Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 14th January 2014 Commons Chamber

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

6. When he expects to publish a revised adult autism strategy for England.

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

The Department of Health is currently leading a review of the 2010 adult autism strategy for England, “fulfilling and rewarding lives”, and we will publish a revised strategy by the end of March.

[Angela Smith]

Given some of the difficulties encountered by local areas in developing and sharing innovative practice in progressing the strategy he has just talked about, what consideration has the Minister given to the National Autistic Society’s proposal for an innovation fund as laid down in its “Push For Action” report?

[Norman Lamb]

I thank the hon. Lady for her question. The National Autistic Society is doing fantastic work, working closely with the Government. It has put this idea forward and we are considering it seriously; it has real merit. We shall announce our decisions when we announce the results of the consultation in March.

[Mr Robert Buckland (South Swindon) (Con)]

What plans does my hon. Friend have to use the review as an opportunity to bring forward programmes that will increase autism awareness among the general public?

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[Damian Hinds (East Hampshire) (Con)]

8. What progress his Department has made on introducing a cap on care costs.

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

Everyone will be protected against catastrophic costs by the insurance that, in line with the Dilnot commission recommendations, the cap provides from April 2016. We are currently considering the responses to the recent consultation on how the cap will work, and will publish draft regulations and guidance later this year.

[Damian Hinds]

Thanks to tough decisions from this Government, we can look forward to a time when people will no longer have to sell their home to afford care, but what can be done to raise awareness of this landmark policy so that older people, and indeed younger people, can be reassured?

[Norman Lamb]

I thank my hon. Friend for that question, and I am immensely proud that this coalition Government are reforming a grossly unfair system—something that should have happened a long time ago and is massively overdue. This Government completely recognise the absolute importance of an awareness-raising campaign, which will be carried out by local government, national Government and the financial services industry.

[Bill Esterson (Sefton Central) (Lab)]

Ministers have repeatedly claimed that no one will pay more than £72,000 in care costs, but given that the cap will be based on the rate local authorities charge for care and not the actual amount people have to pay, will the Minister confirm that people will have to pay more than £72,000 and that the so-called cap is not a cap at all?

[Norman Lamb]

People can always choose to spend more than local authorities deem it necessary to spend in order to secure care. However, we are implementing exactly the scheme that Andrew Dilnot recommended, and when he announced his proposals they were welcomed by the hon. Gentleman’s own party as a significant advance.

[Sir Edward Leigh (Gainsborough) (Con)]

9. What steps he plans to take to improve the quality of health care provision in the east midlands.

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[Annette Brooke (Mid Dorset and North Poole) (LD)]

T2. Will the Secretary of State join me in congratulating the UK Chronic Fatigue Syndrome/Myalgic Encephalopathy Research Collaborative for providing a mechanism for ME charities, researchers and clinicians to work together in a co-ordinated way? What support will his Department give research into the causes of and treatment for ME?

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

I am not the Secretary of State, but I would be very happy to join my hon. Friend in congratulating the collaborative, which is doing excellent work to generate more CFS/ME research. Spend by the National Institute for Health Research has already doubled in two years, and more funding applications are welcome. The NIHR has awarded nearly £0.9 million to the collaborative’s deputy chair for a senior fellowship studying paediatric CFS/ME.

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[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

Although I support the principles of the Better Care Fund, does the Minister recognise that, in the context of severe cuts to local authorities and cuts in the NHS, the top-slicing of existing budgets is not sufficient? To encourage the kind of innovation that we need to get better integration, we must have additional funding.

[Norman Lamb]

The Government are getting on and implementing integrated, joined-up care. I remember talking about it constantly when the hon. Lady’s party was in government, and nothing ever happened. We are taking concrete steps to join up the system with the benefits of the £3.8 billion Better Care Fund.

[Iain Stewart (Milton Keynes South) (Con)]

T9. The Secretary of State is aware of the plans being developed by Milton Keynes hospital to expand its A and E capacity. In the interim, will he set out what assistance he can provide to ease short-term pressures?

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[Huw Irranca-Davies (Ogmore) (Lab)]

Does the Minister believe that social isolation, which is a key contributor to the health and well-being of older people living on their own, has got worse or has improved under this Government?

[Norman Lamb]

I think that social isolation, if we are honest about it, has got worse over quite a long period, particularly as extended families have been dispersed far and wide. The answer has to be for the whole of society and must involve statutory services working together with the voluntary sector. In Cornwall, one of the pioneers in integrated care, there is a fantastic collaboration between the voluntary sector and the statutory sector to ensure that they directly address the problems with loneliness.

[Mr Speaker]

Last but not least and I hope with exemplary brevity, I call Tessa Munt.

Dementia Care and Services

Norman Lamb Excerpts

Tuesday 7th January 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) on securing another debate on dementia. It is important that we maintain the pressure, keep talking about this subject and keep challenging ourselves to take the necessary further steps. I am delighted to hear he is a dementia friend. I hope that everyone in the Chamber this evening is a dementia friend. [Interruption.] There is lots of nodding, which is encouraging.

[Bob Stewart]

Will the hon. Gentleman define exactly what a dementia friend is so that those of us who are not yet one can understand what we should do?

[Norman Lamb]

I am delighted by that intervention, because it gives me the opportunity to say something very quickly about the initiative being taken by the Alzheimer’s Society. If someone applies to be a dementia friend, they can go along to an hour-long session on understanding dementia better. It is very illuminating to go through that process. We got the initial idea from Japan, where it has gathered enormous momentum. If we can get a million people across society who better understand dementia, it could have an enormously powerful impact by making our communities more dementia-friendly and understanding and giving people with dementia a better life. I would therefore encourage my hon. Friend to become a dementia friend.

The right hon. Member for Salford and Eccles (Hazel Blears) talked about her constituency office. I will accept the challenge she laid down. I absolutely accept the case she makes. We are all serving the public, and it is critical that we make our own facilities friendly for people with dementia and their carers. My constituency office staff do not know this yet, but I will encourage them to go through this process, as all right hon. and hon. Members should.

I was struck by the constituency examples that my hon. Friend the Member for Elmet and Rothwell gave. He mentioned Paul Mancey of Orchard Care Homes, which is ensuring that people entering care homes get proper care and support and that their particular needs are met, and the Springfield Healthcare initiative.

[Glyn Davies (Montgomeryshire) (Con)]

I thank the Minister for allowing me to intervene on an issue that, usually because of personal experience, is close to our hearts. He speaks of the importance of care homes, understanding dementia and caring for sufferers properly, but does he agree that the best treatment is care in the home of the person suffering from dementia? In my experience, a change in circumstances advances dementia faster than anything else. By far and away the best way to treat people suffering from dementia is to make it Government policy to support people to stay in their own homes.

[Norman Lamb]

I broadly agree with my hon. Friend. The most important thing is that the care and support should always be right for the individual. Whatever they need they should be provided with. I recently visited the most amazing GP surgery in Gnosall, Staffordshire, which has managed—this demonstrates a point that my hon. Friend the Member for Elmet and Rothwell made about the variability of dementia diagnosis rates—to achieve diagnosis rates of close to 100%. That demonstrates what is possible. Most of the diagnosing is done in the community within primary care without referral to a memory clinic. What they have found is that by getting early diagnosis and then having very good community follow-up and support—the general practice is central to that—people are staying in their own homes and maintaining a good life for far longer and admissions to care homes and nursing homes are significantly reduced. That demonstrates what is possible and confirms the point that my hon. Friend the Member for Montgomeryshire (Glyn Davies) made.

[Steve Rotheram]

Will the Minister give way?

[Norman Lamb]

I will. I am still on page one of my speech.

[Steve Rotheram]

I thank the Minister for giving way. He is absolutely right about the individual care package that somebody who, unfortunately, has dementia or Alzheimer’s gets. Thankfully, long gone are the days when somebody was given a couple of tablets in the hope that that might somehow affect their condition. Is he aware of the House of Memories project in Liverpool? Is he also aware that there is an event that I am hosting here on 17 June that Members of this House are welcome to attend?

[Norman Lamb]

I thought for a moment that the hon. Gentleman was not going to mention the House of Memories. He always does. Of course I am aware of it because he keeps talking to me about it and knows what I think. I am incredibly impressed by it and there is a plan for me to visit and see it for myself. He is right constantly to make the case for it and for spreading what has been demonstrated is possible in Liverpool to other parts of the country.

It is less than two months since the last debate on dementia and it is a measure of the importance that Members put on the subject and the extent of the challenge that we face as a nation that, thankfully, the House has recognised the importance of debating it regularly. It is also less than two months since we published our dementia state of the nation report, which sets out the progress that we have made on dementia and the challenges we are facing.

The report is an incredibly important document because it also includes online a set of interactive maps that, for the first time, allows someone to enter their postcode to see how their local dementia services are performing and how that performance compares with the rest of the country. Having this level of transparency, as well as the extent to which people will be able to hold their own local areas to account, will have a big impact on driving up diagnosis rates. I have already made the point that some parts of the country have demonstrated that high diagnosis rates are possible. There is no rocket science here and no reason why other parts of the country cannot follow suit, understand and learn that best practice and, critically, apply it to ensure that people get the support they need.

My hon. Friend the Member for Elmet and Rothwell is absolutely right when he makes the point that unless someone has had that diagnosis, they do not get access to the advice, guidance, support and services that are potentially available in a local area to make the life of that individual better and, critically, to provide more support for the carer as well. The maps highlight the variation in dementia care across the country and allow people, but also commissioners and providers, to use the data to see how they compare against other areas and then work to deliver improvements.

Around the world, someone is diagnosed with dementia every four seconds. Over 35 million people have it and as people live longer than ever before that figure is set to double every 20 years. Among them, 58% live in low to middle income countries and this proportion is projected to rise to 71% by 2050. We cannot ignore the pressure on our health and care systems and dementia costs society as a whole as much as £23 billion in the UK alone. The cost of dementia worldwide has been estimated at about £400 billion, or 1% of the world’s GDP. This is why dementia is a major priority for the UK Government and why the Prime Minister launched a dementia challenge in 2012. But we must fight back on an international scale, breaking down barriers and joining forces to address this issue, which has such an enormous human and economic cost.

Five years ago, the national dementia strategy was developed. It has achieved a lot, laying the foundations for real change. We are currently evaluating progress on dementia and on how we have achieved improvements in dementia care, and we are looking at both the national dementia strategy and the Prime Minister’s challenge. I shall come back later to the point about what comes after, and it seems to me sensible first to understand—

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[Norman Lamb]

That was unexpected; I have never had this happen to me before, so I apologise for looking confused! I shall carry on.

It makes sense to understand the success—and, indeed, sometimes the failures—of the current strategy and the Prime Minister’s challenge before designing what follows on afterwards. It is absolutely clear—I have tried to demonstrate this on other occasions—that something must follow; there must be a continuation. This disease has such a profound impact on people and on society that we have to keep developing our understanding and maintaining the momentum.

[Hazel Blears]

I am grateful for the Minister’s commitment that there will be a follow-on from the dementia strategy. He is right to look at what has worked and what might not have worked quite so well. My concern is that whatever comes next must find a way of uniting the whole system. In proceedings on the Care Bill, we debated integration and how important it was, particularly for dementia, because it will save us money. When the Minister looks at the next set of strategies, I urge him to bear in mind that the country must not have in place a set of fragmented relationships that are not bringing the system together to make things better for people with dementia and their carers. The economic impact on the country is also important.

[Norman Lamb]

I very much agree with the right hon. Lady on that. I think that what she argues for is developing. We are not there yet, but it is important that we have developed this ambition to achieve a diagnosis rate of two thirds, which encourages every part of the system to focus on what it needs to do. It is not a nationally imposed arbitrary target; it was based on getting every part of the system to think about what it can achieve by setting ambitious objectives. Collectively, that amounts to an ambition to achieve a two-thirds diagnosis rate, but in itself, of course, a two-thirds diagnosis rate is not good enough. We should not be satisfied when we achieve that; we have to press on. We know that the community in Gnosall has a diagnosis rate of close to 100%, so we should not be satisfied until everyone is getting properly diagnosed on a timely basis. I agree with the right hon. Lady’s point. Under the new system, with the health reforms making clinicians much more involved in the commissioning of care locally, there is a greater chance of getting the engagement of general practice across the country than we perhaps had in the past through the primary care trust route.

[Jim Shannon]

Has the Minister had an opportunity to consider the point I made in my intervention on the hon. Member for Elmet and Rothwell (Alec Shelbrooke), which was about the exchange of good practice and information between the four regions of Scotland, Northern Ireland, Wales and England? Ever mindful that the highest levels of diagnosis for the whole of the United Kingdom are found in Northern Ireland, has the Minister had a chance to discuss these matters with the Health Minister, Edwin Poots from the Northern Ireland Assembly, for instance, to take the issue forward? We all gain from good practice across the whole of the United Kingdom of Great Britain and Northern Ireland, and we all gain from the exchange of good ideas.

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[Norman Lamb]

I completely agree. This disease knows no country boundaries. We all face the same challenge across the whole of the UK and, critically, across the world. That is why we pursued the matter in the G8 summit of December. There should be good collaboration across the UK through all of the devolved Administrations and the Government here. I am always happy to engage with colleagues from Northern Ireland to understand what we can learn from Northern Ireland and also because the exchange of information helps everybody to improve.

