Psychosis: Early Intervention

Baroness Keeley Excerpts

Thursday 15th March 2018 Westminster Hall

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

As has already been said, and I will echo it, it is a pleasure to speak in this debate with you in the Chair, Mrs Moon.

I also join others in congratulating the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate, and on the way that he opened it. In addition, I thank my hon. Friends the Members for Stockton South (Dr Williams) and for Liverpool, Wavertree (Luciana Berger), as well as the hon. Member for Faversham and Mid Kent (Helen Whately), and the hon. Member for Airdrie and Shotts (Neil Gray), the Scottish National party spokesperson, for their contributions.

Experience of psychosis can be frightening for those affected by it, and for their families. The hon. Member for Faversham and Mid Kent talked about how debilitating and frightening that experience of psychosis can be.

A story that came to my attention was from a woman called Louise, who wrote a blog for Mind, the mental health charity. In that blog, she described her experience of psychosis. She said:

“While everyone was celebrating the Olympics, I was sectioned and spent a week in hospital. I had started to hear voices and was living in a very strange world. Being in hospital was a terrifying experience and I couldn’t understand why I was there or what had happened to me. I thought the nurses were trying to kill me and I refused medication. Eventually, I accepted the drugs and I did recover. I was released after a week and received treatment in the community.”

The interesting thing about that story and blog is that Louise goes on to say:

“Even a year on, I still find it hard to accept that this happened to me: an independent, strong career woman.”

I wanted to touch on this story because it demonstrates how psychosis affected somebody who was

“an independent, strong career woman”.

The story shows, even in those few words, how debilitating and frightening a first experience of psychosis can be.

Given that, and we have heard about it extensively in this debate, it is clear that early intervention and access to treatment for psychosis is a really vital issue: a moral issue, an emotional issue, a financial issue, and an issue of investment. It is about helping people when they are at their most vulnerable and supporting them to recover.

From this debate alone, the evidence is clear that early intervention can significantly improve a patient’s mental health recovery. That has been highlighted by all the contributions we have heard today. One of the most important benefits of early intervention—this has not yet been mentioned—is the finding in studies that it can reduce the risk of a young person who is experiencing psychosis attempting suicide. That is clearly an important thing. As we have heard, the care packages approved by NICE can also have an impact beyond the mental health recovery of a patient, impacting on their physical health and their chances of remaining in employment. Each part is vital. A key statistic comes from the mental health charity Rethink. It found that 35% of young people in early intervention in psychosis care are in employment, as compared with just 12% of young people in standard mental health care. The right hon. Member for North Norfolk discussed that.

The access and waiting time standard for early intervention in psychosis is not being met, partly because the official figures are for patients who have started treatment. As my hon. Friend the Member for Stockton South discussed, YoungMinds has stated that in January 2018, even though 722 patients had started treatment within two weeks of referral, 1,344 patients were still waiting to start treatment, and 727 of them had been waiting more than two weeks since referral. We are getting a partial picture from NHS England. We were all sent a briefing this morning that said that the access standards are being met, but they clearly are not if they are not taking account of patients who are waiting. The figures for January 2018 also showed that 401 patients had been waiting more than six weeks and still not started treatment, and 217 patients had been waiting for more than 12 weeks without starting treatment. As is familiar when we are looking at issues around mental health, it is the people waiting for long periods who we have to reflect on.

We have also heard about the regional variations. This has been an important debate for highlighting them. The right hon. Member for North Norfolk reported in detail on performance in the south region, which is the best-performing region. YoungMinds reported that the north of England is the worst-performing region. It has the lowest proportion of pathways completed within two weeks of referral.

It is clear that the Government have not invested in the staffing and resources needed to deliver the full package of NICE-evidenced support and treatments. It is clear that many local areas are facing challenges in implementing the early intervention in psychosis access and waiting time standard because of those substantial variations. What is the Minister’s assessment of how those challenges can be overcome? That is one of the most important questions from today.

We have had a briefing this morning from NHS England on the NICE-recommended interventions and the scoring matrix to be used, including on carer support. The hon. Member for Airdrie and Shotts mentioned carers, but I will discuss the subject a bit more fully. Psychosis can cause considerable distress not only for the person experiencing it, but for their family members who are carers. Why are the targets for carer support so low within that NICE evidence package? The figures that NHS England sent to us this morning show 38% of carer support taken up against targets of 25%, 50% and 75% for 2017-18. Take-up of support by fewer than four out of 10 carers is a poor achievement, given the impact that psychosis can have on unpaid carers.

I do not want to miss the opportunity to question the Government about the shameful way they have been treating carers in recent months. I have raised this before with the Minister, but the Government have abandoned their promised carers strategy after 6,500 carers gave up their time to contribute to the consultation. I know it is not her responsibility any more, but it was at the time, and she gave this reply to me in December. She said that,

“it is very important to pull together exactly what support there is at present and then respond to that, and we will publish our action plan in January”.—[Official Report, 7 December 2017; Vol. 632, c. 1239.]

