Medical Centre (Brownsover)

Alistair Burt Excerpts

Monday 7th March 2016 Commons Chamber

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

I thank my hon. Friend the Member for Rugby (Mark Pawsey) for bringing the debate to the House, and for the courtesy and kindness with which he has described my role. I certainly get it. I certainly get the frustrations involved in dealing with property matters in relation to the NHS, matters to which I have become more accustomed in the past nine months or so. I wish I was able, at the conclusion of my remarks, to give him all the assurances he wants, but as the NHS is an independent body I cannot quite do that. However, we can, perhaps, get somewhere towards it, because of how he has brought the case and defended his constituents’ interests.

My hon. Friend has fairly described the issues in his community of Brownsover, with its mix of peoples and complex needs. The medical centre is a matter of extreme concern to his constituency. The uncertainty over the future provision of GP services in Brownsover has continued for more than a year, and that is only the latest chapter in the catalogue of events that he described. It is clearly unacceptable to him and his constituents. I am fully aware that local people and patients have expressed their frustration in a number of ways. I know he shares that feeling, and so do I. I will say a little about the general position of our GPs, their premises and the pressures they are under, and then turn to the particular.

Like every other part of the country, Brownsover needs good local health services, in particular its local GPs. General practice is the bedrock of the NHS and it is at the heart of this vision. It reflects the GP’s key role in providing continuity of care, which is especially important to people with long-term health conditions; the importance of expert generalists, doctors and wider practice teams who look at the whole person, including their medical, social and psychological needs in the round; the fact that general practice is rooted in local communities; and the key role of general practice in public health in immunisation and screening programmes. We ask our GPs to look after people from cradle to grave, and to know when and where to refer patients when specialist care is needed. We also expect them to commission much of the specialist care provided in hospitals.

The key factors affecting the environment within which general practice works, and the challenges and the opportunities they present, include: an ageing population, with increasing numbers of people living with multiple health conditions; higher public expectations, linked to the role of digital technology; a very constrained financial position over the past five years, with general practice seeing a steady decline in its share of the overall NHS budget, albeit after a rapid growth in resources after the 2004 GP contract; and a change in the structure of practice, including a struggle to maintain partners, a growing proportion of salaried GPs, a growing number of GPs wanting to work part time—not just women, but men—and a rise in portfolio careers.

There has been an increase of about 25% in GP consultations since 1998—an estimated 340 million consultations every year. That is the work we expect our GPs to do and which they perform extraordinarily. Within five years, we will be looking after 1 million more people over the age of 70. Quite simply, if we do not find better and smarter ways to help our growing elderly population to remain healthy and independent, our hospitals will be overwhelmed. That is why we need effective, strong and expanding general practice more than ever before in the history of the NHS—an NHS committed both through its premises and through its commissioning to respond to the sorts of pressures my hon. Friend rightly described in relation to Brownsover.

At last year’s election, we committed ourselves to the challenging objective of increasing the primary and community care workforce by at least 10,000 and ensuring that 5,000 more doctors work in general practice, as well as more practice nurses, district nurses, physicians, associates and pharmacists. We will focus recruitment on the most under-doctored areas, where the problems are most acute. Since 2010, the GP workforce has already increased by 5%, with an additional 1,700 GPs working or in training. Over 90% of all NHS patient contact happens in general practice. The average person in England sees their GP six times a year.

All that has profound implications for how general practice works—for the clinical model, the business model and the career model—but, under all that pressure, the profession is rising to the challenge. Practices are increasingly coming together in federations or networks to build on all the traditional strengths of general practice, working at a greater scale to improve efficiency and spread innovation to offer a range of services they struggle to provide individually. There is a strong push towards greater integration with community health services, mental health services, social care and some specialist services, and there is increasing use of the wider primary care team, including nurses and particularly pharmacists.

That is the background to the work, the concerns about general practice and how the Government intend to meet the challenges by delivering pilot projects and vanguards and by looking at different ways of providing GP services. However, people need premises to work out of, so I will now turn to the circumstances that my hon. Friend described. This matter goes back some time, but I can deal in detail only with the events since the notice of closure last year. I am grateful to him and representatives from NHS England and NHS Property Services for meeting me recently to discuss the matter in the round.

The Albert Street medical practice in Rugby and its branch surgery in Bow Fell, Brownsover, closed in April 2015, and Rugby Town medical practice took over the provision of GP services for the patients affected, with the expectation, at the time, that a new practice in Brownsover would open in 2016. In November 2015, representatives of NHS Property Services met NHS England and the Coventry and Rugby clinical commissioning group, and subsequently the Department of Health, and it was agreed that NHS Property Services would be the lead property company supporting NHS England on the development of the new Brownsover facility. NHS England is the lead organisation for the new development.

At a meeting with members of the Brownsover patient action group and my hon. Friend, NHS England explained that the business case previously approved for the development required reviewing because of the change in the size of the development and the change to the lead organisation. A project team, which included members from NHS Property Services and NHS England, was set up to determine the most appropriate method for delivering the scheme. Additional information required for the development of a new business case is now in place. At a meeting with me and my hon. Friend on 22 February, NHS England in the west midlands confirmed that a decision to award a contract would be made that week, and the partner has now started work. This included an initial meeting, on 29 February, with NHS England, the community health partnership and a representative of the Brownsover patient action group.

As I indicated to my hon. Friend, the provision of premises in the NHS is not always straightforward. Ownership of existing premises tends not to be in the same hands—they might be owned by a former GP, a property company or the NHS itself—and all the issues connected with the division of proceeds of land and the need to move carefully on planning come into play even for GP premises and services. Add to that the uncertainty around new developments and the like, and the difficulties, although frustrating, can mount, and that has been the situation here.

Some questions and answers might help my hon. Friend and his constituents. Patients in Brownsover were told that their facility would open this year. When can they now expect it? I understand that NHS England has updated him, as he said, and he is now aware that a contract was awarded on 24 February, but a full business case needs to be developed, which NHS Property Services estimates will take nine months to produce. There will then be a two-month period in which to reach financial close, and around a year for construction and commissioning.

I will say a little about that because it is complex and it might help my hon. Friend’s constituents and others if I put it on the record. It may also help me, in dealing with NHS Property Services, to see how we might streamline the processes rather more than they are streamlined at the moment.

The outline business case and full business case process is an NHS England requirement for commissioners to progress where public capital funds are being invested. Commissioners are required to develop and update an estate strategy that aligns with their commissioning strategy. For very large investments, it might be expected that a strategic outline case is produced. This aims to ensure that all relevant parties are signed up to the associated expenditure.

The clinical commissioning group has included the proposed new Brownsover surgery in its strategic estates plan. This is fundamental if NHS England and the CCG apply for primary care transformation funds or customer capital investment moneys. Once the capital investment has been approved in the estates strategy, the scheme moves forward to an outline business case, and demonstrates the options, costs and benefits. There may be some preliminary design work to establish that planning consent will be achievable. The outline business case also sets out the preferred option and confirms affordability. Because there are different methods of procurement, the outline business case will establish the preferred procurement route and identify the source of funding.

Once the preferred option is identified and approved as being value for money and affordable, the case moves on to the more detailed design and costing to confirm that it meets all requirements and that the budget is set. Again, this detailed work is used to confirm value for money and affordability. The timescales for each stage tend to vary depending on the complexity and scale of the business case.

The Brownsover case is relatively small and less complex than some, but it still involves an option appraisal, land acquisition, design and costing, planning application, procurement tendering processes, agreements for lease and then construction. The House will be glad to know that NHS Property Services advises that it has streamlined its approvals requirement so that investment capital or lease acquisition requires executive approval by two directors and does not need to go before a committee.

That outlines some of the issues pertaining to the background and the agreements that need to be put in place before planning permission can be approved and the matter can move forward. The timetable will be determined partly by the commissioners’ approval process and partly by NHS Property Services procurement route.

“Why so long?”, patients will ask, and they will say that it is a bureaucratic mess. Well, it perhaps sounds more complex than it might be, but this is a public scheme with public value for money, and detailed work is needed to confirm that value for money and affordability. While the Brownsover case is relatively small and less complex, it still involves, as I said, an option appraisal, acquisition, design and costing, planning application, tendering, agreements for lease and then construction.

It must be frustrating for patients and for my hon. Friend to hear all that set out, but in all honesty, I felt that I had to do so. It is not all the fault of those handling property services. They know that if there is a flaw in their process and something goes wrong, they will be hauled over the coals. However, the mere recitation of the process—to you, Madam Deputy Speaker, and to the House—gives rise to the thought that perhaps somewhere, something might be telescoped to give patients the hope that an element of urgency might be produced, particularly where a closure has been in place and it was anticipated for some time before that that new premises might be available. In those circumstances, it is perhaps the Minister’s job to stay on hand with my hon. Friend to make sure that any such urgency flows into the system.

In conclusion, I can confirm that NHS England now believes that the previously approved business case had to be reviewed because of the changes in the size of the development, but it is working on amending the business case and I am told that it will be completed shortly. Once that has been done, NHS Property Services will be in a position to decide how the Brownsover scheme is to be delivered. Although it seems it will not be built in 2016, the fact that progress has been made—in no small measure due to my hon. Friend’s activity—means, I hope, that there will be good news in the future. The closure was not of NHS England’s own choosing, and it has had to respond to that fact. The difficulties outlined by my hon. Friend, together with the frustrations involved in dealing with the complexity of the building processes, have combined to make the situation for patients sadly more difficult than it should be, but there have been reasons for that.

I hope that we can now move on, given the determination of NHS Property Services to fulfil the commitment that it has given to me, and to my hon. Friend, to do all that it can to work with him and with the patients. It is working very hard in that regard, and I pay tribute to those who are now involved in the process of moving that work forward. I pay tribute to the patients for their own patience. Perhaps in due course, they will have the new facility that they so richly deserve.

Question put and agreed to.

Draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016

Alistair Burt Excerpts

Tuesday 1st March 2016 General Committees

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

I beg to move,

That the Committee has considered the draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016.

It is a pleasure to serve under your chairmanship, Ms Dorries. The draft order makes changes to the pharmacy regulators’ powers to regulate pharmacy premises. In broad terms, the intention is to remove the General Pharmaceutical Council’s duty to set standards in rules; it will instead set them as code of practice-style obligations that are enforced through disciplinary committee procedures. The Northern Ireland regulator, the Pharmaceutical Society of Northern Ireland, will have a statutory duty to set standards for registered pharmacies, and the draft order will clarify what those standards can cover.

The draft order will make changes to the regulators’ ability to issue interim suspensions from the premises register. The General Pharmaceutical Council’s powers relating to improvement notices will be amended. It will be enabled to publish reports of pharmacy premises inspections. Its powers to obtain information from pharmacy owners will be changed. A correction will be made to the Pharmacy Order 2010 in respect of the notification of the General Pharmaceutical Council of the death of a pharmacy professional. All the changes have been developed with the agreement of the regulators, the Government and the devolved Administrations. The General Pharmaceutical Council’s pharmacy premises standards may relate to the regulation of pharmacy technicians, which is a devolved matter, so the draft order has also been laid in the Scottish Parliament. The draft order was debated in another place on Monday 22 February.

I will give the Committee some background. All pharmacists and pharmacy technicians who practise in Great Britain must be registered by the General Pharmaceutical Council. Pharmacists who practise in Northern Ireland are registered with the Pharmaceutical Society of Northern Ireland. Pharmacy technicians are not a registered healthcare profession in Northern Ireland. Unlike most other healthcare regulators, the pharmacy regulators are also responsible for the regulation of registered premises. The regulation of retail pharmacy premises is the subject of the draft order.

The key change for the General Pharmaceutical Council, and one of the Law Commission’s recommendations, is that it should no longer be required to set standards for registered pharmacies in rules. Instead, the standards should be aligned with other regulatory standards and be code of practice style-obligations, enforced through disciplinary procedures. This supports the General Pharmaceutical Council’s approach, since its inception in 2010, to move to an outcomes-based approach to pharmacy premises regulation. Overall, the draft order will align the legal status of registered pharmacies standards with the status of standards for individual registrants.

As a consequence of moving the standards out of rules, they will no longer be included in a statutory instrument that is subject to Privy Council approval. Increasing the autonomy of the General Pharmaceutical Council in this way is in line with Government policy. However, the draft order includes an explicit requirement for the General Pharmaceutical Council to consult Scottish Ministers, as well as English and Welsh Ministers, on changes to pharmacy premises standards.

The General Pharmaceutical Council’s standard setting powers are being extended to include associated premises; that is, premises at which activities are carried out which are integral to the provision of pharmacy services. This reflects the fact that, in some respects, the traditional model of pharmacy premises being entirely self-contained operations at which all aspects of the retail pharmacy business are carried out is outdated for some businesses. Integral parts of their business operations—for example, electronic data storage—may be elsewhere. Very similar changes are being made in relation to Northern Ireland.

The disqualification procedures for pharmacy owners and the procedures for removing premises from the premises register will be amended for both regulators: first, so the disqualification procedures apply to retail pharmacy businesses owned by a pharmacist or a partnership, as well as bodies corporate; and, secondly, to clarify that the test to apply sanctions, where premises standards are not met, is whether the pharmacy owner is unfit to carry on the retail pharmacy business safely and effectively. The General Pharmaceutical Council already has powers to issue improvement notices where a pharmacy owner breaches the standards for pharmacy premises.

The draft order will make two amendments to the sanctions provisions relating to breaches of improvement notices. The two changes mean that the General Pharmaceutical Council will deal with all breaches of premises standards as disciplinary matters. Both regulators are being enabled to make suspension orders, pending a full hearing of the case against the owners of pharmacy premises, and to make interim suspensions from the register prior to a disqualification decision or a removal decision taking effect. These changes reflect the move to better align the disciplinary provisions for pharmacy owners, in respect of breaches of pharmacy premises standards, with those for individual registrants.

[John Redwood (Wokingham) (Con)]

The power in article 18, which the Minister has already referred to, is that Ministers have to be consulted before a change is made to the rules. What is the point of that? It does not seem that Ministers have any right of veto, or to insist on anything different, so why do they not just trust the regulator?

[Alistair Burt]

Bearing in mind Ministers’ overall responsibilities to duties under the NHS, legislation about what pharmacies do and the general mandate of the NHS in relation to pharmacies, a consultation procedure is still required so that Ministers are made aware of the sort of changes that are being included, to ensure that those changes fit with other aspects of the NHS mandate for which Ministers are responsible. In no sense is that anything other than permissive. If there was disagreement and Ministers did not want to continue, that would be an important part of the discussion. But I do not think that a general duty to consult is necessarily a bad thing and it conforms with other responsibilities that Ministers may have.

The remaining changes are for the General Pharmaceutical Council. It is currently required to make rules in relation not just to premises standards but to the information obligation of pharmacy owners. The latter duty is permissive. The draft order will also clarify when the General Pharmaceutical Council can require pharmacy owners to provide such information and the type of information covered. Currently, there is no provision about how these information-gathering rules are to be enforced, and this gap is being filled by making use of the existing enforcement regime via the General Pharmaceutical Council’s improvement notice system. The General Pharmaceutical Council is also being enabled to publish reports and outcomes from pharmacy premises inspections.

The opportunity is being taken to correct an error in the Pharmacy Order 2010 to require notification of the death of a registered pharmacist or registered pharmacy technician by a registrar of births and deaths, or in Scotland a district registrar, rather than by the Registrar General, as the legislation currently states.

A full public consultation on the draft order was conducted across the United Kingdom from 12 February 2015 to 14 May 2015. There were 159 responses and the overwhelming majority supported the proposals, with many welcoming them. However, the need for guidance—whether from regulatory professional bodies or others—was raised in response to a number of the proposals, to help understand the proposed changes and their impact in practice. To supplement the consultation, a number of events were arranged across the UK for patients and the public. Participants at the events gave unanimous support to the proposals for an outcomes-based approach to standards for registered pharmacy premises. The emphasis on patient safety was welcomed and it was recommended that pharmacy users should have a voice in whether good outcomes for patients are being achieved by pharmacies. Publication of inspection reports in Great Britain was also welcomed.