We recognise the need to build on the strategy. That is why the Prime Minister’s challenge on dementia is now the main vehicle for change and improvement across health and care, in the community and for the purposes of research. The Prime Minister’s challenge runs until 2050, not just outliving the dementia strategy, but broadening its vision and providing better accountability.

Last year we hosted the G8 dementia summit. I was delighted that the right hon. Member for Salford and Eccles participated in it, and challenged me during one of the sessions. The summit attracted interest all over the world, and harnessed the efforts and expertise of the G8, health and science Ministers, the World Health Organisation, the OECD, industry, researchers, philanthropists and civil society to secure much greater international collaboration in order to tackle and defeat dementia. The declaration and communiqué announced at the summit set out a clear commitment to working more closely together on a range of measures to improve early diagnosis, living well with dementia, and research.

The G8 announced an ambition to identify a cure or a disease-modifying therapy by 2025, which we hope will focus minds internationally. It is backed by a commitment to increase significantly, together, the amount spent on dementia research—we know that at present it is a fraction of the amount committed to research in other areas of medicine—and to increase the number of people involved in clinical trials and studies of dementia. The United Kingdom has committed itself to funding a global dementia innovation envoy to draw together international expertise, stimulate innovation, and co-ordinate international efforts to attract new sources of finance. That will be incredibly important if we are to crack this disease.

In partnership with the OECD, the WHO, the European Commission, those involved in the EU joint programme on neurodegenerative disease, and civil society, the G8 will hold a series of high-level forums throughout 2014 on social impact investment—it will be critically important to attract new sources of funding—new care and prevention models, and academia-industry partnerships, which will also be extremely important. The G8 will meet again in the United States in February 2015, along with other global experts including the WHO and the OECD, to review the progress that has been made on the research agenda. That will enable us to focus minds and try to increase the momentum.

The G8 is an exciting global initiative, and I am immensely proud that the United Kingdom led the way in that regard. However, we are also keeping our focus on dementia in England, and we have made progress since the launch of the Prime Minister’s challenge. We have launched a new dementia friends scheme—which has already been mentioned—to make a million people more aware of what dementia actually is, thus helping to break down the barriers between people with the condition and their local communities. It is important to challenge the stigma that still exists in many places. The Alzheimer’s Society has published guidance setting out the criteria for becoming a dementia-friendly community. I was pleased to hear that Rothwell, near Leeds, is becoming a dementia-friendly community: that is very good news.

The NHS continues to support dementia care in hospitals through its CQUIN scheme—commissioning for quality and innovation—which is generating between 3,000 and 4,000 referrals for diagnosis each month. We have allocated £50 million to 116 schemes to make health and care environments such as hospital wards and care homes more dementia-friendly. Making the environment in which people live with dementia more dementia-friendly is critical to the provision of a calm atmosphere. When we see places to which attention has been given and in which investment has been made, we realise what a difference can be made. The Government’s mandate for the NHS prioritises dementia, and, as I said earlier, includes the ambition of a diagnosis rate of two thirds. My hon. Friend was right to say that the current rate is far too low. We are letting people down in many parts of the country by not securing early diagnosis.

[Mr Ward]

Obviously there is an opportunity to do something once a person has been identified as needing a diagnosis, but in my experience the problem is that other things are usually taking place in people’s lives, and GPs often assume that they are just part of the ageing process. There is a failure, often because of the lack of skills of the GPs, to recognise that diagnosis is required.

[Norman Lamb]

My hon. Friend is absolutely right and there are still GPs who do not really believe in the importance of a timely diagnosis. I have heard GPs say, “What’s the point, because it will make no difference?” However, we know it does make a massive difference not only to the person with dementia but to the rest of their family, in understanding the condition and what they can do to help. Education among GPs is incredibly important, and attitudes are changing but we still have a way to go.

Clinical commissioning groups are working with their local councils and other partners to better understand how widespread dementia is in their communities, including among people living in local care homes. This will mean they can identify and support people with dementia in a timely way. GPs are now able to use the new directed enhanced service to improve the diagnosis of dementia by asking people in certain at-risk groups about their memory. This proactive approach should help to identify patients who are showing the early signs of dementia.

Health Education England has prioritised dementia training and has already delivered 100,000 dementia-trained staff. Again, ensuring the work force within health and care have a proper understanding of dementia is critically important.

[Hazel Blears]

I am pleased the Minister has now come on to the area of the work force. He will know that many of the carers in this area are paid the national minimum wage if they are lucky. Many of them are on zero-hours contracts. Many of them do not get paid for travelling between the appointments they undertake. We ask them to do some of the most difficult work that one can ever imagine but the rewards and the training and support they get is minimal. Is the Minister committed to tackling some of these issues in the care sector, which in my view are unacceptable?

[Norman Lamb]

I feel as strongly as the right hon. Lady does about this. We can never get good care on the back of exploiting very low-paid workers. It is not acceptable to not pay a care worker when they are travelling from one home to another. That is a breach of the minimum wage legislation unless their rate overall comes above that level. HMRC has specifically targeted the care sector and has found quite widespread abuse of, or failure to comply with, the national minimum wage. It is very important that it is complied with.

It is also important for councils commissioning care to be absolutely clear with those they contract with that they expect total compliance with the law. If a council is commissioning in a way which almost becomes complicit in a breach of the law, that is completely unacceptable. Some of the commissioning around the country is very poor and we have got to move on from commissioning on these 15-minute, short-time periods resulting from contracts being opened up for bids and there being a race to the bottom with the cheapest offer winning the contract. We have got to move on to commissioning for quality and for better outcomes.

Wiltshire has now introduced commissioning for home care based on outcomes and quality. One of the care providers now pays salaries to its care staff. So the whole attitude and approach changes and the incentive on the care provider is to improve care, not to get away with the quickest possible care visit.

It comes down very often to the way in which the care is commissioned. That is what has to change and we are working with the Association of Directors of Adult Social Services and the Local Government Association to change the way in which commissioning is undertaken. There is also an amendment to the Care Bill which will require that commissioning takes into account an individual’s well-being. Councils cannot commission on the basis of 15 minutes of care when important care work needs to be undertaken. They will not meet their obligation under the Care Bill if they are doing it in that way. That change will also help to drive up standards. Care workers need to be respected. They do incredibly important work, and they are undervalued by society.

Since 2009-10, Government-funded dementia research in England has almost doubled, from £28.2 million to £52.2 million in 2012-13. Over the same period, funding by the charitable sector has increased, from £4.2 million to £6.8 million in the case of Alzheimer’s Research UK and from £2 million to £5.3 million in the case of the Alzheimer’s Society. In July 2012, a call for research proposals received a large number of applications, the quality of which exceeded expectations. Six projects, worth a combined £20 million, will look at areas including: living well with dementia; dementia-associated visual impairment; understanding community aspects of dementia; and promoting independence and managing agitation in people with dementia.

The hon. Member for Liverpool, Walton (Steve Rotheram) made the point about doing research into how we can prevent the onset of dementia in the first place. We know that vascular dementia is often related to lifestyle, including factors such as heart condition, smoking and alcohol consumption. If we can understand better how to prevent dementia from occurring, we will achieve a massive advance. Research needs to focus on that as well as on finding a cure and on living better with dementia, which is another critical area of research. It is essential that we do all this collaboratively and internationally. We cannot simply find all the results by ourselves, here in the UK. There needs to be an international effort.

The coalition Government have clearly demonstrated their commitment to dementia, but there is a massive amount still to do. We are not looking inwards to solve the problems that we are facing. At the G8, we brought the world together to work collaboratively and to look for solutions. By leading the way with the G8 summit, and with our own domestic agenda of the Prime Minister’s challenge, the UK is mobilising all available resources. We should be proud of the leadership we have shown as a nation to date, but as ever, we will continue to push much further, and we must never be complacent.

Question put and agreed to.

Accident and Emergency

Norman Lamb Excerpts

Wednesday 18th December 2013 Commons Chamber

[Lisa Nandy (Wigan) (Lab)]

My A and E in Wigan is, like so many others across the country, under significant pressure at present. Earlier this year we saw an unprecedented rise in A and E attendances. That is a result of a series of problems, including the difficulty in getting GP appointments, as outlined eloquently by my right hon. Friend the Member for Leigh (Andy Burnham), but I think the single most significant cause is the cuts that have been made over the past three and a half years to social care. Does the Minister have any idea what those cuts and the unfair distribution of them—my constituency of Wigan has been cut three times more than Windsor— have meant to people in their lives?

I want to say something about the situation of older people. I have been shocked over the past couple of years by what is happening to older people because of the deep and front-loaded cuts to social care, which have left councils with no option but to cut services. Over the last two years we have seen an unprecedented rise in the number of over-90-year-olds coming into my local A and E and others across the country by ambulance.

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

The hon. Lady talks about the situation in social care and of course I understand that there is real pressure, but will she welcome the fact that in 2012-13 there were 37,473 fewer days lost in delayed discharge due to social care, so in other words social services are doing better now than they were in previous years?

[Lisa Nandy]

In the very short amount of time that I have got I will simply echo the words of my hon. Friend the Member for Stretford and Urmston (Kate Green) who said to the Secretary of State that she thought people would be staggered by the complacency of Members on the Government Benches and would not recognise the picture they paint, which stands in stark contrast to the lived experiences of my constituents, some of whom are old and vulnerable and deserve so much better than this. Behind the increase in the number of admittances to hospital lies a picture of older people who are living alone at home, worried, lonely and ill.

The Minister’s Government have not caused all of this, but, like my right hon. Friend the Member for Leigh, I have talked about my concern about what has happened in social care and the rise of zero-hours contracts and choosing the lowest bidder over recent years, so, by God, I must also say this: his Government have made the situation so much worse. By the end of next year the budget of my council in Wigan will have been cut by £66 million, and we were told this summer that another 10% is still to come. We have done everything. We have pared that organisation to the bone. The truth is there are no more efficiencies to be had; there are only cuts.

I say this to the Minister as well: this is not just about councils, because what this Government have done, and the Darwinian approach they have taken to the voluntary sector, has severely undermined the capacity of charities to respond to this crisis at the very time when they are needed most. This is the true meaning of the big society.

We are seriously disrupted in Wigan—

[Norman Lamb]

rose—

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[Clive Efford]

There is example after example of broken promises. The Conservatives accused people of planning to close hospitals when there was no plan to do so, and then came in and did it themselves.

We have a curious situation. The Secretary of State has been saying, “Crisis? What crisis?” Today, he read out a quote saying that the crisis is behind us. That is a little confusing. Of course, the crisis that he was talking about was a summer crisis. He did not mention that. He presided over a summer crisis. That is pretty unique. I do not think that even Virginia Bottomley achieved a summer crisis, but I could be wrong.

The crisis is of the Government’s own making. The Secretary of State talked about the need for services away from the hospital to protect A and E from being overwhelmed. However, one of the first things that they did was to do away with the 24-hour promise of a visit to the GP. They then introduced 111, which had algorithms and questions that all ended with the advice, “Go to your A and E.” There are now 850 fewer surgeries opening at evenings and weekends, and a quarter of walk-in centres have closed. Talk about reinventing the wheel—the Government are now saying that those are the sorts of things that we need to do. The crisis in A and E is of the Government’s making. It is their decisions that have created the situation.

To return to south-east London, the Secretary of State appointed the trust special administrator to oversee the merger of Lewisham and Queen Elizabeth hospitals. The local authority took on that decision because the powers that the Government took were not within their remit. The Government were challenged in the court and defeated. The Government are now moving the goalposts. Having said before the last general election that there would be no top-down reconfiguration and that they would not enforce closures if the local community did not agree with them, they are taking powers to impose closures on local communities.

In the minute that I have left, I want to say to the Minister that there has been a series of broken promises. It is fitting that a Liberal Democrat is summing up a debate on broken promises on the NHS.

[Norman Lamb]

indicated dissent.

[Clive Efford]

It is true. Where were any of the things that are happening to our NHS in the Liberal Democrats’ manifesto? None of them was in their manifesto. They never put them before the electorate.

We want no return to the closure of Lewisham A and E. The closure of Queen Mary’s, Sidcup has had the knock-on effect of overwhelming the other A and Es in south-east London. That is clear for all to see. Those A and Es are under serious pressure. It is clear that there is no slack in the system to pick up the additional burden from that closure. We must have a guarantee from the Government that they will not impose the closure of another A and E on the people of south-east London. I would like to hear that from the Minister when he sums up.

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

We have heard a lot of scaremongering about the NHS today, including endless claims about a crisis. If the Opposition are thinking about new year’s resolutions, I have one for them: stop misleading and misinforming the public. Let us look at the evidence.

[Andrew Gwynne]

rose—

[Norman Lamb]

I will not give way; I do not have time.

Up until this week, A and E targets were met in the past 32 weeks in a row. Is that evidence of a crisis? The average wait for people in A and E during Labour’s last year was 77 minutes; it is now 30 minutes. Is that evidence of a crisis? Even though more people are coming through the doors, 2,000 more patients are being seen in less than four hours every day under this Government than under Labour. Evidence of a crisis? I don’t think so. The Opposition are scaremongering, plain and simple. In fact, the College of Emergency Medicine’s president, Cliff Mann, has today said that any crisis in accident and emergency is “behind us”.

[Andy Sawford (Corby) (Lab/Co-op)]

May I associate myself with the remarks made by the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone)? We are pressing for funding to meet the additional demand in the Kettering accident and emergency department. Will the Minister encourage us in that?