It is now the middle of March, and we have no carers strategy and no carers action plan. Will the Minister raise the matter with her colleague the Minister for Care, the hon. Member for Gosport (Caroline Dinenage)? I suggest that the Government stop treating carers in this shabby way. In terms of this debate, will the Minister look at the low targets for carer support in the targets for early intervention in psychosis? Will she set a more ambitious target to provide higher levels of support to carers of people experiencing psychosis?

My hon. Friend the Member for Liverpool, Wavertree rightly raised the issue of perinatal mental ill health. As we have just had International Women’s Day, I wanted to refer to the 2003 women’s mental health strategy. It was a comprehensive strategy for women’s mental health issues from the previous Labour Government. I was glancing at the document on my iPad, and section 8.8 is about women with perinatal mental ill health. What has happened to the previous Labour Government’s comprehensive women’s mental health strategy? Does the Minister agree that perinatal mental ill health and other aspects of women’s mental ill health merit a gender-specific approach? Will the Government start to think about implementing that?

I want to briefly touch on one further area of concern—the lack of good-quality data. All of us involved in these debates on mental health have to spend a large amount of time asking parliamentary questions that do not get answers because the data are not there. The right hon. Member for North Norfolk is to be commended for his freedom of information survey. In 2016, Public Health England produced a report into data around psychosis and found what the Centre for Mental Health has described as “massive inequalities” in care, which is just what we have been hearing about in this debate. The report found that the proportion of people who have experienced psychosis who have a comprehensive care plan ranges from around 4% in some local areas to 94% in others. The evidence was there in 2016 that massive variations existed.

As the Centre for Mental Health put it:

“The report is as remarkable, however, for the data it cannot present as for what it can. There is very little information about the lives of people with psychosis and how far the services available help them to recover”.

The report was unable to give any information about the prescribing of anti-psychosis medication. Shockingly, it found that there were no known recent robust estimates of local numbers of people with psychosis. How can we deal with recruitment and staffing issues and the resources plan that Members have talked about if that is the state of the data?

I appreciate that there have been some improvements in mental health data in recent years, but it has been very slow progress and there are still many gaps. The Government talk about parity of esteem between mental and physical health, but it is hard to imagine a situation where we did not know the number of people in a local area being diagnosed with different cancers. That situation just would not arise. When I meet campaigners who work on mental health issues, the lack of readily available data is a constant and major concern.

The former Under-Secretary of State for Health, Nicola Blackwood, liked to talk about accountability through transparency. She said:

“One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health.”—[Official Report, 27 October 2016; Vol. 616, c. 513.]

We still have that severe problem. Despite the publication of the mental health dashboard, we have a far less clear picture for mental health data than we do for physical health. We will never be able to plan, resource or move through these issues unless we do. What is the Minister doing, and planning to do, to make better data available across mental health services, particularly for psychosis?

I briefly return to Louise’s story. She was lucky. She said in her blog that she received good-quality treatment. Despite going through some difficult times, when she wrote the blog she was positive about her future, her relationships and her career. She was looking forward to starting a family. If we want to live in a society that has more positive stories like Louise’s, we have to begin to take a much more preventive approach to mental health. Getting the right support can lead to brighter days.

Mental Health Services: Children and Young People

Baroness Keeley Excerpts

Thursday 8th March 2018 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the Care Quality Commission’s review of children and young people’s mental health services.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Not enough scripture is quoted in this House, but I cannot match what was just said. However, I can tell the House that the Care Quality Commission published its “Are we listening? Review of Children and Young People’s Mental Health Services” report this morning, and, yes, we are listening. It was the second piece of work commissioned by the Prime Minister in January 2017 to look at this area of services, and the findings include examples of good or innovative practice and of dedicated people—we thank every one of them—working in every part of the system and a number of areas with strong practice ensuring that patients and families are involved in planning care, but there are also concerns around the join-up between children’s services. We thank the CQC and Dr Paul Lelliott for their work.

The Government have already committed to making available an additional £1.4 billion to improve children and young people’s mental health services to deliver on the commitments in “Future in mind” and NHS England’s five year forward view for mental health, and the CQC welcomes that progress in its report. I know that the hon. Lady and others have worries about this, but spend is reaching the front line. By 2020-21, we have committed to ensuring that 70,000 more children and young people each year will have access to high-quality NHS mental healthcare when they need it. However, there is so much more to do. Claire Murdoch, the national mental health director for NHS England, said in response to the report:

“CAMHS services are now improving, but from a starting point of historic underfunding and legacy understaffing, relative to rapidly growing need”

We see those things across the service.

In December, the Department of Health, jointly with the Department for Education, published “Transforming children and young people’s mental health provision”. That Green Paper responds to a number of the problems raised by the CQC in this report, and sets out a range of proposals to strengthen how schools and specialist NHS mental health services work together and to reduce the amount of time that children and young people have to wait to access specialist help. The proposals are backed by an additional £300 million of funding. We have carried out extensive face-to-face consultation on the Green Paper proposals and have received a high volume of responses to our online consultation, and we thank everyone for that. We will respond to this CQC review, alongside the Green Paper consultation, in the summer.

