Spinal Cord Injuries

Norman Lamb Excerpts

Wednesday 4th September 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the first time, Dr McCrea.

I congratulate the hon. Member for Wrexham (Ian Lucas) on securing this debate and on his persistence in pursuing the matter. I have noted what he said about his frustration in securing meetings with a couple of Ministers. At least we have had the chance this afternoon, albeit interrupted, to debate this important issue, and I am more than happy to talk to him if there are issues arising from this debate that he wants to pursue further.

The hon. Gentleman makes the point that how care is administered is incredibly important to the individual, and he also mentioned the profound impact that spinal injury has on the whole family and everyone involved. He talks about the emergence of a postcode lottery, but if we are honest with ourselves, the postcode lottery has always existed to some extent. The interpretation of rules has always varied somewhat across the country. Indeed, the Coughlan case was brought because of a failure to apply rules properly. I will return to that in due course, but it is essential that all areas of the country apply the rules properly, according to the guidelines, and apply the precedent that has been set.

I also pay tribute to the important work of the all-party group on spinal cord injury, which has had a major impact on issues affecting the estimated 40,000 people with spinal cord injury in the United Kingdom and Ireland alone. Every eight hours, a new person is told that they will never walk again, which is a stark reminder of the scale of spinal cord injury.

Thankfully, research is making important strides in developing new techniques to help spinal cord injury patients regain as much function and independence as possible. In 2011-12, the Medical Research Council spent £900,000 on research directly related to spinal cord injury. The Government also fund a wide range of research relating to spinal injury, and through the National Institute for Health Research, the Department of Health is funding research on spinal cord injury in biomedical research centres in Cambridge and London.

There is an increasing range of guidance available to provide advice on the causes, treatment and management of spinal cord injuries. Stakeholders such as the Spinal Injuries Association and Aspire provide information and support services for patients and their families following spinal injury, and we should pay tribute to the work of those organisations. In February 2008, the Royal College of Physicians published a guideline for GPs and other health professionals involved in the management of adults with spinal cord injury in the acute hospital setting. I am confident that that range of guidance will be useful for educating people and, critically, professionals on spinal injuries and how to manage them.

More work is taking place to develop guidance for the treatment of those with spinal injuries. The Department has asked the National Institute for Health and Care Excellence to produce guidance on the assessment and imaging of patients at high risk of spinal injury. NICE is developing five pieces of guidance relating to trauma, with expected publication dates in June and October 2015. Each piece of guidance will focus on a different aspect of trauma care. The guidance on spinal injury assessment will form one part of the wider work and is expected to be published in May 2015.

The hon. Gentleman appropriately raised NHS continuing health care for individuals with spinal cord injuries. NHS continuing health care is a package of health and social care that is arranged and funded solely by the NHS for individuals outside the hospital setting who have complex, ongoing health care needs. It is important to say that eligibility for NHS continuing health care is dependent not on an individual’s condition or diagnosis—it is important to maintain this point—but on the individual’s specific care needs. That must be appropriate, so that what is assessed is what the individual needs.

The assessment for NHS continuing health care is complex and involves a multidisciplinary team co-ordinated by the relevant clinical commissioning group looking at an individual’s needs across 12 care domains and assessing how those needs interact. The process determines whether individuals have what is called a primary health need. If they do so, they will be entitled to continuing health care.

The hon. Gentleman specifically referred to concerns about specialist involvement in continuing health care assessments. The national framework, which underpins the assessment and decision making for NHS continuing health care, makes it clear that someone with specialist knowledge is involved in the process, with other highly skilled professionals, such as doctors, nurses, social care staff and therapists. If that is not happening in an area, that is a failure to follow the national framework and should be challenged. I am interested to hear about cases in which that is not happening, because corners cannot be cut—things should be done properly. He made an important point.

The family or representative may also be involved, to ensure that a holistic picture of the individual’s needs is properly identified. After all, the family probably knows best about what the impact really is.

Individuals receiving NHS continuing health care will have their case reviewed three months after the initial decision and annually thereafter. It is important to remember that the focus of the review is not only whether the individual remains eligible, but whether their needs are being properly met and the package of care remains appropriate. Let me be clear, however, that an individual must be kept fully informed about the process and any proposed change to the care arrangement.

The hon. Gentleman expressed concerns about refusals of NHS continuing health care or the package being drawn too narrowly, suggesting that the Coughlan judgment was not being followed and that cases more serious than the Coughlan one were being refused—I think I have put that correctly, from what he said. I again make the point that if any areas are failing to follow the national framework, that must be challenged. I appreciate that families may not always understand or know how to go about challenging, or what they are entitled to, but we all have responsibility to disseminate that message and to encourage people to challenge decisions that cannot be justified.

[Ian Lucas]

The Minister is being very constructive in his response. Is there any process for monitoring the decisions? Organisations such as the Spinal Injuries Association can bring individual cases forward, but there needs to be some sort of system to ensure that the rules, which I am grateful that the Minister is stressing today, are being enforced as a matter of course.

[Norman Lamb]

The hon. Gentleman makes a fair point. I was about to say that I will ask NHS England to provide me with an assessment of how the work of CCGs complies with the guidelines. The very fact of that request for information will help focus minds and ensure that things are being done properly.

I am aware that there are some concerns about how autonomic dysreflexia is reflected in NHS continuing health care assessments. It is unique to spinal cord injuries and should always be treated as a medical emergency. The needs of individuals experiencing autonomic dysreflexia are to manage both the risk of episodes occurring and the risks involved if and when such episodes occur. Such risks, and therefore the needs, vary from one individual to another. It would be relevant to establish whether the individual has signs and symptoms of an advancing episode or whether the episodes are random and unpredictable.

It has been suggested that more people with spinal injuries are being placed in nursing home settings, rather than being offered a care package in their own home. The national framework is clear that NHS continuing health care packages should be as far as possible personalised—designed to meet that individual’s needs—and that the individual’s wishes should be taken into account. It is our hope that personal health budgets—a concept developed under the previous Labour Government, but strongly pursued under this Government—will give people more personal control over their care.

We recognise that it is more efficient for people with long-term conditions such as spinal cord injuries to have control over their own budget for health and social care, because they are less likely to duplicate services or to choose ones that are not right for them. Beyond being efficient, however, it is simply what we should be doing: we should be putting the individuals in charge and allowing them to determine their priorities. On that basis, CCGs are already able to offer personal health budgets to people on a voluntary basis, if they consider that it is cost-effective and will improve the individual’s quality of life.

We have also brought in legislation that will allow CCGs to offer direct cash payments as a way of managing personal health budgets. However, to make personal health budgets more of a reality for people, we have put measures in place to ensure that CCGs go further than offering them only on a voluntary basis. As of April 2014, those receiving NHS continuing health care will have the right to ask for a personal health budget, including a direct payment. Using a personalised care planning process, personal health budgets help people choose how to meet their health needs in ways that work for them.

I have just set out how the process for NHS continuing health care is intended to work. Let us not pretend, however, that it works perfectly in every case—it clearly does not. I am delighted that the Spinal Injuries Association continues to have a strong presence on the NHS national continuing health care stakeholder group. It is important that its voice and that of the people it represents are heard.

Eligibility for NHS continuing health care depends on a needs-based assessment. Therefore, some individuals will not be eligible, but they must still receive the appropriate level of care and support. Disjointed care is a source of complete frustration for patients and staff alike. To stay relevant to changing needs, different parts of the NHS and other organisations such as social services have to work more effectively together to drive joined-up care.

The first NHS mandate sets out a requirement to provide

“care which feels more joined-up to the users of services”,

and which

“ensures people experience smooth transitions between care settings and organisations”.

That is vital, and there is a total focus in Government on integrating and joining up care around the needs of the individual patient. On that basis, we have asked NHS England to make huge efforts to focus on delivering integrated care and support to improve outcomes for patients and for people who use those services.

I thank the hon. Gentleman for securing the debate. The issues that we have discussed this afternoon are important, because of their impact on people who have sustained a spinal injury which in itself is completely life changing. We must ensure that the care and support systems work to meet their needs and to enable the best possible quality of life and outcomes for those individuals.

Question put and agreed to.

Parliamentary Written Answer (Correction)

Norman Lamb Excerpts

Tuesday 3rd September 2013 Written Statements

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

I regret that the written answer given to the right hon. Member for Mid Sussex (Nicholas Soames) on 27 June 2013, Official Report, column 344-45W, contained some incomplete figures in the table.

It has been brought to my attention that the information provided in the original answer did not contain secondary care figures for December 2012. The table below shows the correct figures. The revised answer is as follows:



Expenditure by national health service trusts in London, as defined by the former London Special Health Authority (SHA), is provided for both anti-retroviral HIV medicines and anti-cancer medicines.



London generally has a larger proportion of its medicines costs going through hospitals than other SHAs as patients from areas surrounding London are likely to travel to London hospitals for some treatments.

Public Service and Demographic Change

Norman Lamb Excerpts

Thursday 18th July 2013 Written Statements

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

We have today laid before Parliament “Government Response to the House Of Lords Committee on Public Service and Demographic Change report “Ready for Ageing?” (Cm 8677).

This country faces major demographic and economic challenges as a result of an increasingly ageing population. We welcome the Committee’s report, which shares the Government’s ambition of making this country a great place to grow old in.



We know the challenge is significant. The quality of our later life is an issue which affects us all. Cross-Government co-ordination and focus is crucial to achieving success. We all have responsibility for ensuring we make the most of the extraordinary opportunity of increasing life expectancy. These challenges are for individuals and communities, for local and national Government, for the private sector and the third sector.

This response describes the wide reaching programme of reforms this Government have put in place, as well as the plans we have for further work, which we believe will begin to address the challenges set out in “Ready for Ageing?” The reforms range from changes to pensions, transformation of the health and care system as well as improvements to wider public provision such as housing and transport.

Public provision must continue to adapt and respond as the needs and expectations of the population change. Individuals must take personal responsibility for planning for their later life, making choices and exercising control. This report is not a one off piece of work but an important dialogue between Government and the public, which must and will continue into the next Parliament.

As part of this dialogue, Government have committed to writing to the House of Lords Liaison Committee in a year’s time. This will update on progress of the Government’s reforms as well as provide any new evidence and challenges that might have arisen since the original report was published.

Caring and Support Consultation

Norman Lamb Excerpts

Thursday 18th July 2013 Written Statements

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

Today we are publishing a significant consultation that looks at the practical detail of implementing our reforms to what and how people pay for their care and support.

We have published plans for a new fairer funding system that will help people to more easily prepare for the cost of their future care needs, and will provide financial protection for people’s homes and savings.

The proposals are based on sweeping reforms to how care is paid for to give more certainty and peace of mind over the cost of old age or living with a disability. They will end the unfairness of unlimited care costs and ensure everyone gets the care they need with most support going to those in greatest need.