[Norman Lamb]

I applaud the cross-party effort of those Members campaigning for their community, and I am very happy to engage with them further on that matter.

[Andrew Gwynne]

rose—

[Norman Lamb]

I will not give way again; I do not have time.

Last year, of the 21.7 million people who visited accident and emergency departments, almost 96% were admitted, transferred or discharged within four hours. Target achieved. So far, it is the same this year: target achieved. The right hon. Member for Leigh (Andy Burnham) missed his A and E target in two of the three quarters when he was in charge. Did he go around telling everyone that there was a crisis at that time? No, of course he did not—

[Several hon. Members]

rose—

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[Norman Lamb]

Thank you, Madam Deputy Speaker.

The then Secretary of State, now the shadow Secretary of State, missed the target in this very week when he was in charge. We know that the winter is tough, and that performance always dips at this time of year. We also know that the staff are under a lot of pressure. The truth is that we inherited a dysfunctional system that was crying out for reform, with too many people ending up in hospital because of crises in their care, as my hon. Friend the Member for Bracknell (Dr Lee) made clear. For years, I have argued the case for a different approach.

We are supporting the NHS to enable it to manage better in the short term. For this winter, we are investing an additional £400 million in total—more than ever before. In the longer term, we need to look afresh at how we organise urgent care. That is why Bruce Keogh’s report into urgent and emergency care is so important, and I hope that the hon. Member for Mitcham and Morden (Siobhain McDonagh) will accept the case for a clinically led review in order to achieve the right approach. We will work closely alongside NHS England in putting these reforms into practice. The hon. Member for Stretford and Urmston (Kate Green) was absolutely right to say that we have to communicate better with the public and ensure that the process is a good one.

In the longer term, we need to do more to prevent people from ending up in hospital as a result of avoidable crises. As my hon. Friend the Member for St Ives (Andrew George) said, we need to make two big shifts. The first involves a move to a much greater focus on preventing ill health and the deterioration of health. The second involves a shift from a fragmented system to one that is integrated and joined up. That is the approach that we must follow.

Integrated pioneers around the country, such as those in south Devon and Torbay, Greenwich and Labour-led Barnsley, are doing great work, joining up care, collaborating with the voluntary sector, providing better care and keeping people out of hospital. That is the vision of the health service for the future. These pioneers will help the rest of the country to make the best possible use of the £3.8 billion better care fund. The fund will encourage organisations: to act earlier to prevent people from reaching crisis point; to offer seven-day services; and to deliver care that is centred on people’s needs. I am grateful to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for welcoming that important new fund. We are also introducing named, accountable GPs for the over-75s and improving access to general practice.

We are addressing both the short-term and long-term challenges, giving the NHS the support it needs. I want genuinely to thank the excellent staff throughout our health and care services who are tackling these issues head-on. The measures and changes we have outlined today will support staff to deliver the best possible care, even in the most difficult of circumstances.

Question put.

The House proceeded to a Division.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I ask the Serjeant at Arms to investigate the delay in the No Lobby.

Rare Diseases

Norman Lamb Excerpts

Tuesday 17th December 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bayley. I thank the shadow Minister, the hon. Member for Copeland (Mr Reed) for his generous offer of support, and I am sure that we will be able to deliver his preconditions for that support. I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. He is, as the shadow Minister has said, one of the most assiduous attendees at health debates and a consistent contributor on a whole range of different issues. We all welcome his contributions. He always makes the case for better co-ordination and collaboration between the different nations of the United Kingdom, and I completely share that aspiration. There is great value in a bit of diversity in the development of our health systems, because we can often learn things from the innovation and experimentation taking place in other parts of the United Kingdom. In opposition, I visited Northern Ireland because I was fascinated by the way in which Northern Ireland commissions and provides health and social care together. I wanted to learn more about the experiences in Northern Ireland, good and bad. Such diversity is to be valued and we should not have a one-size-fits-all approach, but I agree with the hon. Gentleman about the importance of collaboration. The Government’s strategy is an example of where that can be really strong and effective.

[Ms Margaret Ritchie (South Down) (SDLP)]

On the Minister’s point about collaboration, is he aware that a drug to deal with atypical haemolytic uraemic syndrome has been approved in England but the same approval has not been given in the devolved institutions, particularly in Northern Ireland?

[Norman Lamb]

I was not aware of that, but I am interested to hear it, and the hon. Lady makes her case powerfully. Before I respond fully to the points made by the hon. Member for Strangford, I want to deal with some of the other issues that have arisen during the debate. Several hon. Members, including the shadow Minister, asked whether the new architecture of the NHS had damaged the co-ordination of work on rare diseases. In many respects, I can reassure hon. Members. There is a danger that if one was coming into this place from afar and hearing the debate, one might think that we were moving from an idealised, perfect scenario into something more troubling. We all know, however, that that is absolutely not the case. The treatment of rare diseases historically has been far from optimal, and the greater involvement of clinicians in the commissioning of care can have real benefits for patients. Until 31 March 2013, far from being a simple matter, specialised commissioning was fragmented across a range of NHS organisations including regional specialised commissioning groups, a national specialised commissioning team and local primary care trusts, which remained ultimately responsible for the specialised health care of their populations. From 1 April 2013, under the terms of the Health and Social Care Act 2012, NHS England became the sole direct commissioner of specialised services, which provides a greater simplicity in the commissioning of services.

[Alison Seabeck]

Will the Minister give way?

[Norman Lamb]

I will continue, because I am conscious of the time. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) made a valuable contribution. I learned something about trigeminal neuralgia, from which I think I understood him to say that he suffers. He asked whether it would be possible to meet once the report that he referred to is complete, and I would be happy to agree to that, diary permitting. I am sure it will be possible to do so at some point. He made some important points about misdiagnosis, and about the importance of support groups and networks. The internet now provides incredible assistance to people with rare diseases, because they can link up not only with those in their neighbourhood but with people and clinicians globally who can guide them in the treatment of their condition. He also spoke about unnecessary referrals to hospitals and the mental health implications of some rare diseases, and I completely agree with him.

My hon. Friend the Member for Wealden (Charles Hendry) made powerful points about the extraordinary work of so many families, and he mentioned in particular the work of Charlie’s Challenge and Tildy’s Trust. Such families do the most remarkable work, and they are often hellbent on producing a really valuable legacy from their experiences. His point about the Department helping to co-ordinate the work of so many such groups was well made. He also referred to the fantastic work that is going on in Edinburgh university, and I applaud all those involved.

The hon. Member for Plymouth, Moor View (Alison Seabeck) made the point that there is extraordinary variability of service around the country. That is something that the strategy can absolutely address, and I believe we will get powerful results. She referred to her constituent, young James, who suffers from Duchenne muscular dystrophy, and she talked about the importance of transition to adulthood. I focus a lot on mental health, and that transition is often a complete disaster. We need to do far more to improve it.

The hon. Member for Foyle (Mark Durkan) made some important points about collaboration. He referred to the British-Irish Council, and although I have no idea whether his suggestion is possible, I am happy to look into it. He talked about the funding challenge. We are in very tough financial circumstances and often—the contributions of many hon. Members this afternoon have emphasised this—the question is how the money is used, because it is frequently not used effectively. A misdiagnosis usually results in an inappropriate referral to hospital, and a patient goes down completely the wrong track. An enormous amount of money is wasted, and the patient receives very poor care. It is essential to improve the way in which the system works to extract better value. We recently announced integration pioneers in 14 areas of the country. None has had extra money, but they demonstrate that, by co-ordinating their efforts more effectively, they are producing much better results for patients. The shadow Minister was absolutely right that the one thing we should all focus on is the patient—the individual citizen—and their experience of the system.

It is fitting that this debate should happen so soon after the launch of the UK strategy for rare diseases. This strategy is an overarching UK-wide framework, setting out a shared UK strategic vision for improving the lives of all those with rare diseases. It is owned by each country in the UK and commits them to more than 50 actions—I think it was identified as 51—that will deliver better outcomes for those with a rare disease. It means that for the first time we are in a position to make a tangible, co-ordinated difference to those suffering with a rare disease. That is something we can all be really positive about.

As we have heard, one in 17 people will experience a rare disease at some point in their life, with the majority of diagnoses made in childhood. That amounts to some 3 million people in the UK. A disease itself may be rare, but having a rare disease is, alas, not unusual, because there are so many of them—a point made by the hon. Member for Plymouth, Moor View. They are a major cause of illness and make considerable demands on the resources of the NHS and other care services. The strategy for rare diseases is based around the more effective and efficient use of services—a point I made earlier—with better links to research and innovation. As the NHS constitution states, no-one should be left behind because of their condition, be it rare, very rare or yet to be diagnosed. To achieve this, England, Scotland, Wales and Northern Ireland have agreed to deliver the 51 commitments that focus on five areas.

The first is empowering patients—perhaps the most significant of all—making sure that they are listened to, informed and consulted every step of the way. No one knows the condition better than the person suffering from it; too often, they are ignored in a rather paternalistic system. We will continue to work closely with patient groups and others to improve services for rare disease sufferers. We will improve access to knowledge and support networks at UK, European and international level, and we will help patients to participate in rare disease registries. We will look at how those might be developed in England to better capture the patient experience.

Secondly, we want to develop more effective methods for identifying and preventing rare diseases. Carrier testing, preconception and antenatal care, along with newborn screening, all play a part. Rare diseases are often genetic in nature, and so can affect more than one member of the family. This makes it important that testing of other family members, where appropriate, becomes more routine.

The third area is better diagnosis, which has been raised during the debate, and earlier intervention. Too many people still wait far too long to get an informed, correct diagnosis. There are several things we need to address. We need to ensure there is better awareness of rare diseases. That is important across all aspects of health care. Not everyone can be an expert, but ensuring that the possibility of a rare disease is considered when a diagnosis is proving difficult can help. We need to ensure that all doctors are alert to the possibility of a rare disease when they see patients, even if they are not able to diagnose specific diseases. This means including better training on rare diseases in university courses and in professional development at work.

The training and education of clinicians is critically important. Health professionals do not need detailed knowledge of every rare condition, but all medical specialties and multi-professional care teams should have a general awareness of rare diseases so that they can make rapid referrals to specialists in the appropriate field. Making genetic testing more mainstream, harnessing the potential of genomic technologies and focusing on what our DNA can tell us will also help us to reduce the time to diagnosis.

Perhaps the most important commitment is to develop clearly defined care pathways between primary and secondary care and regional and specialist centres. Health care professionals, especially GPs who are likely to be the first point of contact, need to know how to access the pathways for those at risk of rare disease.

Fourthly, we want to see better co-ordination of care. Building on the fantastic NHS genetic services that already exist—this country is well recognised internationally for that—we want to see the development of centres of excellence in rare diseases, providing one-stop-shop services to patients through co-ordinated consultation and treatment schedules. The centres should also be knowledge and skills hubs—concentrating the skills together—that support local delivery of services and facilitate clinical trials and other research projects.

The last area of the strategy, but by no means the least, is recognising the absolute importance of research, which several hon. Members have touched on today. The Government are committed to supporting research into rare diseases. Such research holds the key to improved personalised and targeted approaches to health care. These have the potential to improve the effectiveness and safety of treatments, the speed of diagnosis and patients’ quality of life.

In the UK, we are lucky to have some of the best academic and clinical research in the world. It was no coincidence that Earl Howe launched the strategy at Great Ormond Street hospital last month. The hospital itself hosts a National Institute for Health Research biomedical research centre that continues to lead on experimental medicine, including the discovery of diagnostics and new treatments for childhood diseases. The shadow Minister—if I can briefly divert him from his iPad; I am sure he is catching up on important stuff—made the point about how we ensure that we make the right decisions on research priorities. Ultimately, it comes down to the quality of the proposition that is put forward, but I will write to him and other hon. Members on the issues raised that I have not touched on.

We also want to see more collaboration between patients, health care professionals and researchers, and for that to become normal custom and practice. At that same event, Earl Howe also announced that the National Institute for Health Research is establishing a rare diseases translational research collaboration to translate research into actual practice. As part of the NIHR rare diseases translational research collaboration, researchers will share their considerable resources and world-leading expertise to increase research collaboration and improve treatment and care.

Some £20 million over four years is being invested by the NIHR to fund the NHS research infrastructure focused on deep phenotyping—the gathering of information on the physical characteristics of people with rare diseases. The TRC will build on our British heritage as a world leader in genomics. It will provide national co-ordination to bring those with significant relevant NIHR-funded infrastructure in the NHS together. That will speed up the development of new diagnostics and treatments. That is also why rare diseases is one of the three priority areas for the Government’s initiative to sequence 100,000 whole genomes over the next three to five years. We want to see innovative research and cutting-edge technology translated into real patient benefit.

The strategy for rare diseases will increase access and lead to a more patient-centred, co-ordinated approach to care and treatment, clearly focused on the needs of patients and families. Each country in the UK will develop its own implementation plans over the next few months. We will ask a reconstituted UK rare diseases stakeholder forum to maintain an overview of the implementation of the strategy. The original forum was established earlier this year and comprises policy officials from the four UK countries, service users, industry, regulators and service providers. The forum played an invaluable role in the development of the UK strategy and will now have an ongoing role in monitoring the strategy’s implementation and reporting back on progress.