In summary, the key proposals concerning the continuing development of an outcomes-based approach to standards for registered pharmacy premises build on best practice. The proposal that the standards should not be placed in legislative rules follows as a consequence of this approach and will enable the General Pharmaceutical Council, and eventually the Pharmaceutical Society of Northern Ireland, to respond quickly when reviewing and updating the standards to keep pace with the increasingly rapid changes in pharmacy service provision. I commend the draft order to the House.

--- Later in debate ---

[Alistair Burt]

I am grateful to the Committee for its response and appreciate the support for the draft order in that narrow part of our discussion. I did anticipate that one or two other issues might be raised. With your permission, Ms Dorries, if you feel that those contributions were in order, I am happy to respond briefly.

The draft order is set in the context of the changes being proposed to community pharmacy. Let me lay out, as best I can, what the Government have in mind. In essence, we want to see community pharmacy better integrated into primary care, by increasing the number of pharmacists who bring their skills to GP practices, care homes, and urgent care and public health settings. We need a clinically focused pharmacy service, better integrated with primary care and public health, in line with the five year forward view.

We are consulting with the pharmacy sector and patient groups on how to introduce, for example, the pharmacy integration fund. That will transform how pharmacists operate in the NHS, reducing pressure on A&E and GPs by making better use of pharmacists’ terrific clinical skills to help deliver seven-day health and care services. Proposals for discussion include more pharmacists in GP practices, working closely with GPs to optimise the use of medicines and promote healthy living; patients often seeing a pharmacist instead of a GP, particularly for minor ailments, adding capacity to the system and freeing up appointments; establishing a named pharmacist in care homes who can discuss and review medicines and work with the patients to get the best possible outcomes; and integrating pharmacists as part of all care processes as standard, as a key means of maintaining public health and preventing ill health.

We want to see that development in pharmacy, and to an extent we are going with the grain of what the pharmacy sector has been looking for for some time. Studies by the Royal Pharmaceutical Society and the Nuffield Trust say that pharmacy needs to change, and needs to recognise that it can contribute further to the NHS, in addition to the excellent services that are based in more and more high street pharmacies. Not all high street pharmacies provide the same services; one issue is that some 40% of pharmacies are in a cluster of three or more pharmacies within ten minutes’ walk.

To address the point made by the hon. Member for Bishop Auckland, we are proposing an access fund whereby more NHS resources will be devoted to pharmacies in areas where the cluster argument does not apply. Quite sensibly, no one wants to lose a pharmacy; if a pharmacy finds itself having difficulties with the new financial regime, we want to make sure that it is able to continue. Discussions are already proceeding with pharmacy representatives about how the access fund will be set out, because there must be national standards—a set of rules to let people see how things are done.

We feel that the combination of the access fund, which will make sure that pharmacies in key areas can continue their work, with the integration fund, which will assist more pharmacists to work in different settings, is what pharmacy needs. Let me be honest among all colleagues: it would be great if that could be done against a background of no reductions in finance, or ever more finance going in, but we are not in that situation. We need to fulfil the commitment, made by my party at the general election, to put more funding into the NHS. That £8 billion commitment is now a £10 billion commitment by 2020. All colleagues know that it is not just about the extra money; it also depends on the £22 billion of efficiencies set out by Simon Stevens, chief executive of the NHS. All parts of the NHS need to contribute to those efficiencies, and that includes pharmacy. It is the Government’s genuine belief that, even within the new envelope that will provide £2.63 billion to pharmacy this year, it will be possible for pharmacies not only to continue their excellent work, but to develop it in the ways that I have set out and that we believe pharmacy wants as well. That is what we intend.

There will be an opportunity for further discussion and debate about this; I know colleagues are receiving letters about it, so the debate has some way to go. We are in discussion and negotiation with those who represent pharmacies; there is an interesting conversation taking place and we want to see it continue.

[Helen Goodman]

Is the £2.6 billion subsidy partly for medicine, or is it a subsidy for the infrastructure of the pharmacy network?

[Alistair Burt]

I would not say that this is a subsidy. It is payment made by the NHS and the taxpayer for the provision of premises and the work that pharmacists do. It is essentially more about infrastructure. The drugs bill is beyond that; that is the agreement. It is still a significant amount of money that will go into the provision of services. Where we find pharmacy services looking to work in different ways, which is already happening—there are pharmacists in GP surgeries and on some hospital wards—we want to encourage that process, without damaging the exceptionally good high street service that is provided by the majority of pharmacists, which we want to see continue.

The draft order fits in with that approach by changing the rules on the regulation of premises. It will make sure that the regulators can do their job in the way we all want to see—with procedures for guidance, as opposed to strict legislative rules. This is in line with the autonomy of professional regulatory bodies that the profession and the Government are looking for. I am grateful for the Committee’s support.

Question put and agreed to.

Mental Health Taskforce

Alistair Burt Excerpts

Tuesday 23rd February 2016 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health to make a statement on the Government’s response to the final report of the independent Mental Health Taskforce.

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

Achieving parity of esteem for mental and physical health remains a priority for this Government. I appreciate the hon. Lady’s raising of the urgent question this afternoon. We welcomed the independent Mental Health Taskforce launched by NHS England last year, with its remit to explore the variation in the availability of mental health services across England, to look at the outcomes for people who are using services, and to identify key priorities for improvement.

The taskforce, chaired by Paul Farmer, chief executive of Mind—I thank him, the vice-chair, Jacqui Dyer, and the whole team for the remarkable work they did—also considered ways of promoting positive mental health and wellbeing, ways of improving the physical health of people with mental health problems, and whether we are spending money and time on the right things.

The publication of the taskforce’s report earlier this month marked the first time a national strategy has been designed in partnership with all the health-related arm’s length bodies in order to deliver change across the system. This also demonstrated the remarkable way in which society, the NHS and this House now regard mental health and how it should be seen and approached.

This Government have made great strides in the way we think about and treat mental health in this country. We have given the NHS more money than ever before and are introducing access and waiting-time targets for the first time. We have made it clear that local NHS services must follow our lead by increasing the amount they spend on mental health and making sure that beds are always available. Despite those improvements, however—and I referred earlier to the way in which we view these matters—the taskforce pulled no punches. It produced a frank assessment of the state of current mental health care throughout the NHS, pointing out that one in four people would experience a mental health problem during their lifetime, and that the cost of mental ill health to the economy, the NHS and society was £105 billion a year.

We can all agree that the human and financial cost of inadequate care is unacceptable. The Department of Health therefore welcomes the report’s publication, and will work with NHS England and other partners to establish a plan for implementing its recommendations. To make those recommendations a reality, we will spend an extra £1 billion by 2020-21 to improve access to mental health services, so that people can receive the right care in the right place when they need it most. That will mean increasing the number of people completing talking therapies by nearly three quarters, from 468,000 to 800,000; more than doubling the number of pregnant women or new mothers receiving mental health support, from 12,000 to 42,000 a year; training about 1,700 new therapists; and helping 29,000 more people to find or stay in work through individual placement support and talking therapies.

I assure all Members that they will have ample opportunities to ask questions and debate issues as we work together to implement the taskforce’s recommendations.

[Luciana Berger]

The final report of the Mental Health Taskforce, commissioned by NHS England, provides a frank assessment of the state of mental health care, and describes a system that is “ruining” some people’s lives. It contains a number of recommendations which, if implemented in full, could make a significant difference to services that have had to contend with funding cuts and staff shortages at a time of rising demand, leaving too many vulnerable people without the right care and support.

It is extremely disappointing that the Opposition have had to compel the Minister to come to the Chamber today to ensure that Parliament can give the report and the Government’s response to it the attention and scrutiny that they deserve. It is all the more regrettable because the Prime Minister himself chose to announce their response to the media during last week’s recess—a courtesy which, had it not been for the urgent question, would still not have been afforded to the House. The Government’s apparent announcements included the announcement of a supposed “additional” £1 billion of investment by 2020, but a number of vital questions remain unanswered.

Will the Minister explain why the report was delayed and published during the recess? Did Ministers or No. 10 have a say in the timing, and, if so, does the Minister accept that such a level of interference on the part of Ministers raises questions about the independence of the report? Can the Minister confirm that no additional money will be allocated from the Treasury to fund what the Government have announced, and that it will be funded from the £8 billion that has already been set aside for the NHS to receive by 2020? Given that mental health is given just under 10% of the total NHS budget, surely mental health services would have expected to receive much of that additional money as part of the NHS settlement anyway. Can the Minister explain how the money can be expected to deliver the “transformation” in our mental health services that the taskforce says is urgently required?

Can the Minister also confirm that he is accepting all the recommendations relating to the NHS? Does he intend to respond to the other recommendations, and when can we expect that response? As the report makes clear, we do not solve the challenges of our nation’s mental health by means of the Department of Health.

On behalf of the many thousands of people who have been let down by the Government, who are desperate to see a change in the way in which we approach mental health, and who are owed a full explanation from the Government of their response to this damning report, I look forward to the Minister’s reply.

[Alistair Burt]

I thank the hon. Lady for her questions, which give me an opportunity to say still more about what we are doing in relation to mental health and how far it has come since 2010. For instance, she could have pointed out that 1,400 more people a day have access to mental health treatment than had access to it in that year, simply as a matter of comparison between what was done then and what is done now. However, it is absolutely right to make the essential point that there is more to be done—a view that we share—and that is what the report did.

The timing of the report was not up to the Government. It is an independent report, commissioned by the NHS from an independent taskforce, and the timing and the content were decided by the taskforce. I had the occasional meeting with Paul Farmer about it. I made sure to speak to him to say, “This is absolutely your report. Forget the guff in the papers about who wants what in the report and all that; this is yours and it’s got to be yours”—and it is absolutely clear that it was. The decision to publish it was theirs. The Prime Minister was able to respond, which was great, and that emphasises again the importance given to this issue now, as compared with times past.

On the finance, the important thing to note is that the Prime Minister announced in January how the £600 million in the spending review, which is included in the NHS bottom line until 2021, would be spent. That included the new money for perinatal mental health, crisis care, psychiatric liaison in A&E and the crisis care community work. What was said by the Prime Minister in relation to the taskforce report represents new money that will be available for the NHS and mental health by 2021. That will be £1 billion extra by 2021, with the additional number of people to be treated that I outlined.

I spoke to the taskforce after the issuing of the report. I do not particularly want just to produce a response to the taskforce report; I said that I would prefer a series of rolling responses, as it were, so that when we have responded to a recommendation and when we are moving on and delivering on it, I would say so. That will come in a variety of different forms, but will be related to what the taskforce has done. That may well involve announcements to Parliament, whether by written ministerial statements or other means. I did not want one big bang of a response, as it were, because the Prime Minister has already said that we will accept the recommendations, as they go with the grain of what the Government were going to do anyway. I wanted to give an indication that the report will not just sit on a shelf gathering dust. By making constant reference to it when we do something—saying, “This is a response to what the taskforce said we should be doing towards 2021”—it can get the stamp of support and recognition, which is important.

On the hon. Lady’s claim that thousands have been let down, again I would gently remind her that this Government were the first Government to set waiting times for physical and mental health—a chance missed by the hon. Lady’s Government when they were in office and set physical health waiting time limits. It is this Government who have actually made the commitment of £10 billion extra to the NHS, a commitment never made by her or her party. It is very easy for people to talk about new things in mental health when they do not have a budget or an economic team producing anything of any credibility, but this Government have got the responsibilities and are doing the work.

We are absolutely agreed that the state of mental health services cries out for more to be done; we have said that, and that is what we are doing. The direction of travel and the physical delivery is happening on a day-by-day basis. We will do more; we will continue to work together to do more, and I welcome the hon. Lady and her team’s very regular pressure on me and my right hon. Friend the Secretary of State to continue to do more. We will meet that challenge—and we are meeting it in a way that no Government have ever met it before.

[Dr Liam Fox (North Somerset) (Con)]

I congratulate my right hon. Friend and the whole of the Government health team on their personal commitment to this issue. Does my right hon. Friend accept that those who suffer from mental ill health are often poor advocates of their own cause, and that it is very easy for money to be diverted into other areas of healthcare spending where others are able to shout louder for the money? Will he and his Front-Bench team consider whether it is possible to ring-fence the NHS budget for mental health care so that it does not become the Cinderella subject in the future that it has been too often in the past?

[Alistair Burt]

I thank my right hon. Friend for the question and his own personal interest and work in this area. He, like me, has come across this conundrum: we talk from the Dispatch Box about more money going into mental health and then we go to areas and they say, “Well, it’s not happening here.” That has been a genuine reality that we need to do something about. We are being more hands-on towards clinical commissioning groups and having a more transparent system of examining their finances. In addition, guidance from the NHS says that it expects the increase in finance to the NHS to go proportionately to mental health services and we have now given specific commitments to the series of services announced by the Prime Minister and contained in these recommendations. In that way, we hope to make sure that the diversion of funds that has happened in the past will not happen in the future. Local areas will thus feel that they, too, must ensure that they have the share of the resource.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

All of us in the House welcome the strides made in changing the stigma around mental health, and people have been brave enough to speak out. In Scotland, we had the “See me” campaign, which was about seeing the person, not the condition.

Despite all the great talk, the money has often not gone to the services. Mental health trusts suffered a 2% cut in their budget between 2013 and 2015, and the number of psychiatric nurses decreased by 1.4%. The right hon. Member for North Somerset (Dr Fox) talked about money often ending up somewhere else, and we must avoid that. We need also to focus on children, because one in 10 of our children suffer from mental health problems between the ages of five and 16, and they are waiting a very long time to get help. We face the same challenge in Scotland. We measure it, we know how difficult it is to deal with, and we have managed to improve things by increasing staff and funding, but we also have a long road to walk.

One thing we are not doing enough is thinking about the whole spread of mental health support out into the community and about the way people work: people having insecure jobs; and people struggling to keep a roof over their head. Later, we are going to debate welfare reforms, and mental health issues arise from that. Three times as many poor children will have a mental health issue as children who are in a stable and well-financed family. Are we not going to try to join up our decisions and look at our other policy areas, in terms of how people work, how people are supported, and the mental health suffering that comes from the lack of that?

[Alistair Burt]

I thank the hon. Lady for her usual well-informed contribution to the debate on these issues, and for what she says about stigma and the general approach the Government have been taking. She is absolutely right about that. We have supported the Time to Change anti-stigma campaign, which has had some success, although we have to do more.

The hon. Lady is also right about children and wider cross-government work. On children and young people, for the first time we have a Minister in the Department for Education in England who has responsibilities for mental health, and the Under-Secretary of State for the Home Department, my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley) is here to demonstrate that we take those cross-government responsibilities very seriously. One way in which we are going to manage the response to the taskforce is by having a cross-governmental team to make sure that Departments are joined up. Housing has something to do with this, as do education and work and pensions, as the hon. Lady said. We will make sure that that is done.

I should have said, but did not do so for reasons of time, that what has been said by the taskforce and what the Prime Minister has said is in addition to the £1.25 billion announced in March for the development of the child and adolescent mental health services in England and the £30 million a year eating disorder work, in order to recognise the increased pressures on children. As the hon. Lady rightly says, the more prevention work that can be done earlier, the better.

[Dr Sarah Wollaston (Totnes) (Con)]

I remind the House that I am married to the registrar of the Royal College of Psychiatrists. I join the Minister in thanking the independent mental health taskforce for the work it has done. Will he go further on how we are going to track this money, with greater transparency, to ensure it is spent in the right place, not just within health, but within social care? He will know that many of those who are suffering from mental health problems are cared for in the community, under social care, and it is therefore vital that we have parity of esteem across both health and social care.

[Alistair Burt]

Yes, I thank my hon. Friend for that and recognise the work of the royal college. Its president, Simon Wessely, was also much involved in the report, as was the college, so I thank them for that. It is very important to track this money. The CCG assessment framework will help us to do that through the health service. The money that the Prime Minister announced in relation to community crisis care—the extra £400 million announced in January—will be spent throughout the community, and it is essential that we track it.

