mean better continuity of supervision and rehabilitation services, as well as better family links for those offenders and a network of prisons more specifically catering for the needs of short-term offenders. As my hon. Friend has pointed out, continuity of care and support when an individual leaves prison is of fundamental importance.

None of the changes made in response to Dr Reed’s report can bring Christina Edkins back, but we can all do our very best to ensure that no other family suffers in the way that Christina’s has done. None of the recommendations in the report is unachievable. They will require hard work on the part of many organisations, but the result will be better care, supervision and support for some of our society’s most vulnerable people.

I close by once again offering my heartfelt condolences to Christina’s family and assuring them that we will ensure that everything that can be done to prevent similar tragic events in future will be done. I shall be happy to work with my hon. Friend and to continue a dialogue with him to ensure that we maintain momentum in addressing the recommendations in the report and the concerns of the family.

Question put and agreed to.

Care Workers

Norman Lamb Excerpts

Wednesday 5th November 2014 Westminster Hall

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on bringing the debate to the House today. A number of colleagues have already spoken about the minimum wage, so I will try not to dwell on those issues too long, and will address some of the other significant and worrying challenges that care staff face.

Too many care workers are underpaid for the work that they do. Unison estimates that, altogether, 220,000 are not paid the minimum wage. HMRC found that half of care providers fail to pay the minimum wage and, despite the consequences of that for care workers, their families, the overall quality of the care work force and the standard of care that people receive, the Government have continued to fail to act.

The failure to pay for travel time is a common tactic and should not be difficult to fix. Earlier this year, during the passage of the Bill that became the Care Act 2014, I and Opposition colleagues raised the minimum wage issue time and again. We tabled amendments on Report asking Ministers to look specifically at travel time and travel costs. We were told that that would be addressed in the guidance that was published at the end of last month. I think that it is fair to say that the guidance is nowhere near strong enough. It says:

“Remuneration should be at least sufficient to comply with the national minimum wage legislation”.

To me, that says that it should be, but it does not have to be. It says that it would be nice if providers paid their staff a decent wage, but that there is no requirement for them to do so.

[The Minister of State, Department of Health (Norman Lamb)]

I just point out to the hon. Lady that this is a criminal offence; it is not an option. I totally agree with the points made by the hon. Member for Sheffield Central (Paul Blomfield). It is a criminal offence, and this is not an optional matter. There is no doubt in the law. Employers have to pay for travel time between appointments at people’s homes.

[Mrs Lewell-Buck]

I thank the Minister for that intervention. If that is the case, why is the guidance not stronger? What I read out is not the language of the minimum wage. The minimum wage is not a target, but a right.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this debate on an incredibly important subject. I agree with him and the hon. Member for Strangford (Jim Shannon) that there are many great providers of care out there and vast numbers of extraordinarily dedicated care workers. Like the shadow Minister, I went out with a domiciliary care worker in London a while ago. He was from Sardinia, which makes the point that very large numbers of people from other countries, primarily from across the European continent, work in our care system. Without them and the dedicated work of care workers, the system would not survive. We should remember that in our debates about the movement of workers around Europe. Our health and care system depends on those dedicated workers, and the man I saw from Sardinia was a very impressive and dedicated man. He was earning a low income and not being paid for travel time between the stops in his working day, which I totally agree is completely unacceptable and a disgrace. I will come back to that issue a little later.

It is also important that we celebrate great care. I went to the first ever awards ceremony in my county of Norfolk that celebrates examples of fantastic care, and to see care workers who hitherto have never been recognised for the amazing work that they do was inspiring. Every part of the country should have similar exercises to acknowledge and celebrate great care.

Secondly, I wanted to comment on the point made by the right hon. Member for Oxford East that sometimes—indeed, quite often—the only companionship that people receive is from the paid care worker who visits their home once or twice a day. Does that not say that there is something profoundly wrong about our society, and if so, do we not all have to recognise that that must change? I have said this before, but we have inadvertently become a rather neglectful society. As our extended families have been dispersed far and wide, often older people are left rather stranded, living on their own, sometimes many miles—often, indeed, hundreds of miles—away from their loved ones. It is not a good society in which the only people seen by those older people are those who are paid to deliver care to them. The wider community and neighbours need to play a part in addressing this massive challenge that we face, whoever is in Government. There is absolutely a role for the total professionalism of paid staff, but the wider community must play its role, too.

There are amazing schemes such as the Cornwall pioneer project, in which volunteers work alongside GPs to combat people’s loneliness. There is also a brilliant community organisation called Friends and Neighbours in Sandwell, in the west midlands. That is a network in the poorest community in the west midlands, and yet volunteers give of themselves, and give companionship to people to give them their lives back. Those volunteers play a part in meeting this massive challenge we face.