In England, our key delivery partner is NHS England. The recommendations of the UK strategy for rare diseases that relate to NHS England’s responsibilities for specialised commissioning will form part of the scope of NHS England’s five-year strategy for specialised services—an £11.8 billion plan to co-ordinate specialist services.

I want to thank all hon. Members for their contributions to a very useful debate. On all the other points that I have not been able to deal with, I will write to hon. Members.

[Hugh Bayley (in the Chair)]

I very much look forward to seeing some of the Front Benchers when we scrutinise the Care Bill in the weeks to come.

Care Bill [Lords]

Norman Lamb Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I shall in a moment.

What are the direct and practical effects of those cuts to council budgets? First, councils have cut eligibility criteria, so more people are exposed to care charges in a way that they were not before. Secondly, those care charges are now rising above inflation year on year, so more people are exposed to higher charges. This means that they are now more likely to pay right up to the new cap that the Government are introducing. That will not feel like progress to the public, and that is why we are making our reasoned objection to the Bill.

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

I am sure the right hon. Gentleman agrees it is important that we are accurate about these matters. He suggested that the Bill “restricts”—that is the word he used—eligibility for substantial or critical care. Does he accept that it does not do that, and that any council that wants to have more generous eligibility can continue to do so?

[Andy Burnham]

I do not disagree with the approach of setting national eligibility criteria and taking a national view, so I agree with the Minister on that. The problem, however, is that if the Government legislate for just critical and substantial levels, they are sending a very clear message to local government that they believe they can only afford to fund it at those levels. Surely the criteria would have been set higher if they were funding local government better.

The truth is that when this Government came to office, many more councils in England were providing social care at “moderate” level. That has been slowly cut back and now only about 23 councils are still providing support to people with moderate needs. It is a fair bet that those councils will soon be unable to provide moderate care and shrink back to providing only critical and substantial care.

[Norman Lamb]

Does the right hon. Gentleman accept that more than 100 councils were setting the eligibility criteria at “substantial” when his party left office? Is he saying that a future Labour Government would fund eligibility criteria at moderate level? If so, how would he fund it?

[Andy Burnham]

That is a political point; let me deal with it. When we left government, 38 councils were providing some free care to people with either low or moderate needs. I correct the figure I gave a moment ago: it is, in fact, 15 councils that are now doing that. The care system is being scaled back. Therefore, people are more liable to charges and are more likely to have to pay them, because support is being withdrawn from people in the home.

--- Later in debate ---

[Andy Burnham]

The right hon. Gentleman shakes his head, but a £72,000 cap is not what Dilnot recommended. That is the Government’s problem. As I said before, the cap will not cover hotel and accommodation costs, either. When both factors are taken into account, an average person in England will take almost five years to hit the so-called cap. Based on average stays in care homes, that means that six out of seven elderly people will have died before they reach it.

If that were not bad enough, people are about to find out that the promises that they will not have to sell their home are also a con. The ability to defer payment for care was one of Andrew Dilnot’s central proposals designed to stop people worrying about selling their home while they were alive. He said that old people would be able to borrow from the local council and repay care bills from what they left behind. The Government initially said that they would implement that proposal and introduce what they called a universal deferred payments scheme. I remember when they used to call that type of proposal a death tax, but things have seemingly moved on for the better.

However, on the day when Parliament rose for the summer recess, the Department sneaked out a consultation document saying that pensioners would not qualify for any help under the universal deferred payment scheme until their savings and other assets, such as valuable possessions, had been run down to below £23,250. That new condition will prevent almost half of those who would otherwise have been able to take advantage of that apparently universal scheme from accessing it.

[Norman Lamb]

Does the right hon. Gentleman accept that that was exactly the same proposal as his party’s Government put forward just before they left office?

[Andy Burnham]

Just as the Government’s proposal is not the Dilnot report, it is not my national care service proposal. I had a range of different proposals, and that one has to be considered in that context.

As the Minister knows, I proposed a universal approach in which everybody would contribute on the NHS principle—I seem to remember that he and I were in some agreement about that. That was a deferred payment, but this proposal is different. The Government are talking about a universal deferred payment scheme in which people will pay from what they leave behind, but—and this is the point—it will not be available to everybody. That was the promise the Minister has broken.

--- Later in debate ---

[Hazel Blears]

My hon. Friend makes an extremely powerful point. I am pleased that the Bill strengthens support for carers. I draw the House’s attention to the Bill introduced by the other Member for Salford, my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), which seeks to make sure that carers have the right to stay in work and the support to be able to do that. We must consider the cost to our economy of people having to give up work in order to care. We have talked a lot today about perverse incentives and false economies, and that has absolutely been a false economy for a long time.

I wish to say a word about diversity of provision and commissioning new models of care that can help with prevention. In my city we have been working on that for a long time, and I look forward to showing the Minister some of our examples when he visits. Social adVentures is a social enterprise that helps people with mental health problems, and one of its projects is “garden needs”. It has taken control of a garden centre, and people with dementia and people with mental health problems are now attending. The way it is keeping people active in the community and able to do many more things than they would if they were isolated and at home is amazing. Unlimited Potential is another fabulous social enterprise, which stands on its own two feet, is not grant-dependent and is able to invest more money back into the community. Last week, I had the pleasure of launching a website called Really Useful Stuff, which is just what it says on the tin—it is a website where people can get aids, adaptations and kinds of social care that are modern, innovative and creative. Those are just a few examples of what is already happening in the community.

I say to the Minister that at a time when money is tight, and will be, no matter which Government are in power, the imperative to innovate and be more creative with the funds we have has never been greater. Therefore, investing, in particular, in the social enterprise sector, which often has these great ideas, and in enabling those ideas to get to scale so that provision can be made across the country, is really important. Another company in my constituency, 2ergo, has recently developed an app for the iPhone where people can see what provision is available in Salford for care, respite care and activity, and how to book it. They can book it over their iPhone—families can do that; they can help the people they are caring for. So this use of new technology is now developing apace, and, again, we have to take advantage.

I commend the Government for organising the G8 summit last week in London—an amazing event where we gathered support from countries across the world. I hope that next year we will be able to expand that to a global event examining dementia, not just one involving the G8 developed countries. Part of that G8 meeting was about how we get more research. I would like to see far more research on the quality of care. There is a lot, but not enough, research on the bioscience, but hardly any research on the interventions we do, particularly for people with dementia. We all know that “singing for the brain” has a great reputation. It helps cognitive development, as do art, drama and reminiscence work. There is no evidence base behind that, so if we are to have a better system of social care, we need better research into therapeutic interventions that work. That will enable commissioners to commission packages of care that they know will make a difference. If money is tight, we need to spend it on things that we know will be effective, and I ask the Minister to support that.

The Alzheimer’s Society has also done a lot of work on dementia-friendly communities. That is not expensive. It is a matter of mobilising the good will of local people, shops and arts centres. In Salford, a taxi firm has trained 400 drivers to look after people with dementia. Such care does not cost a lot of money if we can mobilise ordinary people in their communities. In Japan, 4.5 million people are signed up to be dementia friends. Our ambition is to have 1 million such friends. Again, I push the Government to be more ambitious to see what more we can do.

Clause 5 is about not just diversity and shaping the market, but quality, and that is an area about which we all feel passionate. How can we in this country tolerate a situation in which those who do the most difficult job in caring for our friends and family are actually some of the least regarded workers? It is utterly unacceptable to have zero-hours contracts in the social care sector. The carers who care for my dad come in for 15 minutes. They will do more if they can. They have to ring up to be assessed when they have done 12 minutes. They get no payment for travelling and no expenses for their petrol. They came out one Sunday. They started at 8 o’clock in the morning and went home at 9 o’clock at night, but because they only had five hours of 20-minute slots, they got paid only for five hours. Members should try being out on a Sunday for 13 hours and going home with five hours of minimum wage payment. It is an absolute disgrace and a scandal that we tolerate that in this country. I hope the Minister will assist in bringing such practice to an end.

I want to say something about my own local authority. My hon. Friend the Member for Worsley and Eccles South mentioned the fact that Salford has recently had to change its eligibility criteria from moderate to substantial and critical. We were the last authority in Greater Manchester to have to make that decision, and it was heartbreaking. Our social services have always merited four stars. When I was a councillor 30 years ago, cuts were bad, but we always prioritised social care and nursery care for children. The decision to change the criteria was not made lightly, and the cuts have been absolutely horrendous.

Let me again say to the Minister that we need creativity and imagination to deal with this matter. I want to draw the House’s attention to my unpaid interest in social finance, which appears in the Register of Members’ Financial Interests. We have a real opportunity to draw extra funds into the social care system. If we could have a social investment bond that aimed to keep people with dementia in their own homes for longer, we would save the NHS a fortune. People with dementia are admitted to hospital more often. They stay longer in hospital and many more of them die there. If we could mobilise social investment to offer a reward for keeping people in their own homes, funded by the savings to the NHS, we could bring in some new money, not just what we are getting from local authorities.

[Norman Lamb]

I am very interested in the right hon. Lady’s proposition, and would be happy to talk further with her about it.

[Hazel Blears]

I am grateful to the Minister for that. In these difficult times, we all have a responsibility to look at creative and innovative ways of funding and to try to carry them through. The whole area is becoming very exciting. It was the legacy that the UK agreed to take on from the G8 meeting last week. We are global leaders. We have 14 bonds in this country; America only has one. For once, we are well ahead of the United States, and I am delighted that the Minister wants to discuss that issue.

All of us could talk for at least 20 or 30 minutes on that issue. As I come to the end of my contribution, I will just say that the Bill is a step in the right direction. I am disappointed—I say this to the Minister in the kindest way I can—that we have not been more ambitious. If we want to move towards whole-person care, we will have to be much bolder than we have been. I remember when we said, “We are at our best when we are at our boldest,” and that applies in this case. Nevertheless, over the next few weeks and months, I shall keep holding the Government to account, holding their feet to the fire and pushing them on to see what more we can do. We all feel a personal, deep and emotional responsibility for the most vulnerable people in this country who look to us to care for and support them at a difficult time in their lives.

--- Later in debate ---

[Barbara Keeley]

I agree with my hon. Friend.

Changing eligibility from “moderate” to “substantial” this year will mean that the number of people in Salford receiving council-funded care packages will fall by 1,000, to 7,500. To give credit to Salford city council—my right hon. Friend the Member for Salford and Eccles (Hazel Blears) has already done so—it held off making the eligibility cut until the third year of Government budget cuts, but now it must join the nine out of 10 local authorities setting eligibility at the higher level. I am afraid that the Secretary of State’s earlier claim that they do not have to set it at that level will have sounded very hollow indeed.

Talking of things that sound hollow, the new rights for carers set out in the Bill will sound very hollow to carers in my constituency at a time when many of them are losing the few hours of support they have that give them a break. I want to cite the example of an elderly couple in Salford who have cared for their adult son for over 30 years and who have relied upon respite care for a rest or a break. At the last review of their son’s care package, the respite care element was reduced, which has had a detrimental effect on their physical and mental well-being. They are now not even sure whether they can carry on caring for him. I fear that my right hon. Friend the Member for Salford and Eccles and I will hear many more such cases as 1,000 people in Salford lose their care packages over the next year.

Many organisations involved in social care have raised fears about the crisis in care and their view that the eligibility level should be set at “moderate”, rather than “substantial.” Over the past five years, the number of people over 65 receiving publicly funded care has fallen from 1.2 million to less than 1 million, and for people aged 18 to 64 it has fallen from £570,000 to £470,000. That is a serious fall in the number of people receiving care. Some of those who have lost publicly funded care have funded the care themselves, but in other cases the care workload will have fallen on unpaid family carers.

The number of unpaid carers caring for more than 50 hours a week has increased by over a quarter in the past 10 years. As my right hon. Friend said, Carers UK has told us that 1 million carers have given up work to care, which costs the Exchequer £1.3 billion a year in extra carer’s allowance and lost tax receipts. I believe that reliance on unpaid family care with those heavier carer workloads might also have an impact on the health of those carers, particularly those caring at the heavier end.

The Government plan to set the national eligibility threshold at “substantial”. The Care and Support Alliance says that this means that 105,000 working age disabled people will be left without the support they need to live independent lives. That issue was raised by my hon. Friend the Member for Stretford and Urmston (Kate Green), and she is right to do so. We focus an awful lot on adult social care and older people, but we need to think about working-age disabled people as well.

[Norman Lamb]

I absolutely respect and appreciate the hon. Lady’s concern for carers; she has campaigned vigorously on their behalf for a very long time. Does she accept, though, that when her party left office, 108 councils set “substantial” as the eligibility criterion for support from local authorities? Do we not all face the same incredibly difficult financial circumstances and have to examine the innovation that the right hon. Member for Salford and Eccles (Hazel Blears) talked about? There is not simply a pot of magic money that will appear if ever Labour returns to government.

[Barbara Keeley]

I do not agree at all. These cuts are far too swingeing, and there is nowhere else for my local authority, Salford, to go. After 20% cuts, the £100 million loss of funding that we have sustained cannot be found with any amount of innovative thinking. Ministers are now at the point of kidding themselves. I am sure that the Minister, like all his predecessors, goes round the country and is shown all kinds of examples of innovation, but innovation without funding will not work.