The report calls for the Secretary of State to use the inter-ministerial group on mental health to guarantee greater collaboration across Departments in prioritising mental health. We agree, and that recommendation is already in hand. The IMG has already contributed to the development of the Green Paper and will continue to provide leadership on the issues that the report raises. The CQC also recommends that everyone who works, volunteers or cares for children and young people is trained in mental health awareness. We are already rolling out mental health first aid training to every secondary school and have committed to rolling out mental health awareness training to all primary schools by 2022. The Government and Ministers remain wholly committed to making mental health everyone’s business and building good mental health for our children and young people.

[Barbara Keeley]

The report is the latest piece of recent evidence revealing systematic failures in our mental health services. It follows similar reports of the past few weeks that call into question the Government’s claims to have made mental health a priority equal to physical health. In this report, we see evidence of services actively putting up barriers to treatment, resulting in children and young people having to reach crisis point before being able to get access to the right treatment. Children are suffering because of those high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14 and that 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes more serious? These high thresholds are even prompting GPs to tell children to pretend that their mental health is worse than it is. Will the Minister agree to look into referral criteria as a matter of urgency, so that children and young people get the proper treatment at the right time?

The report links these excessively high eligibility thresholds and reductions in access with funding reductions and not enough capacity for services to respond to local needs, so, whatever the Minister says, clearly not enough money is reaching the frontline. Can the Minister tell us how he plans to address that? The report, like the CQC’s recent report on rehabilitation services, raises concerns about out-of-area placements, which we know are a barrier to recovery. Will he tell the House what action is being taken to increase the number of in-patient beds available locally?

Finally, what will the Minister do to address the clear problems, highlighted in this report and others, associated with the rigid transition at age 18 from child and adolescent to adult mental health services, which is also a barrier to accessing care?

[Steve Brine]

The hon. Lady rightly raises the issue of spend reaching the frontline; I said in my opening remarks that it is doing so, and she asked what evidence there was of that. Last year, there was a 20% increase in clinical commissioning group spend on children and young people’s mental health, rising from £516 million in 2015-16 to £619 million in 2016-17.

On the broader issues raised in the hon. Lady’s response, I said that we have made up to £1.4 billion available over five years to support transformation of these services, and there is the additional £300 million that I mentioned. I want to touch on waiting times, referral routes and workforce. We are the first Government to introduce waiting time standards, and that is relevant to children and young people’s mental health, too. We are meeting, or on track to meet, both targets. We will pilot a four-week waiting time for specialist children and young people’s NHS mental health services, as was outlined in the recent Green Paper. As I say, we are considering responses to that.

On referral routes, our Green Paper proposes senior designated leads and mental health support teams—a new workforce—based on the findings of the Department for Education’s schools link pilot. They aim to improve the join-up with specialist services and to result in more appropriate referrals.

[Barbara Keeley]

indicated dissent.

[Steve Brine]

The hon. Lady shakes her head; I can only tell her the facts. Health Education England’s workforce plan recognises new ways of working as a cornerstone of delivering these improvements. HEE will also work with our partners to continue the expansion of these newly created roles in mental health services, and to consider the creation of new roles, such as that of early intervention workers, who would focus on child wellbeing as part of a psychiatrist-led team.

Points of Order

Baroness Keeley Excerpts

Wednesday 7th March 2018 Commons Chamber

[Mr Speaker]

I will come to the hon. Gentleman, but I have another point of order first.

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

On a point of order, Mr Speaker. In an oral statement on social care on 7 December 2017, the then care Minister, the hon. Member for Thurrock (Jackie Doyle-Price)—as it happens, she is in her place on the Front Bench at the moment—replied to a question I asked about the Government abandoning the carers strategy, which had been due to be published in summer 2017. Of the thousands of carers who had responded to a consultation and then been left waiting, the Minister said:

“We have listened to them, and we will consider what they have said in bringing forward the Green Paper. In the meantime, it is very important to pull together exactly what support there is at present and then respond to that, and we will publish our action plan in January.”—[Official Report, 7 December 2017; Vol. 632, c. 1238-39.]

It is now March, and this is the second time I have raised this on a point of order. Not only do we no longer have any prospect of a carers strategy from the Government, but they have not met their own target to publish an action plan. That is a shabby way to treat carers. Mr Speaker, have you had any indication that the current Minister for Care or, indeed, any Health Minister plans to come to the House to update us on what, if anything, the Government propose to do for carers?

[Mr Speaker]

I have certainly not been advised of any intention on the part of a Minister to make an oral or, indeed, written statement to the House. There is a Health Minister on the Treasury Bench, who has heard what the hon. Lady said. She is welcome to respond if she wishes, but is under no obligation to do so.

Mental Health Act: CQC Report

Baroness Keeley Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

One of the things that we are doing in prioritising mental health is dealing with exactly that issue. We are having discussions with every part of the health community. We recognise that all the professional organisations have a role in spreading best practice, but we need to do that as well, and the CQC report—and the fact that we are undertaking these reviews so transparently—will help us to do it.