From 2016 the reforms will deliver a new cap of £72,000 on the costs of meeting eligible needs, additional financial help for people of modest wealth with less than £118,000 in assets including their home and, from 2015, a scheme to prevent anyone having to sell their home in their lifetime. The consultation confirms details of the plans including:

for people entering a care home, their property will not be included in the assessment of assets if a partner or dependant still lives in the home. In this case if a person has assets of less than £27,000 (excluding their home) they will qualify for financial assistance; and

the cap is based on the total cost of meeting someone’s eligible needs, not just their own contribution, an individual’s payments are added to those made by the local authority when measuring progress towards the cap. This means around two-thirds of people who reach the cap will have contributed less than £72,000 towards their care costs.

The consultation looks in detail at the various elements of the reforms seeking people’s views to help us deliver a fairer and more sustainable care and support system in local areas.

Reforming how and what people pay for their care intends to bring a number of benefits. Currently, a fear of high costs and lack of good information and advice can cause people to delay getting the care they need, and therefore see their needs escalate more quickly. This leads to more people (and their families) seeking and organising care in a crisis situation and risking higher care costs, due to their condition having deteriorated more rapidly.

The reforms will set some limits around how much people can expect to pay for their care, making it easier for them to plan and therefore putting them more in control. It will also protect more of what people have worked and saved up for during their lives.

The consultation launched today is about working out the practical detail of what needs to happen to make the changes to payment of care costs a reality. Reforming what and how people pay for their care will involve significant changes to how local authorities operate currently. We are therefore keen to hear people’s views on how these changes to the funding system should happen and be organised locally, to help us deliver a care and support system that is sustainable and fairer for everyone.

Consultation proposals include:

how best to provide people with information and advice, including on how to pay for

care and support, to help everyone plan for the future;

annual “care account” statements to project when someone will reach the cap or qualify for additional financial support;

the option of joining a not-for-profit “deferred payment” scheme where the local council pays people’s residential care fees and the person is able to repay from their estate, allowing them to keep their home during their lifetime;

possible new products from the financial services sector who are responding to these reforms by looking at how pensions and expanded life or health insurance could help some people plan;

principles behind the level of the cap for people aged under state pension age who have eligible needs; and

the process for providing redress and resolving complaints.

The Government have provided £335 million to local authorities in 2015-16 to cover the costs of implementation of the cap and the requirement to offer deferred payments for residential care. This includes funds that will enable local authorities to begin assessing people’s needs for care and support around six months before introduction of the cap, if they choose to do so.

The Department of Health, Local Government Association and the Association of Directors of Social Services (ADASS) have committed to work in partnership on a joint programme to ensure successful and sustainable delivery of these reforms.

The consultation will run from 18 July until 25 October.

“Caring for our future: Consultation on reforming what and how people pay for their care and support” 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.

2010 Adult Autism Strategy for England

Norman Lamb Excerpts

Wednesday 17th July 2013 Written Statements

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

In line with duties under the Autism Act 2009, the Department of Health is currently leading a review of progress in relation to the 2010 adult autism strategy for England “Fulfilling and rewarding lives” and its related statutory guidance.

The adult autism strategy is an essential step towards realising the Government’s long-term vision for transforming the lives of and outcomes for adults with autism. The Department of Health is the lead policy Department for implementation of the strategy but with delivery shared across a range of Government Departments and agencies, and local health and social service providers, who have the freedom and responsibility to decide how best to design and deliver services for their local populations.

The autism strategy has five areas for action aimed at improving the lives of adults with autism:

increasing awareness and understanding of autism;

developing clear, consistent pathways for the diagnosis of autism;

improving access for adults with autism to services and support;

helping adults with autism into work; and

enabling local partners to develop relevant services.

The strategy is not just about putting in place statutory autism services but about enabling equal access for people with autism to support and opportunities through reasonable adjustments to everyday services, training and awareness raising.

The review is an opportunity for us across Government to assess whether the objectives of the strategy remain fundamentally the right ones, to take an honest look at what progress is being achieved by local authorities and the NHS, and consider what should happen to continue to make progress. We will issue a report after the investigative stage of the review which will last until the end of October, on revising the strategy as necessary by March 2014.

The National Autistic Society’s (NAS) “Push for Action” campaign coincides with the review and has a central thrust on local implementation. We are working with NAS and other key partners to ensure that the voices of people with autism and their families and carers are heard during the review and there will be a range of opportunities for people to feed in. I would welcome views and input from hon. Members and their constituents during these processes.

Liverpool Care Pathway

Norman Lamb Excerpts

Monday 15th July 2013 Written Statements

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

The independent review of the Liverpool Care Pathway has been published today. I commissioned this review in January 2013 in response to concerns raised by patients, families, carers and a number of clinicians. The review was undertaken by an independent panel chaired by the noble lady, Baroness Neuberger.

People who use health and care services have the right to be treated with respect, dignity and compassion by staff with the skills and time to care for them properly. We all want our own and our loved ones’ final days and hours to be pain-free and dignified, with individual needs prioritised and respected, and with families and carers fully involved.

I recognise and value the high quality of much of end of life care across the country. On behalf of the Government, I would like to convey my continued support and appreciation for the work that so many doctors, nurses and others do on a daily basis to care for the dying. While most patients certainly are receiving high-quality care and many families and carers are being properly involved, we need to make sure that this is the case for everyone.

The Liverpool Care Pathway was introduced to improve end of life care by setting out principles for how the dying should be treated, whether they are in hospital, at home, in a care home or in a hospice. The review heard that when the Liverpool Care Pathway is operated by well-trained, well-resourced and sensitive clinical teams, it works well. However, it also heard too many examples of poor practice and poor quality care, with families and carers not being properly involved and supported. This has to change.

The review made a number of recommendations to Government and other health and care organisations. The Government will consider fully the recommendations of the review and over the coming months will be working with these organisations, stakeholders and charities to inform a full system-wide response to the review’s recommendations in the autumn. However, I can announce at this point our intention for the Liverpool Care Pathway to be phased out over the next six to 12 months. Instead, an individual approach to end of life care for each patient will be introduced, with a personalised care plan backed up by condition-specific good practice guidance and a named senior clinician responsible for its implementation.

In addition, the Care Quality Commission will be undertaking thematic work on end of life care, and the three new chief inspectors—of hospitals, social care and general practice—will consider end of life care issues as they develop their new approach to inspections. To support these improvements to end of life care, I am also writing to the General Medical Council and the Nursing and Midwifery Council to highlight both the need for effective guidance on supporting nutrition, hydration and sedation for the dying, but also to stress the importance of the professional regulation issues raised by the report.

However, it is clear that we need to take action immediately. I can therefore announce:

to ensure immediate action for patients, families and carers, I have written to all NHS hospitals asking them to undertake a clinical review, led by a senior clinician, of each patient who is currently being cared for using the Liverpool Care Pathway or similar plans for the final days and hours of life to ensure that the care they are receiving is appropriate. I have also asked them to ensure that arrangements are put in place to provide assurance that every dying patient now and in the future has a named senior clinician responsible for their care. I will be writing in similar terms to those responsible for dying patients being cared for outside of hospital;

it is equally important that the concerns about care are properly investigated and resolved. I will ensure that people who have a complaint about the care given to a dying patient on the Liverpool Care Pathway or similar plans have access to an independent assessment of their case should they want it. I have also asked all NHS hospitals to appoint a board member with responsibility for overseeing any complaints about end of life care and for reviewing how end of life care is provided; and

the review also recommends that incentives paid to hospitals to promote a certain type of care for the dying should cease. In response, I am asking NHS England to work with clinical commissioning groups to implement this immediately.

I would like to thank Baroness Neuberger, the review panel and their support team for their hard work and commitment. Finally, I would also like to thank all the contributors to the review, and in particular the families and carers of patients.

“More care, less pathway: A review of the Liverpool care Pathway” 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.

“Six Lives: Progress Report on Healthcare for People with Learning Disabilities”

Norman Lamb Excerpts

Friday 12th July 2013 Written Statements

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

I have today published the Department of Health’s second progress report in response to the recommendations of the parliamentary and health service ombudsman and the local government ombudsman in their March 2009 report “Six lives: the provision of public services to people with learning disabilities”. At the same time, I am also publishing the Government’s response to the recent “Confidential Inquiry into the premature deaths of people with learning disabilities”.

“Six Lives: Progress report on healthcare for people with learning disabilities” provides an assessment of the progress made since the previous progress report published on 14 October 2010 in health and social care services to fulfil the ombudsmen’s recommendations and improve health care and treatment for people with learning disabilities.

The report demonstrates that more people with learning disabilities than ever before have taken up the opportunity of an annual health check which will help improve their health and enable preventive interventions to stop potential health crises. The report also sets out priority areas for further progress including:

giving greater voice and power to people with learning disabilities and their local communities to develop services for everyone, including those in vulnerable or marginalised groups;

supporting the spread of personal health budgets for people with learning disability with greater integration across health and social care;

ensuring that health and well-being boards have information to support them in understanding the complex needs of people with behaviour that challenges; and

working with NHS England to make sure that the system continues to monitor and improve the health and care outcomes of people with learning disabilities.

The Department of Health worked with Mencap and the British Institute of Learning Disabilities (BILD) to engage with and listen to people with learning disabilities and family carers about their views and experiences of health care to find out more about where progress had been made and where more work needs to happen. Alongside the second progress report, we are publishing a summary of the outputs from that engagement event, including the results of a questionnaire about whether health care is getting better for people with a learning disability.

“Government response to the Confidential Inquiry into the premature deaths of people with learning disabilities” addresses all the inquiry’s recommendations, taking account of the changes to the health and care system which have been set in train since the Confidential Inquiry was established. The Department of Health, NHS England and other delivery partners will have an important role to play in leading change to improve access, experience and outcomes for people with learning disabilities and family carers. Specific changes include:

using the Government’s information strategy for health and care to drive improvements in the way in which we identify people with learning disabilities so that we can better respond to their needs;

linking data about cause of death with other data such as the GP practice learning disability registers to better understand and respond to premature mortality among people with learning disabilities;

using local mortality data on people with learning disabilities to inform Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategies;

using the NHS Standard Contracts to better take account of and respond to people’s needs;

aiming to have a known contact for people with multiple long-term conditions to co-ordinate their care, communicate with different professionals and be involved in care planning with the individual;

looking at introducing patient-held records for all people with learning disabilities who have several health conditions;

looking at the Mental Capacity Act guidance, advice and training for professionals, that is available to inform decisions about people's care; and

assessing with NHS England, Public Health England and other partners the costs and benefits of establishing a National Learning Disability Mortality Review Body.