The eligibility issue interacts with the cap on care costs. The vast majority of older people will fail to benefit from the £72,000 cap on care costs; it will help only those with the most complex needs. As has been said—we need to keep repeating it—a cap set at £72,000 ignores Andrew Dilnot’s warning that it would work only if it were set at a much lower level and if the underfunding of social care were addressed. It is clear from the Government’s own impact assessments that the number of people whose costs will be capped are a tiny minority. It is estimated that just over one in 200 people aged over 65 will be helped in 2016 and that fewer than one in 200 will be by 2026. It is an incredibly sad reflection of this Government’s ambition that they will have spent the whole of a five-year Parliament—in fact, longer than a five-year Parliament—introducing measures on the long-term funding of social care that eventually help only one in 200 people. My right hon. Friend the Member for Salford and Eccles talked about being ambitious; this is not ambition.

On the support needs of carers, I will repeat some of the things that we heard from the right hon. Member for Banbury (Sir Tony Baldry). Full-time carers are more than twice as likely to be in poor health as people without caring responsibilities. I point out to the Minister that this Bill does not do enough to support those full-time carers. The Government have said that carers are the first line of prevention in that properly identifying and supporting them prevents the escalation of demand on statutory services. Given the A and E crisis, we need that prevention. However, identification of carers is not happening and the Bill does not do enough to change that. Macmillan Cancer Support, which has been carrying out surveys on this, tells us that 70% of carers of people with cancer come into contact with health professionals, who are the people who should be identifying them and signposting them for information and advice. Only 5% of that group of carers receive a carers assessment, and only one in three of those surveyed by Macmillan had even heard of a carers assessment. It is meaningless to suggest to people that they have a right to something they have never heard of and are not going to get.

In Salford, we have a project run by the Carers Trust centre to identify carers within the primary care system. I want to pay tribute to the work that the centre does and to mention its manager, Dawn O’Rooke, who is leaving this month after several years of work in this field. Over the years, the project has established a network of links within GP practices to identify carers. Last year, GPs made only 300 referrals to the carers centre, yet we have 23,000 carers in Salford, over 5,000 of whom will be caring at the heaviest levels. The Carers Trust tells us that, nationally, GP practices are identifying only about 3% of carers, but it should be 10% or more. Health bodies must be required—this Bill is the place to do it—to take on the task of identifying carers and referring them for advice and support, because carers are mainly seen in health settings and not by local authorities. The figures I gave about people losing packages mean that 1,000 fewer people in Salford will be seen by, or go anywhere near, the local authority because the person they care for is not getting a care package.

The Minister is aware of my private Member’s Bill, the Social Care (Local Sufficiency) and Identification of Carers Bill, which had clauses to tackle that issue. I am happy to show them to him again and explain how he could go about tackling the issue in his Bill. The clauses would ensure that NHS bodies have procedures in place to identify carers and ensure they receive information and advice. The Government’s own care and support White Paper stated that there is

“still an unacceptable variation in access to tailored support for carers”

and that NHS organisations should

“work with their local authority partners...to agree plans and budgets”.

The right hon. Member for Banbury made that point. Why are there not more robust measures in the Care Bill to make sure that this happens? As things stand, it will not happen. The NHS has been going through an agony of reorganisation and is now going through an agony of finding efficiency savings, and its staff do not have the time, unless they are directed to the right procedures, to take this task on.

As has rightly been said, clause 2, with its requirements for local authorities to provide preventive services, makes no explicit mention of the NHS, and the only duty on NHS bodies is one of co-operation. Anyone who has tried to work in local authorities on co-operation with health bodies, as I did years ago, knows that it does not go anywhere when there is no budget and no duty. Without effective procedures and systems within health bodies, the identification and signposting of carers will stay as it is now—patchy and inconsistent. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers alongside giving information and advice to self-funders and doing a lot more assessments. They will not be able to do that in any way that makes it a worthwhile exercise for carers, and carers will not bother with it if it is not doing anything for them. Indeed, the Joint Committee on the draft Bill received many comments via its web forum from people who said that local authority assessments are of little practical help in their caring role.

GPs and other health professionals are best placed to help carers when they start caring, which is when they most urgently need help and advice. During carers week here, I met carers who told me about a whole variety of things that they needed help with but nobody helped them. Nobody told them that there were schemes to help them with the cost of parking at the hospital. One mother had to buy a hospital bed and nobody told her where to find one; she was looking for one on eBay. She had no advice and support on that whatsoever. GPs deal with dementia patients, stroke patients and patients with cancer. The GP and primary health care team is best placed to establish whether there is an unpaid family carer or whether they live in another town or city. The GP can then refer them to sources of advice and support and, if they are local, give them regular health checks. A new duty on the NHS professionals is the only thing that would make it easier for social care and health services to work together to support carers. I believe that that is wanted by Members in all parts of the House.

Given everything that we are talking about, carers are clearly being placed under ever greater strains. It is essential that the Bill is used to ensure that carers are identified and signposted towards the support they need. It is clear from all the statistics that unpaid carers are the most vital providers of care in this country. I urge Ministers not to miss this chance to improve the support that we give them.

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[Paul Burstow]

I entirely understand that, and I see it in my constituency, where my local authority is grappling with those budget choices, but there is still scope for innovation. There are good, bad and ugly local authorities when it comes to grappling with the resource constraints that the deficit has led to, and I will come back to that in a moment.

I believe that the Bill deserves to be described as landmark legislation, because it will provide a new governing purpose for our social system—the idea of well-being, to which I will return—new rights for carers and, for the first time, parity of esteem between those who are cared for and family members who provide care and support. The new national eligibility threshold will end the postcode lottery for access. We can debate where the line is drawn, but for the first time that will become a national debate rather than simply a local one.

There will also be new obligations on local authorities on behalf of the whole population that they serve. There will be obligations to prevent and postpone the need for care, to ensure quality and choice of services and to ensure that there is good information and advice about the whole range of choices that people might need to make as they approach the point at which they need care. Importantly, the Bill is foundation legislation upon which a more co-ordinated and integrated system of health and social care can be built.

I could stop there, but the Bill will do more than that. It will simplify and clarify entitlements to state-funded support and put personal budgets into law for the first time. That is all before I have even mentioned the Dilnot reforms, about which it is important to give some context. Social care in this country today is not free. That is the nasty little secret that families discover when they are tipped into crisis and have to negotiate with their local authority over whether they will have access to any means-tested support. Most people do not know that, and it comes as a shock and creates anger and dismay in many families. While I was a Minister, Members from both sides of the House showed me letters of anguish from people who felt that the system was letting them down. To understand the value of Dilnot is to make a true comparison not with what people hope the system will be but with what it actually is today—a nasty, mean system that is means-tested. That is why the Government deserve to be commended for having the courage to start to put in place the principles that Dilnot proposed.

The right hon. Member for Leigh gave no direct quotation from Andrew Dilnot in opposition to what the Government are doing. I know why—it is because there is no direct quotation of that sort. Andrew Dilnot supports the changes and sees them as a much-needed step towards implementing all the principles that he recommended in his report.

Of course, it is important that we recognise that not everyone will ever need formal care. A minority of our population will need formal support, no matter where the threshold is drawn. Perhaps some will need it right at the end of their life. Those who do will want the Bill to give them peace of mind, and that is what Dilnot provides to everyone. Some people are confused by the idea of catastrophic costs based on all people needing care, but the reality is that most people will never reach the cap wherever it is drawn, because they will never need to draw down that much resource to pay for care costs. Moving the means test threshold from £23,250—the meanest of means tests in our welfare state—to £118,000 is a huge step forward.

For all those reasons, the Bill can be marked out as a comprehensive reform of our social care system, and it deserves the House’s wholehearted support today. There are other reasons why it deserves support, too. The draft Bill was consulted on extensively and has been subject to pre-legislative scrutiny, of which I am a great fan. As the Minister at the time, I actively sought permission for it to be subject to that approach. By a curious twist of fate, I then found myself chairing the very scrutiny Committee that I had advocated. I was lucky to have cross-party support from both Houses in doing that job, and it was a strong Committee. We made 107 recommendations, the vast majority of which the Government accepted before introducing the Bill. Many of the others have been persuaded upon them through their lordships’ scrutiny, and I am grateful to colleagues in the Lords for what they have done.

All of that will be worth nothing if the Bill is not well implemented. As the debate has demonstrated powerfully, there is a huge knowledge gap that leaves people struggling in a crisis. It means that people do not plan or prepare for care, financially or in other ways. We need not just local information and advice services but a multi-channel, multi-media campaign to inform and educate the public, hon. Members and the people who work in the system. We need to ensure that we manage changes well, such as deferred payments, about which I hope the Minister will say more later, not least because it is not a sufficient defence to say, “Because Labour did this when it was in government, we will do it as well”. I hope the Minister will have a better answer on that point.

I want to give one example of why the implementation challenge is big. There are 300,000 to 400,000 people in this country who already pay for their care. It would make no sense for them all to be told to line up on 1 April 2016 to get their care accounts sorted out. The change needs to be phased and planned so that we do not overwhelm local authorities in April 2016. I hope that the Minister will be able to reassure us about that.

The hon. Member for Sheffield, Heeley, said that the Bill was a look back to 20th-century models of care. I disagree, because at front and centre, in the Bill’s first clause, is the disruptive idea that we should promote individual well-being. It states that well-being is about quality of life, work, leisure, study, the right to be an active member of the community, being in control and maintaining and recovering physical and social function—all things that were anathema to many of the paternalistic models of 20th-century care.

We need only compare current care plans for older people with those for active and working-age people to see the stark difference. The plans for working-age people are about their being engaged with their communities, but for far too many years the plans for older people have too often been about “task and finish”, with tasks being burned down to just 15 minutes or less. That cannot be right, and it has to change. That is why I welcome the fact that the Secretary of State will also be subject to the well-being principle in discharging his obligations under the Act to regulate the system.

I would welcome some clarification of the term “beliefs” with regard to well-being. It would be helpful if the Minister said whether it applies to religious and spiritual beliefs, and whether that point will be covered in guidance.

On prevention, which has an important link to the well-being principle, can the Minister confirm that the duty set out at the beginning of the Bill will be outside the consideration of national eligibility, and that it will be a universal obligation that will not just apply to those who qualify for care? Will the local authority actively have to secure it?

[Norman Lamb]

I pay tribute to my right hon. Friend for his amazing work in launching the Bill and in its pre-legislative scrutiny. I can confirm that the prevention duty will be universal and have no relation to the criteria for eligibility.

[Paul Burstow]

That is very helpful, and I am grateful. The fact that the prevention duty will be outside the eligibility criteria gives the lie to the idea that it will be curtailed. That is important to understand. There has been some dispute about that, and the Association of Directors of Adult Social Services now suggests that the change in eligibility will be more generous than many people have thought.

Several Members have touched on the issue of carers. Progress has been made in the Children and Families Bill, and I hope that there will be progress on the identification of carers as well. One of my deep frustrations as a Minister was that, even when I had pulled all the levers available to me to try to get the NHS to do more on carers, it still did not get it. It did not do enough, and although there are beacons in the NHS, the whole thing has not been set afire so that the NHS really changes how it engages with carers. We need seriously to consider legislation on that, and I look forward to the Minister setting out how that might be achieved.

I want to touch on the role of the Care Quality Commission. It might be right to remove its duty to do periodic reviews, but it is important that it can exercise its power to conduct special reviews of commissioners without reference to Ministers. Where it finds that there a provider’s failure is attributable to commissioning failures, it should be able to inspect the local authority in question without having to seek Ministers’ permission. In that way, the special inspection powers could be used much more creatively.

A lot has been said about integration in this debate. I hope that we can make more progress on the matter to include it in all parts of the Bill during its passage through the House. I believe that the Bill deserves a Second Reading tonight, because it offers a transformative vision of how care is delivered in this country. By making well-being the central organising principle, we can deliver a much better quality of life for those who need care.

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[Nick Smith]

My hon. Friend makes a good point.

I was struck when speaking to victims’ families in south Wales that although many were regular or even daily visitors to their loved ones’ homes, they were not informed about bedsores or concerns that their relatives were not eating or drinking properly—such concerns were just brushed aside. Yes, individuals must be responsible for their actions, but what was uncovered was institutionalised neglect, with instructions on cutting back on food and incontinence pads coming from the top.

I am pleased that in Wales the First Minister has agreed a review of Operation Jasmine, led by Dr Margaret Flynn, who wrote the excellent Winterboume View hospital report. Although it will not report in time to amend this Bill, I hope the Government will consider any additional measures that that crucial review may highlight because we know that such issues are not just a problem for Wales. Information supplied by the House of Commons Library shows that, in 2011-12, 65,580 allegations of abuse of vulnerable adults aged 65 or over were made at different locations in England. Of those, 29,555—about 45%—were alleged to have taken place in care homes. This is a big national issue.

Looking to the future, we must improve the law on wilful neglect. If a patient does not die from poor care and does not have a loss of capacity under the Mental Capacity Act 2005, guidance from the Crown Prosecution Service states that a criminal offence is difficult to identify. Given that, respected groups such as Age UK support the proposal that organisations—not just employees—found to have contributed to abuse or neglect in a care setting should be liable to criminal prosecution.

[Norman Lamb]

The hon. Gentleman is making some serious points. Does he welcome the fact that the Government have consulted on a change so that we introduce fundamental standards of care, and that those providers of care—the organisations, and indeed their directors—can be prosecuted for failures of care? That has not been possible until now due to a flawed regulatory system.

