Oral Answers to Questions

Alistair Burt Excerpts

Tuesday 5th July 2016 Commons Chamber

[Imran Hussain (Bradford East) (Lab)]

5. How much funding he plans to make available for the proposed pharmacy access scheme.

[The Minister for Community and Social Care (Alistair Burt)]

We intend to announce details of the pharmacy access scheme, including funding, as part of a wider announcement on community pharmacy in 2016-17 and beyond.

[Imran Hussain]

Pharmacies play an important role in our community healthcare system. An accessible pharmacy is particularly important for those with mobility issues and for those from communities with a greater propensity to experience health inequalities. However, the planned changes to pharmacy funding risk closing the pharmacies that serve these groups. Will the Minister give me a direct assurance that the pharmacy access scheme will be properly organised and that no pharmacies serving those vulnerable groups will close because of changes in funding?

[Alistair Burt]

The hon. Gentleman is right to praise the role pharmacies play and right to identify that we must do all we can to ensure that those who are most vulnerable retain the excellent access they currently have. The national formula on access proposal will be used to identify those pharmacies that are most geographically important for patient access, taking into account isolation criteria based on travel times and distances, and population sizes and needs. Both deprivation and isolation will be covered in the access formula.

[Kevin Barron (Rother Valley) (Lab)]

Given that the access scheme could potentially alter the situation for community pharmacies, will the Minister consider more money than was originally proposed for community pharmacy budgets to stop any shock from the cuts we are expecting later this financial year?

[Alistair Burt]

There are no changes to the funding issues announced when the review of pharmacies started on 15 December. As my right hon. Friend the Secretary of State said, we are hoping to make an announcement on pharmacy when we can. I am aware that pharmacy is waiting for that.

[Will Quince (Colchester) (Con)]

7. What progress his Department has made on improving the safety of maternity care.

--- Later in debate ---

[Kelly Tolhurst (Rochester and Strood) (Con)]

11. What steps his Department plans to take to improve local dispensing arrangements.

[The Minister for Community and Social Care (Alistair Burt)]

For improving local dispensing arrangements, patients need to receive their NHS prescribed medicines promptly, efficiently, conveniently and to high quality. NHS England is responsible for ensuring that there are adequate arrangements in place for the dispensing of medicines so that this happens across the country. We keep this under constant review.

[Kelly Tolhurst]

I have been contacted by a number of disabled constituents who have encountered difficulties receiving dispensed drugs from their local GPs because they fall outside geographical criteria as of last year, therefore adding a significant financial burden. Given instances where dispensing GPs have blocked the arrival of some local pharmacies in parts of my constituency, will the Minister give some consideration to how this discrepancy could be remedied?

[Alistair Burt]

I am sorry to hear about the difficulties of my hon. Friend’s constituents. There is a provision within the regulations to enable patients who have serious difficulty in getting to a pharmacy because of the distance involved or the lack of transport to receive dispensing services from a doctor. Doctors should certainly not be blocking the addition of local pharmacies. If my hon. Friend writes to me, I can look into the matter in greater detail.

[Jim Shannon (Strangford) (DUP)]

Taking into account the immeasurable value that community pharmacies provide for some of the most vulnerable people in sections of our society, does the Minister agree that, when it comes to Government budgets, these dispensing services should be included in any ring-fencing that goes on around front-line services?

[Alistair Burt]

The hon. Gentleman’s support for these services is well known and what he says is right. The regulations do protect the more vulnerable, but when I next look at them, I will make sure that they fulfil his requirements.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

12. What assessment he has made of the potential effect of the proposed removal of NHS bursaries on the number of applications from mature students for nurse training places.

--- Later in debate ---

[Dr James Davies (Vale of Clwyd) (Con)]

Will the Minister confirm how he plans to implement the General Practice Forward View? Will he also confirm that sustainability and transformation plans will be returned to for further development if they fail to deliver the investment in general practice mandated by the forward view?

[The Minister for Community and Social Care (Alistair Burt)]

Yes indeed, we are developing detailed plans to implement the 80-plus commitments set out in the General Practice Forward View, which has been widely welcomed. The development of GP practices will be incorporated into sustainable plans.

[Derek Twigg (Halton) (Lab)]

There is a shortage of GPs across the country, but certain areas, especially deprived areas such as Halton, have a high rate of sickness, in particular respiratory diseases and cancer. Is any action being taken to target those areas? Has the Minister had any discussions about that with NHS England?

[Alistair Burt]

Although there is a general shortage, to which my right hon. Friend referred when speaking about the work being done to recruit, retain and return GPs, bursaries are available in particularly difficult areas as incentives for people to go to such areas. NHS England concentrates on trying to ensure that under-doctored areas are properly resourced.

[Amanda Solloway (Derby North) (Con)]

The recently published Mental Health Taskforce report recommended that NHS England should by 2021 support at least 30,000 more women annually with specialist mental healthcare during the perinatal period. Will my right hon. Friend assure me that the Department will be working to reach that target?

[Alistair Burt]

I thank my hon. Friend for her question. Thanks to the Prime Minister’s excellent initiative in relation to perinatal mental health and the £390 million extra added to that, I can indeed confirm that work is already under way to increase the number of beds in the 15 existing perinatal mental health units. There are plans for three more in the south-west, the east of England and the north-west. This has been an important initiative, and perinatal mental health is very high up among my priorities and those of the NHS.

[Several hon. Members rose—]

--- Later in debate ---

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

As we celebrate the 68th birthday of the NHS—one of the Labour party’s proudest achievements—let us not forget the fact that there are thousands of people across our country with mental health conditions who continue to face stigma, discrimination and prejudice. Recent reports tell us that young people are waiting up to a decade to receive the appropriate treatment, and future plans for children and young people’s mental health are not up to scratch. Will the Minister please tell us how many more NHS birthdays will have to pass before real equality for mental health is secured?

[Alistair Burt]

How I miss the hon. Lady sitting on the Opposition Front Bench with her questions on mental health. I pay tribute to the exceptional work that she has done in this particular area. The £1.25 billion extra that is going into children and young persons’ mental health over the course of this Parliament—I along with other Members in the House have absolutely fought to make sure that it stays in the plans—will help. We have done more work than ever before in relation to combating stigma, but she is right to raise that, as it is essential that we do. It is also essential that the money that is provided centrally goes through clinical commissioning groups into mental health spending, and I am quite sure that she and I will make sure that happens.

[Alison McGovern (Wirral South) (Lab)]

The Secretary of State and others have sought to reassure us that nothing changes immediately with Brexit, but that is not right for the NHS. The impact on the economy is already clear, and that will have a knock-on effect on our health service. That is why I will meet local leaders in Wirral on Friday to try to formulate a Brexit plan for the NHS. Will the Secretary of State receive that plan and take all necessary steps to protect the health service in Wirral?

Hearing Loss: Action Plan and Commissioning Framework

Alistair Burt Excerpts

Thursday 30th June 2016 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to speak under your chairmanship, Ms Vaz. Thank you for chairing this important debate.

Whatever else may be going on in this place at the moment, it is important that every now and again we return to what most people would regard as real life. As both Government and Opposition Members, we should give a strong sense of how we remain very engaged with matters that affect people every day. We will continue to do so.

I am grateful to my friend, the hon. Member for Poplar and Limehouse (Jim Fitzpatrick), for bringing the subject before the House. It is some time since we played football together—too long—and we will have to find another way to do that. I have great fondness for the hon. Gentleman, who represents his constituents well, and who has always raised this cause in the best possible way, being informative as well as challenging when in opposition. I appreciate his work, and the work of the hon. Member for Nottingham South (Lilian Greenwood), in particular with the all-party group, which is so essential to keep Members informed about what is going on and what we need to be engaged with. I endorse the thanks to those who promote and support the all-party group and its work.

I welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her role as the shadow Health Secretary. I thank her for her contribution today, and I look forward to hearing more from her. I appreciate the many burdens on her and her colleagues, so I appreciate her taking part in the debate.

The hon. Member for Poplar and Limehouse set out, broadly, the situation affecting the action plan and looked forward to the next stage, including the commissioning framework, which I will touch on. He spoke about the practicalities of life, paying tribute to those who put in the loop systems, and about how well technology has improved over the years—a sentiment I share. He made reference to a couple of specific topics that I will cover.

The hon. Member for Nottingham South did the same and spoke about the effects of deafness. Some years ago, as colleagues might be aware, I was Minister with responsibility for people with disabilities, and when she spoke about the importance of communication, I remember in particular a visit I made to Sense, the deaf-blind charity, at its premises in Peterborough, where I was introduced to a number of people. The importance and value of communication were brought home to me when I engaged with one particular gentleman, who understood what people were saying because he put his finger on their lips to follow the conversation. He could not see or hear, but his finger on their lips meant that he could follow the shape of the mouth. He then tapped out his reply on the back of his carer’s hand. Think how easily we communicate, at the drop of a hat, and see what someone was prepared to do because he was desperate to communicate. That reminds us of the absolute value of communication to human life and existence. I remember that example to this day, even 20 years on.

When the hon. Lady and other colleagues were talking about what being deaf means, how it affects life, how hearing and communication are a vital part of people’s existence, and about the absence of those and the difficulty that it brings, they brought home to me just how important the subject is. That is why I value the debate, and I am grateful to the Backbench Business Committee for allowing it and to the hon. Member for Poplar and Limehouse for securing it.

The shadow Secretary of State for Health also raised matters of rationing, financing and screening, so I will now cover those with my prepared remarks.

I congratulate the hon. Gentleman on securing the debate on NHS England’s action plan on hearing loss and the adult hearing service commissioning framework. The advent of the commissioning framework on 19 July will mark an important milestone. I share his sense that it is an important event. We hope that many people will come to the launch. It is only right, therefore, that we come together to discuss the opportunities and challenges that the publication presents.

As colleagues have mentioned, hearing loss is widespread. More than 10 million people in the UK are affected, and our rapidly ageing population means that that number is set to grow. As mentioned, projections show that by 2031 there will be more than 14.5 million people with hearing loss in the UK. Those demographics alone provide compelling evidence for why the UK needs to step up its response to hearing loss to enable further research, to take action on prevention and to enable people with hearing loss to access the services and support they need.

The Department of Health and NHS England’s action plan on hearing loss, published in March 2015, recognises the impact of deafness and hearing loss on individuals and society as a whole. Crucially, in my view, the plan accepts that hearing loss is not only a health issue, as we have been saying, but a cultural one. Tackling that societal challenge requires an integrated approach across the public, private and third sectors.

NHS England is therefore committed to delivering 20 outcome measures across five key areas, which have been touched on: prevention; early diagnosis; patient-centred, integrated management; ensuring that those diagnosed do not need unscheduled care or become isolated; and enabling inclusion and participation. That work will be spearheaded by a range of multidisciplinary groups with cross-sector representation.

The publication of the plan heralded an important new chapter in driving essential improvements, but we know that there are significant challenges for hearing services. Adults with hearing loss wait, on average, 10 years before they seek help—again, as colleagues have said—and, when they do visit their GP, 30% to 45% are not referred on for a hearing assessment. We know about significant unmet need and variation in services. For example, only about two fifths of people who need hearing aids have them. I have also heard some disquieting anecdotal accounts that some clinical commissioning groups have been taking difficult decisions and considering the rationing of hearing loss services.

Some of the news is helpful, such as the statistics on when referrals are made and things move forward. In 2013-14, 84% of people seen were seen within 16 days of referral; 92% were fitted with hearing aids within 20 days; 97% had their first follow-up within 70 days; and 800 different types of hearing aid were available from the NHS supply chain. So once someone is in the system, things are available, but we want to improve the provision of services.

[Jim Fitzpatrick]

Will the Minister give way?

[Alistair Burt]

I was about to come on to rationing, but I am happy to give way at this stage.

[Jim Fitzpatrick]

My hon. Friend the Member for Nottingham South (Lilian Greenwood) mentioned—I think this was in my notes, and the Minister just repeated it—the numbers who are not referred on by GPs. I have not got to the bottom of why that is. GPs are not auditory specialists, so we would think that if someone comes to them and presents with audiological problems, the logical thing would be to send them to their local trust, who are the experts and have sound-proof booths, technicians and specialists, to identify and assess the nature of the problem. I have read that figure a couple of times. but I have not got to the bottom of why they are not being referred. I am not sure whether the Minister will have an answer, but I thought I would raise that point.

[Alistair Burt]

I must confess that I do not have an answer. He makes a perfectly fair point. Whether or not that is what people raise at the time they are in the surgery or whether they recognise it themselves or minimise it by saying, “I’m just getting old” or whatever, I do not know. I will make an inquiry and see what research we have at present. Family practitioner care and GP services are under constant review, and we have a number of different pilots and vanguards looking at the provision of primary care services.

I will see what emphasis is being given to this particular aspect. Certainly we recognise that the demographics indicate that all issues associated with getting older, which can include hearing loss, are rising up the scale and the agenda. I will make specific inquiry about whatever reasons we have at present in relation to this matter and write to each of the hon. Members present to give that information. I am very happy to do that.

[Lilian Greenwood]

I wonder whether the Minister thinks there is a role for raising public awareness to empower patients not just so that we improve GPs’ understanding—that might be the issue—but so that people are a bit more demanding and recognise that hearing loss is not an inevitable consequence of growing old that has to be put up with but something that can be addressed.

[Alistair Burt]

Absolutely. Again, there may be more to be done through charities, the third sector, the Royal College of General Practitioners and perhaps the British Medical Association, certainly about the thing that people have in the back of their mind and do not always raise. Clearly, if there has been a sudden change, people may mention it. I suspect that part of it may be that people’s hearing loss is gradual. Perhaps there is an earlier stage.

All colleagues mentioned early intervention and perhaps there is a point at which it should be stated that hearing loss is not necessarily a natural thing that people should accept; it is something that they could and should do something about. My father is a GP and he always said that the most important part of any consultation was when the patient had taken their coat from the chair and put it on and was just leaving the room and said, “Oh, there’s one more thing, Doctor.” At that point, he always brought them back. I wonder whether, for a number of patients, that one more thing that they think they might not bother the doctor with is actually that: “I’ve just been getting a little bit hard of hearing. Maybe it is something and nothing” and so on. Perhaps that is something we could promote and say, “If that is your circumstance, do let someone know, because there is support available.”