There has been a data lack; the hon. Member for Liverpool, Wavertree (Luciana Berger) knows about that well, because I answer far too many of her questions by saying, “This information is not collected” or, “This information is not collected centrally”. [Interruption.] I have noticed that. We are in the process of changing that situation; the dataset was in the process of being changed and more information will be available. In order to track things properly, we have to have the information available. The question is right and we are improving the data. It is important to track this, both in local authority work and in NHS work.

[Mr Speaker]

I know that the right hon. Gentleman will take it in the right spirit when I say that it is immensely encouraging that he notices his own answers.

[Mr Kevan Jones (North Durham) (Lab)]

Parity of esteem and extra resources are important, but one of the main messages from this report is that we need to hard-wire mental health and well-being into public policy. Twice as many people take their own lives as are killed on our roads each year. Does the Minister agree that it is now time for a national campaign to address this issue?

[Alistair Burt]

Yes, I do, and I thank the hon. Gentleman for his comments and for his work and interest in this area. Included in the taskforce’s recommendations is a national ambition to reduce by 10% the number of suicides—that would be a reduction of some 400 a year. Three areas are already piloting a “zero suicide ambition strategy”, and this probably needs to be given more prominence than it has been. A national suicide prevention strategy is in place, which I am reviewing to see how it can be better implemented locally, because not all local areas have a similar strategy. It is right that that gets extra prominence, and we had a debate on it not too long ago in Westminster Hall. We recognise that it is a significant issue for men in particular, because three times as many men as women take their own lives. The recent increase in the number of women doing so, which was noted just a few weeks ago, is also significant. It is important that we talk about this more, recognise that suicide is not inevitable, and have a national ambition to challenge it and do more. I am confident that the hon. Gentleman will be able to champion that work, just as he has championed other things.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

It is a very sad fact that in healthcare those professionals who add the most to the service do not necessarily receive the same acclamation as those working in more glamorous specialties. What does the Minister think can be done to improve the status of those working in mental healthcare and thus mental healthcare as an attractive career option?

[Alistair Burt]

That is a good question. It is very important that true value is given to those who work in such an area, at all levels. When we have seen examples of poor-quality care and the tragedies that have occurred, we realise the value placed on those who display kindness as well as skill and demonstrate their qualifications. We need to talk about the quality of good care. We need to make sure that people who go into these professions have a career path, whatever their entry level. We want to encourage greater psychiatric awareness in medical training and clinical medical training for those who are leaving medical schools. Again, I know that Simon Wessely of the royal college has done much work in this area. We should emphasise that those who care for those in the most distressed situations, be they in hospital, community or specialist services, deserve our thanks, encouragement and proper training. Increased money for training is included in the package that the Government will be working on, and it will be a vital part of that.

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

Two weeks ago, the Minister kindly came to Hull to talk to parents who are campaigning to get an in-patient facility for children and young people in the Hull area, as the previous one was closed several years ago. Will he update my constituents about any progress in the past two weeks and about whether any of the £1 billion allocated to mental health services will be used in Hull?

[Alistair Burt]

I thank the hon. Lady for her question. It was good to see her in Hull with her constituents and those of the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). I do not think that any new money is specifically needed to deliver on the commitment to provide in-patient care for young people in Hull and the surrounding area. It seemed to me that people had already agreed on that; the problem was in the delivery of it. She will recall the frustration that I expressed when I was sitting round a table with representatives from the clinical commissioning group, the NHS and the trust, because for some reason it was impossible for us to reach a decision.

The update is that I have already taken that matter away with me to consider how to resolve it, because I had some concern about it. A national decision has to be made about the allocation of finance and priorities, but there is a clear local need that needs to be addressed. We will make progress on that. On beds generally, we have more beds for young people than ever before, and 50 more since I came into my role, but they are not always in the right places, as we saw in the hon. Lady’s constituency. I do not think that anything in the announcement affects the importance of that matter, which has already been recognised.

[Mr Stewart Jackson (Peterborough) (Con)]

I warmly welcome the Government’s initiative and the taskforce report. I am slightly disappointed by the Opposition’s rather churlish tone, as I thought this was a cross-party matter.

May I make two brief pleas to the Minister? First, we must not lose sight of acute mental health episodes among children and young people at weekends and out of hours, which is a long-standing issue, including in my constituency. Secondly, Tourette’s syndrome falls between the strategies and provision of education and health. One in 100 children are diagnosed with Tourette’s. It is an important neurological condition that we need to address. Will the Minister keep focused on that as part of his wider mental health review?

--- Later in debate ---

[Alistair Burt]

Absolutely. Attention is now being paid to crisis care in A&E, which recognises the fact that people who need urgent treatment will go to A&E. The Government are determined to ensure that there is emergency access 24/7 by placing more psychiatric liaison teams in hospitals and by improving crisis care in the community. My hon. Friend is right to recognise the problem. A number of syndromes and issues have particular qualities associated with them that need individual care, and he is right to raise his concerns about those who suffer from Tourette’s.

[Joan Ryan (Enfield North) (Lab)]

The taskforce emphasises the importance of supported housing for people with mental health problems. I think it is right to say that the Minister’s Department made no representations to the Treasury before the changes to housing benefit for tenants in supported housing were announced. It had made no official representations to other Departments as recently as three weeks ago. Will the Minister now make the case to his colleagues in the Departments for Communities and Local Government and for Work and Pensions on the need to exempt vulnerable people from the changes in housing benefit?

[Alistair Burt]

I understand the right hon. Lady’s point. I know that such issues are being considered extremely carefully by those who are responsible for developing the policy, but I will ensure that her further concerns are noted and that the Departments recognise them.

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

There is so much good stuff in this report that I must congratulate the authors on their work and my right hon. Friend the Minister on his interest. I particularly welcome the recognition in the report of the gap in the provision of psychiatric liaison services, and the commitment to have such services at the core 24/7 level in at least half of all hospitals by 2020. Will my right hon. Friend advise me on whether such provision is fully funded? Given the difficulties of getting such services in place at the moment, will he take a close interest in the plan to make it happen in practice?

[Alistair Burt]

I thank my hon. Friend for her interest in this subject, which she had expressed to me previously, and her work on it. Yes, our determination is that the extra £1 billion a year that will be spent on mental health services will cover the training and the commitment that we have made to 24/7 cover. It is very important that such cover is there. The issue was identified when the Care Quality Commission looked at the work of the mental health crisis care concordat, which has been so successful in its first 12 or 18 months. I can assure her that I am determined to ensure that we provide these facilities.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

The report adds to the consensus that arose from Lord Crisp’s commission and the cross-party work led by my right hon. Friend the Member for North Norfolk (Norman Lamb) on ending the practice of out-of-area treatments. Will the Minister commit to putting a timetable on that process so that we might know when it will happen?

--- Later in debate ---

[Alistair Burt]

The taskforce recommendation is that out-of-area placements should be eliminated by 2020; Lord Crisp’s report said 2017. I would like to see it done as soon as is reasonably practicable. We want to ensure that, where possible, people can be treated locally, as it makes a real difference. The hon. Member for Kingston upon Hull North (Diana Johnson) mentioned one or two cases of young people being treated some way away, and the impact that it has had on them. They lose local community links and the community work that can be done to assist them. We all want to see that ended, and I want it to be done as soon as possible. It will certainly be done within the taskforce’s recommended timescale. If it can be done any quicker locally, area by area, I will be very happy.

[Mike Wood (Dudley South) (Con)]

I welcome the Government’s positive response to the taskforce report. Although effective acute care is vital, prevention is better than cure. Will the Government look at ongoing training for all GPs in mental health so that all patients can have access to early diagnosis, care and treatment, to prevent problems from escalating?

[Alistair Burt]

My hon. Friend makes a good point. GPs are often contacted first when a problem is developing, as I know from my contacts with the British Medical Association and with the Royal College of General Practitioners, which was also very interested in the taskforce report. Those organisations want to ensure that doctors have enough training, because training levels tend to vary according to interest. I know that all GPs are concerned about the matter and want to ensure that they have the skills. Equally, they need to know that they can then refer to the right place. That is what the increased support for both emergency and community services is all about. It is to ensure that there are proper pathways so that people do not get stuck at any particular stage.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

My 15-year-old constituent Matthew Garnett, who has autism, has spent the past six months in a psychiatric intensive care unit 30 miles from home. The unit does not have the specialism to meet Matthew’s needs and he has deteriorated significantly. The specialist bed that Matthew needs is in Northampton, where Matthew’s family have been told there are five young people who are ready for discharge but whose ongoing care cannot be arranged. Clearly, there is a crisis in mental healthcare for children and adolescents. When will the Minister bring a plan to the House to address that, and will he intervene to secure the bed that Matthew Garnett so desperately needs?

[Alistair Burt]

I thank the hon. Lady for her question. If she wants to make a particular approach on that case, I am ready to listen.

[Helen Hayes]

I have already done that.

[Alistair Burt]

It is already in the works. Okay, thank you. Let me say a couple of things with regard to specialist care. First, even though we want most young people to have access to care close to home, there will always be some specialist care that will require out-of-area treatment—perhaps those are the circumstances to which the hon. Lady is referring. It is then a question of getting the place.

That issue emphasises why it is so important to have the community care available. We need to be able to discharge patients and put in place a proper care package. That is precisely what the taskforce considered and made recommendations on. That work is already ongoing. As my time in office has shown me, there are variations in practice in different places. Discharges are handled better in some areas than in others. The practice of the best must become the practice for all. Everything must be done to ensure that people are treated in the appropriate place at the appropriate time, and keeping people in hospital unnecessarily is not what anyone wants. That work is already going on, and I will make sure that the hon. Lady gets an answer to her particular question.

[Stephen McPartland (Stevenage) (Con)]

I welcome the Minister’s personal commitment to this issue and the Government’s investment in this area, which demonstrates the importance of mental health issues alongside physical health in the NHS. Will the Minister clarify how he will hold the NHS to account so that the money is spent on additional mental health services as opposed to just being frittered away?

[Alistair Burt]

The engagement of the NHS with the taskforce needs to be recognised and emphasised. The NHS set up the taskforce because it wanted to be clear about the state of mental health services and take a five-year forward view. That is what the taskforce does, but it goes beyond that to say that it has a 10-year vision, which I welcome. Not everything can be done in neat, parliamentary-cycle chunks, so it is important that people have a continuing sense of commitment. The certainty that my hon. Friend wants is demonstrated by the involvement of the NHS, the endorsement of the recommendation by the chief executive, and the work on transparency, which is important to us, to make sure that we can all see where money has been spent. That should hold clinical commissioning groups and the NHS to account on the expenditure issue.

[Rachael Maskell (York Central) (Lab/Co-op)]

Paul Farmer’s report highlights the fact that 50% of diagnoses of mental health challenges are made by the age of 14, and 75% are made by the age of 24. He also says in the report:

“Yet most children and young people get no support.”

Will the Minister explain what specific work will be undertaken to look at prevention and early intervention, including early diagnosis?

[Alistair Burt]

I thank the hon. Lady for her interest and her considerable knowledge of these issues, which she has raised a number of times.

There are two things to say. First, on expenditure on children and young people’s mental health services, £1.25 billion will be spent over the next five years to improve the baseline for child and adolescent mental health services, including early prevention. I would also mention the full roll-out of IAPT—improving access to psychological therapies—services for children by 2018. That is already in place for, I think, 70% of the country, and it will be completed by 2018. It is a way of ensuring that children have early access to the psychological therapies that they need. That is an important development, which I hope the hon. Lady welcomes.

[James Morris (Halesowen and Rowley Regis) (Con)]

As chairman of the all-party parliamentary group on mental health, I very much welcome the report, as Members in all parts of the House should. There is a high-quality public debate about mental health, in which we are addressing stigma, and the Prime Minister has made two speeches in the past three weeks about mental health, setting out the Government’s priorities. Does the Minister agree that there is a unique opportunity for him and the Government to drive forward real, quality change in mental health?

[Alistair Burt]

I pay tribute to my hon. Friend for the work that he has done as chair of the all-party group, and indeed to all colleagues in the House who have raised these issues over a period of time and, partly as a result of their personal experiences and their bravery in talking about them, have helped in the process in which we are engaged.

Yes, we have a great opportunity. The taskforce has set out a 10-year vision, and there is a commitment from the NHS. At the top level, in all parts of the House, there is a commitment to the issue, and I hope that we will have an opportunity to develop the services that people want and for which, in all honesty, they have waited too long.

[Tom Elliott (Fermanagh and South Tyrone) (UUP)]

I welcome the taskforce report and the Government’s response. The Minister indicated that £1 billion would be made available by 2021. What is the relationship between that and the devolved institutions in Scotland, Wales and Northern Ireland, and are there any Barnett consequentials?

[Alistair Burt]

Although I read the answers to my own questions, I cannot recall one on that point, so the hon. Gentleman has caught me out. I genuinely do not know the answer, so I will write to him about the devolved Administrations or place an answer in the Library. I think we are talking about responsibility in England, because this is a devolved matter, but there is good, close co-operation between officials on the development of mental health services in the devolved Administrations, which will certainly continue. I will make sure that an answer on the finances is placed in the Library.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

The work that the Minister has outlined is, to my mind, one of the most important pieces of work in this Parliament, and I very much welcome the investment and improved services that have resulted.

May I build on the comments of my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) and the hon. Member for Central Ayrshire (Dr Whitford) about the stigma of mental health? Depression is one of the most terrible diseases that people can suffer, and they often suffer because of the stigma attached to it, too. I congratulate the writers of “Coronation Street” on the Steve McDonald storyline, which was dealt with sensitively and addressed some of the stigmas and stereotypes. I urge my right hon. Friend the Minister to ensure that as much effort is put into tackling the stigma of mental health as into the practical investment in services.

[Alistair Burt]

My hon. Friend is absolutely right. I praise the storyline editors of “Coronation Street” just as much as I do those of “EastEnders”, which has done a remarkable job in relation to perinatal mental health with Stacey’s story over the past few weeks.

The Government’s anti-stigma campaign will certainly continue. We are much informed particularly by young people, with whom we have worked on Time to Change, to which we have made a further commitment of financial support. Stigma is a terrible thing, and is partly responsible for breaking the link between physical and mental health. The taskforce recommended that the Government deliver on the objective to make sure that more people with mental health problems receive help for their physical issues, so that we can deal with the terrible difference in mortality rates between those with mental health difficulties and other people. Dealing with the stigma, so that people feel able to raise their problems, is an important part of that.

[Mark Durkan (Foyle) (SDLP)]

I thank the Minister for his statement, and I acknowledge the work of the taskforce and its report.

I encourage the Minister, along with his colleagues in the Department for Education, to take a particular interest in the mental health in schools training programme, which has been developed by practitioners to ensure that schools are better equipped to support the mental health and wellbeing of pupils. Will they help to safeguard those interests in a system that is designed to be run in a similar way to the child protection system, with which schools are familiar?

[Alistair Burt]

The hon. Gentleman has a long-standing interest in these issues. He is absolutely right: in England, a pilot project with 27 schools is being run by the Department for Education to locate and identify a single point of contact in those schools on mental health issues for young people. Depending on the results, more projects can be rolled out. Early identification and support in school are absolutely essential, and that work is under way.

There are a number of different initiatives, sometimes inspired by people who have experienced personal tragedy in their own family. They realise that the tragedy that has befallen their young person might not have happened if their friends had been more aware of their circumstances, or if the school or college had been more aware. We look at all those different initiatives to see how best practice can be spread, but the hon. Gentleman is right to raise the issue.

[Jeremy Lefroy (Stafford) (Con)]

I congratulate the Minister and the Government on their commitment on this. He has just spoken about best practice. Last month in Stafford we held a round table on mental health. One of the issues that came up was that there were a lot of good local initiatives, both in the public and the non-governmental organisation sector, but sometimes they did not know about each other. Will he point us to best practice in the sector?