For both the Six Lives progress report and the response to the confidential inquiry, we want to see a fundamental culture change so that people with learning disabilities, autism and those people with complex needs and behaviour that challenges and their family carers have the same rights as anyone else to accessing the best possible quality care and support. We expect this in turn to lead to better outcomes and fewer premature and avoidable deaths.



The Government are determined to work across the system to improve standards of care. Following events at Winterbourne View and Mid Staffordshire hospitals, we have conducted thorough investigations and delivered strong responses to enable the system change and shift in attitudes needed to support people with learning disabilities and their families.

I want to put a stop to bad practice. Good practice must be our everyday expectation and services must strive for excellence. Everyone involved in the provision of services needs greater awareness of the personal impact they can make on the health and quality of life of people with learning disabilities so that poor practice and unacceptable health inequalities can be tackled head on.

Both the report and the response have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The documents are also available at:

www.gov.uk/government/publications?departments[]=department-of-health.

Social Care Reform (Disabled People)

Norman Lamb Excerpts

Thursday 11th July 2013 Westminster Hall

[Mr David Ward (Bradford East) (LD)]

I was pleased when I heard that you were chairing this debate, Ms Clark, as I know that you have strong views on this issue. Most of us ought to have strong views on it.

In everyday conversation, we tend to use the word “ability” to indicate that we believe that someone has a special talent. We mean that someone has the ability to play the piano or tennis or to speak in public rather well. That is an inaccurate way to use the word, but it can sometimes lead to the false view that a disabled person is seeking special attention. We have heard that for ourselves: “They’re always after something.” Such disparaging remarks are often made. The reality is that that is simply not true. What disabled people seek constantly is not special attention at all—as a good liberal, I would say this, wouldn’t I?—but the basic human right to a normal life.

Of course, that does not mean that people with disabilities cannot ascend the heights and cannot have unbelievable special abilities—we know that all too well, and history is full of countless examples—but the starting place must be the basic human right to access all life’s opportunities, such as work, leisure and family, things that non-disabled people far too often take for granted. As a good left-of-centre liberal, I believe that the state has an important role to play in supporting people, not necessarily through direct state provision but by helping them attain their rights.

I thank the Backbench Business Committee for granting me time for this debate, and I thank the hon. Member for South Derbyshire (Heather Wheeler) for her support, as this debate is co-sponsored. I also congratulate her on the work that she has done on the issue—I am sure that she will refer to it—as the chair of the all-party parliamentary group on local government.

I thank Scope for the great support that I have received so far on this campaign and for the partnership work that we are carrying out in Bradford, where we are preparing at this very moment for the launch of the “Bradford Cares” campaign, part of the wider national Scope campaign “Britain Cares”. The launch will take place next Monday in Bradford, and I am delighted to say that the former Care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow) will be speaking.

To add more power and force to our arguments when bidding to the Backbench Business Committee for this debate, we were rightly asked to justify the time devoted. We were given eligibility criteria, including topicality and importance. As for topicality, we know that social care is the largest remaining area of reform for the coalition Government in this Parliament, and the Care Bill is on its way through the legislative process. The crucial issue of eligibility, to which I will return, is extremely topical, not least for people in Bradford, where the council is one of the few remaining local authorities to use the moderate level of need when assessing support. However, the council is consulting as we speak with a view to moving to assessments of substantial need. That consultation will last until 4 August.

As for importance, we must acknowledge that much of the debate about meeting and funding care needs has focused on the elderly. We understand the reason perfectly, but we must also remember that one third of care users are working-age disabled adults. That one third equates to more than 500,000 people between the ages of 18 and 64. It is a big issue for us as a nation, and the numbers are projected to increase substantially. In addition, working-age adults have considerably different aspirations from the social care system. They are not more important, but they are different and must be clearly understood when developing social policy.

A report called “The other care crisis: Making social care funding work for disabled adults in England” was published in January this year by Scope, the National Autistic Society, Mencap, Leonard Cheshire Disability and Sense. The report highlights the fact that, since 2008, there has been a constant move from moderate to substantial needs as the basis for assessment in local authorities. Since 2008, the number of people using care, at a time when we know need is increasing, has fallen by at least 90,000, or one in six of all people using care. We also know that there is a shortfall of £1.2 billion in the funding required to support social care for working-age disabled adults.

The report states that if social care reforms go ahead as planned, a further 100,000 people or more risk losing vital care and support. I know the Minister, and I know that if that is true, it will not be acceptable him. I am willing to admit that all the organisations that I mentioned and I must be wrong in our fears, but the trouble is that I cannot see how, which is why I wanted to have this debate.

On the first page of the briefing prepared for this debate by the Library, there is an article by Baroness Grey-Thompson, who apparently can see that we are all wrong. She states:

“The Chancellor announced a £3.8 billion investment”—

I know that the Minister will refer to it—

“including £2 billion of new money, in social care—the support disabled and older people get from their council to get up, get washed and dressed and live independently.”

My understanding is that setting the national eligibility threshold at the substantial level of need would mean that that was simply untrue. People would not get that support. The needs that Baroness Grey-Thompson refers to would not be met.

I know that the Minister will say that local authorities can provide support at what levels they choose. They could provide it, as many did for many years, at the moderate level of need, but the trend is moving in the opposite direction and at a rapid rate of knots, hence the figures that I gave earlier, which are getting smaller and smaller, on the number of people receiving support.

We all understand the need to avoid the existing confusion with the so-called postcode lottery—the differing levels of support in different parts of the country—but I must ask a question. What is the value of having the certainty, wherever I live in the country, of being guaranteed a level of support that fails to provide me with my basic human right to live an independent life? That is not a freedom: to be told that I cannot have the life that I deserve. It is not an improvement to provide the certainty of not knowing what care I will get, which we have at present, with the certainty of getting almost no support at all. I know the Minister and that that is not his intention, so I am in the Chamber today not to bury Caesar—not to criticise my hon. Friend—but to understand better how the planned reforms will work. I cannot work them out; we cannot work them out; and we desperately need to know.

I read the discussion document on the draft national minimum eligibility threshold for adult care and support and I do not get it. To me, there seem to be four crucial elements to the provision of care and support, and there may be more. First, without sufficient funding, there will be a problem, no matter how effectively and efficiently we deploy the available resources. Funding will always be vital. The other three parts are integration, eligibility and the actual care services provided.

We are told that £3.8 billion—£2 billion of new money—is there to help with that crucial integration, but good integration will improve the efficiency and quality of care and support at any level of funding. If we were given 1p, through good integration we could spend that penny better than by being disorganised and chaotic. Eligibility, however, will determine the level at which a person can access the wonderfully improved care and support that we will achieve through integration. Eligibility is the gateway, and the integration can take place at any level of care. We could remove all the postcode lottery uncertainty by setting the eligibility level at critical and yet integrate wonderfully, but how would the improved integration help the hundreds of thousands of people whose needs fall below the threshold level? I do not get it.

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

If my hon. Friend were to go somewhere such as Torbay, where completely integrated teams of health and care workers have been created, he would see that those teams can together make rational judgments about the people who need care and support, by identifying the individuals most likely to end up in hospital and allocating a worker from an integrated team to support them. I absolutely recognise that the eligibility criteria play a role, but the joint team can assess the needs in the area and do whatever is necessary to maintain people’s health and to prevent the deterioration of health and people ending up in hospital. Integration seems to be essential to what he seeks to achieve.

[Mr Ward]

It is not an either/or, or a route from one to the other. We can integrate at any level of support, and greater integration would certainly improve the system with greater economies and, we hope, greater equality of provision. If the Government had planned to introduce a whole new system and remove all criteria—looking simply at people and their needs—I could possibly see, with a wonderfully well funded and integrated system, how that might work. What is planned, however, is not that but an eligibility threshold against which people will be assessed. At that point, even with the washing, the getting dressed and all the other things that Baroness Grey-Thompson was talking about, the decision might be made that the person is simply not at the required level—the threshold—to be given support.

In the foreword to the discussion document, the Minister stated:

“We are establishing a system that will place a greater focus on prevention, which will mean that the care and support needs of people will be considered earlier than is currently the case.”

That is good, and it must refer to the early identification of potential future needs through improved integration. From my own background—in particular, in the area of children with special needs—I am well aware that early identification, so that support can be given, even from mainstream provision, can stop those needs developing to a level at which additional funding and support are required.

I understand all that, but a working-age adult can, for example, have a stroke—something that we saw at the Stroke Association event yesterday—and move, within a day, from being perfectly healthy to having needs that might even be classed as critical. On the direction, however, this is not about progression for many working-age disabled people, because they may move from critical or substantial down to moderate, but about how someone who has had a stroke perhaps may never move back to a point at which support is not required and live a truly independent live. The danger is that such people might go down, in terms of the needs as assessed, and fall out of the system. Where will they then end up? Later, at greater cost, they will go back into the system. That is the concern.

The discussion document refers to the creation of a working group to take matters forward. My problem is that it also states that developing and evaluating the research carried out by the working group may take three to four years. Too many disabled people, however, may quite literally not have that long.

[Heather Wheeler (South Derbyshire) (Con)]

It is a pleasure to serve under your chairmanship, Ms Clark.

I warmly welcome this Back-Bench debate, which allows us the opportunity to discuss the findings of the joint all-party group’s important report on social care reform for working-age disabled people. I congratulate my colleague, the hon. Member for Bradford East (Mr Ward), on securing the debate, and it is a pleasure to follow him.

I take a moment to thank the right hon. Member for Stirling (Mrs McGuire), the Baroness Campbell of Surbiton and the all-party disability group for joining me and the all-party local government group in writing our report, “Promoting Independence, Preventing Crisis”. I also thank Scope for all its superb help in facilitating the inquiry.

Social care reform is a cross-party concern and provides a clear example, notwithstanding what has recently been splashed across the media, of how all-party groups do good work in Parliament. I applaud the Government’s commitment to investment in social care, which they set out in the 2013-15 spending review—£3.8 billion is not a small sum. As our joint inquiry underlined, the social care system has faced decades of underfunding, and the Government’s understanding of the need to address the problem effectively should be recognised.

It was extremely important to me to be involved in the all-party group’s inquiry. For the first time, we managed to bring together the voices of working-age disabled people with those of local authorities. That represented a valuable and timely opportunity to continue to build on the Government’s positive vision for social change, and to develop the positive disability strategy, “Fulfilling potential: making it happen”.

We want to bring the focus of social care on to working-age disabled people. I praise the Government’s ambition to deliver a care system that is capable of meeting the needs of both the older population and working-age disabled people. The plans to improve integration and closer working between health and social care bodies have been a positive development. However, in the Chancellor’s speech on the spending review no reference was made specifically to the one third of care users who are working-age disabled people. I hope that the Minister will confirm the Government’s commitment that the purpose of moving the money from the NHS to local government was to meet not only older people’s needs but those of disabled people of working age. We must ensure that this group remains in the spotlight when reforming the care system.