[Nick Smith]

I welcome that but I am not sure it goes far enough. I think the issue needs to be teased out further in this debate and possibly in the Bill Committee.

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[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Sefton Central (Bill Esterson), who speaks so compellingly about his family’s experiences and sets out the case for why we must get social care right.

I welcome the Bill. It was a pleasure to serve on the Joint Committee on the Draft Care and Support Bill and I think the legislation has been greatly improved by its passage through that Committee and through the House of Lords. It establishes that we need a social care system that works around the needs of individuals, as well as the well-being principle and the vital prevention principle set out so compellingly by the hon. Member for Sefton Central. The Bill also consolidates a confusing patchwork of legislation that I remember coming up against in my time in the NHS. People were not sure what their eligibility was, and they could move from one part of the country to another and find that they no longer qualified in the way that they used to.

There are many things to welcome in the Bill. The hon. Member for Lewisham East (Heidi Alexander) compellingly set out the effect of losing everything in the ghastly lottery of eligibility. Setting a cap on costs and raising the threshold from that paltry £23,250 to £100,000 is very welcome. So too is the focus on better information, advice and advocacy, and the assessment and better support for carers. My hon. Friend the Member for South Swindon (Mr Buckland) made some important points about child carers and the transition from children’s services to adult services.

There is a huge amount to welcome in the Bill and I could talk for 10 minutes on why all these aspects are important. Unfortunately, we also need to focus on the challenges. The predominant challenge is demographic. Nationally 2.2% of the population are over 85, but in my constituency we got there 31 years ago. By 2020-21 2.9% of the population will be over 85, but for Torbay that figure will be 4.9%. That represents an enormous demographic challenge. We were discussing with the right hon. Member for Leigh (Andy Burnham) the reasons why age is so important in assessing need. Because of their demographics, places such as Torbay and wider south Devon face additional challenges with rurality, which means that they are under pressure like never before. Although I fully understand that we must take into account deprivation and health inequalities, unless we take sufficient account of age and need in assessing the formulae, the system will collapse.

I should point out that Torbay is not only nationally renowned but internationally renowned. As a member of the Health Committee, when we visited Copenhagen and Sweden, I ended up being shown slides of Torbay—how Torbay organises health and social care. If we look at the challenges facing Torbay, we see that it was those demographic and financial challenges that were the driver for looking at how health and social care could be better integrated and—I refer to the experience of the hon. Member for Sefton Central—how avoidable admissions could be reduced. Enormous progress has been made. Waiting times for occupational therapy have been reduced from two weeks to two days, for physiotherapy from eight weeks to 48 hours, and for urgent equipment to help keep people at home from four weeks to four hours. As a result, Torbay has the lowest hospital admission rate for elderly vulnerable people in the whole of the south-west.

[Norman Lamb]

I am grateful to my hon. Friend for giving way. Does she share with me the excitement at the plan for Torbay as a pioneer to bring mental health back into primary care, properly to integrate that part of patient care? We have seen in other places that this can do an enormous amount to prevent a deterioration of health.

[Dr Wollaston]

Absolutely. I welcome the fact that Torbay will be part of one of the integrated care pilots, and particularly that focus on mental health, as my hon. Friend says.

Services in Torbay have been transformed through the use of care co-ordinators, so that only one phone call is necessary. There has been transformational work in sharing information and records and in rapid response to a crisis and putting prevention in place. The challenge that Torbay now faces is financial. Unfortunately, the elastic can stretch only so far before it snaps. Torbay’s funding is set to fall from £71.2 million this financial year to £63.6 million in 2014-15. Those cuts are in addition to the demographic challenges, the challenging situation in relation to children’s services, and the fact that we know that across the country 2015 is set to be a crunch year for NHS funding.

I welcome the £3.8 billion transfer for better care. We heard in the draft Bill Committee and in the Select Committee how such joint funding arrangements are the best driver to integration. A formula for integration cannot be dictated. What works for central London or central Manchester will be very different from what works in south Devon and in rural areas, but the fund will force people to work better together in a way that fits their area. That is very welcome.

[Dr Wollaston]

Indeed. It operates very well already in Torbay, but it cannot be dictated centrally. We need to get the hurdles out of the way, allow people to work together locally and facilitate that. We heard on the draft Bill Committee that joint funding streams were the best way to move that forward.

Unfortunately, in Torbay in the crunch year 2015 we will see the funding drop below 90% of projected expenditure. At that point, rather than driving further integration, it will cause systems to start to fall apart because people need to protect their own silos. That is a real danger. As the Bill proceeds to Committee, I hope we look very carefully at the effect of the funding gap and make sure that we are not setting a system up to fail. One of the problems with the Bill is that it sets up many new statutory responsibilities. Councils will have to fund care accounts, which will undoubtedly be complex, bureaucratic and subject to challenge. Councils will have responsibilities for carers’ assessments. There will be increasing numbers of eligible people as the thresholds and caps change. We will see safeguarding adults boards, more rights to information and advocacy, and for many, deferred payments, if they have not already been making those.

Once we create these additional statutory responsibilities, there will be less money to go around for the very things that are at heart of the well-being and prevention principle. That is what concerns me. Would it not be a tragedy if we set up carers’ assessments but there was no funding left for services to respond to needs? Voluntary organisations in my community can function incredibly efficiently on very little money. They do not need to be fully funded, but they need some funding. If that money dries up, I worry about how we will move forward with a genuine well-being and prevention principle.

I want the Bill to succeed. In the remaining minutes I shall touch on those aspects that I think are, sadly, still missing, which were recommended by the draft Bill Committee. One is how we calculate care costs according to their actual cost, not the cost to the council. For a person living in their own accommodation, it sometimes costs a great deal more to access support than it would cost a council to provide it. We need to look at that again.

There is a small but important area relating to powers of entry in exceptional circumstances for those who are subject to abuse in their own home. It would be wrong for us to ignore that possibility. Although the overwhelming majority of carers of course do a wonderful job in challenging circumstances, there are occasions, sadly, when people can be at risk from those who love them. Very often that is as a result of the intensely challenging circumstances that carers face. We need to reserve a power of entry in exceptional circumstances where there are very serious concerns about individuals who may be vulnerable and unable to communicate easily.

Another issue is free social care at the end of life. We know that 73% of people would like to be able to die at home. In my experience working as a GP in rural areas, where that broke down for most people was as a result of a lack of social care, and the challenge of caring for somebody right at the end of their life, when they may, for example, be doubly incontinent. Until people are in that situation, they may not understand how incredibly demanding it is to have to be with someone 24 hours a day, trying to stay awake and provide the intensive support they need. Allowing everybody to access free social care in those terrible final days would be a very important step forward.

Finally, the duty of candour we have introduced for foundation trusts is welcome, but I think that it should be extended to social care.

[Norman Lamb]

It will be.

[Dr Wollaston]

I thank the Minister for that clarification. Also, an offence of wilful neglect already exists with regard to adults who lack capacity, but I would like the Minister to consider extending it with regard to those who have capacity.

We heard earlier about reconfiguration. We need to streamline reconfiguration processes. It is not right that the NHS’s valuable resources should be spent on long, drawn-out and expensive legal challenges. We know that in many cases we need to reconfigure in people’s best interests. Let us take out the party politics and get it right. Let us ensure that people have the right care and that we face the financial challenges in the NHS in a mature fashion.

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[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I am grateful for the opportunity to speak in this debate, not least because this Bill, particularly part 1, is being followed very closely in my constituency. I am pleased to follow my hon. Friend the Member for Easington (Grahame M. Morris), who spoke very well about the issues at hand. Given the high level of interest in my constituency, I recently held a listening event that was kindly supported by Age UK Sunderland and Sunderland Carers. I wanted to find out what the people who would be affected by the Government’s planned reforms thought of them. In the time available, I will give a potted account of that discussion.

Before I do so, I want to say a few words about young carers. After concerted lobbying by Members on both sides of the House, particularly my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), we now have clauses in the Children and Families Bill providing for young carers’ needs assessments and there are clauses in this Bill covering a young carer’s transition to adulthood—a very welcome step forward. I pay tribute to the Minister and to his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), who are both in the Chamber today, and to the children’s Minister, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), for listening to Members and campaigners on this very important matter. However, I would like the Bill also to include a duty on medical professionals to identify and refer young carers so that they can benefit from those needs assessments. Family doctors are by far the best placed professionals to be able to identify where a child or young person is probably providing support to their parents, and it is not unreasonable to expect them to make sure that that child or young person has their needs assessed by the local authority. I very much hope that we will see more progress on this issue as the Bill continues its passage through the House.

Turning to the main provisions of the Bill on social care, if the Minister thinks that my constituents are happy with the package we have before us at present, he is very much mistaken. People’s first question is understandably, “Will this benefit me or my family members?”, and many of them, when they look beyond the press releases at what the Bill actually says, are finding out that it does not. They know that only people who are eligible for care will be covered by the headline-grabbing £72,000 cap on care costs. Therefore, if the Government say—as looks likely—that only those with the most severe needs are deserving of help, very few will be covered by the cap at all. Even if they are covered, £72,000 will not be the maximum amount they will have to pay; they will also have to pay hotel and accommodation costs of £230 a week, as well as any difference between the rate the local authority is able to pay and the actual care costs. All in all, they could be looking at an extra £300 a week that does not count towards the cap. That means that, over five years, a pensioner would have to find an additional £78,000.

The situation may be different for the Secretary of State’s constituents, but I cannot think of many pensioners in my constituency who would be able to afford that kind of bill without selling their home. Of course, there will be a deferred payment option, but that is just a more expensive version of what 95% of councils do already and it will not be available until a pensioner has run down all their other assets. Assuming they do qualify and they defer five years of care home charges, they could end up clocking up an extra debt of £13,800 in interest, on top of the £78,000 charge and the £72,000 cap.

[Norman Lamb]

I am grateful to the hon. Lady for acknowledging the change we made in the Children and Families Bill with regard to young carers. Does she welcome the fact that we are massively extending the means-tested support by increasing the threshold from £23,250 to £118,000, which means that people with assets right up to that level will get some contribution to their care costs for the first time ever?

[Mrs Hodgson]

But that is only if they and their needs are eligible. In all the cases I have looked at, no one has been able to convince me otherwise.

The average price of a home in my constituency is £150,000, so someone needing care for five years could see the entire value of their home gobbled up. Whether the home is sold before or after they die is academic, because it will still need to be sold and all but £23,000 will be called on to pay for care bills and the interest on them. The only real difference I can see between that and the current system is that people will pay interest for the privilege of deferring their home sale, and that is why the Opposition say that this is nothing more than a care con. Ministers have been keen to gloss over those facts, but they cannot con my constituents, who are wordly wise and have seen straight through all the spin.

The next thing my constituents asked me at the listening event was whether the Bill will improve the quality of care that they or their loved ones can expect to receive. The issue of quality of care quite rightly hits the headlines every now and again when particularly shameful examples of the treatment of the elderly or vulnerable are exposed. Those peaks in interest only reinforce the worries people already have about either moving into residential care or becoming dependent on strangers who come into their homes on a daily basis.

There are tens, or even hundreds, of thousands of very capable and dedicated care workers out there who do what they can in an extremely challenging job and often on terrible terms and conditions, examples of which we have heard today. The Bill does very little to tackle the problems of long hours—or even zero hours—and those of low pay, no training and low staffing ratios that can lead to demotivation and desensitisation with regard to the dignity of the people being cared for. Ultimately, that is what brings down the standard of care that everyone who needs it should have a right to expect.

On the quality of care that people receive and the impact is has on their quality of life, I received an e-mail today from my constituent, Steve Hudson, regarding clause 48, which has been inserted in the Bill thanks to my noble colleague, Lord Low of Dalston. Clause 48 extends the protection of the human rights framework to everyone receiving regulated social care, whether they are in residential care or their own home and whether they are self-funding or in receipt of local authority support. Frankly, I was surprised that that was not the case already. As the Equality and Human Rights Commission said in its briefing, closing that loophole would be extremely beneficial in ensuring that the dignity and basic human needs of every person receiving care are at the forefront of every manager and business owner’s mind. I therefore hope that if the Bill progresses tonight, the Government will not seek to remove that provision in Committee.

The final big concern that my constituents shared with me at my listening event relates to funding constraints. It is clear to everybody that cuts to local authority budgets have a knock-on effect in the NHS, with beds, clinical staff and other resources unnecessarily tied up while care packages are put in place or even just reasonable adjustments to accommodation are made. It is no coincidence that delayed discharging is at an all-time high and costing the NHS some £20 million a month at a time when many local authorities are at financial breaking point and struggling to see how they can provide even the services they are legally obliged to provide over the coming years, let alone the kind of preventive services that they provided until recently.

Of course money is tight, but because it is tight, we should use the money we have in a smarter, more innovative way, as my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said so eloquently. That means pursuing the ideas put forward by my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Leicester West (Liz Kendall) for a whole-person care approach and the full integration of health and social care.

My constituents do not hate this Bill—they are pleased that there is a Care Bill—but they are frustrated by its lack of ambition and disappointed that the Government have watered down and cherry-picked the Dilnot recommendations so much that very few people will actually be any better off in the long run than they would be under the current system.

The Bill is inadequate and the House should decline to give it a Second Reading today, so that the Government can go away, have one of their famous pauses and come back with a version that meets the challenges that our health and social care systems will face over the coming years. Most importantly, the Government need to come back with a Bill that lives up to the hype that Ministers have tried to generate, and which does what all our constituents want and need it to do.