--- Later in debate ---

[Alistair Burt]

I am happy to do so, and I welcome my hon. Friend’s question. As I indicated earlier, something that has perplexed me since I have been in this role is the variation in practice in different places. It has never been easier to transfer information by electronic means and make people aware of best practice, but it is still difficult to move things around. We need to make sure that there is a website—a clearing house—for ideas in such areas.

[Luciana Berger]

It already exists in the Positive Practice collaborative.

[Alistair Burt]

Absolutely. We need to make sure that we have proper ways to access all the different ideas. A lot of work has gone into this, and we need to make sure that it is easy to access different ideas. There is a lot going on, and a lot can be done in relation to spreading best practice.

[Mr Speaker]

I gently remind the House that exchanges in the Chamber are not a private conversation. It is quite important, from the vantage point of those who take a full and complete record of our proceedings, that they can hear what is said.

--- Later in debate ---

[Alistair Burt]

Yes, we have indicated that we accept all the recommendations by the taskforce. I would like to roll out responses to them over a period of time so that they are regularly brought back to the House. Our commitment to expenditure, training and dealing with the recommendations is clear.

Mr Speaker, you would not want to hear all the private conversations that go on on the Floor of the House, nor would those who report our proceedings, but I see the hon. Member for Liverpool, Wavertree (Luciana Berger) so often at events such as this that it is not unnatural that we have the odd exchange over the Dispatch Box.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I declare an interest as a registered clinical psychologist. I thank the Minister for his commitment and the taskforce for its informative report. In considering mental health across the lifespan, the report highlights the fact that 40% of people living in care homes are affected by depression, which contributes to morbidity. Alongside medical and social care, will the Minister commit to funding specialists in older adult psychological treatment, to address the growing mental health needs of our population?

[Alistair Burt]

I thank the hon. Lady for her work in this area, for her commitment to this area since she has been in the House, and for being at the National Autistic Society event last night, where she again demonstrated that interest. May I look at the suggestion that she makes? It is well recognised that with the growing incidence of dementia and other issues, and with those in care homes being increasingly frail, there will of course be a need for further specialised work. May I look at that area in particular and come back to her in due course?

Community Pharmacies

Alistair Burt Excerpts

Tuesday 23rd February 2016 Westminster Hall

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

As others have said, it is a great pleasure to serve under your chairmanship, Mr Streeter. Thank you for chairing this debate. I also thank my hon. Friend the Member for St Ives (Derek Thomas) for bringing this debate to Westminster Hall and giving colleagues the opportunity to make such a range of comments. They all have a good knowledge of things in their areas, and some have more specialised knowledge. We heard from the right hon. Member for Rother Valley (Kevin Barron), my hon. Friend the Member for Bexhill and Battle (Huw Merriman), the hon. Member for Ealing North (Stephen Pound), my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), the hon. Member for Ceredigion (Mr Williams), the hon. Member for Hyndburn (Graham Jones) and, not least, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in whose constituency I have spent many happy hours—my father was born in Auchterderran, so I know the area very well. Although the hon. Gentleman is from Scotland, his contribution was welcome, and he made some pertinent points.

Before I make some prepared remarks, I want to put some things on the record. I would be foolish if I did not understand the widespread interest in this debate. I would also be naive if I believed that this is the last time we will discuss this issue. Many questions were asked, so this will run for a while. Let me set out the background before I make my prepared remarks.

First, we are having this debate at a relatively early stage of the negotiations between the Government and the Pharmaceutical Services Negotiating Committee, which is handling matters on behalf of the pharmacy profession. Many of the questions and issues raised by colleagues on both sides are at the heart of those discussions. What sort of services will there be? Where is pharmacy going? How exactly will the reduction in finance be handled and distributed? Not all the answers are available at this stage because a proper negotiation process is being undertaken. Understandably, colleagues will look at the most adverse potential consequences to make a point when representing their constituents. I understand that, and the points have been perfectly fair. We are at that point in the process. We think we know what the worst may be, but we do not know the outcome or what changes there will be for the better.

Secondly, on finance, we are all realists here. We would love to work in a world where the status quo is not changed except for improvements, where the only issue with money is where more can be spent and where change, if there is to be any, takes forever to bring in. Life is not like that. The Government’s spending commitment for the national health service—an extra £10 billion a year by 2020—has to start being found early. It is not only about extra money, but about the efficiencies that the NHS chief executive identified, which are to be found across the board and could partly come from the pharmacy sector’s £2.8 billion of funding, which the Government propose to reduce. It may be an appropriate place. Again, we often approach such matters with the view that no possible reduction could ever improve services anywhere. That is not true, as we know from the experience of successive Governments.

The third bit of the background is where we are in relation to where pharmacy is going. The Royal Pharmaceutical Society’s November 2013 report, “Now or never: shaping pharmacy for the future”, states that the traditional model of community pharmacy needs to change due to

“economic austerity…a crowded market of local pharmacies, increasing use of…automated technology to undertake dispensing, and the use of online and e-prescribing”.

The Nuffield Trust’s report, “Now more than ever: Why pharmacy needs to act”, states:

“Community pharmacy is subject to a particularly complex set of commissioning arrangements, which appear to support the status quo and inhibit innovation at scale.”

We would love to be in a situation where, as the hon. Member for Ealing North described, everything is absolutely great and every pharmacy offers all the services and delivers them marvellously, but that is not necessarily the case. Accordingly, change is sometimes inspired by necessity and can be for the better. That is part of the background to where we are.

[Graham Jones]

The Minister makes the point that, to pay for the £10 billion increase in NHS funding, funds are being shifted from other sources, including the £2.8 billion spent on pharmacies. However, the principle should not be to shift funding from primary care to secondary care. Our fundamental principle should be to shift—if we have to—money from secondary care to primary care, which is preventive and will cut costs in the long term.

[Alistair Burt]

The hon. Gentleman makes a fair point, and that is indeed being done in the NHS, but we are looking at where efficiencies can be made and at what different parts of the health sector can contribute. In doing so, we can see what changes are inspired in the service provided to patients.

To emphasise where we are with pharmacy, there are 11,674 pharmacies in England, which has risen from 9,758 in 2003—a 20% increase—while 99% of the population can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. The average pharmacy receives £220,000 a year in NHS funding. On clusters, which my hon. Friend the Member for Plymouth, Sutton and Devonport mentioned, the Government contend that money can perhaps be saved in one place and used elsewhere for the delivery of new services. That is the reality of life. It would be great if new money was always coming from somewhere, but bearing in mind that the Government are dealing with an Opposition who could not commit to the extra £8 billion that the NHS was looking for, we have to make the changes that others were not prepared to make and still deliver services.

Let me move on to where we are going. Everyone in this room, Government Members included, recognises the quality of the best pharmacy services around the country. We are familiar with the valued role that community pharmacy plays in our lives and those of our constituents. I am grateful to my hon. Friend the Member for St Ives for giving me the opportunity to put on public record the high esteem that we hold them in and to set out our plans for the future.

I am a firm believer that the community pharmacy sector already plays a vital role in the NHS. I have seen at first hand quite recently the fantastic work that some community pharmacies are doing across a wide range of health services that can be accessed without appointment. Many people rely on them to provide advice on the prevention of ill health, support for healthy living, support for self-care for minor ailments and long-term conditions, and medication reviews. There is also real potential for us to make far greater use of community pharmacy and pharmacists in England. For example, I am due to speak at an event tomorrow that is looking at the role that pharmacy can play in the commissioning of person-centred care for vulnerable groups.

Our vision is to bring pharmacy into the heart of the NHS. We want to see a high quality community pharmacy service that is properly integrated into primary care and public health in line with the “Five Year Forward View”. I cannot answer all the questions that the hon. Member for Worsley and Eccles South (Barbara Keeley) asked, but she did at least mention the integration fund for the first time in the debate.

[Barbara Keeley]

There is a difficulty, in that funding for integration should recognise that the extra work needs to be done. The point of today’s debate has been about the Government using blunt instruments, such as a 6% cut in funding, reducing the number of pharmacies in clusters, changing dispensing charges, and the warehouse pharmacy that my hon. Friends mentioned. It is the use of those blunt instruments, not the working with the sector, that is the fault.

[Alistair Burt]

That working with the sector is ongoing. That is what the negotiations with the Pharmaceutical Services Negotiating Committee are all about. I take the hon. Lady’s point, but those discussions are under way. We are consulting with a wide range of groups, not just the PSNC, including patients and patient bodies.

As part of what we are doing for the future of pharmacy, we want pharmacists and their teams to practise in a range of primary care settings to ensure better use of medicines and better patient outcomes and to contribute to delivering our goal of truly seven-day health and care services. As part of that, I want to work with NHS England to promote local commissioning of community pharmacy within the health community, so that we can ensure the best use of this valuable resource. That is why we are consulting on how best to introduce a pharmacy integration fund to help to transform the way pharmacists and community pharmacy will operate in the NHS of the future. By 2020-21, we will have invested £300 million in the fund.

While it is understandable that the focus of most colleagues’ comments today was access to existing services, little was said about where pharmacy might be going and what new opportunities there will be. That is part of the overall development that we are hoping to achieve, which will include the work not only of the access fund, but of the integration fund.

Colleagues asked several questions about access. I want to provide some reassurance. We recognise that some of the Government’s proposals have caused concern, and that will take some time to distil as the negotiations are worked through. We are committed to maintaining access to pharmacies and pharmacy services. 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, both of which were raised today. Qualifying pharmacies will be required to make fewer efficiencies than the rest of the sector. We certainly recognise that rural pharmacies will need to be considered in that, and we want to ensure that location matters in areas of sparsity. That work is ongoing.

In conclusion, the process has some way to run. I simply put it to colleagues that, in relation to good community services on the high street, there is more for modern pharmacy to do. Looking at the proposals of the past, we hope that the profession shares the Government’s determination to move pharmacy into a new future, and I am convinced that the future will be good.

[Mr Gary Streeter (in the Chair)]

Derek Thomas has 40 seconds in which to respond coherently.

Health

Alistair Burt Excerpts

Monday 22nd February 2016 Ministerial Corrections

[Ian Lavery (Wansbeck) (Lab)]

The same survey indicates that one in four people are now waiting more than a week to see their GP, and a staggering 1 million people are heading off to A&E because they cannot get an appointment with their GP. It is a total meltdown. What is the Minister doing about it?

[Alistair Burt]

There are 40 million more appointments available for GPs than in the past. The Government have made a commitment to transform GP access, and £175 million has been invested to test improved and innovative access to GP services. There are 57 schemes involving 2,500 practices, and by March next year more than 18 million patients—a third of the population—will have benefited from improved access and transformed service at local level. That is what we are doing about it.

[Official Report, 9 February 2016, Vol. 605, c. 1422.]

Letter of correction from Alistair Burt:

An error has been identified in the response I gave to the hon. Member for Wansbeck (Ian Lavery) during Questions to the Secretary of State for Health.

The correct response should have been:

[Alistair Burt]

There are 40 million more appointments available for GPs than in the past. The Government have made a commitment to transform GP access, and £175 million has been invested to test improved and innovative access to GP services. There are 57 schemes involving 2,500 practices, and by March this year more than 18 million patients—a third of the population—will have benefited from improved access and transformed service at local level. That is what we are doing about it.

Oral Answers to Questions

Alistair Burt Excerpts

Tuesday 9th February 2016 Commons Chamber

[Ian Lavery (Wansbeck) (Lab)]

3. What estimate he has made of the number of patients who went to A&E after having been unable to make an appointment with their GP in the most recent period for which figures are available.

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

The results of the last GP patient survey show that 91.9% of all patients get convenient appointments. Of the 8% who are unable to get an appointment or a convenient appointment, 4.2% indicated that they went to A&E.

[Ian Lavery]

The same survey indicates that one in four people are now waiting more than a week to see their GP, and a staggering 1 million people are heading off to A&E because they cannot get an appointment with their GP. It is a total meltdown. What is the Minister doing about it?

[Alistair Burt]

There are 40 million more appointments available for GPs than in the past. The Government have made a commitment to transform GP access, and £175 million has been invested to test improved and innovative access to GP services. There are 57 schemes involving 2,500 practices, and by March next year more than 18 million patients—a third of the population—will have benefited from improved access and transformed service at local level. That is what we are doing about it.[Official Report, 22 February 2016, Vol. 606, c. 2MC.]

[Mr John Baron (Basildon and Billericay) (Con)]

The Minister will be aware that, despite great improvements in cancer care under this Government and the previous Government, one in five cancer patients—more than 20%—are first diagnosed as late as when they go to A&E. The Government rightly focus on one-year survival rates as a means of driving forward earlier diagnosis. Can he give me an assurance that that will remain a key focus?

[Alistair Burt]

My hon. Friend raises a serious issue. Pursuing the earliest diagnosis of cancer is very important to the Government; it is obviously also important to all patients. We are going to publish the statistics on early detection through the clinical commissioning groups to improve transparency still further, because as this Government have shown, transparency often drives improvement in performance.

[Kate Osamor (Edmonton) (Lab/Co-op)]

24. Can the Minister tell me how the Government are urgently going to tackle safety of care at the North Middlesex hospital A&E department, following revelations last week that a patient died at the hospital in December 2015 after being forced to wait an unacceptable time in A&E? The department has also received a notification of risk.

[Alistair Burt]

The hon. Lady gives an example of why it is so important to continue to seek to improve the quality of care in A&E and why it is so important to keep transparency going. This is one of the reasons that we have a new inspection regime, which has been designed to highlight these things, but the introduction of 1,250 new doctors in accident and emergency departments over the past five years will also make a difference to the improvement in quality of care. However, she is right to highlight this matter. The NHS does not do everything right, but what is important is that we value what is done with the vast majority of stuff and that, when things do go wrong, we say so, we examine them and we learn lessons.

[David Tredinnick (Bosworth) (Con)]

According to information that I have received, 16 of the 25 ambulances on duty in Leicestershire one evening before Christmas were queueing outside Leicester royal infirmary to discharge patients. I have written to my right hon. Friend the Secretary of State about this issue. Please will the Minister update me and the House on the steps he thinks we should be taking?

[Alistair Burt]

The issue with ambulances and with quality of care elsewhere is the variation in quality. It is so important to ensure that local leadership addresses those local problems, because they are handled very differently in different places. It is right for my hon. Friend to raise this matter, and I am sure he has raised it with his local ambulance trust, as well as the hospital, to see how there can be better facilitation of patients going in and being discharged so that ambulances need not queue.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Health and Social Care Information Centre has shown that last year 124,000 patients waited more than 12 hours after arrival at accident and emergency, which compares with a figure of 1,700 in Scotland, and the number has doubled since 2013. The Royal College of Emergency Medicine has explained that these tend to be the sickest patients and that this delay is associated with increased mortality, so how do the Minister and the Secretary of State plan to improve that performance?

[Alistair Burt]

I have to tell the hon. Lady that patient satisfaction with A&E was rather lower in Scotland than it is in England, which indicates that we all have problems to deal with in this area. It is correct that we continue our progress both to increase resources throughout the health service and to A&E, and to improve transparency and people’s ability to see what is going on. Unacceptable waits are not part of what we all want to see from the NHS, which is why we are determined to drive them down. Patients in England will have the best information anywhere in the world about what is happening in their NHS, as we continue to drive efficiency and improvement.

[Dr Whitford]

Patients will not have the information about the four-hour waits, as that has not been published since November. The doctors required to look after these people are A&E specialists. There is already a major problem in retaining A&E trainees because they work a higher proportion of unsocial hours. These are exactly the hours that will be less rewarded in the new contract, so how does the Secretary of State plan to recruit and retain doctors in emergency medicine in the future?

[Alistair Burt]

There have been 500 more consultants in A&E medicine since 2010. The new contract is under negotiation at the moment and the majority of it has been agreed with junior doctors. It is designed to replace the failures in the old contract, which everyone knew needed to be corrected, and it provides the basis for the profession for the future to deal with some of the issues the hon. Lady mentions. All of us are concerned to ensure that the negotiations continue and that there should be no strike tomorrow, so that this pattern for the future, which is wanted by doctors and patients alike, as well as by the Government, gets a chance to work.