I want to reiterate the importance of addressing the national eligibility criteria that my hon. Friend the Member for Bradford East raised. Despite the intention that the current fair access to care services criteria should be a broadly national framework, councils have considerable leeway in setting the threshold for eligibility. That has resulted in significant variation throughout the country. Moreover, councils have been tightening their own local eligibility criteria in response to budget pressures. That is completely understandable, but the implications are that people are living with the fear that they will lose their support. The new eligibility framework and national threshold proposed in the Care Bill will therefore go a long way towards alleviating the lottery of care, and will be vital in ensuring more clarity and consistency in the provision of care for disabled people in England.

The Government published the draft regulations for the national eligibility threshold on 28 June and confirmed in the accompanying document their intention to set the threshold at a level equivalent to “substantial” in the current FACS system. People tell us that that means that, for more than 100,000 working-age disabled people, the bar has been set too high to receive the care and support they need to live independent lives. I hope that the Minister will respond to that.

[Norman Lamb]

I reiterate that the proposed eligibility level set out in the document to which my hon. Friend referred would maintain for the vast majority of people what already exists within their local authority area and, as my hon. Friend the Member for Bradford East (Mr Ward) said, do absolutely nothing to prevent other authorities that choose to be more generous from maintaining that level at “moderate”, as currently exists in Bradford and about 15 other places around the country. Nothing will take away from anyone what they already have as an entitlement.

[Heather Wheeler]

I thank the Minister for his intervention.

I turn to what social care means to our constituents when real help is given. It means that someone can get up, and be washed, dressed and fed each morning. Those are basic, everyday actions that many of us take for granted. When that level of support is offered comprehensively, the person may hold down not only genuine social interaction but employment. Real social care may also prevent social isolation. For example, a member of the National Ankylosing Spondylitis Society has said:

“I feel overly tired most days. Outside of work my participation in activities has been reducing. I don’t spend as much time as I used to socialising with friends and family. I used to be very active and go out in the evenings but now I have early nights instead.”

It is brilliant that, with help, that person feels able to remain in the work force, but we must ensure that the care offered is not at the cost of other factors, such as mental health or well-being.

Well-being is an unambiguous concern of the Government and is clearly addressed through the well-being principle in clause 1 of the Care Bill. That reflects the fact that it is, first and foremost, a human issue. The principle is the thread that runs through the whole of the Bill and ensures that the care system not only delivers basic support but promotes disabled people’s independence, allowing them to realise their potential by participating more fully in their communities. That is a bold vision for the future and will truly revolutionise the care system.

It has been stated that for some people social care means

“being able to have the same aspirations as others. I hold down a job, live independently and I am able to live life in the way that I choose. I believe this is a fundamental right, but it has also given me an immense sense of freedom and satisfaction as I am able to contribute to society.”

Those great quotes come from our inquiry.

Well-being and independence also means providing support when an individual moves from one local authority area to another. The Care Bill should ensure that the receiving authority has a duty to ensure that any social care provision for an individual will ensure the same outcomes as those of their previous local authority. I stress to the Minister the importance of that portability factor to our constituents. They live in a mobile world.

A preventative social care system not only has benefits for the quality of care and the lives of disabled people but represents a financially sustainable approach for the future. In addressing the concern about the eligibility threshold, local authorities will be in a position to deliver appropriate care at an earlier stage, reducing escalation of the crisis. As the British Red Cross told the all-party group’s inquiry:

“There must be a dramatic rethink to the way social care is organised in the future, with a focus on preventing crises before they occur and keeping people independent for as long as possible.”

Without a truly preventative system, councils will have no choice other than to intervene at crisis points when the personal and financial costs are already too great. The former president of the Association of Directors of Adult Social Services, Sarah Pickup, told the inquiry:

“Prevention is one of the very few things where you can get both a better outcome and a reduced cost.”

The Government have recognised that local authorities are delivering innovative solutions in social care provision, and have rightly chosen health and wellbeing boards as the mechanism through which social care can be delivered effectively. The boards have been implemented fully since April 2013. The Health and Social Care Act 2012 mandates a minimum membership consisting of one local elected representative, a representative of the local healthwatch organisation, a representative of each local clinical commissioning group, the local authority director of adult social services, the local authority director of children’s services and, crucially, the director of public health for the local authority. That will ensure a wide range of views and experience on the boards and will help with the implementation of preventative social care.

If the Government fully resource local authorities to implement preventative social care, the financial returns to local authorities, national Government and the NHS will be significant. Deloitte’s economic modelling in Scope’s report, “Ending the other care crisis”, has shown that a £1.2 billion investment in establishing a lower national eligibility threshold would lead to a £700 million saving for the Government and a £570 million saving for local authorities and the NHS. That is care and compassion at a better net price for the nation.

In addition, that money must be available to be used for care services within communities that are not exclusively health focused such as housing and employment. Such support would aid many disabled people in actively contributing to society as independent, participating, tax-paying citizens. As Sue Brown, head of policy at Sense, told our inquiry, the employment market currently risks losing out on the contributions that disabled people can make. That is the crux of the debate; we want to get disabled people living the lives that they want to lead, and being as independent and as self-sufficient as possible. Not only do they benefit from that, but the economy benefits too.

The National Autistic Society told me that new economic modelling by Deloitte published earlier this month shows that for every £1 invested in support for people with autism—and other disabilities—who have moderate needs, returns of £1.30 are generated. As the Government have rightly recognised, social care is not merely about allowing people to survive; rather, it is about enabling them to live full and independent lives. The Bill explicitly places a duty on local authorities to provide care that promotes the well-being of individuals. Let us now establish that the regulations fulfil the Government’s ambition and ensure that more than 100,000 disabled people with significant needs can live full, varied lives, with the basic dignity that we all take for granted.

To reiterate—and to be absolutely clear—I feel that the care provisions that we put in place need to be standardised between local authorities in order to promote portability. Those affected by the provisions are the most vulnerable in society. We do not want to make moving house an ordeal for people, with tensions and stresses about the level of care that they can expect to receive in the new area. Before the excellent changes to this groundbreaking, joined-up government measure can be implemented, we would like to ensure that a proper impact assessment is undertaken. We would like any administration costs, or other associated costs, to be known to local authorities before implementation. We want to ensure that costs do not force the most vulnerable in society to be left behind, because of new bureaucratic layers imposed on local government.

In conclusion, the Care Bill is a significant, welcome step in the right direction that acknowledges that reforms need to be made. Provided that they are properly resourced and supported, local authorities, working with the NHS, now have the opportunity to demonstrate their considerable experience of delivering social care in a financially sustainable manner. Funding preventative social care in the manner that the report recommends represents a win-win situation for the Government. I look forward to the Minister confirming the new way of working, by recognising that budgets between the NHS and local government, as announced in the recent spending review, will be used, not only for the elderly, but for working-age disabled people. Thank you, Ms Clark.

[Mrs Anne McGuire (Stirling) (Lab)]

It is a genuine pleasure to serve under your chairmanship this afternoon, Ms Clark. I also want to congratulate the hon. Member for Bradford East (Mr Ward) and the hon. Member for South Derbyshire (Heather Wheeler) on promoting this afternoon’s debate. Protocol would not allow me to join them in sponsoring the debate, but I am delighted to be able to participate by making a short contribution.

For the record, I also want to identify colleagues from both Houses of Parliament who took part in what was a groundbreaking inquiry in terms of our Parliament. It was cross-party and cross-House, so I want to recognise the contributions of my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), Baroness Eaton of Cottingley, the hon. Member for Meon Valley (George Hollingbery), Baron Low of Dalston, the hon. Member for Truro and Falmouth (Sarah Newton), Baron Tope of Sutton, the hon. Member for Broxbourne (Mr Walker), and the hon. Member for Bradford East, who gave up their time to participate. I also want to thank the all-party parliamentary local government group, under the admirable chairmanship of the hon. Member for South Derbyshire, for joining with the all-party parliamentary disability group in promoting the inquiry.

It is also worth nothing that a distinguished group of people presented evidence to us, both as individuals—people who came from a variety of backgrounds—and as organisations, including the Joseph Rowntree Foundation, Sense, the Royal National Institute of Blind People, the NHS Confederation, Inclusion London, Mencap, Mind, the National Autistic Society, and the president of the Association of Directors of Social Work. I hope that the Minister and my hon. Friend the Member for Leicester West (Liz Kendall), the Opposition spokesperson, will recognise that the evidence brought together a significant spectrum of expertise from organisations, but more importantly, that it brought to the inquiry the particular experiences of disabled people themselves. It was not only about talking to the organisations that are out there, either representing or delivering services for disabled people; it was also about listening to disabled people. To echo the comments made by the hon. Member for South Derbyshire, I would like to thank Scope most sincerely, not only for servicing the inquiry, but for going beyond the bounds of what was expected to ensure that it happened—and happened professionally—and that our publication is both professional and challenging. I want to place that on record.

Disability can happen to anyone at any time. We could have an undiagnosed condition, a car accident, or we could develop a progressive illness. Last week, I attended a reception in the House of Lords for the management of bowel problems. I met a young man who became disabled in his early 20s when a rugby scrum collapsed on him. He never thought, in his wildest dreams, that he would be disabled in his 20s. He loved and played rugby, and one day, an accident happened. I hope that that would be the context in which we can discuss some of the issues that both my colleagues have identified today, because my benchmark for social care is what we would want to happen if it were us. If we start from that premise, we can build a picture of what we think should be the exemplar in terms of social care.

I want to identify why the inquiry took place, and why now. There is a momentum with the Care Bill, with both political parties—perhaps, in this company, I should say three political parties—coming together to recognise the importance of social care. As the hon. Members for Bradford East and for South Derbyshire highlighted, a third of those who rely on social care are, in fact, working-age adults. Sometimes, there is a great frustration among the disability community that working-age adults are not mentioned. We talk about care of older people—indeed, sometimes we use care of “the elderly”, which I think is somewhat disparaging, as we are talking about “older people”. That is only my particular pedantry, I suppose. However, working-age adults sometimes get forgotten, and I certainly welcome the focus that we are giving those younger people today.

As both my colleagues have identified, care cannot only be about basic survival. There is more to life than getting up, eating and drinking, getting into your pyjamas and then going to bed. Frankly, although the Minister mentioned Torbay, that, sadly, is exactly what social care means for many people around the country. For disabled people who want to live fulfilling lives, care is a facilitator for independent living, fairness and respect. It is an enabler to a social and family life and, thankfully, for an increasing number of disabled people, to participating in their own way in the wider life of their community through employment.