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[John McDonnell (Hayes and Harlington) (Lab)]

First, may I apologise to the House? I was here for the early stages of the debate and listened to the Front-Bench speakers and others, but then had to leave. Tomorrow’s announcement on aviation, and the fact that we seem to have yet another Government who want to build over a third of my constituency, means I have been at other meetings to deal with that.

I will not take up much time, but I just want to raise a couple of issues that have been raised with me by constituents, and in particular by Jonathan Kaye. I would welcome an intervention by the Minister if I have got this wrong, but Mr Kaye’s first concern is about the regulation of carers who are recruited as a result of direct payments. In my constituency, the borough has moved progressively towards direct payments, where the individual recruits carers on the open market. That is extremely difficult, but at least they have some choice. I want to be clear about whether these carers are included in the regulation system of the Care Quality Commission, as set out in the Bill. Who will inspect them, and how will their performance be monitored?

[Norman Lamb]

Personal assistants are not part of the CQC regulatory system. That has always been the case, including under the previous Government. We would certainly encourage personal assistants to seek to secure the new care certificate qualification, however, so as to demonstrate their care skills, but they are not part of the formal system.

[John McDonnell]

I think Mr Kaye would like me to press that at some stage during the Bill’s progress. His view is that they should be regulated in the same way as others, and that there should be appropriate inspections as well. I understand the difficulties, particularly in terms of family relationships with regard to carers. I understand the subtleties of that, but there does seem to be a gap in the Bill as it stands. I might want to look at that in Committee, and certainly on Report.

The second point is that I believe that in the other place Baroness Greengross or Lady Greengross—I am never sure of the titles of the bourgeoisie—moved an amendment to cover the whole range of abuse. That was partly a response to the lobbying for abuse by carers to be properly covered by this Bill. I hope the Government’s attitude is that the amendment will remain in the Bill. I am happy to give way again to the Minister if he wants to respond; perhaps he will do so later.

The third point Jonathan wanted me to raise was about assessment and reassessment. I do not know what other Members find in their constituencies, but I find that the process of assessment can be extremely difficult—first, getting an appropriate person who can do the assessment, then getting that appropriately skilled person to do the assessment, and then the bizarre continual reassessment after reassessment that amounts almost to harassment. Some people with severe disabilities —with permanent conditions who, to get a cure, would need a trip to Lourdes, to be frank—get reassessed time and again. That becomes worrying for them, and some individuals can lose some element of their benefit through this process.

--- Later in debate ---

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

I thank everyone who has taken part in what has been a lively and interesting debate on a subject of the utmost importance for the future and for many very vulnerable people in our country. I absolutely share the view of the shadow Minister, the hon. Member for Leicester West (Liz Kendall), on that. Incidentally, I also share her view that it is not possible to get great care on the back of exploiting low-paid workers. We have been very clear about that.

I do not anticipate having time to be able to respond to every point that has been raised—there were many excellent contributions—but I will write to hon. Members who participated in the debate so that everyone will get a full and proper response, including on the cross-border issues raised by the hon. Members for Arfon (Hywel Williams), for Strangford (Jim Shannon) and for Edinburgh East (Sheila Gilmore) among others.

The effect of passing the reasoned amendment would be to defeat the Bill, which is why the Government are so dismayed by the decision taken by the Labour party on what we regard as a Bill that will be groundbreaking in its overall impact. It seeks to modernise the law on care and support, shifting the focus from a very paternalistic system to one that is acutely personal and focused on an individual’s well-being. The Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell) and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) both focused on the important principle of well-being, which will be new in legislation, but is absolutely central to what we seek to achieve. There is also a focus on preventing ill health and—

[Barbara Keeley]

Will the Minister give way?

[Norman Lamb]

I will just finish this point.

There is also a focus on protecting everyone from catastrophic care costs, ensuring that people will no longer have to sell their homes during their lifetimes to pay for care. The Bill reforms a fundamentally unfair system, drives up standards in GP surgeries, hospitals and care homes through the new chief inspectors, adds a new statutory duty of candour so that hospitals, care homes and other care providers are open with patients when mistakes are made, and introduces valuable new rights to carers. Of enormous significance is that it signals the first ever big step, as the Chair of the Select Committee said, towards joining up our health and care systems through the better care fund, which is worth £3.8 billion.

The best description of the Bill was in a letter forwarded to me by a Labour MP, which said that the Bill is a groundbreaking piece of legislation that has the potential to make a big difference for older people. Despite that, the Labour party is declining to give it its support.

[Hazel Blears]

rose—

[Barbara Keeley]

rose—

[Norman Lamb]

I give way to the right hon. Member for Salford and Eccles (Hazel Blears).

[Hazel Blears]

The debate this evening has been fabulous and has engaged people from across the House on one of the biggest challenges we face. Earlier in the debate I asked the Secretary of State whether, on reflection, he thought that he could have been more ambitious about the integration of health and social care. The costs to our system are now unsustainable, and this was an opportunity to seize the moment. The Minister has tinkered around the edges of integration, so may I press him to be more ambitious, to think bigger and to be more committed to greater integration that will benefit us all?

[Norman Lamb]

I note the challenge, but I have been passionate about integrating care for many years. I made the case for it on many occasions when I was my party’s spokesman in opposition, and I remember not getting much of a response from the right hon. Lady’s party when it was in government. The Bill is really ambitious and marks the potential for a fundamental change in how our system works.

The right hon. Member for Stirling (Mrs McGuire) welcomed the principles of the Bill and rightly said that it is the duty of the Opposition to challenge and to probe. However, to use her expression, I think that many Opposition Members have been “churlish” in their response, with a few honourable exceptions, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke). I say that because in 13 years, Labour had two manifesto commitments, one royal commission, another promised commission, a Select Committee report, a White Paper, a Green Paper and numerous independent reviews on the issue, and what was the net result of all that talk? Absolutely nothing. In 1997, Tony Blair told the Labour party conference:

“I don’t want our children brought up in a country where the only way pensioners can get long-term care is by selling their home.”

That is exactly what happened throughout Labour’s time in government. In contrast, the coalition Government are getting on with reform.

Even now, we have no idea what the Opposition’s policy is. The shadow Health Secretary has hinted that he prefers an all-in approach—everything free, paid for by new taxes on death and by cutting hospital beds—but he has clearly failed to persuade his own colleagues about the plan or to set out how he would pay for it. Opposition Members’ criticisms can only be of any real value if they can answer the question about how they would pay for anything that costs more. So it was good to hear the right hon. Member for Salford and Eccles, who seemed to be about the only Opposition Member who recognised the scale of the challenge that we face, whoever is in power, and the fact that we need to think afresh about where money can come from. Her ideas about innovation using social investment bonds are welcome, and I would like to talk further to her about them.

We want to reshape care and support so that it is focused on enabling people to live more independent lives and giving them a good life. The Bill provides a new framework that places people’s well-being right at the centre and empowers them to take control of their care and support. It consolidates 60 years of legislation and pulls a dozen Acts together into a single legal framework, and it has been roundly welcomed. The King’s Fund has said:

“The government’s proposals for funding reform are an important achievement against the odds in a daunting fiscal and economic climate.”

Baroness Pitkeathley of Carers UK has described the Bill as the “most significant development” in the history of the carers movement.

[Barbara Keeley]

rose—

[Norman Lamb]

I did not get much of an impression of that in the hon. Lady’s contribution, but I give way to her.

[Barbara Keeley]

I thank the Minister for eventually giving way. I am surprised and disappointed that he is repeating the same type of inaccurate information that we heard from the Secretary of State earlier. Will he think about the point that I made in my speech? How hollow is it to talk to carers in Salford, 1,000 of whom are involved in families who are losing their care packages, about new rights? What rights are there for someone whose family member has lost their care package? That is what people face this year.

The Minister has also just repeated the ridiculous notion of the £3.8 billion for the integration of health care. That is not new money. It includes care—

[Mr Speaker]

Order. I call the Minister.

[Norman Lamb]

I note the position in Salford, and I recognise that finances in local government are tight. However, the Opposition have not recognised that 108 councils were already providing social care with substantial need as the eligibility criterion before the general election. They never mention that, but it is the truth.

Baroness Campbell has called the continuity of care provisions a “landmark reform”. Although we have heard the suggestion that we have somehow moved away from what Andrew Dilnot suggested, he has said:

“For the first time you don’t have to be terrified of the consequences of needing care…this system will radically reduce anxiety…It doesn’t seem to me that it’s so different from what we wanted.”

Several references have been made to the funding of social care, and as I have said, I fully recognise the tough financial settlement that local government has faced. However, that has been necessary because of the dire state of the public finances that we inherited from the Labour Government, and we have sought to protect social care. Despite what the hon. Member for Easington (Grahame M. Morris) and others have said, a recent budget survey by the Association of Directors of Adult Social Services showed that most of the savings that local councils have made have come through efficiency changes, and that services have largely been protected. [Interruption.] Well, that is what the survey showed.

As the population continues to age, our health needs become more complex, and it is essential that we continue to adapt. We need to ensure that the care and support system is sustainable, and the Bill lays the foundation for that sustainable system. At the top of the agenda has been the issue of how we pay for care. The current system simply does not work and is not fit for the 21st century. Too many people have faced catastrophic care costs and had to make impossible financial decisions at a time of huge personal crisis. It is deeply unfair. If someone who has worked hard all their life and budgeted carefully is unlucky enough to be diagnosed with dementia or some other condition, they lose pretty much everything they have ever worked for.

Through the Bill, we are putting an end to that unfair system. We have addressed how people can plan and pay for their care, following on from Andrew Dilnot’s recommendations. We have listened carefully to what he and his colleagues have said, and we have been absolutely consistent about how these reforms will support people to plan for their future effectively. From April 2016, extending the means-test support to £118,000 will immediately result in 35,000 more elderly people receiving financial help with their care costs. That figure will rise to 100,000 people getting extra help by 2024-25.

[Andy Burnham]

Can the Minister guarantee to older people listening to the debate this evening that nobody will pay more than £72,000 for their care—yes or no?

[Norman Lamb]

Of course we have made it clear that people can choose to spend more, but I can say absolutely that by 2024-25, far more people—100,000 people—will be getting more financial support than under the system we inherited from the Labour Government. Everyone will be protected from catastrophic costs through the reassurance provided by the cap on care costs.

[Liz Kendall]

rose—

[Norman Lamb]

I need to press on.

Many people will pay significantly less for care than they do now. People will not be forced to sell their home within their lifetime to pay for care because we are introducing a universal, nationwide system of deferred payments to prevent that.

On deferred payments, there is total confusion about what Labour stands for. Lord Lipsey in the other place, apparently supported by the shadow Secretary of State and the shadow Minister, has attacked the threshold for our deferred payment scheme, which is currently under consultation. He argued that the threshold should be lowered so that those with bank accounts or shares worth considerably more than £23,000 will have access to the scheme. In the previous Government’s 2010 White Paper, however, the same £23,000 threshold was considered acceptable under the universal deferred payment scheme. Which is it—do the Opposition support a low threshold of that sort, or do they want to give more help to people with money?

[Liz Kendall]

I thank the Minister for giving way because I want to press him again about the care cap. On 11 February, the Health Secretary told The Guardian in relation to the cap, that

“that is the maximum anyone will have to pay.”

Does the Minister agree with his Health Secretary?

[Norman Lamb]

It is the maximum people have to pay once they have reached the threshold for care, but they can choose to pay more if they wish. The hon. Lady has refused to answer the question about what Labour Members believe is the right threshold. They have been utterly inconsistent. The shadow Secretary of State has also attacked our plans to charge interest to cover the costs of the deferred payment scheme, yet his 2010 plans proposed exactly the same thing. The only difference was that Labour’s plan was hidden in the impact assessment, not set out in the consultation for everyone to see.

Throughout these reforms we have worked alongside people involved in the care system, and tried to address the needs of people receiving services, their carers, local authorities, the NHS and voluntary groups. We wanted to build a consensus around the future of care and support in England and we have been willing to amend the Bill in the other place to address the concerns raised. The result is a powerful reform package that includes the well-being principle, legislation for personal budgets, incredibly important new rights for carers that have been widely welcomed, and legislation for adult safeguarding for the first time.

Many hon. Members have recognised the powerful case for integrating and joining-up care, and the hon. Member for Sheffield, Heeley (Meg Munn) highlighted the fact that many councils do not place integrated care high on their agenda. That is why the Better Care Fund is so important—it gets every local area talking now about the importance of joining up care and preventing ill health. Around the country we have 40 pioneers in integrated care, demonstrating how things can be done differently and how we can provide better care with less money.

I visited Barnsley, Torbay, Greenwich, Worcestershire and Islington—all have inspiring local leaders who are redesigning a dysfunctional system to provide better care for their citizens. This is a quiet revolution in care, but the changes will resonate across the country. I am immensely proud and grateful to my right hon. Friend the Member for Sutton and Cheam for producing the original draft Bill and for his support since then. Colleagues in the Lords have made important improvements to the Bill, and when—I hope—it becomes law next year, the Care Bill will be the most valuable legacy in health and care reform for a generation.

Question put, That the amendment be made.