Let me develop the discussion. We spoke about rationing services. I am aware that NHS England supported a recent decision from North Staffordshire CCG because it was able to demonstrate that its commissioning policy was evidence-based and had followed extensive public engagement. The hon. Member for Nottingham South was right to say that I am extremely wary of rationing early intervention and hearing aids at the very early stage. I fully accept all the evidence that says that it is doing something at that early stage that prevents something else later on. As colleagues have said, no one else has yet followed that. There has been a lot of challenge. It remains possible for NHS England to intervene if it thinks that commissioning has gone badly askew, but for now that has not been followed.

I will make a general—if slightly light-hearted—remark about resources in the national health service. Due to the decision taken by the nation last week, those who promoted a decision to leave the EU have promised, I think, £350 million a week—or maybe it is £100 million a week—to come to the NHS. My understanding is that that will not happen immediately, but perhaps in two or three years’ time we might see that money written into the health service’s baseline. It would be nice if that were to be. That remains to be seen. Certainly if that comes to pass, it would be one silver lining in the clouds of last week, but I suspect that that will not be a decision for me to take.

[Ms Abbott]

I want to press the Minister on the issue of rationing—I was involved in the discussions on the current reorganisation in my earlier incarnation on the Front Bench. Is he saying that nothing can be done until a CCG announces that it plans to ration, or is there any way—even under the reorganised NHS—of giving central direction to CCGs about that?

[Alistair Burt]

There is not a way of giving a central direction, because the whole direction of travel in the health service in recent years, as we know, has been to allow decisions to be made as close to people as possible. CCGs and the areas covered by them vary in the nature of their provision—there is variation in services, as we know—and if we were to go back to giving national direction on virtually everything and taking decisions that amount to micromanagement, as this one would, we would be moving away from that.

I will come on the commissioning framework and the action plan in a moment, but the commissioning framework should set out what the expectations are. However, it is right to leave local decision making to those working locally. Indeed, the recent decision and the pressure in other places have reminded CCGs of the importance of early provision, which has probably been far better than any directive from the centre.

[Ms Abbott]

So the Minister is saying that, in respect of the rationing of hearing aids, all we can really do is cross our fingers.

[Alistair Burt]

No, in all fairness I am not, because it has happened in only one CCG. It has not spread everywhere, and I think that is because the concerns that have been raised in the NHS and elsewhere have persuaded CCGs that they would not like to make that restriction.

To come back to the issue of resources, and to be a little more serious, the NHS remains under significant financial pressure. We have committed to making an extra £10 billion available to the NHS by 2020, as the chief executive has requested, but money will remain tight. Unless we want to go back to a situation in which everything is directed from the centre, we must leave local decision making to those closest to an area—that idea will remain in place. To characterise that as crossing our fingers is not entirely fair, and it has not proved to be the case.

The forthcoming commissioning framework will support CCGs to make informed decisions about what is good value for the populations they serve, using an evidence-based methodology to determine policy. NHS Improvement has received expressions of concern about commissioners reducing prices for audiology services, causing firms to exit those services, and reduced access and choice for patients. So far, except in one case, those allegations have not been substantiated and no formal complaint has been made to enable NHS Improvement to consider taking regulatory action.

NHS England could consider any immediate concerns about a CCG’s behaviour at local level under the assurance framework, and there may be scope for NHS Improvement to consider them under the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013, under the pricing rules contained in the national tariff.

Hon. Members raised the issue of screening. I am aware that the “Hearing Screening for Life” campaign has called for hearing screening to be introduced for everybody at the age of 65. However, advice from the UK national screening committee—the expert group that advises Ministers on all aspects of screening—suggested that the evidence did not demonstrate that screening would provide any hearing-related improvement in quality of life in comparison with the identification of hearing loss in other ways.

That is different from screening for newborn children—I have seen some of that work in action. I went out to Hounslow, where I will always recall the three-week-old baby who was cradled in her mother’s arms and being tested by the lady responsible, who was watching for the brainwave patterns. The hearing test could only be done when the baby was asleep and the brainwave patterns were absolutely level. The care and consideration taken with that baby was really quite remarkable. We should be proud that that programme exists. Seeing such things in action—even in one individual example—really cuts through all the statistics. In that instance, screening is the right response.

There are, however, a number of other policy solutions under active consideration by NHS England and CCGs, such as better training as part of the ongoing work to support the uptake and dissemination of the action plan and framework, including better training for GPs to identify and improve the response to hearing loss in adults. That will feed into what we discussed earlier about better recognition at an earlier stage.

The hon. Member for Poplar and Limehouse raised the subject of BSL and sign language in general. My hope is that access to personalised information in appropriate formats and support for communication will improve because of the new accessible information standard, which is mandatory. All organisations that provide NHS or publicly funded adult social care must implement and conform to the standard by 31 July this year. More generally, responses to the Department for Work and Pensions review of the market for BSL and communication support for people who are deaf, deaf-blind or have hearing loss are currently being analysed, and the results will be reported this autumn. From my previous work on disability, I know how important British sign language is. It is a culture and a language that is capable of expression, of drama, of comedy and of all sorts of things. We discussed earlier the life and culture of people who are hard of hearing or deaf, which is very important, and we look forward to the conclusions of that DWP review.

NHS England, along with patient groups, charities, CCGs, providers and professional groups, set out to respond to some of the challenges I have mentioned with the forthcoming commissioning framework. The framework ensures that first and foremost, CCGs have a clear guide to what good commissioning looks like. It is designed to ensure that CCGs are properly supported not only to provide more consistent, high-quality integrated care to meet the needs of local people, but to make informed decisions about what represents good value for the populations they serve. A golden thread throughout the publication is action to be taken to help reduce inequalities in access and outcomes. The framework is a real attempt to deal with the issues of variation that we come across.

The framework underscores the value of co-ordination and integration. In a climate of financial constraint, improved understanding of prevention means that effective measures can be taken to improve services and save money. The framework encourages CCGs to utilise outcome-based commissioning to incentivise change and advocates improving patient access to and choice of services. Implementing contracting, pay and monitoring outcomes and referrals from all providers should ensure fair choice and drive up quality. That shows that we are moving in the right direction, but a lot more work is needed to encourage action and promote the change we all want to see across the public sector and across the age range.

System partners have shown demonstrable commitment to working together to ensure that progress is made to achieve the goals set out in the action plan. Although there is no one perfect model, NHS England and the sector need to continue to collaborate to support CCGs to improve value, innovate and build sustainable services. I also think that lessons can be learned and applied across the system from the valuable work of NHS England and system partners.

It is clear, as this debate has demonstrated, that there are passionate advocates out there who are eager to achieve the improvements in outcomes, experience and services that we all want to see. The publication of the framework provides us with the opportunity and the incentive for action. We all need to be on the front foot on prevention. We will only achieve gains through concerted action across all the partners in the hearing landscape.

I will continue to play my part in holding system partners to account for commitments made. Collaboration and partnership working at national, regional and local level are key, and the work of colleagues here in the House and the all-party group in ensuring that interests are constantly represented here will also be of great importance. On behalf of the Department, I am very grateful to the Backbench Business Committee and to colleagues for raising such an important subject and contributing to the debate.

Kentmere Mental Health Ward, Westmorland General Hospital

Alistair Burt Excerpts

Monday 13th June 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

There is no pressure here, then. I thank my friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), for securing this debate and for his vigilance in raising such an important subject, which matters a great deal to his constituents. I put on record my appreciation for the work done by the NHS in Cumbria and I thank the staff for their hard work and commitment to patients. In doing so, I acknowledge what the hon. Gentleman said about the police. As we in the Chamber who know about these matters are aware, the police do a great deal of work in this area. The crisis care concordat, which was piloted by the right hon. Member for North Norfolk (Norman Lamb), has made a considerable contribution to the way in which we look after those with mental health issues at times of crisis, and the police have been intimately involved. I fully accept what the hon. Gentleman has said about the amount of such work that the police in south Lakeland are involved in.

I am fond of South Lakeland. Bury Grammar School had a house at Helsington, near Brigsteer, which I am sure is in the hon. Gentleman’s constituency. I remember the place extremely well. It is a beautiful area, and its constituents are entitled both to good service from an MP and to the best quality services.

Let me turn immediately to the subject of the debate. Cumbria Partnership, the provider trust, announced in May its decision to close Kentmere unit following information from the CQC that highlighted the environmental constraints on the unit. Kentmere is an old mixed-sex unit with no access to outdoor space. The hon. Gentleman’s concerns and comments about the decision have been widely reported. As he knows, and despite what he said at the conclusion of his remarks, this is a matter for the local NHS. Neither I nor any other Minister have a role in the decisions that are taken. The hon. Member for York Central (Rachael Maskell), who spoke forcefully about Bootham Park in York, also knows that well.

However, I understand, as the hon. Gentleman rightly says, that the NHS now says that the unit will not close as announced and that decisions will depend on further work. It is, therefore, worth setting out the background and indicating the interest that I have in making sure that the best possible services are provided, while recognising that the old levers of Ministers and the NHS are not quite as they were.

Mental health services for Cumbria are commissioned by the NHS Cumbria clinical commissioning group. Cumbria Partnership NHS Foundation Trust is the provider of mental health services for patients in Cumbria. The CCG has been working on a new mental health strategy for Cumbria for some time. It is fair to say that one of the problems that the NHS, in common with other public services, faces in Cumbria is the geography. The largest towns are at the northern and southern ends of a region that covers a large area, and it is difficult to travel between the smaller towns because the roads are often slow. This means that the NHS has to make difficult decisions about where and how to provide services. To put it bluntly, everything cannot be available in every local community. While cost is a real factor, the main problem is maintaining quality. It is not about saving pennies; it is about making sure that the quality of service is high.

Like everyone else, NHS clinicians learn and improve through experience. Skills that are not being used will decline. Facilities seeing only a few patients tend to lack the patient throughput needed to ensure that services remain of high quality. The cost of employing staff is the main factor driving the cost of services, and providing services from a greater number of locations means that more staff are needed. There are only so many staff to go round. The NHS invariably finds that larger units do better in terms of patient outcomes, but the question is where those larger units should be located. Inevitably, decisions taken by the NHS will disappoint those areas not chosen.

NHS services in Cumbria overall—not just mental health services—are facing a range of challenges, and in many cases the reasons are the same. The northern part of the area is part of a success regime aimed at improving all patient services; the issues at the University Hospitals of Morecambe Bay NHS Foundation Trust in recent years are well known. It is against this background that the NHS is considering what should happen at Kentmere and what is best for the hon. Gentleman’s constituents. Cumbria Partnership announced on 17 May that the Kentmere unit would close from the end of June 2016. At the same time, it was announced that the adjoining health-based place of safety would close at the end of May. The trust said that the decision was a result of quality and safety concerns raised by the Care Quality Commission. The CQC had inspected the unit in November 2015 and its report was published in March. However, the CQC says that the decision to close the ward and the health-based place of safety is not a necessary outcome of the findings of the CQC inspection, to which the hon. Gentleman referred. In short, while it did identify problems, the CQC report did not recommend the closure of the unit.

The report clearly highlighted concerns about the ward environment, which it said placed service users at risk and did not support good care and treatment. Something does need to be done about those concerns. The unit, which treats men and women, does not meet minimum standards on single-sex accommodation and has poor access to outside space. As I understand it, one issue is that privacy for bathing and sleeping cannot be guaranteed on the mixed ward. That poses an obvious risk to patients.

On 25 May, the trust gave a reassurance that the closure would be temporary and that timescales for the closure would be reviewed. I now understand that, following discussions with the CQC and with commissioners, any decision on closure will be delayed to allow further exploration of what improvements can be made. More needs to be done, and I will say a bit about that later. It says here that the trust accepts it did not get its messages right on the closure, and I think that hon. Members will probably agree strongly with that. Many hon. Members will be aware of similar experiences in other areas, and I think the NHS needs to think carefully about how it communicates with patients and the public, particularly when the news is not good. The facts need to be clearly set out, and it is important not to rush to announcements prematurely.

These circumstances reminded me of the closure last year of Bootham Park Hospital in York, in the constituency of the hon. Member for York Central. There are differences, in that the CQC recommended the closure of Bootham Park on patient safety grounds, which is not the case here. But the report produced on the closure by NHS England makes a number of observations about how difficult processes such as this need to be handled by the NHS. I have discussed this matter with the hon. Lady and I would be happy to discuss these matters further with the hon. Gentleman if we get an opportunity to do so. These are difficult decisions to get right—safety considerations really matter and when things are identified as needing to be put right, they must be put right—but the question then becomes how to do it, on what timescale and what the options are. I will come to that in a moment. The difficulty of handling such decisions, and the way in which they have not been handled well at Bootham Park, reminds us of the importance of getting such decisions right. The report on Bootham Park, particularly in relation to owning and communicating decisions, has been made public, and I have placed a copy of the report in the Library.

As I have said, in relation to Kentmere ward, we have moved in the space of a few weeks from a permanent closure to a temporary closure, and then to the unit remaining open while more work is completed. The safety of patients has to be the primary concern, and we would be failing patients if the NHS continued to tolerate the risk to the quality and safety of care that the environment at Kentmere places on local services. Something needs to be done, and it is up to the local NHS to decide what that is, but I do not think it will do so on its own. That is where the hon. Gentleman and his friends come in.

The CCG recognises that mental health services in Cumbria need to improve and it has already involved service users, their families and carers on this project. Much of the work so far has shown, not surprisingly, that patients want better services closer to home in their local community. Later this year, NHS Cumbria CCG will therefore be consulting about the future configuration of adult in-patient mental health beds across Cumbria. That will ensure it has the right beds in the right place, with a sustainable service that the local NHS can staff for the future. The CCG has already said it will not support any permanent service change at Kentmere without full public consultation.

In preparation for this, the CCG is looking at the current configuration of adult in-patient mental health beds, benchmarking how it is managing mental health needs across Cumbria with other mental health providers and advising on areas where the NHS needs to develop services to meet future needs. The CCG also needs to make sure it has the right kind of beds in place—for example, facilities for children and young people, older adults and psychiatric intensive care beds.

[Tim Farron]

There is not much time left, and I am very grateful to the Minister for giving way. I want to point out to him, first, that there is not a single tier 4 adolescent or child mental health bed in the whole of the county of Cumbria, and secondly, that the 12 beds on Kentmere ward are nearly always full and the majority of them are for people under a section, so there is no opportunity for community options. It is not the case that there is a lack of demand.