[Andy Slaughter (Hammersmith) (Lab)]

4. What assessment he has made of the implications for his policies of the findings of the Independent Healthcare Commission on the NHS in north-west London.

--- Later in debate ---

[Daniel Zeichner (Cambridge) (Lab)]

10. What progress his Department has made on reviews investigating the end of the contract between Cambridgeshire and Peterborough clinical commissioning group and UnitingCare Partnership.

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

The CCG expects to publish its internal review by the end of February, and NHS England’s independent review is expected to be completed by the middle of the month. Monitor is assessing the project from the providers’ perspective and will share its findings with NHS England in due course.

[Daniel Zeichner]

The UnitingCare contract in Cambridgeshire was an attempt to join up unintegrated services. We now appear to be having a series of unintegrated reviews. What is actually needed is a single overarching review that looks at the roles of NHS England, Monitor, the strategic projects team, and, of course, Ministers. When are we going to get that review?

[Alistair Burt]

As I said, there are ongoing reviews concerning the precise responsibilities of each individual part. There is no doubt that this is a very serious matter—a serious failure—that raises series concerns. We want to know what went on as much as the hon. Gentleman does, so once the reviews have been completed and we have been briefed, I will be very happy to talk to him about their consequences.

[Mr Speaker]

I call the victorious team leader, Mr Stephen Pound.

[Stephen Pound (Ealing North) (Lab)]

11. What assessment he has made of the potential effects on public health of his Department’s proposals on the future of community pharmacies.

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

It is my considerable honour, Mr Speaker, to respond to the hon. Gentleman in his victorious mode.

Community pharmacy is a vital part of the NHS and it plays a pivotal role in improving the public’s health in the community. We want a high-quality community pharmacy service that is properly integrated into primary care and public health. The proposed changes will help us, in conjunction with the pharmacy profession, to do just that.

[Stephen Pound]

I am very grateful to the Minister for that answer. There is always a place for him in our team next year, although we are running trials in the next few weeks.

Despite the generosity of the Minister’s response, does he not accept that community pharmacies are of great and growing importance to our constituents and provide an ever-increasing range of healthcare and advice in accessible high street locations? What message does he have for these dedicated professionals, who, frankly, now fear for the future due to the uncertainty arising from the announcement of a 6% cut in funding for the NHS pharmacy service?

[Alistair Burt]

I am grateful to the hon. Gentleman not only for his question but for the way he put it. The message is that community pharmacy does, and is doing, an extraordinary and important job, but it will change. In 2013, the Royal Pharmaceutical Society said in its publication, “Now or Never: Shaping pharmacy for the future”:

“The traditional model of community pharmacy will be challenged”

due to

“economic austerity in the NHS , a crowded market of local pharmacies, increasing use of technicians and automated technology to undertake dispensing, and the use of online and e-prescribing”.

It pointed to the massive potential of community pharmacists to do more and sees pharmacy as ideally placed

“to play a crucial role in new models of…care.”

All that is to come. We are negotiating with the pharmaceutical profession. A consultation is going on. There is a great future for pharmacy, but, like so much else, it will be different.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

13. What progress his Department has made on making the UK a world leader in tackling antimicrobial resistance.

--- Later in debate ---

[Sir Simon Burns (Chelmsford) (Con)]

14. What assessment he has made of the adequacy of provision of GP practices in Chelmsford constituency.

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

NHS England advises that in Chelmsford there is a GP to patient ratio of 1,927 patients per whole-time equivalent GP, which is slightly lower than that for the Mid Essex clinical commissioning group area. The Care Quality Commission has inspected eight of the 13 Chelmsford GP practices—seven were rated “good” overall and one, Sutherland Lodge, was rated “outstanding”.

[Sir Simon Burns]

Does the Minister think it would be possible for the NHS review of the personal medical services scheme to ensure that the good and innovative work promoted by PMS, as exemplified by Sutherland Lodge surgery, can be sustained?

[Alistair Burt]

I hope so. I appreciate my right hon. Friend’s visit to my office yesterday with members of that surgery and NHS representatives. The £1.4 million released from PMS in Essex will be reinvested in the CCG area, but it is important that there is an opportunity for all practices to bid for that money so that some of the work already done under PMS gets the chance, if it is vital and still needed, to continue, which certainly includes services that are rated “outstanding”.

[Rosie Cooper (West Lancashire) (Lab)]

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

--- Later in debate ---

[Ben Howlett (Bath) (Con)]

T4. I am sure Ministers will join me in congratulating Number 18 surgery in Bath on being ranked in the top 10 GP practices in the country. Do they agree that patients having a choice of where they are treated will increase patient satisfaction in the NHS?

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

Yes, it certainly will. That is another reason why we hope to have 5,000 more doctors and 5,000 more allied health professionals working in general practice, to expand the primary care service by 2020.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Today’s The Independent reports that a potential deal on the junior doctor contract was put to the Government that would have resolved junior doctors’ concerns without costing any more money and potentially avoided tomorrow’s industrial action. A source close to the negotiations told the newspaper:

“The one person who would not agree was Jeremy Hunt. Even though the NHS Employers and DH teams thought this was a solution he said no”.

So let me ask the Health Secretary a very direct question: have the Government at any point rejected a cost-neutral proposal from the BMA on the junior doctor contract—yes or no?

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

T6. Will my right hon. Friend update us on the progress in decriminalising dispensing errors for pharmacists?

[Alistair Burt]

I am aware of my hon. Friend’s keen interest in the rebalancing programme of work, and particularly the work on dispensing errors. We are fully committed to making that change. There are a number of stages to amending primary legislation through a section 60 order. Given the timetable, it is likely that the order will be laid before the Westminster and Scottish Parliaments in the autumn.

[Tommy Sheppard (Edinburgh East) (SNP)]

T2. The Secretary of State will be aware that Maximus is recruiting junior doctors to perform work capability assessments in the Department for Work and Pensions. The company is offering £72,000 a year, which is up to twice the salary that junior doctors would get in the health service. Is he concerned that that will result in inexperienced medical staff making judgments that relate to people’s livelihoods? Is he not also concerned that it will result in a drain of staff resources out of the NHS and out of providing general healthcare for the public?

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

I am pleased to support the National Society for the Prevention of Cruelty to Children’s “It’s Time” campaign, which is an initiative to ensure that children who have been the victims of abuse receive ongoing support. May I seek assurances from the Government that they will actively help with this initiative?

[Alistair Burt]

Yes, indeed. We strongly support the initiative. Our work to look after children who need extra care, particularly in relation to their health and emotional needs, has been helped by the transforming care package, which is going through local authorities at the moment. Their vulnerabilities are certainly a matter of great concern, and that will be followed up by the Government.

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

Over 1 million elderly people are able to maintain independence and remain in their own homes due to the attendance allowance. What discussions has the Minister had with his colleagues about ensuring, when the fund is transferred from the Department for Work and Pensions to the Department for Communities and Local Government, that the allowance will remain at the same level?

[Alistair Burt]

The consultation is ongoing between Departments. A unit has been set up by the Department of Health and the DWP to look at a range of issues that concern us both. The actual detail of the future attendance allowance has not been finalised yet, but it is a matter of concern and discussion between Departments.

[Dr Sarah Wollaston (Totnes) (Con)]

In asking a question about mental health, may I remind the House that I am married to an NHS forensic psychiatrist, who is also registrar of the Royal College of Psychiatrists? Have the Government looked carefully at today’s report from the independent commission on improving mental health services, particularly its finding that provision nationally for the most severely ill acute patients is inadequate? Will the Government set out what measures they will take to make sure we really see progress on parity of esteem and on improving access to such severely ill patients?

[Alistair Burt]

I thank my hon. Friend for her question, and the Royal College of Psychiatrists for its work on Lord Nigel Crisp’s commission, which we have supported. The report and recommendations have only just come to us, but they certainly travel in the direction in which the Government are already going. We want to reduce out-of-area placements. The NHS is already committed to that, and is working on moving to a definitive target to reduce the number of them and, I hope, eventually to scrap them. I was up in Hull last week to look at problems in that particular area. The recommendations on waiting times are very important. As we all know, this area has been undervalued in the past. It is under greater scrutiny, and more investment and support are going in through the Government. Today’s report will help us in relation to that.

[Greg Mulholland (Leeds North West) (LD)]

rose—

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

The 6% cut in the pharmacy budget will come in in October—halfway through the next financial year. Will the Minister tell us what the percentage cut will be in a full financial year?

[Alistair Burt]

Negotiations are ongoing with the Pharmaceutical Services Negotiating Committee. The amounts that have been set out cover this financial year and the settlements are moved on from year to year, so the discussion is ongoing. The future for pharmacy is very good, although it will be different, as the profession has wanted for some time. Not only is there a great future for high-street shops in areas where we need them, but there will be an improvement in and enlargement of pharmacy services in healthcare settings, primary care settings and care homes around the country.

[Several hon. Members rose—]

Bootham Park Mental Health Hospital

Alistair Burt Excerpts

Wednesday 3rd February 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone, especially in the circumstances of the powerful case put forward by the hon. Member for York Central (Rachael Maskell), with whom I have been in contact pretty much since this incident started. We spoke on the telephone around the day things happened and I have been in regular contact since. It is true that we have not met in a round table, but that is not a decision of mine. We agreed that when there was a point to meeting all together, we would, but things had to happen and we had to go some way down the line before that. My door has always been open and the hon. Lady has always been able to speak to me.

[Rachael Maskell]

indicated dissent.

[Alistair Burt]

If she would like to deny that, I will be happy to sit down, but she knows full well that I have spoken to her regularly and I have been available. I will happily see her and her constituents at a time that is entirely appropriate: when there is something to discuss. I do not think that her charge is particularly fair.

[Rachael Maskell]

I am confused because I have been trying to get a meeting with the Minister—I have got correspondence for three months. I am therefore sorry if his office has let him down, but we have been trying to get a meeting, which senior clinicians also want to hold.

[Alistair Burt]

Let me be clear. I spoke to the hon. Lady at an early stage and first I advised that a debate would not be a bad idea to bring issues out. I was concerned that there might be delays with the trust in terms of what may happen with the new premises, but at the time of the incident there was no point in having a meeting about what would happen next. Since then I have genuinely not been aware of a request for a meeting. I am very happy to have such a meeting, but at the time it seemed sensible that we would wait until there was a point in having a meeting. We have met and passed each other pretty regularly in the meantime and, had there been a delay that had caused grave concern, it would have taken a matter of a second to say, “How about that letter —are we going to meet?” but I have not had that conversation.

May I thank my hon. Friend the Member for York Outer (Julian Sturdy) for his interest? We have spoken on this subject from time to time.

Those issues, however, are incidental. The hon. Lady’s interest has been sincere and consistent, and she highlights a pretty unhappy story in which there are circumstances that cause me genuine concern. I will first say a little about what we know about the circumstances and then what we can do next.

Bootham Park hospital could provide care to about 25 to 30 in-patients and about 400 out-patients. The Vale of York CCG had previously announced its intention to commission a new, state-of-the-art facility and is working with NHS Property Services Ltd and NHS England to press for funding. I understand that the intention is to provide a new hospital in York to replace Bootham Park by 2019. At this stage, I have heard no suggestion that that will not be the case.

[Julian Sturdy]

On that point, will the Minister highlight what discussions he has had with the new trust, TEWV, about the new hospital, and whether the timelines are still on track?

[Alistair Burt]

I have not had those discussions at this stage, because my understanding is that the timelines are on track. I suggested to the hon. Member for York Central that if there were concerns about foot-dragging, I was very willing to have that conversation with other colleagues in the room, to ensure that the original stated timetable was stuck to. I was interested in whether there was any opportunity to bring that forward, but my understanding is that that is not the case. I will come to what happens next in a moment.

Until recently, as the hon. Lady said, the hospital was operated by Leeds and York Partnership NHS Foundation Trust. In October 2015, the Vale of York clinical commissioning group ended the relationship with that trust and asked Tees, Esk and Wear Valley NHS Trust—TEWV—to take over the provision of services.

Bootham Park is a very old building, at 200 years old, and is probably one of the oldest buildings in use for patients in the NHS. It is also a grade I listed property, which has not necessarily made things any easier over time. The hon. Lady said in her maiden speech:

“Bootham is not fit for purpose and the CQC concurs.”—[Official Report, 2 June 2015; Vol. 596, c. 512.]

She was entirely right. As such an old building, Bootham Park had a number of problems that modern buildings designed for healthcare services normally avoid, one of which was ligature points—in other words, fixtures or fittings that someone could use to hang themselves from. As the hon. Lady knows, that was sadly not a theoretical problem at Bootham Park, since a lady was found hanging in her room at the hospital in March 2014.

The inquest heard that in December 2013, CQC inspectors had already identified the ligature point that that lady later used, along with a number of others, and asked that it be removed. The CQC’s report, published in 2014, clearly said that there were a significant number of ligature risks on the ward, but that work was unfortunately not done by the trust. The coroner noted at the inquest that he would have expected management to see that the work was done.

The Leeds and York Partnership NHS Foundation Trust fully accepted that it should have done the necessary work. However, when the CQC returned to inspect the hospital in January 2015, it again identified risks to patients from the building infrastructure and a continuing need to improve the patient environment. Refurbishment had been taking place both before and after the January 2015 inspection. Work carried out since February 2014, at a total cost of £1.76 million, included a number of improvements. Among those was an attempt to remove all the ligature points, as well as an overhaul of the water hygiene system and other repairs.

The CQC inspected the hospital again in early September 2015. At that point, it once more recorded a number of familiar problems, although it acknowledged the effort the trust had made to deal with them. The CQC found insufficient staffing numbers; areas with potential ligature points that could have been remedied without major works; poor hygiene and infection control; poor risk assessments, care plans and record-keeping; an unsafe environment due to ineffective maintenance; areas deemed unsafe or found unlocked; and poor lines of sight on ward 6. Furthermore, part of the ceiling had collapsed in the main corridor of the hospital. The debris was cleared away but the area was not cordoned off, which meant people were still at risk of harm.

The building’s listed status meant that it was not possible to remove all potential ligature points. The quadrangle-shaped wards meant there could never be a constant line of sight for nurses to observe patients. Despite the money already spent, the systems for sanitation and heating were outdated. The CQC felt that despite repeated identification of problems at inspections, not enough had been done—the hon. Lady was quite right to point that out—or perhaps could be done to provide services safely at the hospital. Patients remained at risk. The CQC therefore took the decision, as the regulator, to close the hospital with effect from October 2015. The CQC and the Vale of York CCG both agreed, as the hon. Lady said, that the current estate was not fit for purpose.

The timing of the closure was unfortunate. Mental health and learning disability services in the Vale of York were due to transfer from the Leeds and York Partnership NHS Foundation Trust to TEWV on 1 October 2015. That meant the new provider was taking over as the facility was being closed down for safety reasons. However, when the CQC, as the responsible regulator, comes to the conclusion that a building is so unsafe for patient services that they cannot continue and that it cannot be made safe, the local NHS has no choice in the matter.

The hon. Lady spoke about the number of different organisations involved. I understand her frustration, and I am interested in looking at how that has happened. Different bodies have different responsibilities. Bodies’ not having separate responsibilities for regulation, supply, commissioning and so on runs other risks. She is quite right, however, that having such separation and so many different parties involved means we run risks. If people are ducking and diving to evade responsibility—I will come to that in a second—that is a risk too. There is no easy way to do this, but I am quite clear that bodies have specific responsibilities that they should live up to; I do not think that that is necessarily wrong, provided they all know what they are doing. This situation was particularly difficult.

Nearly two years had passed since the CQC identified serious safety issues at the hospital, which seems more than adequate notice of the problems. The CQC said that it could not allow the service to continue indefinitely or allow a new application to open services at the hospital until the risks to patient safety had been addressed. Ensuring continuity of services for patients immediately became a priority. By midnight on 30 September, eight patients had been transferred to facilities in Middlesbrough, two went to another facility in York and 15 were discharged home. Arrangements were made for some 400 out-patients to continue to receive services at other locations in York. That was a considerable undertaking for the local NHS and achieved under great pressure. It was, of course, not what patients needed or wanted. The change and speculation about what would happen was inherently unsettling.