Frankly, social care for working-age adults cannot only be about fitting them into a pre-ordained system, nor can it be about a template that is pulled down, and then someone’s name is slotted into it. It is about ensuring that the individual disabled person has real independence, choice and control. Sometimes we talk glibly about independence, choice and control, without thinking about exactly what they mean; they can be different things for different people. There is no point in having someone come in to help a person dress at 11 o’ clock, when they need to get to their work at 10 o’clock. What is the point of that? That does not allow them to live a fulfilling life, and there is little dignity and respect in getting that person into their pyjamas at 6 o’clock when they might want to go out to the cinema, to visit their friends, or, indeed, to have their friends round to visit. Let us just imagine what that must be like. Their family, friends or neighbours are there, and the person is sitting there in their jimjams. That is not what we should mean by social care, but sadly it is what is happening in many parts of the country.

In addition, as the hon. Member for South Derbyshire highlighted, social care should not just be another arm of the emergency services. It should not be a response to a crisis. That is where some of the difficulties in terms of preventive measures come in, but I want to make two or three points to echo some of the recommendations in the report.

First, I think that the current Government, like previous Governments, believe in principle in the right to independent living. We believe, I hope, as a Parliament, in breaking down barriers for disabled people and breaking down some of the Government silos that create those barriers. Disabled people do not live their lives according to the Department for Transport, the Department of Health, the Department for Work and Pensions—we can add on whichever number of Departments we want. That is not how people live their lives and it certainly is not how disabled people live their lives, so it is important that we do not just talk about independent living, but look at how it can be delivered.

Both my colleagues identified the important issue of the portability of care, and I cannot emphasise enough how important that is to disabled adults of working age. I ask the Minister to think about this issue. Let us consider the case of a disabled person in the borough of Lambeth who has to move to Westminster but finds that they cannot take their care package—their support—with them. That is echoed across the country. If it is difficult within one city, just think how much more difficult it is if someone happens to live in Carlisle and wants to go and live in Bradford. Let us just think of the challenges that that poses for an individual disabled adult.

However, it is not just individual disabled adults who are affected. Let us consider the case of people who are the parents of a disabled child. The mum or dad gets a new job and moves from Bradford down to Birmingham. The disabled child has some sort of support mechanism. This starts in childhood and can develop into adulthood. I appreciate that we are talking specifically about working-age adults, but I think that we must recognise that the picture is even bigger than the focus that we have today. In many cases, this is an issue from the cradle to the grave.

[Norman Lamb]

I agree with the case that the right hon. Lady is making, but I want to ask her this. Presumably she is pleased that the Care Bill introduces the capacity to move from one part of the country to another without the care package collapsing and that it stays in place until the person has been reassessed in their new area. It may be that someone’s needs change if they are closer to a loved one, their home is different or whatever, but the care package stays in place until the reassessment happens.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Clark. I thank the Backbench Business Committee for giving us time to debate this very important issue, and I congratulate the hon. Members for Bradford East (Mr Ward) and for South Derbyshire (Heather Wheeler) for sponsoring the debate. It is a great pleasure—this is the first time that it has happened to me—to follow my right hon. Friend the Member for Stirling (Mrs McGuire), who made a very powerful speech.

This subject is hugely important. One in five adults in Britain has a disability of some kind, and that figure is rising due to medical advances and better survival rates. As my right hon. Friend says, it could happen to any of us, so this is not a side topic but an essential issue. Britain will not be a fair country if disabled people are denied the opportunities that many of us take for granted, and we will not be a successful country if we miss out on the talents and contribution of disabled people, not only in economic terms, but in our communities and wider cultural and social life.

Good social care is essential to enable disabled people to be full citizens and live full and fulfilling lives. As hon. Members have said, that is about not only the basics of life—help getting up and getting washed, dressed and fed. It is about what I call the very stuff of life—ensuring that disabled people can spend time with their family and friends; learn and get new skills; find a job; contribute to their local community; take part in sport, art, culture and music; and have fun. In other words, it enables disabled people to have the same aspirations as every other citizen. That is why today’s debate, the joint report from the all-party groups on local government and on disability and “The other care crisis” report are important.

This is not about a particular public service, but about what kind of society and country Britain should be in the 21st century. Despite all the economic challenges, we are one of the richest countries in the world. What kind of country and society do we want, to ensure that we have genuine fairness and opportunity for people of all kinds? The debate is therefore about not only social care, but wider life, which is why it is so important.

As hon. Members have said, there is a growing crisis in social care for working-age adults with disabilities, and services have now reached breaking point. That is eloquently spelled out in the joint report of the all-party groups and “The other care crisis”, the report by Scope, Mencap, Leonard Cheshire Disability, Sense and the National Autistic Society. It rightly says that social care does not only affect older people: one in three people who use social care are working-age people with disabilities. It also says that local authority budgets for adult social care have been under pressure for many years, but have now reached breaking point, as councils have lost a staggering 28% of their budgets so far under this Government, with even greater reductions announced in the latest spending review. As a result, councils are reducing the number of disabled people eligible for free care and support.

The report says that 40% of disabled people are failing to have their basic needs met. They are unable get the help that they need to eat, wash, dress or get out of the house, and their mental health suffers. There are some terrible, upsetting and distressing quotes from people with disabilities. Disabled people’s families also suffer huge stress and strains.

[Norman Lamb]

I agree with the points the shadow Minister makes, but she mentions cuts to local government budgets and I hope that we can all be realistic and honest about the situation that we face. Is she saying that a future Labour Government would substantially increase funding for local government? Alternatively, does she recognise that, collectively, we must all think about different ways to make the money go further?

[Liz Kendall]

I believe that we must fundamentally rethink how our care and support system works. The Minister knows that my right hon. Friend the Member for Leigh (Andy Burnham) and I have called for a far bigger and bolder response, by fully integrating the NHS and social care. I shall come to the Government’s proposals for the £3.8 billion of pooled resources. With the greatest respect, I think that the Government should be bigger and bolder in their response, with full and true integration that goes beyond the NHS and social care. If we really join up local services and support and bring together support from the Department for Work and Pensions, there is huge potential to do much more to give better care, better outcomes and better value for money. I will say more on that in a moment.

In “The other care crisis”, organisations raised concerns about the number of people—105,000 in total—who will lose out if the Care Bill goes ahead as it stands, given where the eligibility criteria will be set. The report warns that the huge strides made over recent years in promoting independence and personalising care and support will go backwards, as councils and other providers revert to more traditional service models—salami slicing services separately—thus restricting peoples’ independence. That specific crisis in social care for adults with disabilities will lead to a far bigger crisis: a crisis in opportunities for disabled people to live the life they want, which other citizens have; a crisis for taxpayers, because failing to invest in up-front preventive social care services will lead to more expensive NHS and social security bills; and a crisis for our country as whole, as Britain misses out on the talents and contribution of disabled people and we all end up paying more as the price of failure.

What should happen instead? The Care Bill could and should be a profound opportunity to establish a framework for social care that could be truly transformational for disabled people. The Bill is the result of the Law Commission review of adult social care legislation, initiated by the previous Government.

[Norman Lamb]

Give us some credit for it.

[Liz Kendall]

I give much credit to the Minister, but the Bill is the continuation of a process that Labour established when we were in government—I want that on the record. [Interruption.] I fully and readily acknowledge that local council budgets have been under pressure for many years. He knows better than anyone that towards the end of Labour’s time in Government we tried to reach an agreement on a social care funding system, which I will come back to in a moment. [Interruption.]

[Katy Clark (in the Chair)]

Order. I ask the Minister to intervene formally if he wishes to say anything, for no other reason than it would assist the Hansard writer.

[Norman Lamb]

I formally apologise.

[Katy Clark (in the Chair)]

No problem at all.

[Liz Kendall]

I never mind interventions in debates; I warmly welcome them.

I shall make five specific suggestions to the Minister about how the Care Bill could be developed. First, the definition of well-being in the Bill is important. I welcome how broad it is. It covers mental, physical, social and economic well-being; personal relationships; and a person’s ability to contribute to society. The definition also includes ensuring that individuals have control over their day-to-day living, but I question whether the definition is as strong as it could be. The joint report from the all-party groups asks why it could not specifically include promoting independence, to strengthen the definition further.

An issue raised by my right hon. Friend the Member for Stirling relates to my point about definitions. The duty to co-operate in the Bill says that local councils will need to work with a range of partners. I understand that Ministers usually do not want to specify lots of organisation types, but I am concerned that although local councils would, we hope, know that they had to co-operate with the NHS, there is a real issue about the DWP. There is not that link-up locally, and if people’s ability to get training and to participate in the work force is so important, will the Minister consider whether, either in the Bill or in guidance, there needs to be more detail about who local councils should co-operate with? I am concerned that that local relationship might not be there.

Secondly, the eligibility criteria are, as the hon. Member for Bradford East said, the most crucial aspect of the social care system because they determine who is and is not eligible for social care support. We absolutely welcome the commitment to clear national eligibility thresholds, but the Minister knows that disabled people, organisations that represent older people and many of the groups involved are hugely disappointed that the draft regulations have set the thresholds at substantial rather than moderate. I am fully aware of the cost pressures on the system, but has the Department done a true cost-benefit analysis, to consider the potential saving? The hon. Member for South Derbyshire made a point about how investing up front can save money further down the line. Has the Minister discussed with his Treasury colleagues whether, if a longer time frame were used for assessing the costs, we would end up saving money for taxpayers if the moderate level was set?

My third point relates to the so-called capped care costs model—aka Dilnot. The Minister knows that I am concerned that the so-called cap on care costs is not really a cap. I am concerned not only because it does not cover hotel accommodation, but because it covers only what someone’s local authority would pay rather than the amount they might actually pay in residential care and because no one will benefit from the cap until 2020.

[Norman Lamb]

Does the hon. Lady accept that if the cap were to cover all someone’s care costs, however much they chose to pay, wealthy people who chose to live in much more expensive care homes would be at a substantial advantage?

[Liz Kendall]

The Minister will know that my point is that I warn Ministers, including the Prime Minister and the Deputy Prime Minister, that going around the country strongly saying that it is a cap on care costs will create confusion—that is the best word I can use.

I do not want to focus on older people; I want to come to the point that the APPGs raised. The joint report states that the majority of working-age people with disabilities will not benefit from the so-called capped social care costs model, because they will not have had the chance to acquire assets. How many disabled people will benefit from the model? Why does the Minister believe that it is more important to put in excess of £1 billion into implementing the Dilnot model rather than into the current system, which is being increasingly squeezed?