[Alistair Burt]

I take the hon. Gentleman’s point. I cannot be as au fait with the situation as him, but I fully understand the point in general. Whereas there is a tremendous move towards improving community services, which is important and vital in its own right, that cannot be a total substitute for the in-patient acute beds that are needed. I understand his point, and that is my view and the Department’s. Getting the right balance is important, but the one is not a cheap substitute for the other. Such services are an important component, because it is important that more is done in the community to keep people away from acute beds and make sure they do not need them, but I entirely take his point.

NHS Cumbria CCG is working with its providers—mainly the foundation trust, as well as clinicians, service users and carers—to help develop the model of care it will need in the future to deliver its vision of improved mental healthcare and sustainable services. I am told that public consultation will be carried out in line with best practice and the latest Government guidance. There will be sessions for stakeholders and the public to share their views, ideas and concerns in communities around the county. I spoke to health service chiefs this afternoon in preparation for this debate, so I know how seriously they take the point about the need for consultation, as well as that they recognise the communication difficulties in relation to how they have got to where they are and that they are open to such a consultation. I therefore urge the hon. Gentleman and his constituents to involve themselves fully in that consultation, which will shape whatever happens to Kentmere in the long term.

Tempting as it is to follow the hon. Gentleman’s suggestion that I should decide on the configuration of services, I am afraid that I cannot do so because that would be outside my authority. I wish him, the hon. Member for York Central and other Members in the House good night and good luck.

Question put and agreed to.

Carers

Alistair Burt Excerpts

Thursday 9th June 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

I congratulate my hon. Friend the Member for Eastleigh (Mims Davies) on securing this debate and on the way she opened it, and I thank the Backbench Business Committee for allocating time for this important debate during carers week. I will start where the hon. Member for Worsley and Eccles South (Barbara Keeley) ended, and thank all those who are involved in caring in our society. As we have heard from every speaker, carers make an invaluable contribution to the UK that we could not do without, and perhaps I can illustrate that by citing some of the remarks made by colleagues during the debate.

I will touch on some of the points raised by my hon. Friend the Member for Eastleigh in the remarks I have prepared for this debate, and I will also comment on her other points. She started with a graphic description of what might happen if carers were not around and if they decided not to do what they do every day, which brought the point home to us. She spoke about how people become a carer, and said that it could happen to any of us at any time. At last year’s national care awards I remember watching a video in which the point was made vividly that any of us in that hotel room could become a carer within 24 hours, and we can all understand that. As others pointed out, carers are no longer a minority group but people we all know—many of us are closely connected to carers, if not carers ourselves—and we are all only going to become more closely involved in the future. She, like others, made that point very well.

My hon. Friend also spoke, as did others, about the need to identify people not solely as carers but as husbands, wives, partners, employees—everything else they still are—and about the great danger of someone being pigeonholed because they have become a carer. It is important to remember that someone does not lose their identity when they become a carer. Hon. Members also highlighted the importance of carers week. I am proud to be the president of Carers in Bedfordshire—I have been for some years—and I thank it for its work. All hon. Members have thanked their local groups.

My hon. Friend was not the only colleague to speak of her personal experiences of caring. As I have mentioned from the Dispatch Box before, the range of Members’ experiences goes far beyond what the media are keen to portray and touches on virtually all aspects of life outside. When I hear the cares and experiences that colleagues bring to this place, I always hope that people outside read our debates and understand a bit more about us, why we want to be representatives in Parliament and the personal experiences we bring.

The hon. Member for Workington (Sue Hayman) and others spoke about finances, on which subject I could spend the whole 15 or 20 minutes. I know that this subject is particularly important to the hon. Member for Worsley and Eccles South, the spokesperson for the Opposition. On carers allowance, which the hon. Member for Workington focused on, the Government keep the earnings limit under review and keep under consideration whether an increase is warranted and affordable. The increase of 8% in 2015 far outstripped the increase in wages. The earnings limit is currently £110 a week, but that is a net figure, and if allowable expenses, such as childcare and pension contributions, are deducted, a claimant might earn significantly more. The limit enables a carer to maintain some contact with the employment market and achieve greater financial independence, but I recognise and would not minimise the constant financial pressures and difficulties facing families. The limit is kept under review. Also, as I said, there is a wider review of the carers strategy, which has allowed a lot of people to make contributions on finance, not just the amount but the important interlinking of benefits. That point will not be missed, and I thank her for raising the matter.

[Barbara Keeley]

Carers charities often raise with us the link with things such as the national minimum wage. The Minister talked about the figure last year, but the national minimum wage changed in April, and many of the carers trying to keep a part-time job going will be at that level, so it seems sensible to link the threshold with the national minimum wage so that when the national minimum wage increases, so does the threshold.

[Alistair Burt]

I cannot make that specific commitment, but I understand fully the hon. Lady’s point. As I said before, the earnings limit and all the factors affecting it are kept constantly under review, but I am sure that Treasury colleagues will not have missed the remarks made today.

My hon. Friend the Member for Chippenham (Michelle Donelan) also made the point about carers not being a small minority. She commended Carers in Wiltshire, and I commend her for being a volunteer—another example of the experience we all bring to this debate—and she raised the important issue of entitlement to benefits and signposting. In our call for evidence as part of the review of the carers strategy, respondents raised the importance of people being directed towards the things they need as soon as possible. The moment someone becomes a carer, their world changes, and they need as much information as possible at that time. She was right to mention the importance of signposting in particular. She spoke with great passion on the subject.

The hon. Member for Ayr, Carrick and Cumnock (Corri Wilson), who also spoke from personal experience, made a point about access to work. I shall talk about employment later, but she made her point strongly, and again she was not the only person to recognise that, although we all wish for a world in which burdens are shared equally, in truth they are not. Women carry the biggest burden when it comes to caring, and will probably continue to do so for some time. Recognising the extra pressures on women is particularly important. The hon. Lady made that point very well.

The hon. Member for Paisley and Renfrewshire North (Gavin Newlands) was particularly helpful in saying that although it is carers week for us, it is just another week for carers. I also liked it when he said that it was a week to talk “with”, not “to” carers. That was a particularly well made point. He spoke forcefully about the reality of life—the sleepless nights and other issues that carers experience.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) brought up the issue of care homes. I am not going to linger on that subject, but, as some colleagues know, I am particularly exercised about safety in care homes. It is my belief that someone in the care of the state, whether it be the NHS, local authorities or anyone else, needs to be as safe in a care home, a mental health institution or in learning disability facilities as they would be in an intensive care unit. As I expressed in yesterday’s debate about Southern Health, that is simply not the case.

I am very conscious of issues surrounding care homes. I have a round-table meeting on Monday with those responsible for the monitoring and regulation of care homes, and I pay tribute to the Care Quality Commission and others who are trying to do a good job of regulation, but this also involves some of the groups that are critical of regulation, want to see more done and want to ensure that there is safety in care homes. Some of the stories of abuse that we read about in the papers need to become fewer and fewer until they are extinct.

I want to praise the National Care Association because there are many good care homes, as my hon. Friend the Member for Bexhill and Battle said. It is important to keep the right balance in recognising the quality of good homes without minimising the pressures on them. When things that should not be happening are going on, it is quite difficult to maintain that balance. I appreciate the fact that my hon. Friend mentioned this important issue. I commend, too, the ideas coming forward from the carers team in East Sussex, and I urge members to ensure that the ideas put to my hon. Friend will be put into our national call for evidence. They have until the end of this month to do so. I do not envisage a statutory instrument to extend that still further, should there be a rush of evidence at the end of the month, but we never know in the present circumstances. Getting that information in would be very helpful.

The hon. Member for South Antrim (Danny Kinahan) was not the only one to refer to the pressures on our own caseworkers, who do so much work to look after people in the House. I appreciated his mention of that point. He hoped that the carers strategy would be a long-term strategy. I hope it will, too. The strategy should be reviewed from time to time—this is the first review for two or three years—and that is certainly the aim. That is why I would like the strategy to look slightly beyond the immediate and consider how to build for the future rather than simply having a snapshot now.

My hon. Friend the Member for Strangford (Jim Shannon)—I call him my hon. Friend—is exceptionally generous and courteous to all Front-Bench Members when he speaks. I would like to tell him how much that is appreciated—it really is—when he is so genuine in expressing his views. He spoke of his personal experiences, pressures in Northern Ireland and the Crossroads young carers in Newtownards who particularly stressed the difficulties faced by young carers and the things that they often miss out on. My hon. Friend spoke about a singing group. A few weeks ago, I went to Biggleswade at the request of the Alzheimer’s Society to join a singing group, and I sang some songs with the people there. It was certainly an uplifting experience that morning. I commend those groups and the carers who work with them.

The hon. Member for Central Ayrshire (Dr Whitford) made a considered and thoughtful contribution, as usual. She spoke about all the financial pressures. Particularly telling was her comment that although there are a relatively fixed number of carers and although it is steadily growing to 6.5 million, it is a replaceable 6.5 million and about a third leave for all sorts of reasons.

On bereaved carers, I was contacted through Twitter by someone in that position who asked whether the strategy and review would cover them, and I answered “Yes, it will and it should”. The moment that caring for someone stops because of bereavement, the carer’s life has changed—perhaps in an anticipated way, but it is has still changed. Caring for people in those circumstances is really important. We must not forget this group, so I greatly appreciated what the hon. Lady said. She also spoke of the need to ensure that social care is seen as a profession as much as nursing and domiciliary care are throughout the NHS and elsewhere, and I thoroughly agree with her.

The hon. Member for Worsley and Eccles South (Barbara Keeley), whose background in caring requires her to be listened to seriously every time she speaks about this issue, made a number of comments. I shall deal with the subject of finance a little later. Let me say first that I will ensure that the review that we are conducting will cover early identification in the NHS. We are trying to ensure that it takes place earlier and earlier. The issue of GP identification is very important, and I am pleased that the hon. Lady raised it again.

[Barbara Keeley]

I should be happy to send the Minister a copy of my Bill and the explanatory notes if that would help to elucidate the points that we have made.

[Alistair Burt]

I have no doubt that those are already deep within the recesses of the Department of Health, but if it would speed things up and provide encouragement, I should be grateful if the hon. Lady did indeed do that.

The hon. Lady also made an important point about our staff in the House. She said that we should look after them. I appreciate the point that she made about the staff of the Independent Parliamentary Standards Authority, and I will look into how we can best ensure that we recognise properly—in line with best employment practice elsewhere—that those who work for us bear considerable burdens of caring from time to time.

I am grateful for the opportunity to come to the House and share the important work that is under way to develop a new cross-Government strategy for carers. I continue to be humbled by the many powerful, honest and informed contributions that we have heard throughout the afternoon from Members who have described the carers whom they know and represent, as well as their personal experiences. Those views, and the many others that we have received so far, will be fully taken into account as the Department works with Government colleagues, stakeholders and, crucially, carers themselves to develop the new strategy.

Today we have been reminded that behind the statistics stand spouses, partners, parents—in fact, all manner of relatives, friends and neighbours—who are providing care right now in our communities. Their commitment can scarcely be quantified or questioned, and we must ensure that our own commitment to support people is demonstrated clearly as well.

I pay tribute to the national care awards, which are sponsored by LloydsPharmacy, Carers UK and The Sun. I was at the awards ceremony a couple of weeks ago, and we met the winners at lunchtime. The Prime Minister was kind enough to offer No. 10 Downing Street for a lunchtime reception, and we took people round. We are always struck when people like that say that it is a privilege to be there. We say to them, “No, it is our privilege that you are here with us. It is the other way round.” Those people were a great group—great winners. We went to a dinner that night. Radio 2 was very good: there is always a table of wonderful people to support the awards. When we hear the personal stories—which have been reflected in some of what we have heard in the House today—we are all immensely impressed. Let me again pay tribute to those awards: they do one of the jobs that we have all been speaking about this afternoon—valuing and recognising carers for what they do in so many different circumstances.

Before we go any further, may I offer a small philosophical comment? I picked this up from a piece in The Guardian by a writer called Madeleine Bunting. I do not read The Guardian all the time, contrary to the belief of many of my colleagues, but every now and again I am struck by something that is really good, and what Madeleine Bunting wrote is important. She was writing about what care is. We talk about it—we talk about the facts and figures and the finance here in the House—but what is it precisely, and where is it going? Madeleine Bunting wrote:

“We recognise instantly when we experience it: an interaction that acknowledges a moment of human connection. It may be brief, but it expresses and confirms a common humanity, a recognition of the individual—and always involves a particular quality of attention.

But the characteristics needed to provide this kind of care are losing cultural traction. Attentiveness requires two crucial ingredients: patience and the willingness to put one’s own preoccupations aside and to be available to another. Yet in a myriad of ways we are all being groomed by consumerism and digital media—to be the opposite: impatient and self-preoccupied. That impatience makes us easily distractable, addicted to the next stimulus.”

I think that Madeleine Bunting was making a really important point. The people about whom we have been talking have avoided that: they have patience, and a commitment to others that is beyond many of us. However, there is concern about society—concern about where it is going and the pressures that it is under. Demographics suggest that we will need more care, and yet certain pressures are making it more difficult for that to be realised. What will carers be like in the future if they have become too distracted and too self-occupied? That is not the case with carers now, but it is a valid point to raise with regard to the future.

We owe a duty of care to this vast army of people, who show their patience and their compassion for others. I am talking about not just providing them with the support, tools and information that they need to care well, but ensuring that their own health, wellbeing and life goals are not compromised. Our respect is unreserved, but respect is not enough. We must never lose sight of that fact if a new carer strategy is to succeed.

I should say at this point that I do not wish to paint a negative picture of caring. Although personal sacrifices are made each and every day, many carers have told us that it remains a privilege to care, and that they have a strong desire to repay the kindness of others. Indeed, carers derive immense satisfaction and peace of mind from being the primary source of comfort and reassurance for friends and loved ones. However, that satisfaction must not be at the expense of carers’ own mental and physical health.

We have also heard this afternoon about the great diversity in types of caring. There is no such thing as a typical carer—carers are people of all ages and from all walks of life, and those for whom they care have different needs. In particular, we neglect at our peril the needs of children and young people with caring obligations. They are most at risk of having not just their health and wellbeing compromised, but their education and career ambitions too.

There is no “one size fits all”. We must be alert to that as we attempt to craft new and improved support for all those providing care in our communities. It is no surprise that one in six of us is currently caring. As lifespans extend and our population grows, caring for others has already become part of the fabric of our lives. All those who have spoken today have made it clear that they are not affected by the lazy mindset that tells us that carers are other people; carers are all of us. As a constituency MP, I have had the privilege of visiting carers and carers’ groups in Bedfordshire. As a Minister, I have spoken to carers’ groups in relation to pulling together the new carers strategy. I strongly commend those who work in my own county.