The NHS had to get matters back to an even keel as soon as possible, and that is what has been happening since. As the hon. Lady said, there has been a recovery of the section 136 services at the hospital. The NHS now has an interim solution in the adaptation of Peppermill Court. The in-patient service for older men with dementia, formerly provided at Peppermill Court, will now be provided at Selby. TEWV started work this week on the development of Peppermill Court as an adult in-patient unit and intends the refurbished 24-bed in-patient unit to be completed by the summer. Out-patient clinics continue to be held at a number of locations in York, and TEWV hopes to move all out-patient appointments back to Bootham Park hospital later this month.

That is where we are, with one further caveat: the business of trying to find out what has happened and why. My understanding is that an external review has been taking place, involving a number of different bodies that have had responsibility and are now looking at this. It seems almost impossible for the review to be concluded without its findings being made public, which would be a good opportunity for people to examine exactly what has been done. I want to see that review’s findings. I want to see the questions that the hon. Lady has raised today answered, and I want a good, clear line of sight as to what has happened, how it happened and, as far as lessons learned are concerned, how to ensure that this could not happen again in the rest of the system, as she says.

Based on what the review says, I will have further thoughts about the questions the hon. Lady has asked. Until we see the review’s findings, we will not know how complete it is or the answers to all the questions. Let us see the review’s findings first. If it is plain that the review is inadequate and leaves things unsatisfactorily handled and dealt with, with questions still arising, we will need to have a conversation at that stage. It might be appropriate, after the review has concluded, to have a round table and use it as an opportunity to have that conversation. However, until I have seen the review’s findings, I cannot decide whether there is anything further to be done at this stage. I want to ensure that the questions are answered, and that there are ramifications across the system. We also want to make progress with the new hospital. Let us see what comes out of the review, and then we will meet again.

On the hon. Lady’s request for a meeting, I have just been handed a note—we had an email from her office on 15 January. We are now going through the invitation process but have not responded.

[Rachael Maskell]

I was chasing up.

[Alistair Burt]

If there has been correspondence that has not been answered, I apologise, but as the hon. Lady knows from my previous contact with her, she can come and see me, and we will sort that out as soon as we can.

[Mr Peter Bone (in the Chair)]

Order. I thank Members for a very important debate, but I am afraid time has beaten us, and we must now move on.

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

Child Dental Health

Alistair Burt Excerpts

Wednesday 3rd February 2016 Commons Chamber

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

It is a great pleasure to respond to my hon. Friend the Member for Mole Valley (Sir Paul Beresford) and his excellent speech. The House has been fortunate to benefit from his professional knowledge on a number of occasions. As a new Minister coming into office some nine months ago, I had an early meeting with him, from which I benefited hugely and continue to benefit. I am grateful for the way in which he put his case and for the heads-up in respect of what I might do and the speech that I might make to the British Dental Association in due course.

I am grateful that the usual suspects have been here to listen because of their interest in these matters, namely the hon. Members for Strangford (Jim Shannon) and for Nottingham North (Mr Allen). I thank my hon. Friend the Member for Battersea (Jane Ellison), who is the public health Minister, for being here, together with the Whip and the Parliamentary Private Secretary. I also saw the hon. Member for Dewsbury (Paula Sherriff), who has been to see me to talk about dental matters and who clearly cares very much about these issues.

I congratulate my hon. Friend the Member for Mole Valley on securing this very important debate about children’s dental health. Poor oral health in children and young people can affect their ability to sleep, eat, speak, play and socialise with other children. Other impacts include pain, infections, poor diet and impaired nutrition and growth. When children are not healthy, it affects their ability to learn, thrive and develop. To benefit fully from education, children need to enter school ready to learn and to be healthy, and they must be prepared emotionally, behaviourally and socially. Poor oral health may also result in children being absent from school to seek treatment or because they are in pain. Parents may also have to take time off work to take their children to the dentist. This is not simply a health issue; it impacts on children’s development and the economy.

It is a fact that the two main dental diseases, dental decay and gum disease, can be almost eliminated by the combination of good diet and correct tooth brushing, backed up by regular examination by a dentist. Despite that, as my hon. Friend has set out, their prevalence rates in England are still too high. Dental epidemiological surveys have been carried out for the past 30 years in England and give a helpful picture of the prevalence and trends in oral health. Public Health England is due to report on the most recent five-year-olds survey in the late spring.

There is a mixture of news, as the House might expect. The good news is that the data we have at present show that oral health in five-year-olds is better than it has ever been, with 72% of five-year-old children in England decay free. Between 2008 and 2012, the number of five-year-old children who showed signs of decay fell by approximately 10%. The mean number of decayed, missing or filled teeth was less than one, at 0.94. Indeed, the data suggest that, notwithstanding the All Blacks’ rugby success and their bone-crushing efforts on the field, oral health in children is currently better in England than in New Zealand. New Zealand’s data for children aged five in 2013 showed that the proportion who were disease free was 57.5% and that the mean number of decayed, missing or filled teeth was 1.88.

[Jim Shannon]

We have had a marked reduction in dental decay in children since the year 2000, as I said earlier in an intervention. With respect, Minister, I would say that we are doing some good work in Northern Ireland. The Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) knows that I always say, “Let’s exchange ideas and information.” We are doing good work in Northern Ireland and we want to tell Ministers about it.

[Alistair Burt]

This is possibly the fourth or fifth invitation that I have received from my hon. Friend to come to see different things in Northern Ireland, and he is right about every one. He finds in me a willing ear, and we will make a visit because there are several different things to see. Where devolved Administrations and the Department can learn from each other, that matters, and I will certainly take up my hon. Friend’s offer.

In older children there are challenges when comparing different countries, because of how the surveys are carried out. The available data still show that we have among the lowest rates of dental decay in Europe, but despite that solid progress we must do more. There is disparity of experience between the majority of children who suffer little or no tooth decay, and the minority who suffer decay that is sometimes considerable and can start in early life. In this House, we know the children who I am talking about—it is a depressingly familiar case. We can picture those children as we speak, as my hon. Friend the Member for Mole Valley described in the sometimes horrific parts of what he told the House. The fact that we know that such decay affects children in particular circumstances makes us weep.

Public Health England’s 2013 dental survey of three-year-olds found that of the children in England whose parents gave consent for their participation in the survey, 12% had already experienced dental decay. On average, those children had three teeth that were decayed, missing or filled. Their primary, or baby, teeth will only have just developed at that age, so it is highly distressing for the child, parents, and dental teams who need to treat them. Dental decay is the top cause of childhood admissions to hospitals in seven to nine-year-olds. In 2013-14, the total number of children admitted to hospital for extraction of decayed teeth in England was 63,196. Of those, 10,001 were nought to four-year-olds, and so would start school with missing teeth.

From April 2016, a new oral health indicator will be published in the NHS outcome framework based on the extraction of teeth in hospital in children aged 10 and under. That indicator will allow us to monitor the level of extractions, with the aim of reducing the number of children who need to be referred for extractions in the medium term. Extractions are a symptom of poor oral health, and the key is to tackle the cause of that. Today I commit that my officials will work with NHS England, Public Health England and local authorities to identify ways to reach those children most in need, and to ensure that they are able and encouraged to access high-quality preventive advice and treatment.

The good news is that the transfer of public health responsibilities to local authorities provides new opportunities for the improvement of children’s oral health. Local authorities are now statutorily obliged to provide or commission oral health promotion programmes to improve the health of the local population, to an extent that they consider appropriate in their areas. In order to support local authorities in exercising those responsibilities, Public Health England published “Local Authorities improving oral health: commissioning better oral health for children” in 2014. That document gives local authorities the latest evidence on what works to improve children’s oral health.

The commitment of the hon. Member for Nottingham North to early intervention and the improvement of children’s chances is noteworthy and well recognised in this House and beyond, and of course he can come to see me. I would be happy to discuss with him what he wants to promote in Nottingham, which sounds just the sort of initiative we need.

Public Health England is also addressing oral health in children as a priority as part of its “Best Start in Life” programme. That includes working with and learning from others, such as the “Childsmile” initiative in Scotland, to which my hon. Friend the Member for Mole Valley referred. It is important that health visitors—I know that the Public Health Minister takes a particular interest in their work—midwives, and the wider early years workforce have access to evidence-based oral health improvement training to enable them to support families to improve oral health.

Public Health England and the Royal College of Surgeons Faculty of Dental Practice are working with the Royal College of Paediatrics and Child Health to review the dental content of the red book—the personal child health record—to provide the most up-to-date evidence-based advice and support for parents and carers. The National Institute for Health and Care Excellence has also produced recent oral health guidance that makes recommendations on undertaking oral health needs assessments, developing a local strategy on oral health, and delivering community-based interventions and activities for all age groups, including children. Community initiatives to improve oral health include supervised fluoride tooth-brushing schemes, fluoride varnish schemes and water fluoridation.

I agree with my hon. Friend that water fluoridation is an effective way of reducing dental decay. However, as the House knows, the matter is not in my hands. Decisions on water fluoridation are best taken locally and local authorities now have responsibility for making proposals regarding any new fluoridation schemes. I am personally in favour. I think I am the only Member in the Chamber who remembers Ivan Lawrence and the spectacular debates we had on fluoridation in the 1980s. He made one of the longest speeches ever. Fluoridation was bitterly and hard-fought-for and I do not think there is any prospect of pushing the matter through the House at present. I am perfectly convinced by the science and that is my personal view, but this is a matter that must be taken on locally.

Diet is also key to improving children’s teeth and Public Health England published “Sugar reduction: the evidence for action” in October 2015. Studies indicate that higher consumption of sugar and sugar-containing foods and drinks is associated with a greater risk of dental caries in children—no surprise there. Evidence from the report showed that a number of levers could be successful, although I agree with my hon. Friend that it is unlikely that a single action alone would be effective in reducing sugar intake.

The evidence suggests that a broad, structured approach involving restrictions on price promotions and marketing, product reformulation, portion size reduction and price increases on unhealthy products, implemented in parallel, is likely to have the biggest impact. Positive changes to the food environment, such as the public sector procuring, providing and selling healthier foods, as well as information and education, are also needed to help to support people in making healthier choices.

Dentists have a key role to play. “Delivering Better Oral Health” is an evidence-based guide to prevention in dental practice. It provides clear advice for dental teams on preventive care and interventions that could be delivered in dental practice and school settings. Regular fluoride varnish is now advised by Public Health England for all children at risk of tooth decay.

For instance, the evidence shows that twice yearly application of fluoride varnish to children’s teeth—more often for children at risk—can have a positive impact on reducing dental decay. In 2014-15, for children, courses of treatment that included a fluoride varnish increased by 24.6% on the previous year to 3.4 million. Fluoride varnishes now equate to 30.9% of all child treatments, compared with 25.2% last year. This is encouraging progress.

There are many measures that can and should be taken in order to reduce the prevalence of decay in children, but we recognise it is unlikely that we will be able to eradicate entirely the causes or the effects of poor oral health in children. This means that the continued provision of high quality NHS primary dental services will continue to be an important part of ensuring that every child in England enjoys as high a standard of oral health as possible. NHS England has a duty to commission services to improve the health of the population and reduce inequalities—this is surely an issue of inequality—and also a statutory duty to commission primary dental services to meet local need. NHS England is committed to improving commissioning of primary care dentistry within the overall vision of the “Five Year Forward View”.

[Mr Allen]

The Prime Minister announced an excellent initiative on life chances less than two weeks ago. The cornerstone of that was improving parenting skills. Will the Minister’s Department ensure that feeding into that process there is, within the parenting programmes, stuff around health in general, but dental health in particular?

[Alistair Burt]

Yes. [Interruption.] Immediate information passed to me by the Minister with responsibility for public health indicates that that is a very positive initiative and we are indeed taking it up.

Overall, children’s access to NHS dentistry remains consistently high, with the number of children seen in the 24 months to September 2015 by an NHS dentist standing at 8 million, or 69.6% of the population. There are localised areas where children have access difficulties, but the more common problem is that the parents and carers of the children most at risk do not seek care until the child has developed some disease—this again emphasises the importance of health visitors and others in the process.

To help focus on prevention, the Government are committed to reforming the current system of primary care dentistry to improve access and oral health further. In line with the welcome improvements in oral health over the last 50 years, we need an approach in primary care dentistry that can provide a focus on prevention, while also incentivising treatment where needed.

That is why, following the piloting of the preventative clinical pathway, we are now prototyping a whole possible new system remunerated through a blend of quality, capitation and activity payments. The aim is to allow dentists to focus on prevention and, where appropriate, treatment, and how effective that could be for the children we are talking about. The new approach will be tested until at least 2017. We need to do a proper evaluation and, if successful, numbers will increase with a possibility of a national roll-out for 2018-19.

I hope I have been able to demonstrate the seriousness with which the Government take this subject—a seriousness that I know is accepted by the whole House. It comes back to some fundamental issues of inequality in health that are, as I said, depressingly familiar and which we are all absolutely dedicated to removing. The concept of total clearance for a child—I suspect that none of us has had to contemplate that in our personal lives, but it affects some of our constituents—is something that brings us all up short. I am grateful to my hon. Friend the Member for Mole Valley for raising this subject for debate.

Question put and agreed to.

NHS and Social Care Commission

Alistair Burt Excerpts

Thursday 28th January 2016 Commons Chamber

[Mr Nick Clegg (Sheffield, Hallam) (LD)]

I join all those who have spoken so far in congratulating my right hon. Friend the Member for North Norfolk (Norman Lamb) on securing the debate. It concerns what is undoubtedly one of the biggest questions that we face as a country, as a Parliament, and as a political class: the question of how we can square the circle of an ageing population, and how we can put the NHS on to a sustainable financial footing.

My grandfather was editor of the British Medical Journal from the time when the NHS was founded until the mid-1960s, and I suspect that if he were around today, he would say that the challenges currently faced by the NHS would be entirely unrecognisable to his generation of medics.

It is right that my right hon. Friend is pushing us all to try to sketch out solutions on a cross-party basis. It could be said that he and I tested the virtues and pitfalls of cross-party working to destruction—some would say, unfairly perhaps, to self-destruction—in the last Government. Notwithstanding that experience, however, I think that issues such as pensions, long-term infrastructure investment, Europe, decarbonisation of our economy and, in this context, the sustainability of the NHS are not susceptible to single-Parliament, single-Government, single-party solutions. I therefore say, “All power to my right hon. Friend’s elbow”, and I hope that the Government will look kindly on his proposal.

I intend to dwell on an issue which I hope the commission will subject to real examination, namely the role of mental health in the NHS. We have come a very long way. I remember standing, eight years ago, a little way in front of where I am standing now, shortly after becoming leader of my party, and asking Gordon Brown a question about mental health during Prime Minister’s Question Time. I recall that I was heard in what was almost a slightly shocked silence, because at that time raising the subject of mental health was considered to be rather “novel” and brave. The extent to which the debate has advanced since then is fantastic.

There have been truly moving debates in the Chamber, when a number of our colleagues have spoken for the first time, very openly and movingly, about their own struggles with mental health conditions. Society and the media now talk more comfortably about mental health, and a barrage of celebrities have lent their considerable weight to that. The debate, the rhetoric, and the awareness of mental health as a major challenge that affects one in four of our fellow citizens have been transformed in recent years, which is a wonderful development. We have lifted the lid, lifted the taboo, and lifted the slight foot-shuffling embarrassment that used to overshadow the subject of mental health, which is a great step forward.

I am immensely proud of some of the things that our coalition Government managed to do in pushing the agenda forward and putting mental and physical health on the same legal footing. My right hon. Friend and I worked together closely on the introduction of NHS waiting time standards relating to mental health, which had existed in relation to physical health issues for a long time, and took many other important steps.