My fourth point is about personalisation. I am a huge champion of personal budgets. I have seen them transform many of my constituents’ lives, not just because they promote genuine independence by giving people a say in how they live their lives rather than the system telling them how they should, but because they are essential to integration. The people themselves know best about how to join up their needs and support, because they do not see the two things as separate. However, I have heard the concern expressed in many different places across the country that personal budgets are getting a bad name. People feel that they are increasingly not based on their needs and that less money is being given than is needed, because of how the resource allocation system works.

Another important recommendation in the joint APPG report is about considering whether the resource allocation system should go on to a statutory footing, supported by new duties on councils to be transparent about decisions. I do not want personal budgets to get a bad name, with people feeling that they are a cover for cuts, rather than being based on what people need.

My final point is on the absolutely essential issue of prevention and integration. The Government announced in the spending review that there will be pooled budgets across health and social care totalling £3.8 billion, including £2 billion transferred from the NHS. The joint APPG report states that much of the previous transfer of money from the NHS to social care never reached the front line, and there is a concern that just continually transferring money in that way is not sustainable. How will the Minister ensure that the money gets to the front line? Will it be available, as I think the hon. Member for South Derbyshire said, for working-age adults with disabilities, rather than just for older people? Finally, will the Minister acknowledge that if this keeps happening year after year, it would be far better to have much fuller integration, such as the whole-person care approach proposed by Opposition Members?

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

I join others in saying that it is a pleasure to serve under your chairmanship, Ms Clark, and I apologise again for my rudeness earlier. I noted that the right hon. Member for Stirling (Mrs McGuire) said that it was a “genuine pleasure” to serve under you. I am not sure what it means when on other occasions she leaves out “genuine”; none the less, it was clearly a tribute to you, Ms Clark.

I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate. This is the second time this week that the two of us have discussed and debated care issues, and I know that he cares passionately—and genuinely—about the subject.

I want to make a number of points at the start. I very much welcomed the fact that the hon. Member for South Derbyshire (Heather Wheeler) highlighted the absolutely central importance of the principle of well-being in the Care Bill. The Bill has the potential to be transformational in how it challenges culture—how the system works and how it treats people. In part, it is about a big shift from a paternalistic system in which people get done to, to a personal one in which their needs and priorities come first.

The right hon. Member for Stirling made the point, absolutely correctly, that there is more to life than getting up, being washed, eating and going back to bed. I am not sure who focused on the important issue of social isolation, but the truth is that many people in this day and age live miserable lives. If someone lives on their own and has substantial care needs, and the extent of their life is getting out of bed, getting washed, sitting in a chair and going back to bed, with no one to see during the day, that is a miserable life.

One point I want to make today is that this is not just about care services. If we are talking about a good society and about giving people a good life, there must be collaboration between statutory services and communities, families and the streets on which we live. I have floated the idea of neighbourhood watch groups applying to provide care. We have a national movement that looks out for whether our houses are being burgled, so should we not be thinking—all of us stepping up to the plate—about whether there are people on our streets who have care needs, or who might just be very lonely and could do with a bit of companionship?

If we are to have a civilised society, the focus has to be not just on statutory services but on collaboration within the community. That is all the more important given the extraordinary strains which the public finances are under now and will be under in future. All political sides in the debate must face up to the extraordinary financial challenge and how best to meet it.

Reference was made to setting the eligibility criteria. My hon. Friend the Member for Bradford East argued cogently for the level to be set at moderate, and the shadow Minister, the hon. Member for Leicester West (Liz Kendall), asked whether there had been a cost-benefit analysis. The problem faced by any Government is that the up-front cost for both working-age and older people is £2.7 billion. I absolutely buy into the case for preventing ill health and the deterioration of health and into making another fundamental shift from repair to prevention—the whole system must reflect that—but Governments should be very careful about committing themselves to that level of up-front cost. That would be exactly the same if Labour were in power.

The shadow Minister and the hon. Member for South Derbyshire asked whether the £3.8 billion pooled sum applied to working-age disabled people as well as older people. Absolutely, yes. My passion for integrated care and for preventing ill health and deterioration in health applies to people of whatever age. We have a particular challenge with frail elderly people, but we also have an understated challenge with people of working age who have disabilities, because often the focus is not enough on them.

[Mr Ward]

In relation to the impact on people, “The other care crisis” report states that we must look at not only what may happen but what has already happened over the past two years up and down the country, and the impact there has already been and no doubt will continue to be on people. I understand that the legislation is due to go through in 2015, and there is talk of having a working group over three to four years. That seems an awfully long period before we will have an assessment of what has happened and what may occur as a result of the legislation.

[Norman Lamb]

I will come on to the work that we intend to do on a more sophisticated way of assessing eligibility and responding to assessments. I absolutely accept the current danger that the system in effect says, “Go away, become more ill or more disabled, and when there is a real crisis, we might help you.” I want us to be more sophisticated and to intervene in ways that will help to build capacity and resilience and to stop the deterioration of health. I genuinely believe that the Care Bill will give us the foundations for a much more rational approach.

[Liz Kendall]

May I take the Minister back to the £3.8 billion pooled budget? He said that it was absolutely available for care and support for working-age people with disabilities. Will he explain, when the money goes down to clinical commissioning groups and local councils, first, where it will go to, and secondly, how he will ensure that it actually goes to working-age people with disabilities? I know how the NHS works, and all the focus is on the frail elderly because they are in hospital. The NHS wants to get them out of hospital—that is its prime focus—so unless there is something specific in what the Minister sets up, the money will not go to working-age people with disabilities.

[Norman Lamb]

We will publish further details about how the system will work. To deal with the hon. Lady’s challenge to our approach, we could go for another massive re-organisation, which in a sense is what she is advocating—

[Liz Kendall]

indicated dissent.

[Norman Lamb]

Well, it is. To bring health care and social care together structurally would be a massive re-organisation, and there is no way of avoiding that. The smart way is to focus on the care that an individual receives. The issue is not just about bringing health and social care together and integrating those two systems but about the health service itself and the fact that, institutionally, we have separated mental health from physical health and primary care from secondary care, which is crazy. The whole thing is fragmented, but we should shape services around the needs of patients. The Government’s approach, based on the duties to integrate in the Health and Social Care Act, is the smart, fast way of achieving much more joined-up care for the patient, whether individuals are elderly or of working age. I want to make some progress with my speech.

The Government are committed to improving the lives of disabled people and to supporting them in their independent lives. In very difficult financial circumstances, we have done much to achieve that through the disability strategy, welfare reform—it is incredibly controversial, but any Government would have to pay attention to the extraordinary growth in welfare spending—and a whole raft of condition-specific initiatives.

One outstanding issue still needs to be addressed—social care reform. The importance of care and support for disabled adults cannot be understated: it is the enabler of independent living. We hear much about the ageing population as the driver for care reform, but a third of all health and care users are working-age disabled people, so it is vital that the social care reforms address their needs. The fact that my hon. Friend the Member for Bradford East and his colleagues have secured this debate is valuable because it ensures that we focus on the needs of working-age disabled people. I repeat that there is a risk of their being forgotten, which must not happen.

Earlier this year, I read with interest the “Promoting Independence, Preventing Crisis” report into making social care reform work for disabled adults. It was a joint inquiry by the all-party groups on local government and on disability. I congratulate them on an important piece of work, and I will attempt to address some of the points raised in a moment. I first want to talk about some of the things we have done.

We know that disabled people face a number of challenges. They are far less likely to be in employment than non-disabled people. In fact, shockingly, only 46% of disabled people are in employment compared with 76% of their non-disabled counterparts. Some 19% of individuals living in a family with a disabled member are in income poverty, although I am pleased to say that that has been falling over time. Progress is being made, but much more needs to be done.

The first thing to say about all the Government’s reforms is that we are committed to the UN convention on the rights of disabled people, which includes the right of disabled people to independent living. The Department of Health has been working closely with the Office for Disability Issues on the new cross-Government disability strategy, “Fulfilling Potential”, which was published last September. It is about making the UN convention a living reality for disabled people in Britain. It describes the rights that disabled people—just like anyone else—have in all areas of life, and the duty on Government to ensure that those rights are met.

The shadow Minister made a point about co-ordination with the DWP. There is scope for much more joined-up working at a local level to bring disparate public services together and to achieve far more bang for our buck than we presently manage.

[Mrs McGuire]

Will the Minister give way?

[Norman Lamb]

I am conscious of time, but I will briefly give way.

[Mrs McGuire]

I do not wish to embarrass them, but I suggest that both the Minister and his officials look at the disability strategy report based on the “Fulfilling Potential” report that he mentioned. That update was published last week. I think the jury is out on what it says, but in the interests of joined-up government, he should have the most up-to-date picture.

[Norman Lamb]

I am grateful to the right hon. Lady for that intervention. What remarkable timing she shows. On 2 July, the follow-up document, “Fulfilling potential: making it happen” was published, which sets out the indicators that will show where we are making progress and where more work needs to be done.

In my Department, we have been working to ensure that we can hold the new health system to account for the quality of services and outcomes that they provide to disabled people. The NHS outcomes framework includes a number of measures that relate specifically to disability, including, critically from my point of view, mental health, which is an area that is sometimes forgotten. Talking about an outcomes framework sounds like horrible jargon, but it is actually about focusing on results for people—the impact on people of what we spend. If we can measure that and then measure the changes that happen over time, we can focus the whole system’s attention on the need to achieve outcomes for people rather than on process. Essentially, we will expect to see a reduction in premature death among people with a learning disability and people with serious mental illness. It is a scandal in this day and age that such people die so much younger than others. We will also expect to see an enhanced quality of life for people with mental illness and an improvement in their experience of health care.

This matter is not just about the NHS. We will also be holding to account the adult care and support system through the adult social care outcomes framework for ensuring that

“people are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation”.

We will be measuring that through the proportion of adults with a learning disability who are in contact with secondary mental health services, who are in paid employment and who live in their own home or with their family.

We have responded robustly to the challenges posed by the really dreadful events at Winterbourne View hospital and to the way in which people with learning disabilities, autism and behaviours described as challenging are viewed and treated. All too often, society has treated them as second-class citizens. I take a simple view that people with learning disabilities have exactly the same rights as anyone else, and we have to ensure that the whole system respects that basic position. By April 2014, every area will have a joint plan to ensure high-quality care and support services for this group of people in line with best practice. By June next year, everyone inappropriately in hospital will have moved to community-based support.

We are reviewing the national autism strategy to assess how it is addressing the barriers that people with autism face, and how care and support services are responding to their needs. However, that is not something that the care and support system can do on its own. As a Government, we are also aiming to make the benefit system fairer, more responsive and more affordable to help reduce poverty, worklessness and welfare dependency, and to reduce levels of fraud and error. For many, that will include support to work, which is the best route out of poverty and is very often beneficial for those with long-term health conditions. It is worth reiterating that severely disabled people who need support will always get it, and we will provide unequivocal support for those who cannot work.