Thirdly, part of the answer is for care workers to be far more embedded in joined-up and integrated teams of health and care workers. The work in Islington that the shadow Minister referred to is another of the brilliant and inspiring integrated care pioneer projects that join up health and care services and enable care workers to work alongside nurses, so that they recognise that they can possibly go on to become a nurse or a health care worker. Such projects give care workers a status and professionalism that they deserve, which can play an incredibly important part in this process.

Fourthly, I commend to right hon. and hon. Members an example from my county. The GP practice in the village of North Elmham, in the middle of Norfolk, has set up a social enterprise that provides domiciliary care to a widely dispersed rural area. As it is a social enterprise, it is able to pay its staff better. When staff stay and demonstrate reliability, they receive more pay. The consequence is that people know who their care worker is, there is continuity of care, and there is not, as the shadow Minister suggested is too often the case, a situation in which someone different turns up each night. I had a case—indeed, it involved Care UK—of an elderly lady finding a different man turning up each night to shower her, which was an assault on her dignity. The concept of locally based social enterprises, tied in closely to GP practices, seems to be an attractive way forward.

Fifthly, there is the issue of pay. To start with, I will say that Unison is right to campaign on pay; I support it in doing so, and I am very happy to work alongside it. The right hon. Member for Oxford East and others made the point that it appears that 220,000 people in the care sector are being paid below the minimum wage. That situation is completely unacceptable, and I hope that all of us in Westminster Hall today acknowledge that we find that practice to be totally unacceptable.

However, it was this Government who decided that Her Majesty’s Revenue and Customs should carry out a dedicated push in this sector to root out employers who are breaking the law in that respect. Indeed, I can confirm to the shadow Minister that I have specifically asked for a further dedicated focus on the care sector, because it is absolutely needed.

[Liz Kendall]

I am glad that that work is continuing. However, the Minister has said several times in the newspapers that care companies that do not pay the minimum wage should be named and shamed, and yet that has not happened. Why not?

[Norman Lamb]

I am grateful to the shadow Minister for raising that issue. When I was a Minister in the Department for Business, Innovation and Skills, I specifically pushed for a change in the rules to make it easier to name and shame poor employers. That process was not completed by the time I left BIS to go into the Department of Health, but I continue to push for it. Indeed, the rules were changed, so that whenever there is a notice of underpayment of the minimum wage, the employer is named.

There is a complication in the care sector, in that arrangements are often quite complex and reaching a final decision often requires an investigation to be carried out. However, I can assure right hon. and hon. Members that I anticipate the naming of poor companies within this sector in the relevantly near future. I totally support that process; there should be no hiding places for employers who break the law in that way.

[Mr Andrew Smith]

What we all want to hear is a commitment that HMRC will proactively go out, uproot and stop these illegal practices. The thought comes to my mind that in other sectors where the Government have been shown to be negligent in regulating areas of activity—such as investment, with Equitable Life and so on—the Government end up having to pay back the victims. Why do the Government not pay back all these care workers who have lost so much money because of the incompetence of HMRC?

[Norman Lamb]

I thank the right hon. Gentleman for that intervention. However, I repeat the point that it was this Government who arranged for that themed work in the care sector. A substantial sum of money was collected from employers who had broken the law and returned to their employees who had been underpaid. I repeat that I have requested that that themed work should start again. As he will understand, I do not have responsibility for HMRC. However, I have made that request and I will continue to push for that themed work to happen. Where it seems that there is clear evidence that a problem is endemic in a sector, we ought to be prepared to focus on it.

The hon. Member for Blaydon (Mr Anderson) talked about outsourcing. That problem did not start in 2010. Most of the outsourcing—the creation of a predominantly private sector work force—happened before 2010, and we all have to acknowledge that. It is an endemic and deep-rooted problem in the sector, which needs to be challenged effectively.

I will talk briefly about the care certificate, because another issue raised by right hon. and hon. Members is the fact that training standards are often inadequate. I must say that when I came into this job I was rather shocked to discover that there were no proper mechanisms for ensuring that employers were required to provide proper training for their staff. We are changing that situation. We commissioned Camilla Cavendish to produce a report on this issue, and we have now legislated through the Care Act 2014 for a care certificate, which will come into force next April. That certificate will set a national standard for minimum training and competence levels that every employer will have to meet. They will have to ensure that their staff either have the care certificate or something equivalent, and they will have to satisfy the Care Quality Commission that that is the case. If they cannot satisfy the CQC, it can take enforcement action against them. I am proud of the fact that we are taking decisive action to improve training standards.

Hon. Members have also raised the issue of the role of the CQC. It has the power—and Ministers have the power to request it to use that power—to carry out themed inspections of local authorities where there is evidence that commissioning is falling short, resulting in poor care. Part of poor care can sometimes be the terms and conditions offered by employers. I am determined that, if evidence of poor practice emerges, we use those powers to ensure that local authorities, as well as providers, are held to account, in order to raise the standards in this sector. We all agree that that is necessary, and that the underpayment of wages to care workers is not an acceptable practice.