Almost 20 years after the Carers Act 1995 first gave official acknowledgement to those providing “regular and substantial” care, the Care Act 2014 now gives carers new rights, including parity of assessment, advice and support with those for whom they care. Those new rights are a historic step forward. We have provided local authorities with £433 million in 2016-17 for new burdens arising from the Act.

We know that the Care Act is taking time to bed in. The hon. Member for Worsley and Eccles South referred to the matters that affect assessment, and I understand them very well. Care varies from place to place. A group from the Association of Directors of Adult Social Services working with the Department is looking at those variations in care, so that in places where assessments are much slower than in others, we are looking at what can be done and how things can be improved. That is very much on our mind.

[Barbara Keeley]

Having been present during discussions about certain groups of carers, perhaps the Minister will tell us whether he believes that carers of people who are at end of life should be prioritised for assessment. It is pointless to have people waiting six months when the person for whom they care may have only a few weeks or a few months to live.

[Alistair Burt]

I will ensure that that is considered as an important point of the assessment. I will write to the hon. Lady in relation to that.

Let me turn to finance now. There is always concern about the amount of finance that is available. It is almost impossible to get the right amount. By spending around £2.5 billion a year on benefits in Great Britain, benefiting more than three-quarters of a million carers, we are trying to respond to the needs that are there. That money provides a measure of financial support and recognition for people who give up the opportunity of full-time employment in order to provide care. As I said earlier, those allowances remain constantly under review. As this debate has made clear, it is not just about finance, but about all the other things, including supporting young carers and making sure that they are not forgotten and remembering that employers play an important part. I commend NHS England for the important work that it has done in relation to carers and for its commitment to carers.

I also want to mention the results that our call for evidence has produced, just to give people some assurance that these things are on our minds. We have received 3,800 responses so far, 85% of which are from carers themselves. A great number of the responses have been candid and honest, and it will frighten my officials if I read them out. They describe financial hardship; a lack of recognition and involvement; the impact on carers’ health and wellbeing; the difficulty of maintaining life outside caring; and frustration with access to assessments and services. All these issues are on our minds.

The need to ensure that carers get the recognition they deserve has been well illustrated in the compassionate speeches that we have heard today. Carers are vital, and not just in carers week. There is also a young carers awareness day—it was on 27 January this year—sponsored by the Carers Trust. I also commend my hon. Friend the Member for Truro and Falmouth (Sarah Newton) for holding a round-table about carers recently. This matter is on the minds of everyone in the House and I appreciate the courtesy of hon. Members in giving their time to deal with this important issue this afternoon.

Southern Health NHS Foundation Trust

Alistair Burt Excerpts

Wednesday 8th June 2016 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank my hon. Friend the Member for Fareham (Suella Fernandes) for securing this important debate on the governance of the Southern Health NHS Foundation Trust. I also thank all Members who have spoken, by way of either significant speeches or interventions. The number of colleagues from the area who are involved—from across the House—gives an indication of how seriously we all take this issue. I urge the trust’s representatives to read the report of this debate extremely carefully, so that they absorb everything said by my hon. Friend and all those who have spoken in support.

May I begin by once again apologising to all the patients and families who have been affected by the failure of the trust to provide safe care for its patients? I met Sara Ryan yesterday when I visited the National Forum of People with Learning Disabilities. I had an opportunity to have a conversation with her, and I met more parents and families today before the start of this sitting. Nothing that an official can write on a piece of paper can adequately describe what it is like to meet and talk to families who have been involved in the sort of things that we are talking about here. This is not the first time I have had such meetings: I have had them since coming into post a year ago. It is impossible to convey simply and straightforwardly all that people feel.

What worries me most—I have said this to families in private and I say it again here—is that I hear the same things again and again. I hear about the frustration and concern about the time taken to get anything done when it has been agreed that something should be done, about the time taken to get any answers about what might be done in the first place, and about the defensiveness in the attitude of the institution being dealt with—my hon. Friend the Member for Eastleigh (Mims Davies) described it as a bunker mentality. I do not know whether it is a reflection of a professional attitude—because clinicians and others see things every day—but it is genuinely upsetting to hear people who have lost their loved ones talk about the lack of simple sympathy from those who deal with them. I have heard from enough people in enough different parts of the country to know that what I am hearing is not a one-off.

I also get distressed when I hear through the system that people can be difficult. People have every reason to be difficult, but that is not an acceptable way of describing people who are concerned and upset.

Because this point is made in place after place, as the hon. Member for Liverpool, Wavertree (Luciana Berger) knows well, by many different types of people, I am not sure that the system’s response deals adequately with some of the individual issues that have arisen over the past year—I will come to that later. I say to the parents and families involved that their individual contact, when they get the opportunity, with Members of Parliament and Ministers is not time wasted. It is easy to say that people will feel that only when they see something done, but the contact has a profound impact on officials and Ministers alike.

The first duty of any care provider is to keep its patients safe. The reports of inaction, bordering on complacency, set out in the recent Care Quality Commission report were truly shocking. I responded to an urgent question on the safety of care and services at the trust on 3 May, and I welcome the opportunity provided by today’s debate to update the House on the actions taken in response, several of which pick up on issues raised by the hon. Member for Liverpool, Wavertree and others.

As hon. Members are aware, NHS England commissioned a review by Mazars in November 2014 of deaths of people with a learning disability or mental health problem in contact with the trust between April 2011 and March 2015, in response to serious concerns surrounding the avoidable death of Connor Sparrowhawk. On publication of the report in December 2015, my right hon. Friend the Secretary of State for Health asked the Care Quality Commission to carry out a focused inspection of the trust to review its governance arrangements and its approach to investigating and learning from incidents, as well as its progress in responding to Monitor’s action plan.

On 12 January, Monitor announced further regulatory action in response to the Mazars report, including the appointment of an improvement director for the trust. The CQC inspection took place in January 2016 and led to a warning notice and an announcement of further regulatory action by NHS Improvement, which were both published on 6 April 2016. On 5 May, following the resignation of the trust’s chair, Mike Petter, NHS Improvement required the trust to appoint Tim Smart as the new interim chair. Those actions were in response to the persistent failure of the trust’s senior management to address the environmental and governance risks identified by CQC as far back as October 2014.

The hon. Member for Liverpool, Wavertree and others asked about what has been happening. The issue is split into looking at what has happened and—to use that terribly clichéd phrase—what lessons can be learned, and what is happening now and what confidence people can have in the future. That is vitally important.

I have sought assurances from NHS Improvement and CQC that the regulators are now able to oversee a rapid programme of remedial action by the trust, and I understand that the following measures are now in place. First, at monthly progress review meetings, NHS Improvement challenges the trust’s death and incident reporting action plan and its progress. Secondly, at the request of NHS Improvement, the death and incident reporting action plan is currently subject to external scrutiny. Thirdly, Alan Yates, the improvement director, is acting as a direct link from the trust to NHS Improvement, providing support and constructive challenge to the trust’s board in its oversight of the implementation of the action plan and providing assurance to NHS Improvement and other stakeholders about the trust’s approach.

On the work being done to bring the governance question to a swift conclusion, and in answer to the hon. Lady’s question about pace, the interim chair has already overseen improvements to clinical governance and the trust’s response to the CQC warning notice and NHSI licensing conditions. In parallel, he has commissioned an external review of the capability of the board, which extends to executive and non-executive directors and will inform a decision on leadership by 6 July. That will give the chair, whom I met a couple of days ago, the opportunity to review current capabilities with a view to the future. It is important that he has done that.

Tim Smart has also been in discussion with clinical commissioning groups and other trusts across the local health economy about the provision of services in accordance with the NHS five year forward view, and what that might mean for Southern Health. The transfer of the learning disability service in Oxford to Oxford Health will have been completed by the middle of October.

I spoke to Tim yesterday, and I am absolutely clear that he is right to insist on the highest standards of governance, with leadership concentrating on the real business of the trust—patients and their care. We have an imminent deadline, processes are in place and I am confident that a better Southern Health will emerge, but my confidence counts for very little. It is important that I am able to say that to colleagues with confidence, but the real confidence Southern Health has to gain is that of its patients and families and those who are involved. Having met some of them today, I know that that is a difficult hurdle to overcome, but it is the most important one. A description of processes and what people such as me are doing is not sufficient.

It is necessary that I have said what I have said to colleagues, and that I put on the record that I am confident that NHS Improvement’s review process and its ability to make management and executive changes—which will be carried out by Tim Smart, a newly appointed, experienced chair—is a good response to what has happened. The right person is in place with the power and ability to make the necessary decisions, but any confidence in them will come from the quality of the actions taken as a consequence of the powers invested in the chair and NHS Improvement. Unless actions that have the confidence of people are seen to be taken, something will be lacking. It is important that the chair’s judgment is relied on at this stage, and that I am able to reassure colleagues that the way in which NHS Improvement is working with the chair, and the powers that it and CQC have, are appropriate at the present time, but we must see what happens next.

[Nicola Blackwood]

The Minister opened by expressing his frustration that, since taking his post, he has been hearing about similar failings again and again. Of course, it is not just us in this place who hear about those failings, but the public and patients too. Every time they do, they lose confidence in the ability of the health service and the Government to address those failings. What in the steps that the Minister and Southern Health are proposing will break that mould? What will be different about the response this time? How will our response to this crisis restore the confidence of our most vulnerable constituents?

[Alistair Burt]

I will address that a little later, if I may, but I will come to it.

I should also answer the right hon. Member for Oxford East (Mr Smith) on the chain of accountability for NHS Improvement, and on who makes the decisions there. The decisions are made by Jim Mackey, who leads NHS Improvement. He is a direct appointment of the Secretary of State, so the Secretary of State invests his confidence in Mr Mackey, who makes the decisions on the work of NHS Improvement.

I will now turn to some of the issues raised by my hon. Friend the Member for Fareham and others. First, on the position of Katrina Percy, I need to be clear: Ministers have no authority to intervene in such matters, and nor would it be right for them to do so. I have been assured by Jim Mackey, the chief executive of NHS Improvement, that agreed processes are in place to review the performance of the senior leadership team and to make any changes that are in the best interests of patients. A Minister has to leave that there, and is not able to express any further view. That there is confidence in decisions taken is clearly of huge importance to Members in the Chamber, as they have expressed, and to others. A process is in place to decide that, and it will be decided by the chair.

I share my hon. Friend’s concern that inspectors have pointed to repeated failure by the trust to close out necessary improvement actions until the beginning of the year. NHS Improvement has asked the improvement director to ensure that the trust does not treat actions as complete until sufficient robust evidence supports that claim. The repeated failure to complete actions is one of the things that I will come on to in answer to my hon. Friend’s questions. When people are told what to do by a serious regulator, why do they not just do it? Why do they not do it in Southern Health, but do it in other places? What is the point of accountability and what is the process whereby in other parts of public service something is demanded by a regulator—say, in the acute part of the NHS—and something therefore happens, but something does not happen if dealing with those with mental health or learning disability issues?

[Mims Davies]

Yesterday, Mr Smart told me that his initial view on exactly this point was that the senior executive team had a focus on dealing with Southern Health’s public relations issues, and not really on the care and quality in what was being delivered. That, simply, was why there was no change.

--- Later in debate ---

[Alistair Burt]

My hon. Friend makes her own point about a conversation I was not part of. I am sure people will read what she has to say.

As I have already set out, a clear and robust process is being taken forward by the interim chair to review the capability of the board and to take any necessary action. My hon. Friend the Member for Fareham has called for far-reaching changes. I ask that we await the conclusions of the review and look for the right balance to be struck between continuity and stability to ensure that the trust is able to deliver what it has promised. Wholesale change could introduce further delays to making progress on such work.

Recent media reports have suggested that the trust might be split up. I repeat that the priority now is to ensure safe and effective care in the present and in the future for the population served by Southern Health. NHS Improvement is working with the trust to explore all available options.

Members have also asked why the trust has not been prosecuted for historic safety breaches. I am aware of the allegations of historic health and safety breaches made by a former health and safety advisor to the trust, who has also briefed CQC about such concerns. I share the concerns of all those who are asking why it has taken so long to get a grip on the issues. CQC did indeed identify safety concerns back in October 2014 and has provided an assessment of safety in its most recent report. However, it is unforgivable that patients have continued to be exposed to unnecessary risk while the trust has dragged its feet in resolving the problems.

I understand that CQC has now reviewed evidence gathered during the most recent inspections and additional information obtained from the trust and other public bodies, including the Health and Safety Executive. CQC’s review has identified further lines of inquiry, which it plans to complete as quickly as possible in order to inform a decision on prosecution one way or the other.

[Mr Andrew Smith]

Is it not the case that following the gathering of that further evidence and, indeed, of other leaked reports of what Southern Health knew at an earlier stage, which had not previously been apparent, the police are now reviewing the case for prosecution?

[Alistair Burt]

Genuinely, I am unaware of that. The police may review evidence at any time. If CQC has certain evidence that it wishes to take to the police for prosecution, that is a matter for it. I understand the processes that people would want to go through. It is important for me to offer reassurance that those processes are in place, and that things that for too long have been swept under the carpet are open for examination, which I understand to be the case.

Let me deal with the question of a public inquiry. Ministers face many calls for inquiries, and it is important for public inquiries to be considered only where other available investigatory mechanisms would not be sufficient. Public inquiries are rare events. I argue that the processes now being followed by NHS Improvement and CQC are the best way to put right the safety and governance issues at Southern Health. That does not rule out the dissemination of wider learning from this case through NHS Improvement or, where appropriate, the holding to account of individuals via professional regulation or normal performance management routes.

It is right and proper that we should ask such questions. We can perhaps examine whether the system would have responded in the same way had the trust been an acute trust, as I mentioned earlier. I am passionate about improving the care and outcomes for people with mental illness or learning disabilities by ensuring that all aspects of healthcare for people, whatever the issue that has brought them into the care of the NHS and others, are given equal priority with physical health. That must include regulation.

Let me now deal with the point made by my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood). As I have indicated, what I have observed over the past year has worried me. That is to say, there seems to be greater tolerance of when things go wrong in mental health than in acute services. We need to ask ourselves why it has taken so long to resolve those difficulties and to reach the regulatory decisions that are now starting to take effect.