I mentioned care reform. Many people have told us that today’s care and support system often fails to live up to the expectations of those who rely on it. Although many have good experiences, the system can be confusing, massively disempowering, paternalistic and not flexible enough to fit around their lives.

Our White Paper, “Caring for our future”, which was published last year set out a vision for a reformed care and support system. Yes, it was based on the Law Commission report, but it was implemented, I am proud to say, by this coalition Government. We need a modern system that promotes people’s well-being by enabling them to prevent and postpone the need for care and support, and puts them in control of their lives to pursue opportunities, including education and employment, to realise their potential.

The Care Bill, which we introduced in Parliament in May, is a crucial step in delivering that vision. It represents the most comprehensive reform of social care legislation in more than 60 years, creating for the first time a single, modern statute for adult care and support. The existing law that underpins care and support is outdated and confusing. It is rooted in the post-war period and must be overhauled, as the Law Commission concluded after its three-year review. Our new statute will be clearer, fairer, and will empower people to take control over their care and support. It has been done in the most collaborative way, with pre-legislative scrutiny and widespread consultation with the sector and the wider community.

The current legal framework is narrow and paternalistic; it is built around the idea of providing state-defined services, rather than of meeting and responding to the needs and goals of individuals. The other day, my hon. Friend the Member for Bradford East talked very movingly about the brilliant community work on dementia care that is under way in Bradford. That is where we see this collaboration between ordinary people who are good citizens and who care for one another and the supportive role that the state always has to play to back that up. The Care Bill will help to shift the focus of care and support from paternalism to a much more personal approach. It will place personal budgets on a legislative footing for the first time. I agree with the shadow Minister about the importance of personal budgets being real; they must empower people and not mask a cut in support or provision.

We want to extend the greater roll-out of personal budgets to give people who are assessed as needing care and support more choice and control over how their care is provided. Where personalisation has taken root it works—people get better results and it is popular with users and carers. That is particularly true for working-age adults; take-up is relatively high compared with that among older people. This great reform came about through working-age disabled people demanding that they have more control over their lives, and local government responding to them.

The current law fails to reflect the importance of supporting people in caring roles. The Bill, for the first time, puts carers on the same legal footing as those for whom they care, with expanded rights to assessment and new rights to support.

The Care Bill also implements historic reforms to the way in which the care system is funded, by introducing a cap on the care costs that people incur. Of course, as I said in an intervention on the shadow Minister, people can choose to spend more than that if they wish, but if we were to do what I think she was implying it would mean giving enormous financial support to wealthier people, which cannot be justified in times of real financial constraints.

The current care and support system offers little financial protection for the cost of care. As the Commission on the Funding of Care and Support said, because care needs are unpredictable, individuals and families are unable to know what care costs they might face in the future. We recognise that some working-age adults may face having to pay for care earlier than most elderly people do, so we have therefore said in our funding reform proposals that people who need care before they reach retirement age will pay less. In addition, the changes we are proposing will mean that people who are assessed as having care needs before they turn 18 will have their cap set at zero. We will be consulting on those changes very shortly.

We have made it clear from the consultation and publication of the White Paper through to the publication of the Care Bill that the same principles apply to all who need care and support. That applies equally to an adult with a physical disability, someone with a learning disability, an adult with mental health issues or an elderly person needing care. I know that my hon. Friend the Member for Bradford East is particularly concerned about eligibility criteria. We have published draft regulations setting out national eligibility criteria for discussion. They are set at a level that will allow local authorities to maintain the same level of services for service users when they move from the current framework.

Let me end by saying that I would prefer to have a more sophisticated system. Work is under way on developing that. I invite Scope to participate in that and work with the Government to achieve a much more rational system in which we can intervene earlier, provide some support and help to build capacity and resilience so that people get help when they need it rather than when they reach a crisis.

Complex Regional Pain Syndrome

Norman Lamb Excerpts

Tuesday 9th July 2013 Westminster Hall

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

I congratulate my hon. Friend the Member for Milton Keynes South (Iain Stewart) on securing this debate on an issue of intense importance to people who suffer from complex regional pain syndrome. The condition can be debilitating, with a devastating effect on sufferers and their families. I know that there are those, including my hon. Friend’s constituent, who campaign tirelessly to raise awareness of the condition. The description that he gave of what people go through—attempts at self-amputation, for example—are unimaginable.

I pay tribute to Mr Scardifield for his persistent campaigning to raise awareness. It is highly laudable that he has chosen to campaign and maintain the pressure for increased understanding. The experience that my hon. Friend described—the diagnosis was missed by several clinicians, and there was no proper care team or personal care plan—is of concern. I am grateful to him for alerting me to the extent of the challenge faced by his constituent. One great benefit of Adjournment debates such as this is that they ensure that Ministers and officials focus on a particular condition that might not otherwise get the attention it needs. I am grateful for this opportunity. I hope that this debate will prove informative for those here who wish to learn more about the condition and be helpful to those affected, as I say more about the help and support that ought to be available for CRPS sufferers and the research into the condition that is currently under way.

Although it has been recognised as a medical condition for more than 100 years, diagnosing CRPS at its earliest stages remains a problem, as my hon. Friend rightly said, because it is often misdiagnosed or completely undiagnosed. The explanation is threefold. First, CRPS is relatively uncommon and patients do not routinely present to GPs with it. When the Department looked at the representations that we have received on the subject over the last few years, the number of individuals who have approached us is small. The fact that the condition is relatively uncommon and that GPs do not come across it that often creates a problem in terms of their capacity to diagnose it accurately.

Secondly, the range of symptoms associated with CRPS are shared with a number of other, more common conditions, so that when patients do present, they may not be correctly diagnosed in the first instance. Thirdly, there is no single diagnostic test that accurately identifies the condition; a diagnosis is made primarily by excluding other conditions with shared symptoms that can be accurately diagnosed. Those difficulties also mean that there are no reliable figures for the number of people living with the condition, and estimates produced by researchers and clinicians vary considerably, as my hon. Friend said in his speech.

I understand his concerns about having a clear picture of the number of people affected by CRPS. I will approach NHS England to ask whether there is any scope to improve our understanding of how many people are diagnosed with the condition. Ultimately, I think that we can all agree that a better understanding of the extent of the condition and the numbers affected would be a considerable advantage. Let us explore whether it is possible to achieve greater accuracy.

As my hon. Friend may be aware, since 1 April 2013, NHS England has been responsible for delivering improved outcomes for people with long-term conditions such as CRPS.

[Jim Shannon]

On the subject of statistics and information, does the Minister intend to make contact with the regional Administrations, whether in the Northern Ireland Assembly, the Scottish Parliament or the Welsh Assembly, to ensure that all the information comes together so we can galvanise action and respond better?

[Norman Lamb]

I will certainly explore the possibility of understanding how much information is available to the devolved Administrations to increase our understanding of the prevalence of the condition. They may be in exactly the same position as England, where our understanding of the prevalence is ultimately still limited, but let us explore that further.

NHS England draws on a wide range of clinical advice when developing commissioning policies and statements. It has a specialised pain clinical reference group to provide expert clinical advice on pain issues. I will therefore put forward my hon. Friend’s concerns about the need for CRPS expertise.

Turning to the identification of CRPS, an increasing range of guidance is available to improve awareness of it among members of the public and health professionals to support early diagnosis. NHS Choices, to which my hon. Friend referred, provides comprehensive advice on the causes, symptoms and treatment of the disease. More detailed clinical guidance is provided via the NHS Evidence website.

In May last year, the Royal College of Physicians published a guideline for clinicians on CRPS, setting out best practice on the identification and management of the disease. The guidance was developed with the involvement and endorsement of 21 key organisations involved in the care of people with CRPS, including the Royal College of General Practitioners, the British Orthopaedic Association, the British Pain Society, the British Society of Rehabilitation Medicine and the British Society for Rheumatology, to name but a few. I am confident that that collaborative guidance will prove useful in supporting clinicians to identify and treat patients with CRPS more effectively. When such guidance, produced by clinicians, is developed, one does not achieve a sea change in understanding overnight. It takes time to get the message across, in particular throughout the whole of primary care. The production of the guidance, however, is the starting point, and it will aid clinicians in diagnosing and treating appropriately.

Once a patient has been diagnosed with CRPS, a range of treatment options is available. Unfortunately, there is no cure for the condition, but many patients with pain disorders can be managed through routine primary and secondary care once they are appropriately diagnosed. For patients with CRPS, treatment can involve: physiotherapy; occupational therapy; a neurologist to examine the effect on the nervous system; sometimes a psychologist, who may be appropriate, because of the psychological problems caused by living with CRPS, as well as with a host of physical health conditions; a social worker for advice about what extra help and services are available; and a doctor or other health care professional trained in pain relief, which is critical.

NHS England is aware that more needs to be done to identify those patients with the most severe and complex chronic pain who need access to nationally commissioned specialised services. NHS England’s specialised pain clinical reference group is working with the royal colleges and the British Pain Society’s guidelines to ensure that the needs of those patients are appropriately met.

I am aware that the absence of clinical guidance from the National Institute for Health and Care Excellence is a real concern of patients with CRPS. I am advised, however, that NICE is consulting on a short clinical guideline on the pharmacological management of neuropathic pain, including CRPS. The draft guidance, setting out recommendations for further research, highlights the need for more research into CRPS. Final guidance is expected for publication shortly, in October of this year. In addition, a quality standard topic on pain management in young people and adults has also been referred to NICE for development. Quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care; they support commissioners to be confident that the services they are purchasing are high quality, cost-effective and focused on driving up quality.

My hon. Friend specifically raised research into CRPS. The Government are supporting a range of research projects into the condition, including a major trial of low-dose intravenous immunoglobulin treatment, funded via the Medical Research Council and costing more than £650,000. The investigators involved have previously treated patients with IVIG and reported encouraging results on pain relief in a pilot trial. IVIG may provide pain relief for patients for whom classical treatments are not satisfactorily effective. If IVIG treatment is proved effective, the trial may also stimulate research on the efficacy of IVIG in treating other chronic pain syndromes.

The National Institute for Health Research clinical research network is also supporting a multi-centre international study to define recovery and the priorities for recovery from the perspective of patients with CRPS. The NIHR welcomes high-quality funding applications for research into any aspect of human health, including CRPS, and judges them on an objective basis.

More generally, I reassure my hon. Friend of the Government’s commitment to improve outcomes for the 15 million-plus people in England who are living with a long-term condition, including those with CRPS. Through the mandate—the set of Government priorities for NHS England—we have asked NHS England to make measurable progress towards making the health service among the best in Europe at supporting people with ongoing health problems to live healthily and independently, with much better control over the care that they receive.