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

Today’s report lays bare the problems that are at the heart of the Government’s short-sighted and incoherent approach to dealing with mental health issues. The CQC has found the system to be “under considerable pressure”, with no improvement in the areas of concern raised in previous reports.

Rather than taking a preventive approach to mental health treatment, the Government have made real-terms funding cuts which mean that more people are at risk of being detained and fewer detentions are being prevented. Crucially, those cuts are causing less restrictive alternatives for the community to be removed at the same time as the reductions in the number of beds for admissions. As the report tells us, the number of detentions under the Mental Health Act 1983 has risen by 36% since 2010, and between 2015 and 2016 it rose by more than 5,000. Will the Minister note that between 2000 and 2009 rates of detention fell, largely owing to investment in community services by the last Labour Government?

Recent research by the Royal College of Psychiatrists showed that mental health services have less money to spend on patient care in real terms than they did in 2012, and more than a quarter of clinical commissioning groups underspent their mental health budgets last year. The Government make many claims about the funds that they have pledged to mental health services—as the Minister has today—but it is clear that the money is not reaching the frontline. The CQC thinks that reform of mental health legislation on its own will not reduce the rate of detention, and reductions in mental health beds and community services are clearly contributing to the rise in the number of detentions. Is it not time to increase funding for mental health, and to ring-fence mental health budgets?

[Jackie Doyle-Price]

I repeat that we have increased mental health spending by £11.6 billion. The hon. Lady suggested that a quarter of CCGs are spending less than their allocations on mental health, but that is not the figure that I have. We believe that 85% of CCGs have increased their mental health expenditure in excess of their allocations, which does not chime with what she said about community services. It may give her some reassurance to know that from next year, NHS England will ensure that the mental health investment standard forms part of its planning guidance. [Interruption.] The hon. Lady says “Next year”, but, as I have said, 85% of CCGs are already meeting the standard, and those that are not are experiencing intervention from NHS England. We are satisfied that the 85%—and it will be 100% next year—are investing more in mental health services beyond their allocations.

I agree with the hon. Lady, and indeed with the CQC report, that the review of the Mental Health Act is not the entire answer. That is the reason for the CQC’s annual inspections, and we will act on its recommendations, but central to the work that Sir Simon Wessely is leading is identifying non-legislative action that we can take in order to make the system work better, and we are involved in many cross-Government initiatives that will enable us to do exactly that.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

It is a fantastic charity. The boy concerned would have been 19 very shortly. It is a very sad story. I thank my right hon. Friend for her campaigning on this issue. We do indeed need to ensure that we have atrial fibrillators everywhere necessary to prevent these tragedies.

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

I welcome the review that the Health and Social Care Secretary has just announced. I also welcome the addition of social care to his role and the Government’s belated realisation that social care should be a Cabinet-level role, as Labour recognised with its shadow Cabinet in 2010. Yesterday, the Alzheimer’s Society reported that care homes were turning away people with advanced dementia—or even evicting them, sadly—because care providers do not get enough money from local authorities to cover the cost of their care. Will the Health and Social Care Secretary now be arguing with Treasury colleagues for the funding that is so badly needed to ensure that people with dementia are not evicted from care homes due to a lack of funding?

[Mr Hunt]

The hon. Lady always speaks powerfully about the social care system. One of the key parts of the social care Green Paper that we are currently working through is on market stabilisation. We have seen a number of care homes go under, although the number of beds overall has remained broadly stable, but our particular concern is, as she rightly points out, people in the advanced stages of dementia who might not be able to get the care that they want. This is a key focus of our work.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 19th December 2017 Commons Chamber

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

The recent Health Survey showed not only that unmet needs were most concentrated among people who are the most deprived, as we have just heard, but that 2.3 million older people, aged 65 and over, now have unmet care needs—2.3 million. Neither the care Minister in her recent statement nor the Chancellor in his Budget said anything about closing the funding gap for social care. Given that the Green Paper is only scheduled for next summer, what is the Health Secretary doing about the crisis in funding social care and meeting staggering levels of unmet needs?

[Jackie Doyle-Price]

The hon. Lady will be aware that, immediately following these questions, we will be having a statement on funding from the Secretary of State for Communities and Local Government. I remind her again that we have made an additional £9.25 billion available for social care over three years, but she is right that the long-term sustainability will be addressed by reform, which is why we are bringing forward the Green Paper. As to the figures on unmet needs, I simply do not recognise them. The entitlement to care is enshrined in the Care Act, and those rights are protected.

Social Care

Baroness Keeley Excerpts

Thursday 7th December 2017 Commons Chamber

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

I thank the Minister for giving me advance sight of her statement, but it is a woefully inadequate response to the Opposition day debate we held in this place on Wednesday 25 October and in no way addresses the motion passed by the House.