I will therefore be looking at the matter with NHS Improvement, to consider both the effectiveness and the timeliness of regulatory interventions in mental health and learning disability services. I am keen to bring independent leadership into that work, alongside NHS Improvement. A task-and-report group will do a piece of work specifically on that.

Let me name the other places that have upset me during the course of the year. In Hull, there has been a problem with in-patient beds and an inability on the part of the NHS to make decisions about it for more than three years. There was the case of Matthew Garnett, the young man with autism in the wrong place; I could not get information on him for weeks, because of the failure of the NHS to provide what I needed. There are the problems in Tottenham with new mental health facilities, similar to what happened in York, at Bootham Park—how that was closed, and the inability of people to handle it correctly. That is a whole series of cases in which I think things could have been done better. The response has not been good enough. An inquiry into one thing is not sufficient, and the processes are in place to deal with that. Looking at the whole range of why such things happen is really important, and that work is now underway.

[Dr Julian Lewis]

Will the Minister give way?

[Alistair Burt]

No, I cannot, because my hon. Friend the Member for Fareham has to have her two minutes.

A further review of the investigation of deaths is being done. It was announced by my right hon. Friend the Secretary of State for Health, but it will not be completed until the end of the year, when the Department will give its response. This has been a hugely important debate, but it is not the end of the matter. It is a staging post, and people will be able to see things following it. I commend my hon. Friend for raising it.

Support for Life-shortening Conditions

Alistair Burt Excerpts

Tuesday 7th June 2016 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Percy. I am sure we have all found the debate that you have conducted enlightening, interesting and extremely collaborative. I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing it. He has a long history of championing the children’s hospice sector as a fundraiser for Martin House and has been at the forefront of efforts in Parliament to publicise the needs of children with life-limiting conditions. I thank him for that, as others have done.

I apologise for the absence of the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), in whose portfolio this subject normally sits. She is overcommitted and trying to be in two places at the one time, so I am delighted to have the chance to respond to the debate. In a lengthy and varied ministerial career I have had the pleasure most of the time of being in a position where I can work with the House rather than deal with confrontational situations. Occasionally politics intervenes, but most of the time I have had the opportunity to do what I am going to do this morning, and I appreciate the way in which the debate has been handled and dealt with.

I shall briefly pick out some of the points made in individual speeches. With his usual courtesy and kindness, the hon. Member for Strangford (Jim Shannon) told some personal stories and made an important point about sharing experience. He also helped us out with some information from Northern Ireland, as he so often does. My hon. Friend the Member for Castle Point (Rebecca Harris) spoke of the inspiration of people such as Lucy, whom I shall quote in a moment. She made several points about transition and the need for people to have a voice. The hon. Member for Lanark and Hamilton East (Angela Crawley) and others raised the issue of mobility, which I shall address in a moment.

My hon. Friend the Member for Eddisbury (Antoinette Sandbach) is very much involved in these issues, and I am pleased that she talked about carers during Carers Week. There is still time for carers who are listening to get involved in the call for evidence on the new carers strategy. On the back of this debate, some information from carers for those with children with life-shortening illnesses would be particularly welcome. If carers could submit their information—they have until the end of June—that would be great. My hon. Friend also spoke about the need for counselling and issues relating to the end of life.

My hon. Friend the Member for Colne Valley (Jason McCartney) gave us moving stories about lack of sleep and illustrated the sort of lives carers lead when looking after their children. That personal insight really brings it home, as do those of other colleagues. I appreciated the interventions made by my hon. Friend the Member for Eastbourne (Caroline Ansell) and other colleagues.

Of the two Front-Bench spokespersons, I know the hon. Member for Worsley and Eccles South (Barbara Keeley) well and, with her background in caring, her contributions are always to be listened to. She touched on several issues, including data and the funding of short breaks. I shall come to them all. I have not had the pleasure of listening to the hon. Member for Aberdeen North (Kirsty Blackman) before, as our portfolios have not crossed, but I really appreciated how she approached the subject, and particularly what she said about our being in uncharted territory. That is the truth.

A generation ago, the Minister in my position would probably not have been having this debate, or it would have been very different. Now, because of advances in medical science, we are working with children and families with whom we would not previously have been working. That gives rise to a whole series of new issues for all of us, and to a certain extent we are all feeling our way. The financial pressures are obvious, whatever the Government—whether it is devolved or in Westminster—but new work is being done all the time to tie up the different elements and agencies that handle packages of care. The hon. Member for Aberdeen North was particularly good on that, and I appreciated what she said. We can always learn from those around us.

I picked up in the debate issues such as data, social care, short breaks, mobility, transition and integration, about which I shall say a little in the course of my remarks. The hon. Member for Worsley and Eccles South read out a quote from Lucy, who has been mentioned several times, and the hon. Member for Aberdeen North mentioned the importance of listening, which is the bit I wanted to pick out from what Lucy said. I had experience of that many years ago as Minister with responsibility for disabled people, and it has come up again and again. I shall read from Lucy’s piece on the website of Together for Short Lives, which I commend for its work on this issue. I would be grateful if the House would take a moment to hear Lucy’s voice:

“All throughout my illness, and my life in general, the one thing I’ve always wanted is to be listened to. That is extremely important. I have very little control in my life, being dependent on others for almost everything. The only bit of control I have is my opinion and my ability to make decisions. I value this greatly. However, I am not in control over whether people listen to my opinion. My opinion or decision is only in my control if people listen to it and take it on board. It’s hard for some people to understand why I get so upset if someone makes a decision on my behalf without my consent and prior knowledge, but when it’s the only thing I have control over, you can understand why. Healthy people make decisions all the time and everyone has their own opinion. But when you’re sick and/or disabled, suddenly some people think it’s ok to make decisions for you, as if, somehow, being sick or disabled makes your opinion worthless or unnecessary. Others do it to be kind, but it still can be upsetting. I am perfectly capable of making my own decisions, and so I should be involved in all decisions that concern me or affect my life. My decision, no matter what it may be, should be supported. Be it what clothes I want to wear, where I want to go or even down to things like whether I want to be kept alive by machines or if I choose not to have life-prolonging treatment. However hard or important the decision, the individual should be listened to—even if you don’t agree with what they’re saying.”

That is a remarkable personal statement from an obviously remarkable young woman, to whom we have all paid tribute during the debate.

Turning to the main part of my speech, I shall start with some remarks about funding before using the generous time I have been allowed by tackling some of the individual issues that have come up. Some children and young people have very complex health needs, which may be the result of congenital conditions, long-term, life-limiting or life-threatening conditions, disability or the after-effects of serious illness or injury. The NHS and related services support such children in a range of ways, but the role of children’s hospices is crucial, and it is right that we focus on it today. I am grateful that so many individual hospices and organisations have been mentioned in the debate, not least by my hon. Friend the Member for Pudsey in his opening speech. I pay tribute to Keech hospice, which is based just outside my constituency on the outskirts of Luton. It covers Bedfordshire, Buckinghamshire and Hertfordshire, and I thank the staff there for the work they do.

I also thank St John’s hospice in Moggerhanger, a Sue Ryder organisation for which I have run a couple of marathons. My hon. Friend the Member for Colne Valley mentioned a time of four and a half hours; my time the other week was six hours. Obviously age is getting to me. I shall have to work on cutting down my time next time, but I did appreciate seeing the Sue Ryder cheering team on the Embankment about a mile away from the finish. A hug at that time of the day was most welcome. I thank all those who partake in fundraising efforts for children’s and adult hospices throughout the country. Those efforts cannot be overstated and are really appreciated.

As hon. Members will recall, the coalition Government initiated work to look at the basis on which palliative care services are commissioned for people of all ages. That work continued under this Government, reflecting the importance that we attach to these services. The aim of the work was to have a more transparent and local approach to commissioning services. Children’s hospices in particular have not always enjoyed a very close relationship with local health commissioners—neither primary care trusts nor clinical commissioning groups. That is largely a reflection of their history. They developed as voluntary sector organisations, driven by people’s time, good will and charitable donations.

Of course, many commissioners do support local children’s hospices and hospice-at-home services, and we have heard of some good relationships today, but there is variation in commissioners’ awareness of the valuable role of children’s hospices, and in the extent to which commissioners—both local authorities and CCGs—fund them. That has been usefully highlighted by research undertaken by Hospice UK and Together for Short Lives, as was mentioned earlier.

Children’s hospices are not just a vital resource for care and support to children with life-limiting conditions; there is also a clear role for hospices and hospice-at-home services in supporting families by providing respite care for children and young people with complex needs and disability. We want that to be encouraged as part of a more strategic approach to children’s health outcomes. We now have new statutory requirements in relation to children with special educational needs and disability that require CCGs and local authorities to work together. Such a model of integrated arrangements would provide a framework for wider support to children and young people with complex or life-limiting conditions, so it is an opportunity we should support.

In supporting more integrated arrangements for commissioning for children and young people, we want to emphasise the role of the hospice sector as a provider of respite care, and how such provision can dovetail with other specialised and universal services in a co-ordinated way. That can be supported through far greater transparency about the nature of care and its costs. As colleagues have mentioned, the coalition Government agreement pledged to introduce a new per-patient funding system for hospices by 2015 to cover care for adults and children, regardless of which organisation provides it. The aim was to have transparency about services and costs, which would allow local commissioning of palliative care.

The long process of data collection and costing—I will come back to data shortly—was a model of co-production with the sector. It identified considerable complexity in developing a new system that is sufficiently responsive to the varied needs of palliative care, particularly in the case of children’s hospices. It resulted in a draft palliative care currency, which is being used and tested locally, and the aim is to publish a final currency next year. As the hon. Member for Worsley and Eccles South said, it is not a mandatory payment system but a first attempt to group specialised palliative care into packages that are similar in the resources needed and, in particular, in workforce requirements. It does not attribute prices to the packages, as they are for local negotiation in the usual way as part of the commissioning process.

There are concerns that the currency approach does not reflect all the services provided by hospices and that a young person and their family might need, and that it perhaps lacks the flexibility that I mentioned. The currency is a useful basis for local discussions between providers and commissioners, but it is work in progress. It is clearly not the end point, although we have moved on from where we were.

NHS England recently convened a round table on children’s palliative care, which included representatives from the children’s hospice sector. It identified that the varied nature of children’s palliative care requires us to consider other funding models. NHS England and Public Health England recognise that a per-patient tariff—the principle behind the currencies for palliative care—may not be the only or the most suitable funding model for palliative care, particularly given the diverse range of the needs of children and young people with life-limiting conditions. NHS England will review with stakeholders a range of potential approaches to palliative care funding for children and young people, using the existing currencies as a basis for different models. My hon. Friend the Member for Pudsey will be glad to know that the children’s hospice sector will be part of that work. The aim is to identify the most practical approach to funding, which will allow strategic discussions between CCGs and providers and transparency about the care packages that are being secured.

I am glad to say that we are able to provide more direct support in the form of the £11 million grant that NHS England makes available to children’s hospices. The future of the central grant is a topic to which we return regularly. I appreciate that it is a source of uncertainty and frustration to children’s hospices that NHS England is not able to provide a long-term guarantee or a multi-year confirmation of the grant. We should recognise, however, that it is not dissimilar to other areas of health funding and that, in that respect, children’s hospices are no different from other providers of health services. NHS England itself does not have a long-term allocation, so it cannot in turn make long-term commitments about grant funding to children’s hospices. However, NHS England, on behalf of the Government, has made a clear, ongoing commitment to continue to support children’s hospices. There is no question of the abrupt cessation of that support if there is no sustainable local commissioning alternative in place. I know the children’s hospice sector will welcome local commissioning arrangements, and ultimately their success should mean an end to a rather unusual central grant, but the former must be in place before we can have the latter. My Department and NHS England are equally keen to ensure that the transitional process is smooth and that it is achieved by working closely with the sector.

There are a number of imaginative funding developments and ideas. My hon. Friend the Member for Winchester (Steve Brine), who was unable to take part in the debate, reminded me of a submission from Naomi House in his constituency. It talked about the very successful 30% contribution contract arrangements that exist across the south-west, including in Wiltshire, Dorset and Bournemouth and Poole. It stated that in many ways, the model in the south-west is a great example of Government policies in action, with services being funded by pooled budgets of health and social funds. It continued by saying that the system of a contribution, rather than full cost recovery, is an example of third sector and public bodies working together to achieve value for money and the delivery of quality services, which helps to avoid family breakdown and unnecessary admissions to hospital, leading to further savings.

I know a lot about data collection from my other portfolio—mental health services—because the Opposition spokesperson, the hon. Member for Liverpool, Wavertree (Luciana Berger), has made it a specialist subject on which she could speak on “Mastermind.” She has helped me to encourage the Department to do better on data collection. As I outlined, the NHS and the Government have been through a process to determine a new funding model, which has assisted in uncovering more of the necessary data. I am assured by my officials that further work will go on.

The identification by commissioners of children with a life-limiting condition is essential to ensure the efficacy of commissioning plans. There is also a need to ensure that professionals who are not usually in contact with children with life-limiting conditions, such as in primary care, are fully aware of the child’s needs. The Department is exploring the potential for a flag on general practice information technology systems to allow practitioners to note when a child or a young person has a life-limiting condition. More data collection is certainly on the cards. Effective conditioning has to start with effective identification. In 2014, the Department of Health issued guidance for health and wellbeing boards on children’s complex needs, which provides key insights on effective needs assessments. That work will continue.

On social care funding and short breaks, a question was asked about local authorities, council tax and the adult social care model. Local authorities have to make complex choices about how to target resources more effectively. With my adult social care hat on, I am well aware of the social care precept. The Department for Communities and Local Government is undertaking a comprehensive and thorough review to devise a new formula to assess councils’ needs and to provide fair funding for every type of local authority ahead of the introduction of 100% business rate retention by the end of this Parliament. There is clearly a lot of work to do over the coming months to work out the details of the new system. The DCLG will consult with local government more widely on the issue shortly. I encourage my hon. Friend the Member for Pudsey to make representations to the DCLG about funding children’s social care in the same way as the adult social care precept works. Perhaps he and other colleagues will take advantage of that review.

Since 2011, the Government have made it a statutory requirement for all local authorities to provide a variety of short break services. Regulations require them to publish a short breaks duty statement describing what short break services are on offer in their area and how they can be accessed. It must form part of the local offer of services for children and young people with special educational needs and disabilities. The Government contend that that transparency is really important. When asked about their implementation of special educational needs and disability reforms in February 2015, the vast majority of authorities reported that they were keeping their short break budgets the same as for 2014-15, but I am aware of the pressure that exists. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea, will certainly review the debate, and I have heard what colleagues have said.