Through the NHS outcomes framework, we will monitor the performance of the NHS in supporting people with long-term conditions, such as CRPS, to live as normal a life as possible and to improve their quality of life. Improvements will be measured in three main areas: how well the NHS is performing in supporting people to look after themselves; how well a person is able to live as normal a life as possible; and how successfully the NHS manages long-term conditions by looking at unnecessary hospital admissions and excessive lengths of stay in hospital. The improvement areas are mirrored in the clinical commissioning group outcomes indicator set—apologies for the jargon—which will be used to hold CCGs to account for and to provide information for the public on both the quality of services and the health outcomes achieved through commissioning.

At service level, the new NHS improvement body, NHS Improving Quality, has made the development of evidence-based tools for the management of long-term conditions a key improvement programme for 2013-14. Interventions will involve care plans, care co-ordination, use of technology, risk stratification, self-care and, crucially, the role of carers. That work will be evaluated and best practice identified to help drive improvement in the management of long-term conditions such as CRPS in every local area.

I thank my hon. Friend once more for securing today’s debate. I very much hope that our discussion has been helpful to him and to his constituent. I am more than happy to discuss further how we can improve outcomes for people suffering from such a pernicious condition.

Question put and agreed to.

Care Services (Bradford)

Norman Lamb Excerpts

Monday 8th July 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate and on all the work he has done both in Bradford and to bring the stories from Bradford to a national forum. He has done more than anyone to highlight the importance of care services and working with the community to improve services for people. Indeed, the extraordinary consultation exercise he undertook following the White Paper last year was an exemplar of how to engage with the local community. The extent to which people felt able to comment and give their views and ideas was commendable.

I also congratulate the Bradford District Dementia Action Alliance on its work. My hon. Friend made the point that Cathy Henwood from the Alzheimer’s Society had identified Bradford as developing the concept of dementia-friendly communities before the Prime Minister’s dementia challenge, but I am pleased that he acknowledged that the Government have done a lot to highlight the importance of improving dementia care. The Prime Minister’s dementia challenge highlighted three strands: improving health and care services; creating dementia-friendly communities, which is exactly what is happening in Bradford; and a much greater focus on research so that we can find cures, understand better how to prevent some types of dementia, such as vascular dementia, and understand through research how best to care for people with dementia. The Government are more than doubling the amount spent on research, which is a good thing in itself.

The work about which my hon. Friend spoke started in the ward of Thackley—

[Mr Ward]

Idle and Thackley.

[Norman Lamb]

Idle and Thackley—those wonderful names. Local councillors got the community involved and that is exactly what needs to happen. When we talk about how to meet the extraordinary challenges of the future, with an ageing community, there must ultimately be collaboration between statutory services and the community. Bradford appears to be showing the way in which that can be done and I stress that it requires the integration of services and care shaped around the needs of the individual with preventive care to stop the deterioration in their condition.

My hon. Friend will be aware of the need for the care and support system to change as local authorities face challenges resulting from an ageing population. That is why the coalition Government have decided to reform the system of care and support. He talked about the situation in Bradford and I understand that more than 71,000 people there are aged 65 and over, about 14% of its total population. Bradford’s joint strategic needs assessment for 2012 predicts that by 2033—not that far off—the number of local people over 90 will increase from 2,800 to 8,700, an increase of more than 200%. We all face an extraordinary challenge.

As we debate access to care and support services, I am aware that City of Bradford metropolitan district council sets its eligibility criteria at moderate. The report that my hon. Friend published earlier in the year indicated that 97% of people who replied to his survey welcomed setting the eligibility criteria at that level. Bradford council now proposes to change its band to substantial, because of pressures on its budget, and that would affect about 25% of people who currently receive care and support. I completely understand that the Bradford Cares campaign wishes to ensure that services are maintained at the existing level.

The care and support White Paper, which was published in July 2012, is an important and fundamental step towards addressing the challenges of an ageing society. Our reforms will focus more attention on people’s well-being—that is at the centre of everything that the Care Bill tries to achieve—and independence throughout their lives, rather than waiting for people to reach crisis point. They will also put people in control by giving them a far greater say about their care and support, as well as by ensuring that services are designed around what people actually want and by putting their priorities and preferences above and beyond the needs of the institution. My hon. Friend will be aware that the Care Bill, which has been widely welcomed, will be a single, modern statute for care and support. It will make legislation clearer and fairer, and it will be built around people not processes, and individuals not institutions.

As the Government’s White Paper made clear, our vision is a modern care and support system that promotes people’s well-being by enabling them to prevent and postpone the need for care and support, and puts them in control of their lives so that they may pursue opportunities, including education and employment, and realise their potential. Assessments will remain an integral part of the system, but rather than acting primarily as a gateway to the adult receiving care and support—or not, if they fail the assessment—the future system will place much more emphasis on the role of the assessment process in supporting people to identify their needs, to understand the options available, to plan for meeting care needs and caring responsibilities, and to reduce or delay needs, when possible.

Any adult who appears to the local authority to have care and support needs, whatever the level of need, has the right to an assessment. That right will cover carers, so this is an extension of their existing rights. The low threshold for entitlement to an assessment will mean that authorities will have earlier contact with far more people with low-level needs.

[Mr Ward]

May I say how much I welcome the policy on the assessment of carers? Many carers who visit my constituency office are on the verge of needing care themselves because of the stress that they are under. It is the failure to identify their personal needs and the support that they require that puts them in such a stressful position.

[Norman Lamb]

My hon. Friend is absolutely right. The Care Bill’s provisions on carers represent an enormously welcome advance. In a sense, they will give carers the same entitlements to assessment and then support, if that is deemed necessary, as the people for whom they care.

The “Fair access to care services” framework was introduced in 2003. It aimed to provide a fairer and more transparent system for the allocation of social care services. The assessment and eligibility framework was reproduced in the “Putting People First” guidance that was published in 2010. The current assessment and eligibility framework is graded into four bands: critical; substantial, which is the case for most local authorities; moderate, which applies to Bradford and some 15 other authorities; and low, which covers only two or three councils. Local authorities can choose which band they wish to set for their local criteria, and Bradford has the legal power to change its eligibility criteria, as long as it consults its local community.

People continue to tell us, however, that the process for determining who is eligible for care and support is confusing and unfair. Decisions are not transparent and there is variation across the country, and the end result is that people can be left without the support that they need. The existing assessment and eligibility framework is therefore not working effectively, and that is widely recognised. That is why we are introducing a national minimum threshold for eligibility through the Care Bill. The Bill will set out the eligibility criteria—the point at which local authorities must meet an adult’s care and support needs, or a carer’s support needs. Local authorities will remain able to meet lower needs locally, if they choose to do so.

On 28 June, we published a set of draft regulations that set out the national eligibility criteria. These are intended to describe an equivalent level to the “substantial” level used by the vast majority of councils. We have committed to providing funding that will maintain the same level of services when authorities move to the new system in April 2015. This is the beginning of engagement with stakeholders before we formally consult on the regulations next spring. I assure my hon. Friend that the setting of the threshold is about establishing a minimum standard, not taking away councils’ discretion to go further. Of course, the more preventive care that can be given, the better, because that improves well-being and ultimately reduces the cost to the system, which is exactly the point that he made.

Under the current spending review, local authorities should be able to protect access to care, but we know that not all the money that was earmarked for care services has been spent in that way. Ultimately, spending on social care is a matter for local people in local authorities, and councils such as Bradford have to make tough decisions. However, we cannot improve care and support simply by throwing ever more money into the system; on the contrary, we need to work in more innovative and effective ways, exactly as is happening in Bradford, where there is really impressive work on dementia-friendly communities. That is exactly the sort of collaboration that we need to encourage.

Local authorities across the country have already been redesigning services to find more efficient ways of working. For example, many local authorities are concentrating on better integration between health and care services, improving co-operation and reducing duplication. That means better use of money, and improved care.

My hon. Friend referred to this year’s spending review settlement. It includes a £3.8 billion pooled health and social care budget to make sure that everyone gets a proper, joined-up service, and the care that they need from whoever is best placed to deliver, whether that is the NHS or the local authority. The £3.8 billion fund, shared between the NHS and local authorities, will deliver integrated services more efficiently for older people and, crucially, disabled people. It covers ensuring that health and social care work together to improve outcomes for local people, through better sharing of information, so that people need explain their problems only once; intervening early, so that older and disabled people can stay healthy and independent at home, avoiding unnecessary hospital admissions and reducing visits to accident and emergency departments; and delivering care that is centred on the individual, rather than on what the system wants to provide. Examples include NHS and social care staff working together to provide seven-day working, and better data-sharing to ensure that people can leave hospital as soon as they are ready.

The Care Bill includes a duty to provide preventive services; that is exactly the sort of thing that my hon. Friend is advocating for Bradford. That new duty on local authorities is seen by many people as potentially transformative. The White Paper sets out our ambition for health care and support to be organised around the needs of the service user, rather than focusing on organisations and services. We want a reformed system, in which organisations work together to give individuals real control and choice over the care that they receive. Good practice already exists, and we need to learn from and build on that.

I understand that Bradford’s clinical commissioning groups are working with Bradford council to deliver a three-year integration programme, which will cover all the services that help to support people so that they can remain at home, stay in their community, and regain and retain their health, well-being and independence. We want to encourage and support local experimentation, to allow areas to provide integrated care at scale and pace. We are working to support local initiatives and to identify what needs to happen to drive change at the national level. We want to learn what works well and how to overcome barriers, and to pass those lessons on to others.

On 14 May, the national partners in health care and support, including the Department, published a document entitled “Integrated Care and Support: Our Shared Commitment”, which sets out 10 commitments that the national partners have made to enable and encourage change to scale and pace, as well as expectations on local areas in return. The national partners have invited the most ambitious areas to apply to become pioneers and act as exemplars to address local barriers and support the rapid dissemination, promotion and uptake of lessons across the country. The national partners will provide the pioneer sites with dedicated central support to help them to break down barriers to delivering integrated care and support.

It is really exciting that the coalition is acting to end that long, historical divide between health and care services and, indeed, between mental and physical health services. The potential for integrated care, with a focus on prevention, and collaboration between the statutory services provided by the national health service and the local authority and the community, exactly as is happening in Bradford, can provide the early intervention that my hon. Friend discussed, and it can address isolation. He mentioned that pernicious problem. Many people live on their own, and often lead lonely lives and, as he said, both their mental and physical health deteriorates. If we can get the community to support the statutory services, providing companionship and friendship, and giving people a better life, the combination with a much more joined-up service from the statutory services can achieve the breakthrough that he described in his community.

I conclude by applauding the impressive community work in Bradford, which began in one local community, but which has the potential to spread to 20 other local communities. That is exactly what should be done, and with the support of the Care Bill, we can make that a reality, not only in Bradford but across the country.

Question put and agreed to.