That motion called on the Government to note

“the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home”,

and we called on the Government not to proceed with their commitment to those proposals. The Minister has today finally confirmed what many of us on the Opposition Benches suspected: they will not be proceeding with their plans to cap care costs by 2020, as legislated for by the House. This a shameful waste of taxpayers’ money. Over £1 million in today’s money was spent on commissioning the Dilnot review, and it was a waste of parliamentary time enacting the cap. It is no good for her to say that the Government are consulting on the cap. They consulted on this during the general election, and their proposals were rejected by the electorate. Meanwhile, very many people are still faced with the catastrophic costs of paying for their care.

The motion also called on the Government

“to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care”.

During the debate, I talked about how Ministers had previously threatened councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care could not be met—fines for targets that half of social services directors believe to be unrealistic. Will the Minister confirm that the Government have listened to the will of the House and will stop these fines, which merely threaten to make the crisis in social care worse?

The motion also called on the Government

“to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.”—[Official Report, 25 October 2017; Vol. 630, c. 312.]

At no point today has the Minister confirmed how the Government intend to enact the will of the House in meeting the funding gap—and of course, shamefully, there was no mention of social care in the recent Budget. Our social care system remains in a perilous state because of the cuts that this Government have chosen to make. The Care Quality Commission has told us that the social care system still remains at a “tipping point”. Will she now confirm that the Government will enact the will of the House and meet the funding gap?

The Minister in her statement addressed the Government’s decision to include the views of carers in the upcoming Green Paper and their failure to respond to the consultation of 6,500 other carers that has already taken place. As I mentioned in the debate, Katy Styles, a carer and a campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard. She told me:

“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”

Will the Minister give more details on the scope of the carers action plan and reassure those 6,500 carers that their time was not wasted?

The Government announced recently, and the Minister confirmed today, that working-age people with disabilities would be consulted as part of a “parallel” workstream to the Government’s Green Paper consultation. Why a parallel workstream? This is an extremely short-sighted approach to reforming social care, and far from one that looks at the system in the round. Will she give us more details about the parallel workstream for working-age people with disabilities who have social care needs?

It is clear that only a Labour Government can deliver much-needed reform to our social care system. Over the coming months, we will also consult experts on how we can move from the current broken system of care to a sustainable service for the long term. We will look at funding options for social care in the long term, such as a new social care levy, an employer care contribution and wealth taxes. These experts will help to clarify our options for funding our planned national care service, and our approach will be underpinned by the principle of pooled risk, so that no one faces catastrophic care costs, as they do now or as they would have done under the Conservative party’s earlier dementia tax proposals.

[Jackie Doyle-Price]

The hon. Lady will not be surprised to hear that I did not agree with much of what she said, but I will address some of her points.

Fundamentally, we are setting out, as has long been established, how to get a longer-term, sustainable system for funding our social care. It is absolutely clear from our debates during the past year that, as far as the public are concerned, there is a real lack of understanding about how, at present, the cost of care has to be met by the person who requires it. That is what leads to catastrophic care costs, and the dementia tax that she keeps mentioning, and that is exactly what we are going to tackle by having a cap on the overall cost. In doing so, it is very important to take the public with us and to have a fully informed public debate. It does not matter how far we think we have had such a debate in this place when legislating in the past, because it is quite clear that the public do not understand this. [Interruption.] We are only going to get public consent for a long-term solution if we have a public debate that is handled with maturity, and so far we have not seen very much of that.

The hon. Lady raised the issue of carers, and she suggested that carers’ voices are not being heard in this debate. [Interruption.] I say to her that they very much are being heard. [Interruption.] She can sit there and chunter, or she can listen to the answer to the question. It is entirely up to her, but it is rather a waste of my time in coming to this place if I am just going to be talked over. [Interruption.]

Social Care

Baroness Keeley Excerpts

Wednesday 25th October 2017 Commons Chamber

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

I beg to move,

That this House notes the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home; further notes that this proposal would leave people with a maximum of only £100,000 of assets; calls on the Government to confirm its intention not to proceed with this commitment; and further calls on the Government to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care and to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.

After the debacle of the dementia tax, there has been continuing concern that the current and future issues about the funding of social care are not being addressed. The worries stirred up by the Conservative party during the general election will not be resolved without a better idea about what the future now holds for social care.

One place where people were expecting to hear some discussion on this was at the party conferences in September, but if we thought that we would hear about it in the conference speeches of the Secretaries of State responsible for social care, we were sadly let down.

At the Labour party conference, I talked about the crisis in social care and how it was failing those who need care and their families, failing unpaid family carers and failing hundreds of thousands of care workers. People needing care and their carers face the greatest impact. Since the Conservatives came to power in 2010, there are 400,000 fewer people receiving publicly funded care and, sadly, more than 1.2 million people now living with unmet care needs, many of whom are isolated and lonely.

[Kelvin Hopkins (Luton North) (Lab)]

My hon. Friend is raising a very important issue, which is leading to a lot of suffering among elderly people in particular. Will she make reference to the Royal Commission on Long Term Care for the Elderly, which, almost two decades ago, recommended free long-term care for all? That is where we should be.