I will also draw my hon. Friend’s attention to the issue of mobility, which virtually every Member has mentioned. When I was the Minister responsible for disability some years ago, I was in charge of mobility, so I am well aware of the benefit and impact of mobility assistance. Concerns have been raised about the age limit, which is an issue for the Department for Work and Pensions. There was a meeting between Together for Short Lives and my noble Friend Lord Freud in February 2016. The response, which is on its way to Together for Short Lives, indicates that my noble Friend the Minister listened very carefully. It says that, if there is to be a change, it will involve primary legislation. That is perhaps not quite the short and simple answer that we all want, but he committed to ask his officials to explore whether there are other ways in which the Department can provide support. I will certainly report to my hon. Friend the Member for Battersea how important mobility is to those with very young children.

The Government provided £420,000 in grant funding to Together for Short Lives to help the transition taskforce look at how the transition between children’s and adult services can be eased. I know that is an important factor for many families and will be increasingly important in the future.

I hope I have covered all the issues that colleagues have raised. If there is anything that I have not covered, I will write to the colleagues who raised it. If it is something substantive, I will put a letter in the Library so that colleagues present in the debate can pick it up there. I am grateful to all Members who spoke and to the constituents who involved them in what they are doing. I again thank my hon. Friend the Member for Pudsey for raising this issue and colleagues for the way in which they have debated it. This is an important issue, and I hope the debate has reflected that.

Motion lapsed (Standing Order No. 10(6)).

Budget for Community Pharmacies

Alistair Burt Excerpts

Tuesday 24th May 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

I congratulate the hon. Member for Barnsley East (Michael Dugher) on securing this debate and on the excellent way in which he put one side of the equation as we discuss pharmacy. His timing is of course impeccable. Over the past few months, we have been consulting on our proposals for the future of community pharmacy. The consultation closes today, as he said, although it is important to note that the confidential part of the consultation with the Pharmaceutical Services Negotiating Committee and other key stakeholders will continue. Today is also the day on which the National Pharmacy Association has handed over its “Support Your Local Pharmacy” campaign petition, signed by 1.8 million people, to No. 10. Colleagues might have also attended today’s “Pharmacy health checks and speed briefing” event. All of this is testament to the very high regard in which community pharmacies are held by patients and the public, and the hon. Gentleman will get no argument from me or the Government that that is not the case.

I said that the hon. Gentleman had addressed one part of the equation. He has indicated clearly what the state of pharmacy is today, but he said very little about what pharmacy could become. I understand that, and it is in fact my job to do that. I shall set that out in a few minutes.

If I may be forgiven for saying so, the hon. Gentleman presents a case that suggests that no Labour Government or local council has ever reduced the money for any service and he gives us the clear impression that, were it left up to him, there would be money for absolutely everything. There is not. In a perfect world in which money is no object, a service can be developed and extra money can be added. In the real world, in which we have to operate, it is rather different, so let me explain exactly how we are going to do that.

[Several hon. Members rose—]

[Alistair Burt]

The right hon. Member for Knowsley (Mr Howarth) approached me before, so I will take one intervention from him; I will not get through my answer otherwise.

[Mr George Howarth (Knowsley) (Lab)]

I am grateful to the Minister for giving way. I want him to take two things into account. First, there is a correlation between clusters of community pharmacies and areas of high deprivation and associated ill health, as my hon. Friend the Member for Barnsley East (Michael Dugher) said. Secondly, small, independent, local community pharmacies do not have the ability of the big multiples to negotiate bulk discount deals. Will he take those two factors into account as he moves forward?

[Alistair Burt]

I thank the right hon. Gentleman for his intervention. He has made representations in the past, and I know how keenly he understands the matter. I will come on to discuss access to funds in due course. It will not be based purely on location, but it will take into account what he says about areas of deprivation. We recognise that these are small businesses, and I understand exactly what he says.

The proposed funding cut has understandably created uncertainty and concern. I assure the House that I see a bright future for community pharmacy and pharmacists, so I urge colleagues to see the opportunity that the consultation presents, as well as the inevitable and understandable concern around funding.

The background to the matter lies in the NHS’s five-year forward view. One of its key strategic aims is to break down the traditional barriers between different primary care services, wider out-of-hospital care services and other sectors, such as social care, to deliver a more cohesive, community-based care model that is focused on keeping people healthy and helping people to manage long-term health conditions. Our vision is to achieve a transformation in primary care and out-of-hospital care more widely as we continue to move towards a seven-day health and care service. We want to empower primary care health professionals to take up opportunities to embrace new ways of working with other health professionals to transform the quality of care that they provide to patients and the public. In particular, we want to free up pharmacists to spend more time delivering clinical and public health services to patients and the public in a range of settings.

I have seen at first hand the fantastic work that pharmacists are doing from within community pharmacies, such as in healthy living pharmacies and other settings, and colleagues have also paid tribute to that work. Pharmacy-led services, such as the recently recommissioned community pharmacy seasonal influenza vaccination programme, can help to relieve pressure on GPs and A&E departments and ensure better use of medicines, better health and better patient outcomes. There are real opportunities for pharmacists and their teams to play an even greater role in helping people with long-term conditions and helping people to make better choices to improve their health and to get the maximum benefit from their medicines.

It is not a zero-sum game of accepting the reduction in funding of £170 million—from a budget of £2.8 billion—and ending this degree of high street care and having nothing in its place. I strongly believe that we can still have a network of high street pharmacies based on a financial regime that rewards quality as well as volume while moving pharmacy into different settings. To that end, we have consulted pharmacy bodies and others, including patient and public representatives, clinical commissioning groups and health and social care providers, on how best to introduce a pharmacy integration fund from 2016-17. The fund will help us to transform how pharmacists and their teams operate in the community, bringing clear benefits to patients and the public. The fund is set to rise by an additional £20 million a year. By 2020-21, we will have invested £300 million in addition to the £31 million that NHS England is investing in funding, recruiting and employing clinical pharmacists to work alongside GPs to ease current pressures in general practice and improve patient safety. The integration fund will help to move pharmacy in a direction that supplements what is already done on the high street and in a way it might not otherwise have done.

The chief pharmaceutical officer, Dr Keith Ridge, has commissioned an independent review of community pharmacy clinical services to make recommendations on future models for commissioning pharmacy-led clinical services. I am very keen that what we are doing is seen in the context of where pharmacy is going to go—not a snapshot of how good it is now, but what it can become. Clinical pharmacists will offer complementary skills to GPs, giving patients access to a multi-disciplinary skill set, and helping GPs manage the demands on their time and provide a better experience for patients. This is a great opportunity for pharmacists wanting to make better use of their clinical skills and develop them further.

Let me give a couple of examples. At the Wallingbrook Health Group in Devon, the work of the local pharmacist on all aspects of medicines optimisation has reduced the need for patient GP appointments by 20% to 30%, making a significant impact on GP workloads and patient outcomes. In Cambridge, Sandra Prater is working with patients to optimise their medicines and supporting patients to self-manage a range of conditions, including asthma, high blood pressure and atrial fibrillation.

The reduction in funding for community pharmacy that we have set out was a commitment in last year’s spending review. I want to emphasise that our aim is to secure efficiencies, make savings and improve quality. It is most definitely not our aim to close pharmacies. I accept that it was me who said to the meeting with the all-party group that up to 3,000 pharmacies could be affected. That was me extrapolating the figures. It is not the aim of the Government to close pharmacies and, as I said in answer to the question, we do not know exactly how the funding will fall, because we do not know yet the result of the negotiations and how this will be handled. I accept that I put that figure into the public domain, but it may not happen in that way at all.

I know that many people choose to access health services through community pharmacies, and I want to assure them that our aim is to ensure that those community pharmacies upon which people depend continue to thrive. That is why we are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, as the right hon. Member for Knowsley mentioned.

Let me deal with another theme that the hon. Member for Barnsley East mentioned. Hand in hand with that approach, we want to ensure that modern community pharmacies reflect patient and public expectations, and developments in technology. Large sections of the population are now accustomed to using digital services through their phones and tablets. Why not do this for people wanting to obtain their prescription medicines? That is why we want to help those patients to get their prescriptions in a way that fits their lifestyle, by promoting the use of online click-and-collect or home-delivery models. We have also consulted on amending legislation to allow independent pharmacies to benefit from hub- and-spoke dispensing models, which facilitate more use of automation and increase efficient dispensing processes. Officials are now carefully considering the responses received and the Government will respond in due course. These are things we want to encourage people to do, but they do not totally replace what is already being done. They might, however, free up more time for the pharmacists to spend on patient contact rather than on doing some of the other work.

The public phase of the community pharmacy consultation may now have ended, but that does not mean that we will stop listening and talking—the hon. Gentleman asked me to keep doing those things. The Department, supported by NHS England, will have further confidential negotiations with the PSNC, and there will also be a final round of confidential discussions with other key pharmacy stakeholders, who take a keen interest in the discussions in this House. Our aim is to communicate the final decisions early in July so that pharmacy contractors are fully informed in advance of the changes being implemented from October 2016.

Our proposals are informed by the discussions that have taken place and by what has been said by those involved in pharmacy in the past—the Royal Pharmaceutical Society and independent studies—about how pharmacy can move in a different direction but that the current funding structure rewards volume not quality and that changes could be made that would widen the reach of pharmacy. I believe that these ideas can be taken forward in the current context. Our proposals can truly place pharmacy at the heart of the NHS and provide a better, more integrated, service for patients and the public. I am confident that the efficiencies we have proposed can be made within community pharmacy without compromising the quality of services or the public’s access to them. I want to thank those in pharmacy, who are working so hard at the moment and making their case very well, and the public who support them. I think pharmacy can have a great future, as can pharmacists.

Question put and agreed to.

Dietary Advice and Childhood Obesity Strategy

Alistair Burt Excerpts

Monday 23rd May 2016 Commons Chamber

[Keith Vaz (Leicester East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health to provide an answer to the urgent question of which I have given him notice.

[The Minister for Community and Social Care (Alistair Burt)]

I thank the right hon. Gentleman for the question. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is principally responsible for this issue, but as she is on Government business in Geneva—a cruel twist of fate— I am pleased to respond to his question.

Tackling the unacceptable level of childhood obesity in this country is a major priority for all of us in this House and for the Government. We know that obese children are much more likely to become obese adults. In adulthood, obesity is a leading cause of serious diseases, such as type 2 diabetes, heart disease and some cancers. Tackling obesity and improving diet, especially in children, is therefore one of our major priorities and an issue that we made a commitment to tackle in our manifesto.

Evidence shows that obesity is a complex issue to which there is no single solution. Tackling childhood obesity requires a full package of bold measures and collective action by Government, businesses, health professionals and individuals. Our comprehensive childhood obesity strategy, which is being launched this summer, will be a key step forward in helping our children to live healthier lives. It will look at the range of factors that contributes to a child becoming overweight and obese, and it will also set out what more can be done by all. Our cross-Government approach, led by the Department of Health, is based on the latest scientific evidence from Public Health England and the Scientific Advisory Committee on Nutrition.

As for the views expressed today by the National Obesity Forum on how to prevent obesity and type 2 diabetes, Public Health England has described them as irresponsible, as they do not reflect the totality of the evidence base. By contrast, Public Health England’s dietary advice is based on advice from independent experts on the Scientific Advisory Committee on Nutrition, which, in turn, is based on all available evidence. SACN conducts full-scale consultations on draft reports and goes to great lengths to ensure no bias. International health organisations agree that too much saturated fat raises cholesterol, increasing the risk of heart disease, and that obesity is caused by consistently consuming too many calories.

[Mr Speaker]

Order. It should now have become clear, but for the avoidance of doubt, in particular for the benefit of those attending our proceedings who are not within the Chamber, that these matters should be self-contained and readily intelligible. The request from the right hon. Member for Leicester East (Keith Vaz) was to the Minister to provide a statement on dietary advice and the childhood obesity strategy. All is now magnificently clear.

[Keith Vaz]

May I thank you, Mr Speaker, for granting this urgent debate and the Minister for his answer to the question?

The National Obesity Forum’s report published today has led to a public outcry and confusion. Indeed, the conclusions of this report contradict much of the health and lifestyle advice issued by the Government and the NHS over the past decade. Ordinary people are now caught in a whirlwind of conflicting advice at a time when they desperately need clarity, consistency and straight talk. Quite simply, they do not know where to turn. The Royal College of Physicians, the Faculty of Public Health and the British Heart Foundation have all raised concerns about this report. Some have claimed that local authorities, schools and the NHS are receiving guidance from organisations whose funding and motivations are not known. I welcome the use by the Minister of the word “irresponsible” in respect of this report.

The critical issue, however, is the delayed publication of the childhood obesity strategy. We were first told that this would be published in December 2015. We were then told that it would be February 2016. It is now expected at the end of the summer. No doubt you will confirm, Mr Speaker, that there is no clear indication from the Government as to when the end of the summer will be. Amid the delays, other voices are filling the vacuum. Clearly, a strategy is required on what steps are needed to prevent and tackle the growing levels of obesity, which, at current rates, are expected to reach 60% of the adult population by 2025. We need a definitive date for the publication of the strategy. Will the Minister give us a date today? In the Queen’s Speech last week, the introduction of a sugar tax was confirmed, which I warmly welcome. That could prevent 2.7 million people from being obese, by 2025.

Finally, obesity is a leading cause of type 2 diabetes, as the Minister has said. Just as the rates of obesity are set to increase, the number of people with diabetes is expected to rise to 5 million by 2025. As a type 2 diabetic and chair of the all-party group for diabetes, I live with how stark the situation is. Sadly, today’s information tsunami has demonstrated a lack of leadership in public health. Although the Public Health Minister should be commended for all the work she has done, the Government must go further. Failure to act now will jeopardise the future of our nation’s health and the solvency of our national health service.

[Alistair Burt]

I thank the right hon. Gentleman for taking the opportunity of the report’s publication to give the Government the chance to respond and, hopefully, to put in the public realm a degree of concern about the report to back up the comments that he has made. I can do no better at this stage than quote what the chief knowledge officer of Public Health England, Professor John Newton, said today:

“Suggesting people should eat more fat, cut out carbs and ignore calories conflicts with the broad evidence base and internationally agreed interpretations of it.”