What worries me is the growing gap between the rhetoric about mental health and the reality of what is happening on the ground. There will always be a gap, because rhetoric is easier to deliver than change on the ground; there will always be a time lag between the moment when the debate and the policy prescriptions alter, and the moment when that change percolates down to the ground. However, I think that this gap is becoming dangerously wide. That is, of course, very bad for the many patients with mental health conditions who are not being properly treated, but I also think that if we do not address it soon and follow up the rhetoric with action, there will be real cynicism about what the political classes have meant during the journey that we have made over the past few years towards talking more comfortably and openly about mental health issues.

I know that many Members are already familiar with the scale of the problem, but I think it worth illustrating that scale with a couple of facts. Mental health makes up 23% of what is somewhat inelegantly described as the UK disease burden, but it accounts for only 11% of NHS spending, and the majority of people with mental health conditions still go untreated. On average, just 30%—less than a third—eventually gain access to treatment. If that applied to any physical health condition, it would be seen as a Dickensian state of affairs requiring urgent action. I hope that the cross-party commission will think carefully about the step change that is required in the organisation, because support and funding for mental health will be critical to its considerations.

Let me now invite the Minister to focus on three issues, in the short term and in the slightly longer term, because I think that there is currently a blockage that is preventing the rhetoric from being translated into the kind of action that most Members on both sides of the House want to see.

The first issue is that, last year, just before the last Budget of the coalition Government and the general election, I announced, on behalf of the Government, £1.25 billion in funds to transform what could be described as the Cinderella service within the Cinderella service, namely child and adolescent mental health services. It was the most ambitious blueprint ever set out by any Government to transform the service and, indeed, to fund it properly. As the Minister will know, that £1.25 billion equates to roughly a quarter of a billion pounds, or £250 million, to be invested in child and adolescent mental health services per year. Over the last financial year, however, the amount invested has been not £250 million but, I think, £143 million.

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

It was about £170 million.

[Mr Clegg]

I stand corrected. Anyway, it was not £250 million.

There may be perfectly explicable teething problems. The announcement was made in the spring of last year, and it will have been necessary for all the mental health trusts to shift gear. However, I hope that the Minister—or, if not him, the commission—will ensure that not only future mental health reforms but previous commitments are delivered and funded in full. The £250 million that has not been delivered over the last year needs to be made up for between now and the end of this Parliament.

My second point concerns the importance of prevention —in all areas of health, obviously, but perhaps especially in mental health. The need for better prevention measures was one of the key findings of the mental health taskforce’s public engagement exercise, yet there has been little if any mention of it in recent Government announcements. Mind, the mental health campaign and policy group, has established that local authorities spend just 1% of their public health budgets on the prevention of mental ill health. That is £40 million out of a total budget of £3.3 billion. Yet we all know—even if we are not clinical experts, we know as parents, and as human beings—that intervening early to improve child and adolescent mental health avoids so much illness, so much heartache, and, to be candid, so much cost to society thereafter. Half of those with lifetime mental health problems first experience symptoms by the age of 14, and 75% of children and young people who have a mental health problem do not get access to the treatment they need.

Waiting times are still far too long. Average waiting times for CAMHS is two months—and as yet there are no waiting time standards in children, adolescent and mental health services. I think we all know, and I certainly accept it, that as we try to revolutionise the approach to mental health, the waiting time standards that have already been announced need to be spread and extrapolated to other parts of the service. Members have talked about the need to reconcile and bring together social care and healthcare, and if we want to put the NHS on a financially sustainable footing, which is the purpose of the cross-party commission, we also need to understand that the lack of prevention and of early intervention on mental health problems is one of the biggest drivers for subsequent inflated costs on the NHS budget. It is therefore essential that the commission looks at this as well.

Thirdly—and arguably most importantly, and also perhaps most technocratically complex—is the issue about the formula or mechanism by which mental health is funded. The problem is that for as long as anyone can remember mental health trusts have been funded according to block grants, through a lump sum of money given to them by some varying formula, while other NHS trusts—acute trusts—are paid on a per patient, per outcome, per recovery basis. That of course is deeply unfair, because it means that any time any Secretary of State for Health, Chancellor or NHS boss needs to make savings, the easiest thing to do is quietly shave a little money off that block grant, as no one really notices it —it does not stick out like a sore thumb like other financial cuts do—and that is precisely what has been happening. That is one reason why—even in recent years, however much new and welcome emphasis there has been on the priority mental health should have in the NHS—the basic funding formula or mechanism constantly discriminates against mental health trusts.

--- Later in debate ---

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

This has been a really great afternoon. I have thoroughly enjoyed listening to all the speeches. It has been the sort of debate that I think people outside this place appreciate. I thank the right hon. Member for North Norfolk (Norman Lamb) and his colleagues for securing the debate. I also thank him, as always, for the contribution he made when he was in the role I am now in. I thank all right hon. and hon. Members for their contributions, not least those with a medical background. We encourage them to remain in active medicine, because it brings an extra dimension to these debates. If I have time, I will address the comments from each Member. I will first respond briefly to the nub of the debate before responding to colleagues’ remarks and making some comments on the structure.

The sustainability of the NHS and social care system, whether financial or operational, is a key commitment of this Government. However, we do not believe that there is a need to launch an independent commission into its future. The NHS and wider health system has already examined what needs to be done to ensure the sustainability of the health and care system. Part of the purpose of making NHS England independent was to allow it to examine the circumstances of its finances and project into the future. It did so independently and came up with a figure. The Conservative party, uniquely, met that commitment at the last election and was able to carry it into government. It is important for the House to recognise that right at the beginning.

[Norman Lamb]

I just want to challenge the Minister on the suggestion that NHS England came up with the figure and the Government met it, because that is not actually what happened. NHS England and Simon Stevens painted three scenarios. The scenario that the Government have met, and on which both my party and his party stood at the election, is based on assumptions that are heroic in their scale and have never been met in the history of the NHS.

[Alistair Burt]

If I may say so, Simon Stevens said, “Look, it needs £8 billion.” It also needs £22 billion in efficiencies. We have met the challenge and put in even more than £8 billion—by 2020 it will be £10 billion. I understand the pressures in the system and fully appreciate the right hon. Gentleman’s remarks. The King’s Fund stated in its 2015 report:

“‘Business as usual’ is not sustainable. But that does not mean the NHS is fundamentally unsustainable.”

Simon Stevens recently said:

“The NHS has a huge job of work to do ensuring an already lean health service is as efficient as it can be—which, in my assessment, people are entirely up for.”

He recently told the Health Committee, “In headline terms, £22 billion is a big number, but when you think about the practical examples and do the economic analysis, we have some pretty big opportunities in front of us.” We know that the challenge is there; nobody denies that. However, NHS England put its assessment of what it needs to the political parties at the last election. We met that challenge and were elected.

We have spoken about a process, and I will return to that in a moment. What NHS England produced was developed by it, along with Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. The Government back the plan, but we need a strong economy to be able to do that, as a number of colleagues have said. Without trespassing too much into other areas, that is the meat of political debate in this country. The public are not just asked to make a judgment on the delivery of one particular service, however precious it is. It is about whether they think that those who are promoting their view of a particular service have the economic background to deliver it. That question was also comprehensively answered at the general election. We now have responsibility for carrying that forward. People believed that we could put the money into it, and we have done so.

[Liz Kendall]

The Minister says that he believes that the Government have met the challenge, so does he think, with regard to funding the NHS and social care, that it is job done?

[Alistair Burt]

I said that we have met the challenge that was put before us, which was to support what NHS England said it needed. We have done that through the financial commitment we have made. We looked very hard in the spending review to see what social care would need, and the Chancellor came up with the £2 billion social care precept, plus the £1.5 billion from other resources, so that is £3.5 billion extra by the end of 2020. We have put in place the financing that we believe will allow the delivery of health and social care over the next few years. But—and it is a big but, which I will refer to later—it is not just about the resources; it is also about how they are spent. Most colleagues have spoken about variability and how best practice is not always available elsewhere. We have to ensure that best practice comes in, and that is not just about resources; it is also about how things are done.

[Dr Philippa Whitford]

Is it not the case that the idea of seven-day-a-week, 8 am to 8 pm GP practice was not included in the NHS England estimates, and therefore the cost of that has been added on top? Will the Minister commit to taking the evidence from the pilot studies on whether that is a good use of money?

[Alistair Burt]

I will. We had this discussion in the Health Committee the other week. I will of course look very hard at the evidence, whether it comes from Greater Manchester and shows that somebody is working effectively and appointments are being filled, or from places where that is not currently the case. We have to wait and see in that regard.

The spending review showed our continued commitment to joining up health and care by confirming an ongoing commitment to the better care fund. Again, the integration process is extremely important. In terms of the general argument about what should be done, a clear commitment was made, based on an independent assessment of what was required. That required a Government who were prepared to make difficult decisions, and a strong economy, and we assumed that responsibility.

Let me deal with some of the remarks made by right hon. and hon. Members during this conversation—for it is, as the hon. Member for Central Ayrshire (Dr Whitford) said, a conversation, and a really good one. If more debates about health had the flavour of this afternoon’s discussion, the public might be happier. She said that her preferred method for dealing with things, as with most of us, is bringing people into the same room and having a conversation—but perhaps not this room. However, there are other rooms in this place in which to do that. Indeed, my hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, does so regularly. This place can provide opportunities for the sorts of discussions that would be at the heart of any cross-party consideration of what we want to do. We should not neglect the fact that we can do that, and we have had a good conversation today.

I agree with the hon. Member for Lewisham East (Heidi Alexander) in that I am fundamentally shy of the idea that we can just put this on to others and with one bound we are free. I understand the sentiment that we somehow need to get, if not the politics, then the heat of the politics, out of it in order to allow for the conversation that we need to have. However, at the end of the day, that still requires a process. Like her, I believe that the process is that we discuss it, come to conclusions within our own party about what we can do, and offer it in a sensible way to the electorate. I entirely agree with those who say that there are times when we have all been guilty of the most ridiculous adverts. At the end of the last general election campaign, I was in a marginal constituency and had a piece of paper in my hand that was our last-minute leaflet. I knocked on doors and said, “Look, we have a choice—I can either hand you this leaflet, which is complete nonsense, or you can give me 20 seconds to explain why you should vote for David Cameron tomorrow and keep a Conservative Government.” They laughed and said, “Go on, then”, and I had my 20 seconds. We all know that we are sometimes guilty of producing material that in the cold light of day we would not wish to, and in relation to health we need to be extra-careful about that.

As the debate went on, I was concerned about whether the commission that the right hon. Member for North Norfolk and his colleagues is proposing can bear the weight of the many different things that we would like it to cover. My hon. Friend the Member for Totnes wanted it to report rapidly, but my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) intervened to say that it had to be for the longer term, so which is it to be? My hon. Friend also spoke about the problem of variation in the system, but that is not to do with resources. No commission could be so directive as to make sure that best practice is delivered everywhere. We have to do that in another way.

The hon. Member for Leicester West (Liz Kendall) in, as always, a very thoughtful and sensible speech, recognised the political problem in agreeing on this, and she was right to do so. It is very difficult for her, or any other Labour Member, to talk about the introduction of private medicine. If I did not stand here and say, with no deviation, that the Conservative party and the Government believe in a tax-funded health system free at the point of delivery, the roof would fall in. Therefore, there are constraints on what we can say politically, and we have to be thoughtful about how we deal with those responsibilities.

My hon. Friend the Member for Bracknell (Dr Lee) added more weight to the commission by talking about structure, and how we deal with these reviews of where hospital premises might be located. Again, there is this problem of politics. When approached by patients or doctors with a vested interest in keeping a physical bit of bricks and mortar and in saving “our” hospital, it would be a brave one of us who said, “Do you know what? That may not be the best thing.” That difficult problem was alluded to by my hon. Friend the Member for South West Wiltshire (Dr Murrison). No commission can get us over that sort of problem.

The hon. Member for Strangford (Jim Shannon) invited me to Northern Ireland to see some integration at work, and I would be keen to visit. My hon. Friend the Member for South West Wiltshire and a number of colleagues made the point about public health. Prevention is about not just the public health budget—significant resources are still going into public health—but what we are trying to do with the shift from secondary to primary care to ensure that people are seen earlier.

The hon. Member for Central Ayrshire talked about ensuring that we keep people well longer. She said that instead of seeing the national health service as an organisation that looks after just the ill, we should consider what it can do before that, which is very important.

The right hon. Member for Sheffield, Hallam (Mr Clegg) spoke principally about mental health. As a Health Minister, I know full well what the coalition Government as a whole did in relation to mental health. They picked up a trajectory that had been disappointingly low, but we are now well on track. I wish gently to correct something that has been creeping into the narrative, which is that it was all going fine until six months ago, but it has slightly come off the rails now. It has not. It was not all sorted during the coalition, and I reject the charge that it is now all about rhetoric and not delivery. We are delivering, and making sure that CCGs spend the increased money that they get on mental health, and we are tracking it for the first time.

That £1.25 billion for children and young people’s mental health, which was a very significant delivery by both the right hon. Gentleman and the coalition, has been increased to £1.4 billion, and it will all be spent in that area by 2020. We are dealing with the issue of mental health tariffs as well, and we want to have waiting and access times for children and young people’s mental health services.

I encourage the right hon. Gentleman to see, at least in this part of my portfolio, that what I seek to do is to build on what the right hon. Member for North Norfolk did in my role. I would rather that the right hon. Member for Sheffield, Hallam did not talk in that manner and think that it has all come to a halt, because it has not. We are having to repair one or two things, such as perinatal mental health, in which we have put significant resources. The conversation has been advanced enormously in exactly the right way by consensual discussion, and we will certainly carry that on.

[Mr Clegg]

The right hon. Gentleman is being a little over-sensitive. I bent over backwards to say that it is entirely understandable that there is always a lag of time between rhetoric and delivery. All I will say, in the most consensual, cross-party, non-finger-pointing way, is that there is a real delay now between the pilots that were started back in 2012 and the paucity of the number of mental health trusts that have placed their financial arrangements on the new non-block grant system. That is the urgency with which we must deal.

[Alistair Burt]

I accept that. I was not in this post in the period from 2012 to 2015. I am certainly ensuring that we are progressing. I am glad that we have sorted that out. The coalition’s involvement with and commitment to this issue have been immense, and I am very proud to carry that on in the way I am doing.

My hon. Friend the Member for Lewes (Maria Caulfield) brought her experience to this debate. She spoke about the integration of budgets for social care and for local authority expenditure in the national health service, which is absolutely crucial. For me, integration is not about getting two groups of people to sit down in the same room every few months or so to have a discussion. It really cannot be done without a combined budget. So long as there are perverse incentives for one budget or another, it will not work.

We are making progress on that and have clear plans to get it done by 2020. We will follow our progress with a scorecard to find out where we are. We have spoken for too long about finding the holy grail, but we are further towards it than anyone has been before. That is not a bad place to be, but we must ensure that we make progress. A lot of this is about relationships; it is not just about organisations being in the same room. Unless people really talk to each other and have a real sense of what can be done collectively, we will not get anywhere.

My hon. Friend made the heartfelt plea, “Leave us be from time to time.” That would certainly be echoed by virtually everybody I have ever been involved with in the public sector during the past 30 years. They just wish we would decide what is to be done and let them get on with it for a while before changing it again. I am quite sure that this Government have absolutely absorbed that lesson.

The hon. Member for Don Valley—[Interruption.] Will she forgive me? Once I have been in the House for a few years, I will get all such distinctions right. The right hon. Member for Don Valley (Caroline Flint) speaks from a position of great experience and great success. She spoke about the successes and the failures in the system, which we all know about, and about how the commission could look at them. Again, I am not quite sure that it could bear the weight of doing so.

The right hon. Lady addressed the political issues and how difficult some of them are. If she will forgive me for saying so, she made an intervention on the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) that exemplified the point. There are difficult political challenges within parties as well as between parties across the Floor of the House, and I noticed the little challenge that was made.