[Barbara Keeley]

I will talk about how the Labour party will take forward proposals on the future of social care. We wait to hear what the Government choose to do. My hon. Friend is right that there is a driving need now.

The number of people—1.2 million—living with unmet care needs will inevitably rise without an injection of new funding. A lack of publicly funded care means that the task of meeting care needs falls more heavily on unpaid family carers. Many carers have to give up work because of the demands of caring, which has a real impact on their finances and future career prospects. The case for listening to carers and giving them more support is overwhelming. We were expecting a new carers’ strategy this spring, or, at the latest, in the summer. Some 6,500 carers had taken the time over and above their caring responsibilities to respond to the Government’s consultation. However, the Care Minister told me that the responses will merely be taken forward into a new consultation on social care.

Katy Styles, a carer and a campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard, alongside 6,500 other carers. She told me:

“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”

That is a shabby way to treat carers—the people who provide more than 50% of the care in this country.

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

The hon. Lady refers to unpaid carers. Labour’s motion references the Communities and Local Government Committee report on adult social care, which looked at the German system of social insurance. Under that system, payments are made to family members to remunerate them for that care. Has she read that report, and is it something that she is willing to look at in further detail on a cross-party basis?

[Barbara Keeley]

I will come on later to discuss how we should proceed and whether we should proceed on a cross-party basis. The hon. Gentleman’s point about carers and family carers is important. The plain fact of the matter is that there was nothing for carers in his party’s manifesto. We had announced that we were going to lift carer’s allowance at least to the level of jobseeker’s allowance. That is the only improvement that was discussed during the general election. He should turn to his own Minister and his own party and ask them what they will do for carers.

[Mr Mark Harper (Forest of Dean) (Con)]

I welcome the hon. Lady’s tone in this debate. It is very valuable. I know that she has taken an enormous interest in this subject, even when it has not fallen within her Front-Bench responsibilities. These debates are very helpful in educating people about difficult issues. I am happy to accept that we did not handle this issue well in the general election. The mistake that we made was not being clear about the current system, which is why her reference in the motion to our proposal without setting out the current system in which people can potentially lose all but £23,000 of their assets is disappointing. Such information would have helped to contribute to the public debate.

[Barbara Keeley]

We will come on to that. If the right hon. Gentleman wants to get into the mess that his party made, the truth is that we legislated a number of years ago to lift the asset floor to £118,000. What his party did during the election was drop that to £100,000. At the weekend, we learned that there was an intention to make it only £50,000. He should be clear about what his Front-Bench colleagues were trying to do. Since then, all we have heard is a deafening silence.

We need to focus on the crisis in social care now. We on the Labour Benches have raised many times just how fragile the care sector is after years of swingeing budget cuts by the Government. A survey by the Association of Directors of Adult Social Services reported that more than two thirds of councils had reported closures of care providers in the first five months of the financial year. Nearly half those councils had had homecare providers handing back contracts.

[Kelvin Hopkins]

My hon. Friend refers again to local authority care homes. In my constituency, three superb local authority care homes were forcibly closed effectively by Government policy. They were loved by the residents. They had full-time, permanently employed trade union staff and were supported and applauded by the local healthcare professionals. They were all closed. Now we have only the private sector, which is in crisis.

[Barbara Keeley]

It is very important that we bear in mind that the 1.45 million workforce in care will have been local government employees and will have enjoyed local government terms and conditions. We have talked many times about the fact that they are not now paid the minimum wage or travel time. They are very badly paid, with no pensions in prospect.

[Kate Green (Stretford and Urmston) (Lab)]

As my hon. Friend knows, in my constituency, which neighbours hers, we have a real problem in recruiting and retaining care workers, many of whom tell me that they can get better paid work in the local Asda than by doing the job that they love. Does she not agree that that is in part due to the fact that private providers, who would like to pay their staff more, cannot do so because of the insufficiency of the value of the contracts that they receive from the local authority?

[Barbara Keeley]

That is absolutely the case. In fact, in a recent meeting with Unison, I was told that, in our area in Greater Manchester, one person could be paid more for putting toppings on to pizzas at Morrisons than for providing care—often to people with dementia or to those who really need that help.

[Huw Merriman (Bexhill and Battle) (Con)]

The hon. Lady talks about a squeeze in funding. On that basis, does she agree that it would be right to ask those who do have the means to contribute more towards their social care in the home?

[Barbara Keeley]

No, I do not agree with the hon. Gentleman. That is one of the reasons why his party’s dementia tax policy failed so badly. Suddenly to bring hundreds of thousands of people into means-testing using their homes was one of the biggest flaws in the policy that the Conservative party floated.

I will now make a little bit of progress on the state of care, because the fragility of the care sector is a key issue. We heard from my hon. Friend the Member for Luton North (Kelvin Hopkins) about closures in his area, but councils cannot even influence these closures much any more because home care providers are handing back contracts. Indeed, one in five councils in the ADASS survey reported closures in all three services: home care, residential care and nursing home services. There are also serious issues of care quality in many areas of the country.