“Winterbourne View: Transforming Care One Year On”

Norman Lamb Excerpts

Monday 16th December 2013 Written Statements

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

On 10 December 2012, I made an oral statement and placed in the Library “Transforming Care: A national response to Winterbourne View Hospital”, Official Report, column 49. This followed our review of the events and appalling abuse of patients at Winterbourne View, a private hospital for the assessment and treatment of people with learning disabilities. Transforming care was accompanied by a concordat setting out an extensive list of commitments for a range of actions spanning across the health and care system and beyond. These involved a series of partners, including NHS England, the Local Government Association, the Care Quality Commission and many others.

One of the commitments in the concordat was that we would publish a progress report one year on and this was published on 13 December 2013. The report shows that the Department and its many partners, working closely with stakeholders, including most importantly self-advocates, family carers and the third sector, have made good progress carrying forward many of the concordat commitments and actions. There are many products from this work, including:

the new learning disability census, published by the Health and Social Care Information Centre;

a stocktake of progress by the joint improvement programme published down to local level;

an enhanced quality assurance programme to support delivery against the June 2014 milestone for people to be cared for in the right setting for them as individuals;

a new approach by the Care Quality Commission to the inspection of health and learning disabilities services from next year, to be led by Professor Sir Mike Richards;

new fundamental standards which will deliver corporate accountability, to be set out in regulations; and

steps to secure adult safeguarding boards through the Care Bill.

The full report includes an appendix detailing progress against all the commitments.

We know, that in spite of the progress over the last 12 months there is a great deal still to be done.

Of the 48 former Winterbourne View residents themselves, one has sadly since died so NHS England is tracking progress for the remaining 47. Thirteen of these people are still in an NHS inpatient setting and 12 of those are out of area. This remains unacceptable.

The new learning disability census data show 3,250 people meeting the criteria for inclusion, while earlier in the year NHS England and the clinical commissioning groups identified 2,677 individuals whose care plans have all now been reviewed. These new data will allow health and care commissioners to track back and resolve anomalies, which are likely to have been caused by definitional issues of terms such as “challenging behaviour”, and commissioning complexities. This information will ensure that all those who meet the inclusion criteria also receive the right attention, including care reviews, to help them move into the type and place of care which is right for them by June 2014.

The progress report “Winterbourne View: Transforming Care One Year On” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Care Quality Commission

Norman Lamb Excerpts

Thursday 5th December 2013 Ministerial Corrections

[Liz Kendall]

To ask the Secretary of State for Health how much the Care Quality Commission has spent on consultancy services in (a) 2010-11, (b) 2011-12, (c) 2012-13 and (d) 2013-14 to date.

[Official Report, 18 November 2013, Vol. 570, c. 825-26W.]

Letter of correction from Norman Lamb:

An error has been identified in the written answer given to the hon. Member for Leicester West (Liz Kendall) on 18 November 2013.

The full answer given was as follows:

[Norman Lamb]

The Care Quality Commission (CQC) has provided the following information:

[Norman Lamb]

The Care Quality Commission (CQC) has provided the following information:

Social Care Budget Changes

Norman Lamb Excerpts

Wednesday 4th December 2013 Ministerial Corrections

[Mrs Glindon]

In the first two years of this Government, there was a frightening 66% increase in the number of people aged 90 and over coming into accident and emergency in a blue-light ambulance. When will the Minister accept that cuts to elderly care have increased pressure on the NHS, and are a major cause of the A and E crisis?

[Norman Lamb]

First, it is worth us all recognising that there is an increase in the number of frail elderly people in our society living with chronic conditions and that that is putting additional pressure on accident and emergency departments. The numbers have increased by over a million a year since 2010. However, the fact that there has been a reduction of 50,000 in the number of delayed discharges demonstrates that the social care system is doing incredibly well, and we should pay tribute to social care workers across the system who are doing so well to ensure that that improvement is taking place.

[Official Report, 26 November 2013, Vol. 571, c. 148.]

Letter of correction from Norman Lamb:

An error has been identified in an oral answer given to the hon. Member for North Tyneside (Mrs Glindon) on 26 November 2013.

The correct answer should have been:

[Norman Lamb]

First, it is worth us all recognising that there is an increase in the number of frail elderly people in our society living with chronic conditions and that that is putting additional pressure on accident and emergency departments. The numbers attending A and E have increased by over a million since 2010. However, the fact that there has been a reduction of 50,000 in the number of delayed discharges demonstrates that the social care system is doing incredibly well, and we should pay tribute to social care workers across the system who are doing so well to ensure that that improvement is taking place.

Roaccutane

Norman Lamb Excerpts

Tuesday 3rd December 2013 Westminster Hall

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

I congratulate my hon. Friend the Member for North Devon (Sir Nick Harvey) on securing this debate, and I say right at the start that I take the issue that he raises extremely seriously. I cannot begin to imagine what families have gone through after suffering such tragic losses, but if I was in their shoes, I would be campaigning and fighting, just as they are. I applaud the work that they have done in raising an issue that is obviously of intense concern to them.

Roaccutane is the brand name for the drug substance isotretinoin—my hon. Friend and I have both had some difficulty in pronouncing it. During my speech, I will refer to “Roaccutane”, although it is one brand name of that drug. I am grateful to my hon. Friend for providing this opportunity to update the House on issues relating to the prescribing of this medicine. I will aim to address the serious concerns that have been raised about the safety of Roaccutane, including the adverse psychiatric effects that my hon. Friend and other Members have expressed concern about.

Roaccutane is a derivative of vitamin A that is used for the treatment of severe and resistant acne; it is important to stress that. My hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made the point that it is used only in those cases.

Acne is a common condition that affects around 80% of adolescents at one time or another; it affects adults more rarely. Although acne is not life-threatening, it can have a significant impact on the lives of sufferers. In its severe forms, acne can be both extremely debilitating and distressing, causing real disfigurement and permanent scarring. It can also have a genuine impact on someone’s mental health. Many forms of acne will respond well to treatment with topical preparations or systemic antibiotics. For severe and resistant acne, however, effective treatment options are more limited.

Roaccutane has been authorised in the UK since 1983. It is available worldwide and has been used by millions of people. Roche, which first licensed Roaccutane, has withdrawn its product for commercial reasons in a number of countries, including the USA. However, other brands of the same drug—so-called generic drugs—are still available in those countries. It is a highly effective oral treatment for severe and resistant acne. However, all effective medicines are associated with a risk of side effects in some people. I appreciate that the side effect, or potential side effect, that we are talking about is of the most serious nature possible.

Unfortunately, it is impossible to predict which individuals will suffer a side effect from a medicine, but a medicine will be issued a licence only if it is considered that the benefits of treatment in the licensed indications outweigh the risks of side effects. The risks and benefits of Roaccutane were carefully considered at the time of licensing and, because of the known safety profile of this drug, it is licensed for use only for severe forms of acne that are resistant to other treatment. Since licensing, the safety of Roaccutane has been closely monitored by the Medicines and Healthcare products Regulatory Agency, with expert advice from the Commission on Human Medicines.

Roaccutane is a medicine that is highly effective at doing what it is designed to do. It is associated with some serious side effects. Roaccutane is harmful to the unborn foetus and therefore must not be taken during pregnancy. When Roaccutane is taken, common side effects include dryness of the skin and the lining of the mouth, nose and eyes. The dryness of skin that is associated with Roaccutane can take the form of cheilitis, which is cracking or inflammation of the lips. This condition can become very severe, chronic and debilitating in some patients. There has also been significant concern about the possibility that Roaccutane may be associated with psychiatric adverse effects, such as depression and suicidal behaviour.

Roaccutane is licensed for use only for severe forms of acne that are resistant to other treatment. This narrow indication for use is not the only restriction on its use in the UK. As my hon. Friend the Member for Romsey and Southampton North said, it can only be given by, or under the supervision of, a consultant dermatologist. The intention behind restricting prescribing in this way is to ensure that the health professionals with the most experience, and who are best placed to give patients advice about the important safety issues related to the drug’s use, make the prescribing decisions.

To underpin the discussions between prescriber and patient, all licensed medicines have a summary of product characteristics, which contains important information for prescribers, and are accompanied by an information leaflet for patients.

[Bob Stewart]

The nephew of a constituent, Elliot Brandon, was prescribed this drug by the doctor, but neither he nor his mother were given any indication that there might be side effects. That has to be stopped. We have to correct that, as soon as possible.

[Norman Lamb]

I was going to make that point. It is important that proper advice is given to patients when a drug is prescribed. My hon. Friend raises a serious concern on behalf of his constituent. I accept his point. The patient information leaflet is an essential document if the patient is to be fully aware of the possible risks of treatment and make informed choices about their care. Of course, unless they are directed to it and advised to read it by the clinician, the chances are that they will never read it. That is an important point.

[Caroline Nokes]

I have sat in on four consultations when Roaccutane has been prescribed. I reassure the Minister that consultant dermatologists tend not to just hand over a leaflet; they stand over a patient while they read it.

[Norman Lamb]

I am grateful to my hon. Friend for her intervention. I am sure that that is the usual practice. However, the concern expressed by my hon. Friend the Member for Beckenham (Bob Stewart) suggests that that may not uniformly be so, though it certainly ought to be.

Since 1998, there has been increasing awareness that Roaccutane may be associated with psychiatric adverse reactions, particularly depression and suicidal behaviour. The assessment of this issue has been complicated by the fact that young people with acne are already at an increased risk of depression, regardless of treatment. All psychiatric adverse reactions were assessed by the working group on isotretinoin in 2005. This working group of the Committee on Safety of Medicines consisted of independent experts, including psychiatrists and dermatologists, who considered the available data from published literature and case reports. All new information on psychiatric adverse reactions has remained under close and regular review since that time.

The product information for Roaccutane, and the other generic alternatives, states that particular care needs to be taken where patients have a history of depression, and that all patients should be monitored for signs of depression and referred for appropriate treatment if necessary. It also states that stopping taking Roaccutane may not lead—as hon. Members have mentioned—to improvement, and therefore further psychiatric or psychological evaluation may be necessary and appropriate.

As it is associated with rare, serious side effects, Roaccutane can only be prescribed by, or under the supervision of, a consultant dermatologist. The British Association of Dermatologists has published guidelines for its members on when to prescribe Roaccutane and how best to monitor patients for adverse effects during treatment. The guidelines recommend that patients be asked about any previous psychiatric illness, and the patient and their family should be made aware that the medicine may affect their mood. Patients should be asked about psychological symptoms at every clinic visit.

I appreciate that, in the case of the constituents of my hon. Friend the Member for North Devon, there appeared to be a rapid deterioration of mental health—certainly, a deterioration that immediately followed the start of taking Roaccutane. Female patients will be asked about such symptoms every four weeks because of the need to rule out pregnancy before a new prescription is issued. The Medicines and Healthcare products Regulatory Agency keeps this issue under close review. Any new information is carefully assessed to see whether there is a need to take action to alert health care professionals and patients.

This debate has provided an important opportunity to update the House on developments relating to the prescribing of Roaccutane, which was last debated about 10 years ago in this place. As with any effective medicine, difficult issues of risk and benefit must be grappled with. Few hon. Members will not have known someone who has suffered, physically or mentally, with the scars of acne—severe and acute acne can be a disabling condition—and few would doubt the serious nature of the potential side effects of this powerful medicine, and their tragic potential consequences. In the short time available, I hope that I have been able to update the House on the measures in place to ensure safe prescribing of Roaccutane.

[Sir Nick Harvey]

I sense that my hon. Friend is reaching his peroration. He has offered us reassurance that the drug is used only under the auspices of specialist doctors and, apparently, only in severe cases, although my constituent’s was a mild case. Is he minded to take any further action at all, because as yet he has not suggested anything?

[Norman Lamb]

I am grateful for that intervention. I was going to suggest, at the end of my speech, that I am happy to talk to my hon. Friend and his constituent, if he wants that, because this concern cannot be dismissed in a half-hour debate. I am happy to look further at his concerns, because they could not be more serious. I recognise that other hon. Members are interested as well, and I am happy to meet others, if that would be of some use. I understand the seriousness of the issue that my hon. Friend raises.

Question put and agreed to.

Pharmaceutical Price Regulation Scheme

Norman Lamb Excerpts

Tuesday 3rd December 2013 Written Statements

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

My right and noble Friend the Under-Secretary of State for Health, Earl Howe, has made the following written ministerial statement:

I am pleased to announce today the publication of the 2014 pharmaceutical price regulation scheme (PPRS). This follows my announcement of 6 November on the scheme’s heads of agreement, Official Report, column WS19. The PPRS is a voluntary scheme agreed between the Department of Health, acting on behalf of the UK Government and Northern Ireland, and the branded pharmaceutical industry, represented by the Association of the British Pharmaceutical Industry (ABPI), under section 262 of the National Health Service Act 2006.

The current voluntary pricing scheme, the 2009 PPRS will terminate on 31 December 2013. Following negotiations, the Department of Health and the ABPI have now reached agreement on the full policy and operational detail of the new scheme. The new scheme will operate for five years starting from 1 January 2014.

The new scheme will provide an unprecedented level of certainty on almost all the NHS branded medicines bill. The bill will stay flat over the next two years and will grow slowly after that. The industry will make payments to the Department of Health if NHS spending on branded medicines exceeds the agreed growth rate. The agreement therefore provides stability and predictability to both the Government and the UK pharmaceutical industry, supporting the industry’s global competitiveness. It will encourage the use of innovative and effective new medicines in the NHS.

The PPRS has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.