I must say to the hon. Member for Oldham East and Saddleworth, who spoke with great passion about her party’s commitment to a publicly funded or taxpayer-funded NHS with no deviation from the line, that that is simply not true. It suits her to say it, but it is not true. Let me quote from an article from the New Statesman of 27 January 2015, under the headline “Labour can’t escape its Blairite past on the NHS, so it should stop crying ‘privatisation’.” It said that Alan Milburn

“serves as one of many reminders that not so long ago, during the New Labour years, the Labour party was driving through dramatic reforms in the NHS and did not shy away from private money in doing so.”

There are variations on a theme, even for the hon. Lady, and she perhaps protested about the public nature of the NHS a little too much.

[Debbie Abrahams]

I am grateful to the Minister for giving way as he did not challenge me when I made that point. Does he, however, accept that Labour stood on the platform of saying that the NHS should be the preferred provider? As other hon. Members have said, we have learned how important it is that policy driving the NHS should be based on evidence. We now have evidence that a health system with an internal market, or a marketised or privatised health system, which is what this Government are seeking, does not help to improve quality or to reduce inequity in healthcare. That was our platform.

[Alistair Burt]

Well, the platform was clearly stunningly successful. I am not embarrassed by being reminded of the Labour party’s NHS platform at the last election, because it did not succeed. For one reason or another, the public did not believe the stories run about us and the NHS, and they did not believe in Labour’s competence to handle the NHS. As we know, the amount of private sector involvement in the NHS is extremely small, and I am not sure that I accept the hon. Lady’s description of how it has all turned out. This is an example of how careful we must all be in dealing with such issues. We must not pretend to our publics that we are something we are not and that our opponents are something that they are not.

My hon. Friend the Member for Stafford (Jeremy Lefroy)—he has great experience, given the work he has done with the NHS—spoke about best practice. He wanted the commission, but again added more pressure in the things it would be doing and considering. I would make the point that such a commission happens at a point in time. I know that it would be designed to look ahead, but it would inevitably consider the circumstances pertaining at the time. We need a process for discussing the NHS and its funding—where the money is coming from and how it is spent. We need to make the process work, rather than thinking that one push into the grass will do the job. Again, I am not sure that the weight will be borne in that way.

[Dr Murrison]

Earlier in his remarks my right hon. Friend talked about having a discussion within the confines of the Palace of Westminster. He appears to be moving in that direction again. Does he agree that there is a need for a more iterative process with the public at large? A commission of the sort that the right hon. Member for North Norfolk has proposed might go some way towards that.

[Alistair Burt]

I think that engagement with all involved is essential. When I am away from Westminster, engaging with patients, the public and staff is fundamental to the visits that I make to the services for which I have responsibility.

There is nothing to stop any of the work that the right hon. Member for North Norfolk is suggesting from starting. It is essential that everybody is fully involved. I do not think that the Government or the Opposition will make any of their decisions on the NHS or its expenditure by excluding anyone.

The hon. Member for Walsall South (Valerie Vaz), in a turbo-charged contribution, also spoke of the importance of getting integration right. She reminded us that Dick Crossman started it all off. I am sure that we have all had election manifestos that have spoken of an integrated transport system and integrating health and social care. Now we just have to make sure it happens. She made the point that no amount of talk or number of recommendations relieves someone of the burden of doing it. At the end of the day, it is doing it that counts. That is the role of the Government, while being appropriately challenged by all others.

I am delighted that my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) spoke of the importance of the workforce, particularly the workforce in social care, who have a very difficult time of it. They have great skills and need to be on a career pathway where they can acquire more. They also need to be valued. Again, my hon. Friend believed that the current mechanisms were better than others for dealing with these difficult problems.

To conclude, I will give my sense of the debate. I found it slightly hard to distinguish what the foundations of the debate were—whether it was about the quantum of funding or how the funding was gathered into the health budget in the first place. The commission is expected to cover a breadth of issues, but I am not certain that it can bear the weight. Decisions need to be made, no matter how the information comes forward.

We do not need a commission to deliver the process or to take the heat out of the debate. We have to be careful about how we speak about these subjects. By and large, what happens upstairs gives the public a good sense of how we deal with witnesses who come in from outside, members of the public and each other. We can do much more of that without the need for a commission. We must remember to handle things carefully.

I am not sure that structural change could be handled through a commission. That is very much a local decision. This is not all about funding; it is about how the funding is used. We have to ensure that we do not get into the trap of measuring everything by what we put in, rather than by output. One of the most telling points was when the right hon. Member for North Norfolk said that in the Commonwealth Fund analysis that gave the NHS such a good rating, the one thing it dropped down on was outcomes—treating people and whether people stayed alive. To most people, that is probably the most important outcome of all. We have to make sure that, for all the other good things that we are doing, such as the work the Secretary of State is doing on transparency and all the efforts we are making to give people more information, we recognise the importance of that.

[Dr Philippa Whitford]

Just on the Commonwealth Fund analysis, the standard that the UK did badly on was actually healthy life expectancy. That is not the same as an outcome in hospital. We may have successful operations, but we have underlying deprivation and ill health.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I just say to the Minister that I did give him the nod. I have been very generous. When we say that he has “up to 15 minutes”, he is meant to take 15 minutes. As he can see from the clock, he has taken a lot longer.

[Alistair Burt]

I beg your pardon, Mr Deputy Speaker. I have tried to accommodate interventions but I entirely take your point. I am just about to finish and am grateful for your generosity.

I take the hon. Lady’s point, but in conclusion, the Government take advice from a lot of sources on everything connected with health. If the right hon. Member for North Norfolk wants to do exactly what he suggested, he can do it, and we will listen very carefully to him, as we do to others. However, I am afraid that, at the moment, I cannot see a Government-sponsored commission. If we have more debates such as this one, the public will be better served and the House will have done its job.

Care Homes: England

Alistair Burt Excerpts

Wednesday 13th January 2016 Westminster Hall

[Peter Kyle]

I am extremely grateful for that intervention. I had not considered that and I will take it on board. I am grateful to the hon. Gentleman for pointing it out and putting it on the record.

It may not be a Southern Cross that fails first. In fact, it is most likely to be the smaller, independent providers in areas that are most dependent on local authority placements. Can the Minister reassure us that his Department and local government have the capacity to respond to any piecemeal closures that are likely to occur?

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

indicated assent.

[Peter Kyle]

The Minister is nodding and I look forward to testing the argument in his statement.

Everyone here wants to ensure dignity for all later in life. That can be assured only if there is a properly resourced residential care sector with stability and financial security. I look forward to hearing the Minister’s response and receiving reassurances that all Members, of whatever party, want to hear, and I look forward to being able to work with him and care home providers in the months and years ahead to ensure that that type of residential care sector becomes a reality.

Mrs Anne Main (in the Chair): I shall call the Scottish National party’s Front-Bench spokesman at 3.30 and then the Opposition Front-Bench spokesman and the Minister. Quite a few hon. Members want to catch my eye and if they divvy up the time between them that will be helpful.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate the hon. Member for Hove (Peter Kyle) on securing the debate and thank him for introducing it courteously and knowledgeably. He is a valuable addition to the House, as indeed are a number of the new Members who have spoken. This is another example of a debate where the House’s knowledge and passion is conveyed in an entirely reasonable but challenging manner. I do not think this is the only debate we will have on this subject, so we will return to a number of issues.

I thank colleagues for their contributions. My hon. Friend the Member for Bexhill and Battle (Huw Merriman) spoke about the quality care provided in our care homes, and it is important not to lose sight of that. The right hon. Member for Enfield North (Joan Ryan) spoke about costs—we will come back to that—and workforce issues. The hon. Member for Rochdale (Simon Danczuk) spoke about the need to ensure that local authorities in poorer areas are covered, and I will speak about that. The hon. Member for York Central (Rachael Maskell) spoke about choices, and I will come back to her on that in a moment.

The hon. Member for Redcar (Anna Turley) spoke knowledgeably about workforce issues. The hon. Member for North Ayrshire and Arran (Patricia Gibson)—we wish her mother-in-law well in the home where she is situated—gave more examples of what is happening in Scotland. I am always keen to see whether we can find anything that can be extrapolated from what is done up there. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke with her usual eloquence and from her strong background in the subject. Again, we will be covering a number of these issues over quite some time, and it cannot be completed today. I thank colleagues from all parties who made interventions.

I will not be able to respond to every point in 10 minutes. I will talk about quality and care issues, the spending issue and contingency—what to do if there is a problem. I think those are the three biggest things. That does not mean that I am uninterested in integration and winter pressures, which we believe we are working through and tackling. I will not talk much about the workforce, but I entirely agree that we should value the workforce at all levels and provide a decent career path. I agree entirely with the view that everyone has to be valued in a way that has not really been the case in social care up to now.

There are a number of other issues that I will just not be able to touch on. If there were specific questions directed at me and I do not cover them, I will go through them and write to the appropriate Member.

In general, we all start from a common position on the importance of this issue and the context in which it is set: an ageing population; people living longer with multiple long-term conditions; and many of our care workers working with dedication, both in homes small and large and in domiciliary care. I praise Chris Ryan of Bedford, who does much the same job as the gentleman the hon. Member for Hove mentioned in looking after a smaller home. It is a family business with a great sense of care and compassion, and I see those things in many homes.

May I start with a few words about quality? I am conscious of time, and I will try to keep my remarks on the three main issues that I want to cover quite short. In a way, we cannot win with the inspection regime. If inspection is done thoroughly and reveals things that need to be changed and improved, I can be lambasted for things that are inadequate. On the other hand, if we do not have a regime that turns up the things that need to be changed, then we are missing things.

The tougher inspection regime and the work that the Care Quality Commission is doing are good for us all. The bulk of homes—60% of the homes inspected, and a third of all homes have been inspected—have been rated “good” or “outstanding”. The CQC started with some local knowledge and wanted to go to the most difficult homes first. When it goes back to them it sees improvement, because the job of inspecting is not just about closing people down; it is also about seeing what improvement needs to be made.

In many cases, care is not about resource per se. I will never stand here as Minister and say that money and resource do not matter, but I will always say that making sure there is good-quality care is about many other things as well. There is tremendous variability of provision. There are people who handle the same resource in very different ways, and some are poorer at it than others. Quality of management, quality of leadership and in particular the use of registered managers in homes are all important issues, and there is much that can be learned through the inspection regime.

It is important for us to set out the five key questions, so that we remember what the regime is intended do. These questions are asked of each service that is inspected: is it safe, is it caring, is it effective, is it responsive, and is it well led? All inspections deliver a rating for the answers to each of those five key questions, on a scale that ranges from “inadequate” to “requires improvement” to “good” and “outstanding”. It is right that we do that, and I am not afraid of the answers that have been produced.

However, I want to go slightly beyond that process. I am never content to rest on what the inspection regime is bringing forward; I listen to other voices as well. Although I do not respond to all the tweets I receive, I read them all, and I am in contact with some of those who represent families and with those who have uncovered things and who do not feel that the inspection regime is doing its job. I say to them that we can do more, and I am listening carefully. I want to use the experiences of those who have been through poor circumstances to see whether we can make any changes that will make such circumstances less likely. There will never be nil bad circumstances, although there should be, but we must do all we can, and I am listening carefully to some less heard voices to try to ensure that that is the case.

I will speak about spending, which I know is at the heart of this debate, before I cover contingency. The hon. Member for York Central spoke about choices. I will not labour this point, but it needs to be said, because it is at the heart of all we do—yes, there are choices to be made. In a different context, I hear much talk about “mandate” from Opposition Members. The Government also have a mandate, and it is a difficult one. It is to try to ensure that our spending on public services matches the needs of the population and also looks after the future, ensuring that we are not running a continuous debt and running into more debt. It is a difficult choice, and we put it to the people and they gave their answer. We are working with that mandate.

The hon. Lady also said that how a society treats its old people is a measure of the quality of that society. That is quite true, as it is of our treatment of our children, those with mental health issues and our prisoners. It is also true of how we treat the future and what we leave for the future. That is why this Government, like every previous Government who have had to make difficult choices, including Labour Governments, have never been able to spend as much money as some would have wished. That is at the heart of this debate as well. We will do what we can with what we have got, and I will explain how we will do it, but that is the difficult choice that we have to make, and the hon. Lady does not have to do so yet. All I will say is that I will explain what we are trying to do in making that choice.

[Peter Kyle]

I am grateful to the Minister for giving way, and for letting us know that he reads all the tweets he receives, because that has opened up another avenue for communicating with him; he may well regret that, even by the end of today.

Part of the Minister’s mandate is to reduce spending—we understand that—and part of his mandate is to spend money better, which is an issue that has come up time and time again in this debate. There was cross-party support for an independent evaluation of the better care fund and how it applies to the care home industry. May I specifically ask him whether he will support the call for that evaluation, which came from Government Members as well as from Labour Members?

[Alistair Burt]

We are constantly evaluating the better care fund. We work on it with local authorities on a regular basis, and with the Association of Directors of Adult Social Services, so it is constantly being evaluated. I do not know whether something else would add to that process.

[Barbara Keeley]

I have made the point about choices to the Chancellor in the past. Perhaps the Minister has not got the Chancellor on side yet; I hope that he will do so. However, the inheritance tax giveaway that this Government have enacted will cost £1 billion by 2020. How far would that £1 billion go in social care? A long way.

[Alistair Burt]

We could all pick items of Government spending that we do not particularly fancy and say, “Oh, if only it was applied to this, it would be great.” Every single Government and every single Chancellor have faced the same argument. We are where we are. We have made choices about a whole variety of things, and we have a range of obligations to deliver to the public. In this particular instance, however, I want to talk about what we are spending and what is new. I will do so briefly, but I must cover that.

The Government are giving local authorities access to up to £3.5 billion of new support for social care in 2019-20. We believe that the precept could raise up to £2 billion a year, and with that money and the £1.5 billion that was included in the spending review, we believe that by 2019-20 there will be the opportunity for a real-terms increase in spending on social care.

[Barbara Keeley]

Will the Minister give way?

[Alistair Burt]

No. I have only three minutes. If I give way, I will not be able to cover everything now.

[Barbara Keeley]

I just want the Minister to say how councils such as the Essex council that wrote to the Prime Minister will manage until 2019.

[Alistair Burt]

I will give two responses to that and talk about the equalisation of funding. First, we are working closely with local authorities and with ADASS. I do not pretend in any way that the situation will not be tough for the next couple of years; it will be. However, we believe the resource is there. Secondly, the social care precept will come in this year, and that money will be made available more quickly. It will be difficult and it will be tight, but a lot of changes are being made and a lot of work is being done to ensure that services are more efficient. Those things are going on all the time.

I want to address the problem that was raised about the precept and explain how it will be used to ensure that local authorities do not miss out. The Department for Communities and Local Government published for consultation a provisional local government finance settlement in December. Recognising that local authorities have varying capacity to raise council tax, it is proposed that the additional funding for the better care fund that will be available from 2017 should be allocated using a methodology that provides greater funding to authorities that benefit less than others from additional council tax flexibility for social care. That will include consideration of the main resources available to local authorities, including council tax and business rates.

[Peter Kyle]

Will the Minister give way?

[Alistair Burt]

No, if the hon. Gentleman will forgive me; I have 90 seconds left.

That is how there will be some degree of equalisation, to respond to the point made by the hon. Member for Rochdale. More money is being spent, and there is an equalisation process.

I will speak about contingency plans briefly. Local authorities now have a responsibility, through the Care Act 2014, to monitor the care providers in their area for any early warning of difficulties. In total, 44 care providers are included. Local councils are also under a duty to provide contingency plans for what would happen if there was a failure of provision, and 95% of local authority areas are currently covered by such contingency plans. Of course, I am looking for answers from the other 5% to ensure that coverage is there. If there is a failure of provision, local authorities have a responsibility to step in, and we are addressing the situation to ensure that contingency provision is in place.

We believe that we have put in money that will assist the system and provide the care that is needed. With local authorities, we are constantly looking at what can be done to make things more efficient. We want to ensure that money is spent properly. That is why the social care precept is there; it can only be spent on social care. I have mentioned the position of councils that might be in particular difficulties over that issue, and over time, we will see whether that provision is sufficient. The Government and I will keep this issue under constant review, and we will talk about it again—

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