He continued:

“This opinion paper from the National Obesity Forum and Public Health Collaboration is not a systematic review of all the relevant evidence. It does not include an assessment of the methodological quality of the studies and should not be confused with the comprehensive reviews of the evidence that are produced by our process. For example, this paper highlights one trial suggesting high dairy intake reduced the risk of obesity, while ignoring a systematic review and meta-analysis of 29 trials which concluded that increasing dairy did not reduce the risk of weight gain.”

I am pleased that the right hon. Gentleman has given us the opportunity to agree with him and others who have said the report is irresponsible.

To respond to the right hon. Gentleman’s questions for the Government, it is clear that the childhood obesity strategy will be much welcomed, but it has to be soundly based. Much though I would like to give a date, I have to say that its launch will indeed be “in the summer”, and the summer is in parliamentary terms a flexible period. In saying that, I do not in any way minimise its importance.

The presence of my hon. Friend the Minister for Children and Families demonstrates that this is a cross-Government strategy. We know it will be scrutinised by many different parties, so it has to be right to give the guidance the right hon. Gentleman talks about. One can look at any national newspaper—one in particular—any day of the week and read conflicting advice on what is good and what is bad. Whereas that might be a source of amusement to the news programmes, for parents looking for what is right for their children, it is vital that they have advice they can trust. That is why the childhood obesity strategy, much commented on in this place, is so important.

The right hon. Gentleman is an important voice in dealing with diabetes. “Healthier You”, the national diabetes prevention programme based on international evidence, will start this year in 27 areas covering approximately 45% of the population and making up to 10,000 places available to people at high risk of developing diabetes, and will roll out to the whole country by 2020. The right hon. Gentleman is right to emphasise the importance of diabetes. I hope he acknowledges that that is recognised by the Government.

[Mr David Nuttall (Bury North) (Con)]

Does my right hon. Friend not agree that instead of all this complex and conflicting nanny state advice, it would be far better simply to advise children to move about more and eat less?

[Alistair Burt]

I am delighted to welcome the question from my hon. Friend the Member for Bury North—may God bless all who live there. I had a small bet with the Secretary of State on how long it would be before the words “nanny state” were uttered, and I was not disappointed.

My hon. Friend is right to ask the question, and we still want to encourage children to move more and eat less—there is nothing contradictory about that. However, a Government who take children’s health seriously, whether in relation to dentistry, deprivation and the environment, or indeed their physical health, weight and wellbeing, are as entitled to comment on this issue as anyone else. The childhood obesity strategy will not contradict efforts to encourage physical activity, but it will, I hope, have elements that my hon. Friend and everyone in his constituency welcomes.

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

Obesity, and in particular childhood obesity, is one of the biggest public health challenges facing our country. Today’s report not only questions official Government advice, but says that it may have had disastrous consequences. Whether that is right or wrong is a matter for debate.

Let me start by asking the Minister about today’s report. It makes a number of recommendations, but perhaps the most controversial has been the call to stop recommending the avoidance of foods with a high saturated fat content. I am pleased that the Minister has reaffirmed that he has no plans to review the Government’s official advice in the light of that call, and has also reaffirmed that the evidence on the current dietary advice remains valid, but does he share the views of experts, including the British Heart Foundation, who have today stressed the importance of official guidance being informed by robust evidence, free from interference by industry?

On the childhood obesity strategy, as my right hon. Friend the Member for Leicester East (Keith Vaz) said, in September we were told that it would be published before Christmas. Then at Christmas we were told that it would be published in the new year. In the new year we were told that it would be published in the spring, and now we are told that it will not be published until the summer, so can the Minister explain this delay? May we now have a cast-iron guarantee that the strategy will be published before the House rises for the summer recess, so that Members will have the chance to question Ministers on the contents of that strategy?

We welcome the recent announcement of a sugar levy, but does the Minister agree that alongside action on cost, we need action on advertising and labelling? Perhaps the real cause of rising childhood obesity has been not the Government’s dietary guidance, but their failure to take tough action on the marketing and packaging of unhealthy products. Will the Minister confirm that the strategy will contain comprehensive and co-ordinated action to tackle this growing public health challenge? Some of the best advances in public health have come about because past Ministers have shown leadership and vision, so may I say politely to this Minister: “Enough of the delay. It is now time to act”?

[Alistair Burt]

I am sure the Under-Secretary, my hon. Friend the Member for Battersea, will be able to pick up a number of issues that the hon. Gentleman has raised, but let me respond to some.

First, in relation to the report, as I emphasised by quoting the remarks from Public Health England, any advice that goes into the public domain which is to have credibility and upon which people should want to rely must be fully evidence based and as thoroughly researched as possible. If there is any doubt about that—if the evidence appears to be scant—it is right that such advice should be dismissed as irresponsible. We should continue to urge people to look at far more in-depth studies and internationally accepted views on health, diet and wellbeing. I made that point and I am pleased that the hon. Gentleman agrees.

In relation to the Government’s activity, the childhood obesity strategy will come forward in due course, but it cannot be said that nothing has been done in the meantime. The sugary drinks tax has been taken forward, and I can assure the hon. Gentleman that advertising, labelling and promotion definitely come into the strategy and will be looked at. Having spoken to my right hon. Friend the Secretary of State for Health, I am sure that the intention is to get the report out at a time when the House will be able to consider it. There is little likelihood of the House not having an opportunity to discuss and debate such an important matter, but it is important to get the report right. It is important that it meet exactly the challenges that the hon. Gentleman made from across the Dispatch Box. If it is not seen to be thorough, well researched and well evidenced, it will fall foul of the concerns raised by the irresponsible report today. I am grateful for his support. The outcome is something we all want to see, and I can assure him that my hon. Friend the Minister will be studying his remarks carefully.

[Philip Davies (Shipley) (Con)]

In the hope that the Minister has doubled up his bets with the Secretary of State, may I join my hon. Friend the Member for Bury North (Mr Nuttall) in urging him to curb the Department of Health’s natural nanny state instincts when it comes to a childhood obesity strategy? If the sugar tax is part of that childhood obesity strategy, can he explain why the tax is being directed at a certain number of products, when other products with far more sugar in them will not be covered by the tax? Will he abandon this policy and encourage the Chancellor to abandon it before it becomes the new pasty tax policy?

[Alistair Burt]

Tempting though it is to use my temporary position for a whole range of announcements in relation to this area, I think that would be unwise. I can inform my hon. Friend that I have him on an accumulator with my hon. Friend the Member for Bury North (Mr Nuttall); I am not saying who is the final part of it. No, the Government will stick to their declared policy in relation to sugary drinks. Perhaps my hon. Friend might welcome the fact that all the money from that is going into physical activity through sports in schools, which I know he is really keen on as well. Perhaps that mitigates any concern he might have.

[Alison Thewliss (Glasgow Central) (SNP)]

We have heard about the evidence base and the importance of looking at that evidence as we move the strategy forward. May I ask, as I did when this was last debated on 21 January, that the childhood obesity strategy look at the evidence that breastfeeding can contribute to reducing childhood obesity? The evidence is there, and it makes a significant contribution, so will the Minister ensure that it gets prominence in the report when it comes to be published?

[Alistair Burt]

Yes, I am very conscious of the issues surrounding this. The hon. Lady already has a meeting with the Under-Secretary, my hon. Friend the Member for Battersea, when these issues can be taken further.

[John Glen (Salisbury) (Con)]

I welcome the Government’s words on the national child obesity strategy and the necessity of making sure that it is authoritative when it is published. However, in the light of today’s unhelpful reports, is not the real point that it is absolutely critical that that strategy deals with many of the myths out there and is truly authoritative and conclusive in the advice that it relays?

[Alistair Burt]

My hon. Friend is absolutely right—that is important. The strategy has been awaited, and if it is to do the job we all want it to do, it should deal with the myths and concerns that have been raised, and do so in a proper evidential manner.

[Norman Lamb (North Norfolk) (LD)]

May I join in a partial, and rather surprising, alliance with the hon. Member for Shipley (Philip Davies) in questioning the sense in taxing just one particular type of product? Would not the Government instead—this is where I part company with him—consider taxing sugar as an ingredient to create an incentive for reformulation of products to reduce sugar content across the board, rather than just picking on one type of product?

[Alistair Burt]

I thank the right hon. Gentleman. He was not on my accumulator, so it has gone down. What he is calling for is exactly what the strategy does. It is designed to be quite wide and to take into account the possibility of other action in other places. He is absolutely correct about that.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Far from raising the nanny state, I welcome the Government’s proposals regarding sugar. There is a difficult issue not only about childhood obesity but about dentistry and the shocking evidence showing that young children today are having to go through procedures that should not be necessary. Will the Minister reissue that guidance and warning to all parents? I have a son who is 19; I know many people will be shocked to hear that. When he was 16, he had not had a fizzy pop; by the age of 18, after he had had fizzy pop from 16 to 18, he had 12 fillings. Will the Minister reiterate the dangers of fizzy pop?

[Alistair Burt]

Now we are back on home territory, as I am the Minister responsible for dentistry and can thoroughly concur with what the hon. Lady has said, while sharing the House’s astonishment at her news. The issue of dental clearances and young children’s teeth is a scandal. I will be speaking about this because on Friday I am going to a British Dental Association conference in Manchester and it will form part of my speech. The question is how to reach the parents and carers who have charge of their children to make sure they have access to the sort of treatments that are available, and how we work through schools, and through dentistry itself, to try to make more provision available for those who can be reached so that we deal with this terrible problem. There are some good experiments going on, not least in Nottingham; I think that the hon. Member for Nottingham North (Mr Allen) is partly responsible for those. The hon. Lady is right: dental issues are a serious matter to be dealt with in the overall health strategy.

[Kelvin Hopkins (Luton North) (Lab)]

May I first declare that I am a believer in the nanny state? It was the nanny state that stopped children being sent down mines and up chimneys, and much more besides. May I applaud my right hon. Friend the Member for Leicester East (Keith Vaz) for raising this very important issue? Last week when I had a peanut butter sandwich, it tasted rather sweet, so I checked the jar and found it had sugar in it. May I suggest to the Minister that we go well beyond a sugar tax and have some means of stopping sugar being put wrongly into foodstuffs?

[Alistair Burt]

We now have a sugar app, which means that the next time the hon. Gentleman goes down to the supermarket and wants to check how much sugar there is in a product, he can use the app by placing a device against the barcode. My family have used it and they have found, to their astonishment, how much sugar is contained in products that they never expected to contain it. This is not only about making sure that there is a reduction in sugar content where that is possible and appropriate, but about alerting consumers to the amount of sugar, which is really important. I shall ensure that the Under-Secretary, my hon. Friend the Member for Battersea, gives him details about the app he can use.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I know the Minister is a very reasonable man, so will he explain to my constituents how it can be reasonable for the public health budget in Hull to be cut by £1.56 million in-year? That means a reduction of £300,000 in the obesity strategy, and local authorities of course lead on obesity public health issues, do they not?

[Alistair Burt]

They do. I just have to tell the hon. Lady that all parts of Government are making the sorts of efficiencies they need to make in relation to such matters, and that can be no different for her area.

[Mr David Hanson (Delyn) (Lab)]

Prior to the reported publication date in the summer, will the Minister make sure that he discusses the co-ordination of the strategy very carefully with the Welsh Assembly? In border areas such as mine—advertising crosses the border and labelling crosses the border—people from my constituency who buy sugary drinks in Chester will find that their resources are put into sport in England, but not necessarily in Wales. It is important to consult the Assembly.

[Alistair Burt]

In accordance with the last answer I made to the last question when I was last at the Dispatch Box, the answer is yes.

[Mr Speaker]

Order. We now come to an urgent question to be asked by Mr Bernard Jenkin. Not here. Where is the fella?

Oral Answers to Questions

Alistair Burt Excerpts

Tuesday 10th May 2016 Commons Chamber

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

8. What assessment he has made of the effect of changes to local authority social care budgets on demand for health services.

[The Minister for Community and Social Care (Alistair Burt)]

Good morning, Mr Speaker—[Interruption]—and everyone.

There is a link between adult social care funding and demand for NHS services. More recent analysis shows no definitive relationship, but Forder’s 2009 study showed a £1 reduction in social care spend increasing NHS demand by 35p. That is why Government have driven the integration of health and social care, and given councils up to £3.5 billion of new support by 2019-20.

[Chi Onwurah]

The Royal College of Surgeons has said that

“the new council tax precept will not raise enough funds for the areas of the country”

with the greatest need. In Newcastle, it will raise £1.7 million this year, but the funding gap is £15 million. Why is the Minister’s Government making my constituents pay more for worse social care, increasing the pressure on the NHS and causing misery for millions?

[Alistair Burt]

The better care fund has been adjusted to recognise that not all councils can raise a similar amount of money through the social care precept, so the issue that the hon. Lady raises has been noted and recognised. The only way in which the NHS can achieve better outcomes and meet the challenges of rising demand is through an increased focus on preventive community health and social care, and closer working with local authorities. That is what the pooled budget is designed to deliver, and that is what it will do.

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

Indeed, good morning, Mr Speaker.

A big challenge for local authorities and adult social care is how to fund the increases in the minimum wage that care providers have to pay. As my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) just detailed, the 2% social care precept does not cover all the increased costs and, indeed, in some areas, it is not even being passed on to care providers. The Local Government Association asked Ministers for £700 million from the better care fund to help with that increased cost this year and next year—not in 2019. When will Ministers listen to local councils and agree to bring forward that much needed funding to support what is effectively their own policy in the care sector?

[Alistair Burt]

I do not think that anyone fails to recognise that the next couple of years in social care will be very tight, but that is why the better care fund is there. Work has been done to increase the amount of money available to meet the challenges that the hon. Lady raises. I have to repeat that to fund this properly there has to be a sufficiently strong economy. There has to be the commitment to funding that the Government have been able to make almost uniquely in the House. I sometimes think it would help if she recognised the strength of the economy that has been able to do that by assisting local authorities, rather than complain about the amount of money available.

[Chris Green (Bolton West) (Con)]

9. What steps his Department is taking to ensure provision of good quality A&E services.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

I concur with the remarks that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), just made.

The Government recognise that the NHS and adult social care face significant demand pressures, and established the better care fund to join up health and care. In 2016-17, the BCF will be increased to a mandated minimum of £3.9 billion, with additional social care funding of £1.5 billion by 2019-20.