The survey reported that 70% of the councils surveyed had experienced quality issues across all three types of care services. ADASS estimates that 28,000 people have been affected by care-quality issues or by a change of service due to contracts being handed back. We know that it is a big issue for a person with dementia to have a continual change in the care staff visiting them. Those arguing in favour of cuts need to think about those 28,000 lives affected negatively by cuts to local authority budgets. Worryingly, the Care Quality Commission now reports that almost a quarter of care services are not meeting standards on safety, and nearly a fifth of services require improvement overall.

I said earlier that budget cuts mean that more than 400,000 fewer people are now getting publicly funded care. Of course, councillors, council leaders and social workers have had to make difficult decisions about cutting budgets and cutting support to local people. It is of great credit to councils and council leaders that so many still continue to prioritise adult social care in their budget setting, but the overall position is one of cuts. There will be a real-terms loss of £6.3 billion to adult social care by the end of this financial year, and we heard earlier from my hon. Friend the Member for Manchester, Gorton (Afzal Khan) about the level of cuts in the city of Manchester. The cuts have an impact on staff working in social care.

[Jack Dromey (Birmingham, Erdington) (Lab)]

At last, the Government and Her Majesty’s Revenue and Customs have acknowledged that care workers who sleep in, giving loving care to those badly in need of care, are entitled to the national minimum wage. But, as a consequence, a crisis confronts the sector. Mencap says that it is the

“final nail in the coffin for many providers”,

with jobs lost and the risk of bankruptcy for a number of people with personal care packages. Does my hon. Friend agree that the Government who created this problem should solve this problem and not expect local authorities to pick up the bill?

[Barbara Keeley]

I absolutely agree, and it was helpful of my hon. Friend to make that point. The sleep-ins issue has been a real cause of worry for many organisations over many months. It just goes to the heart of our assertion that people who work in care should be paid the minimum wage, including when they are working at night, which is what they are doing on sleep-ins. I have a constituent who looks after two households of people in adjoining properties, and she does not get normal sleep during the night as alarms can go off in any part of the properties. It is not right at all that those people were paid just fixed amounts, not the minimum wage. The Government must find the funding for that decision.

[Kelvin Hopkins]

I do apologise for intervening so often. Does my hon. Friend agree, as my hon. Friend the Member for Birmingham, Erdington (Jack Dromey) has hinted, that the whole care sector ought to be in the public sector in the longer term at least, provided on the same basis—free at the point of need—as the national health service?

[Barbara Keeley]

As I said earlier, I will come to our proposals; I do not want to jump around in my speech too much more.

Going back to staff working in social care, it is important to remember and think about social workers, not just care staff. A recent study found that less than half the social workers surveyed felt that decisions about a person’s care and support were being left to their professional judgment; it is now all about budgets. More than a third said that they had felt unable to get people the care they need. Less than half felt supported to have necessary difficult conversations about changes to care with people needing care and their families.

The social care crisis is a direct result of the cuts that this Government have chosen to make. The King’s Fund, the Health Foundation and the Nuffield Trust estimated that there would be a funding gap in social care budgets of £1.9 billion for this year, but the extra funding in the Budget was only £1 billion, so there is still a funding gap of £900 million this year. Labour pledged an extra £1 billion for social care this year to start to deal with that funding crisis. However, the Government have chosen instead to put the pressure on local authorities and hard-pressed local council taxpayers to deal with that social crisis, which was made in Downing Street.

Delayed transfers of care due to social care cuts increased by more than a quarter in the 12 months to August this year, putting extra pressure on local councils. Now, sadly, Ministers are threatening councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care cannot be met. Indeed, ADASS reported that half the social services directors it surveyed believe that their targets for delayed transfers were unrealistic. It is barely believable that the Government’s response to the social care crisis is to threaten to make the situation worse by cutting funding for social care even further. Some councils experiencing problems meeting targets were even summoned by NHS leaders last week to a meeting to review their performance challenges.

Many people have said that the approach of blaming and penalising local councils is not sustainable. The Conservative chair of the Local Government Association, Lord Porter, said of the warning letters sent from Ministers to councils:

“No council wants to see anyone stay in hospital for a day longer than necessary. These letters are hugely unhelpful at a time when local government and the NHS need to work together to tackle the health and social care crisis.”

The president of the ADASS, Margaret Willcox, has described the Government’s actions in threatening councils with further sanctions as, “frankly bizarre”. David Oliver, who is clinical vice-president of the Royal College of Physicians and a geriatric consultant, said about delayed transfers of care:

“Some of these delays are due to systematic cuts to social care budgets and provision. Others are due to a serious lack of capacity in community healthcare services…attempts to solve the problem through initiatives like the Better Care Fund or pressure from NHS England have failed”.

Interestingly, Andrea Sutcliffe, the chief inspector of social care at the Care Quality Commission, said:

“I worry that if people focus just on moving people through the system quickly then does that mean that they will force the discharge of somebody that is old and frail into a service which we have rated ‘inadequate’”.