[Derek Thomas]

NHS Cornwall has a significant overspend in 2015-16 because of the cost of keeping people in acute hospitals rather than their being cared for in the community. Despite the commitment and enthusiasm in Cornwall to achieve meaningful integration of health and social care, the pressure on NHS Cornwall finances threatens this badly needed integration. Does the Minister agree that investment in this today will lead to significant savings for the future and better outcomes for patients?

[Alistair Burt]

I am aware of significant problems in Cornwall that a number of Members have brought to me, and they are very complex. The clinical commissioning group is building on existing work with NHS England to address the financial challenges facing NHS Kernow and the wider local health and care system. Statutory directions were put in place late last year to support the CCG’s work with local partners in ensuring that services are affordable as well as good. An independently led capability and capacity review is being completed and an action plan is being implemented. I encourage the CCG to continue to work closely with NHS England to help to put its finances on a firmer foundation to achieve its integration plans. There is a further meeting planned locally tomorrow.

[Liz McInnes (Heywood and Middleton) (Lab)]

We recently had a Westminster Hall debate on care workers not even being paid the national minimum wage, and now we have private social care providers saying that they will not be able to afford the new national living wage. How does the Department intend to address this impending crisis?

[Alistair Burt]

It is absolutely essential that workers are paid the national minimum wage, and for care workers that includes travel. The Department has been very clear in that regard. Extra money is being provided to local authorities to pay for social care, as we know, but matters are tight—I am well aware of that. We are looking to providers and local authority providers to meet their statutory obligations to ensure that hard-pressed care workers have the financial support they need to do their vital job.

[Helen Whately (Faversham and Mid Kent) (Con)]

14. What progress his Department has made on delivery of the NHS five year forward view.

--- Later in debate ---

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

Research published yesterday by NHS Providers and the Healthcare Financial Management Association showed that half of mental health trusts had not had an increase in their budget in 2015-16 and just a quarter of providers are confident that they will receive a funding increase for this financial year, 2016-17. Will the Secretary of State finally admit that the supposed additional investment in mental health that he talks about so often has not materialised for the patients and services that need it most? What is he going to do about it?

[The Minister for Community and Social Care (Alistair Burt)]

I thank the hon. Lady for her question and for her support for me in the recent London marathon. With reference to her question, it is precisely for the reasons she gives that it is so important for us to make sure that CCGs do transfer the extra money that is available for mental health into mental health services. That is why there will be more transparency and a scorecard for CCGs. She is absolutely correct—it is essential that that money flows through and we are determined to ensure that. Yesterday’s report only shows how right our current actions are to make sure that that happens.

[Mr Alan Mak (Havant) (Con)]

T3. The Havant Men’s Shed movement has created community workspaces across my constituency, helping to boost mental health and wellbeing, especially for older residents. Will the Minister join me in congratulating the movement on its work and come to Havant to open its new building?

[Alistair Burt]

Yes. My family know I am a keen supporter of the shed movement, just as I am a keen supporter of the 5 Live Saturday afternoon movement and the beer in the shed movement. I can assure my hon. Friend that an opportunity to visit the Havant Men’s Shed movement will be an important part of the ministerial diary in the very near future.

[Mr Speaker]

The Minister is an endlessly noble fellow—I think we are very clear about that.

--- Later in debate ---

[Mr Douglas Carswell (Clacton) (UKIP)]

T5. In my corner of Essex, there is a primary care crisis: demand for GP services is rising, the supply of GPs is falling and many surgeries are simply no longer accepting new patients. What assurance can the Minister give me that we will definitely get more GPs, and when will we get them?

[Alistair Burt]

The concerns the hon. Gentleman raises are very real, and they are shared by GPs around the country, which is why we put so much work into analysing them. The recently published “GP Five Year Forward View” addresses a number of concerns brought to us by GPs, but the determination to have 5,000 more doctors working in general practice by 2020 is a reflection of the fact that making sure there are enough doctors physically to work in general practice is an important aim of the Government’s.

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

T8. My constituent Archie Hill and his parents, Louisa and Gary, were really excited when, on 15 April, the National Institute for Health and Care Excellence recommended that the drug Translarna—a breakthrough drug for children with Duchenne muscular dystrophy —should be funded by NHS England. Hon. Members can imagine what happened when, on 4 May, NICE unexpectedly announced that it required extra time to come to an agreement with NHS England. What is going on? We thought this drug had been cleared. Time is of the essence, because the boys affected are eligible for this drug only if they are still walking. Can we please look into this issue, and can we please go back to the original timetable? After all, these boys have had to wait several years to get to this stage.

--- Later in debate ---

[Norman Lamb (North Norfolk) (LD)]

There is growing concern that the additional investment in children’s mental health services committed last year is not getting through to where it is intended. What will the Secretary of State do to guarantee that that money gets through to help children with mental health needs? It would be scandalous if it did not get through. Transparency is not enough.

[Alistair Burt]

I thank the right hon. Gentleman for all the work he did in relation to this. I can assure him that the £1.25 billion committed in the 2015 Budget will be available during the course of this Parliament. As I said to the hon. Member for Liverpool, Wavertree (Luciana Berger), it is absolutely essential to me and to us that we make sure that that money does get through to CCGs. The regime will be more transparent, but there will be a determination to expose it to make sure that the money is spent on child and adolescent mental health services, as it needs to be.

[Bob Blackman (Harrow East) (Con)]

My right hon. Friend will be well aware that the business case for the rebuilding of the Royal National Orthopaedic Hospital has been dragging on within the NHS for more than six years. We now seem to have a decision for the Trust Development Authority to make. Will he put pressure on the TDA to approve this business case so that work can begin this summer?

--- Later in debate ---

[Mr Speaker]

That was possibly the hon. Gentleman’s greatest inquiry in his membership of the House.

[Alistair Burt]

Yes.

[Several hon. Members rose—]

NHS Bursaries

Alistair Burt Excerpts

Wednesday 4th May 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

And where has the hon. Member for City of Chester (Christian Matheson) been during the debate? [Interruption.] Oh, I beg your pardon, but that is not as good as being here in on the Floor of the Chamber in real life.

Thank you very much, Mr Deputy Speaker, for this opportunity to respond to the debate. I thank the hon. Member for Lewisham East (Heidi Alexander) for raising the important question of the development and expansion of nurse training in England. I thank colleagues for a good debate, with discussions informed by those with close connections with the NHS, either personally or through family.

I pay tribute to all those who work and train in hospitals, who fill the posts that we have been speaking about, and who are the subject of our debate. They are not only nurses and midwives; several colleagues made specific references to allied health professionals, such as those in dietetics, occupational therapy, orthotics and prosthetics, physiotherapy, podiatry and chiropody, radiography, speech and language therapy, operating department practice, dental hygiene and dental therapy—all important components of the NHS. We recognise the importance of the work done in our hospitals, and we thank them for their effort.

This has been a not unusual debate in which the Government propose changing something and the Opposition react with horror. Whether the Government’s arguments are good or bad, that is how it goes. There have been a variety of Opposition arguments—some good, some less good—but whenever change is proposed, there is a set of reactions. As for the poorest reaction, I say this to the hon. Member for Lewisham East with great sincerity: please do not go down the class route. It was absolutely unnecessary to try to pick out what people might have heard in various places as they were growing up and graduating. I am the son of a doctor and a teacher, so there were public health workers in my household. The sense that I got of public service and commitment was possibly shaped then. I do not think that the experience was any different from that of the hon. Lady, or of the hon. Member for Liverpool, Wavertree (Luciana Berger), who had a private education at Haberdashers’ Aske’s School for Girls. I see no evidence in the hon. Lady’s obvious commitment to mental health and everything else that her conversations shaped her poorly in any way. To suggest that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), may not have picked up the same sort of information, and that that may have impacted on his care and work as a Health Minister, was pretty low. The hon. Member for Lewisham East should not go down that road again.

The two main arguments presented today against what we are trying to do have been about deterrents, or the idea that the occupations are somehow unpalatable and that people will not go into them. On deterrents, I am old enough to have been here for the original debates on the introduction of student fees. Everyone protesting against them at the time said that no one would ever go to university again, and that people from poor backgrounds would never go to university. The same arguments come up every time the subject is raised, and the same arguments have been proved false time and again. What is not false is the damage done at the time of the debates when it is suggested to those who want to aspire to higher education, and to take themselves in a different direction, that it will somehow be made impossible, and that they should not want to do it. Those arguments have been used time and again, and they have been used again today. They were wrong then; they are wrong now.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

What is unique about this situation, as has been mentioned several times, is that a disproportionate number of the nurses using the bursary scheme enter as mature students, including three of my nieces. If bursaries were not available to them, they would not have gone on to train as excellent nurses.

[Alistair Burt]

If the hon. Lady had been here for the entire debate, she would have heard people speak about the problems of hardship following bursaries; that was referred to by the hon. Member for Ilford North (Wes Streeting) and by Government Members. People want access to more funds, which might help those whom the hon. Lady just mentioned, but the assumption is that, because it will be a student loan and because it is a change, people just will not want to do the courses. There is no evidence to suggest that that is correct. Using it as a scare story is unhelpful for the recruitment that we want.

[Nic Dakin]

Does the Minister accept that the royal colleges and others are genuinely anxious about the proposals? If he does, will he commit to engaging with them as fully as possible?

[Alistair Burt]

That is a good question. Yes, of course. At a time of change, there is a degree of uncertainty. My main point is about how the matter has been blown up yet again, as it was for student loans originally. The idea that people would be deterred from ever going to university, and that no one would go from disadvantaged backgrounds, has been proved false. Of course, the concerns are very much being addressed by the consultation that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich, is undertaking, and he is listening extremely carefully. The consultation process is very wide and genuine, and he is listening particularly to ideas on alterations and proposals. The consultations are not complete and the scheme is not complete, and he is keeping a close ear on those consultations.

There is recognition that there are different characteristics for those who go into nursing, midwifery and allied health professions, which is why we want to make sure that appropriate support is available. Department for Business, Innovation and Skills student support regulations give more support than the bursary; the Secretary of State retains the power to give discretionary funding in exceptional cases; and in the consultation, respondents can give examples of unique characteristics, so that the reforms can reflect that. Our position recognises that, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said, more of the same will not do the job. The need for change is there. We need more nurses, and we need more nurses domestically trained. We are going to do something different, recognising what changes there might be. That is why we have the consultation. Unique characteristics will be reflected in it; that is what the consultation is about. Keeping the current system is not working and will not work in the future. That is why we need change.

[Paula Sherriff]

My local Mid Yorkshire Hospitals NHS Trust is, by its own admission, in the midst of a nursing crisis, with about half the wards staffed at below the minimum staffing level for nurses. Does the Minister think these proposals will help or hinder that?

[Alistair Burt]

I say in all honesty to the hon. Lady, who is knowledgeable about health matters and has been to see both me and the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich, that the proposals help. At the moment, the problem with nurse training in this country is that it is limited. The universities cannot take all the people who want to be nurses; they have to turn them away—37,000 of them. This scheme opens up the opportunity for more people to train, and for more people to come into nursing through the nursing associates route. If the hon. Member for Dewsbury (Paula Sherriff) is looking for a straight answer on whether this will provide more nurses and help her local hospital, I can say: yes, it will. That is why these proposals are being made.

I wish to set out briefly the details of the basis for the reforms, just for those who were not able to attend the whole debate, and then answer one or two questions that were raised. To deliver more nurses, midwives and allied health professionals for the NHS, a better funding system for health students in England and a sustainable model for universities, we need to move nursing, midwifery and allied health students from grants and bursaries on to the standard student loans system. Putting more funding into the existing system was not a sensible or viable option for the Government, if we are also to increase the number of student places, live within our budget, and ensure that the NHS can use the extra £10 billion-worth of additional investment for front-line care by the end of the Parliament.

The subjects that we are talking about are extremely popular with students. In 2014, nursing registered as the fifth most popular subject on UCAS, and in that year there were 57,000 applicants for 20,000 nursing places. Rather than denying thousands of applicants a place to study health subjects at university, surely it is better that the new proposals ensure enough health professionals for the NHS, while cutting the current reliance on expensive agency and overseas staff, and giving more applicants the chance to become a health professional. Part of the reason why we need to modernise the funding system is that student nurses, midwives and allied health students currently have access to less money through the NHS bursary than students using the student loan system do. Under a move to the loan system, these health students will receive an increase of about 25% in the financial resources available to them for living costs during the time they are at university.

It is not possible to pick out all the speeches made today, but I would like to make reference to some. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) discussed issues affecting postgraduate students, which are important. The majority of healthcare students undertaking these courses will be able to access a BIS postgraduate masters loan, although we acknowledge in the consultation that some courses currently fall outside the BIS postgraduate loan package. We are working with BIS and the Treasury on their higher education and lifelong learning review, and we will address these matters in the Government’s response to the consultation, so she is right to raise that issue.

My hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, said straightforwardly that we need to train more nurses. That is our bottom line; it is what we are trying to do. On transition, she said that it was important to listen to needs, and she spoke about getting more professionals away from the acute sector and into primary care. As she knows, that is a major interest of this Government, and these proposals will help in that regard.

My hon. Friend the Member for Morecambe and Lunesdale (David Morris) was straightforward. He talked about his trust recruiting from abroad, but said that it would like to recruit more at home. It will be able to do so under these proposals.

My right hon. Friend the Member for Hitchin and Harpenden (Mr Lilley) talked about what he discovered when he spoke to his local university and trust. He discussed the morality of taking more nurses, and student nurses, from overseas. It is important to recognise that our proposal will ease that situation to some degree. He also spoke about the important issue of the Ministers’ dilemma: of whether to put money into training now, knowing that the benefit will come some years later. It is important for any Government to recognise that more money must go into the training of doctors and of the people about whom we are talking today. There will be a return later.

I am conscious of time, and I am sorry that I cannot cover more speeches. Let me say this: the NHS never sleeps or stays still. As our country changes, so does the NHS; it must. It is always comforting to resist change, even when the status quo is not good enough; however, the need for innovation, which will be challenging and resisted, is imperative. This Government have given the NHS that commitment, and we will promote the finance, planning and innovation that were denied by the Opposition. We will not allow so many people to be denied the opportunity of becoming a nurse. We will not allow those on hardship funds and bursaries to fail to get access to more finance. We will not allow them to be—

[Mr Alan Campbell (Tynemouth) (Lab)]

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

Question put forthwith, That the Question be now put.

Question agreed to.

Question put.