We now have a Government who are driving the NHS to be obsessed with dealing with delayed transfers of care, seemingly above all else. This obsession causes further problems if patients are discharged without planning what they need outside hospital.

Age UK give an example that was brought to it:

“Terry’s father Richard, 85, is in hospital following a stroke. He is ready for discharge and has been assessed as needing rehabilitative care through two home visits a day. However he was then told that there are no reablement services available in his area. Terry has been told to ‘get his father out of hospital’ and to look for and fund the care himself.”

My own local hospital, Salford Royal, sadly seems to have similar issues. Last week, I spoke to a constituent who described her own discharge by saying, “I was thrown out of hospital.” Having had surgery for an infected bite that caused sepsis and a hand that she could not use, my constituent was given no discharge summary, no advice on how to manage her wound and no advice about her recovery. When she struggled to get dressed, she was told that she had to get out quickly, otherwise, “This will count as a failed discharge.” This a theme we may remember from last winter.

I remind the Minister that the British Red Cross talked then of a humanitarian crisis whereby people were sent home without clothes or into chaotic situations. Those chaotic situations involved them falling and not being found for hours, or not being washed because there were no care staff to help them. Ordering patients out of hospital when there is no reablement service for them, without advice about wounds or recovery, or to a care facility rated as inadequate just to meet unrealistic targets on delayed discharge is a recipe for an even worse crisis this winter.

[Huw Merriman]

The social care and hospital budgets have been merged in East Sussex, where my constituency is. As a result, the A&E is now the fastest-improved A&E department in the whole of England. That change is working. Would the hon. Lady’s local authority consider the same model?

[Barbara Keeley]

My local authority has the most advanced example of an integrated care organisation in the country—we have already transferred all our social care staff to work for Salford Royal. I have just quoted a situation that shows how the pressure being put on hospitals because of delayed transfers of care is causing them to treat people such as my constituent in the way I described. Conservative Members ought to listen to that, because it is their Government and their Ministers who are causing this pressure to be put on hospitals.

We know that demand on social care is increasing as more people live longer with more complex conditions. The number of people aged 75 and over is projected nearly to double by 2039. That ought to be something to celebrate, but instead the Government have created fear and uncertainty for older people by failing to address the health and care challenges raised by those demographic changes. Indeed, the Conservative party is spending less money on social care now than Labour was when it left office in 2010. The Government seem to have no plan to develop a sustainable solution to the funding of social care in the longer term; they have talked only of a consultation followed by a Green Paper.

Furthermore—and this is raising real fears—the focus has been entirely on the needs of older people, without consideration being given to the needs of the 280,000 working-age people with disabilities or learning disabilities in the social care system. That is profoundly short-sighted, because the financial pressures on local authorities due to the increasing care needs of younger adults with disabilities or mental health problems are now greater than those due to the need to support older people.

[Kate Green]

I am glad my hon. Friend has mentioned younger adults. Does she agree that investing in the care they need will facilitate the Government’s achievement of their ambition to have more disabled people who can work in paid employment? Relatively low levels of expenditure on care for those people would pay great dividends for the Government and the country.

[Barbara Keeley]

Very much so. I thank my hon. Friend for making that point. It is concerning that planned consultations or discussions about future policy should focus so much on older people, when the needs of people with disabilities and learning disabilities are so important. We talked about learning disabilities in a debate last week.

Labour will fill the policy vacuum that exists around social care under this Government. Over the coming months, we will consult experts on how we can move from the current broken system of care to a sustainable service for the long term. We will look at funding options for social care in the long term, such as wealth taxes, an employer care contribution or a new social care levy. Those experts will help clarify the options for funding our planned national care service. Our approach will be underpinned by the principle of pooled risk, so that no one faces catastrophic care costs as they do now or as they would under the Conservative party’s dementia tax.

Our plans are for a national care service. They are based on a consultation—the “Big Care Debate”—that involved 68,000 people. People in that consultation told us that they needed a system that will support them and their families to live the lives they want, that will treat everyone with dignity and respect and that will give them choice and control over their care. I believe those needs remain the same, and they will be at the heart of our ambition for social care.

I urge hon. Members from all parties to vote with the Opposition today so that we can set the foundations for a safer, more sustainable and higher quality care system for the future and reassure those who have become worried about the Conservative party’s dementia tax mess.

[Craig Mackinlay (South Thanet) (Con)]

I am always very impressed by the hon. Lady’s knowledge in this area, but just to clarify, did I hear her say that she was considering wealth taxes as a means to pay for these proposals? She talked about a policy vacuum, but I would be interested to hear how the money vacuum would be filled. I am also somewhat concerned—I hope she will explain this—that a national care system rather puts families aside.

[Barbara Keeley]

I am obviously coming to the end of my speech, but I recommend that the hon. Gentleman, if he is interested, read a number of documents. The Labour Government produced a White Paper for a national care service; it is still available, and I advise him to look at it. Given everything I have said about carers in this speech, there is no way that we would not include them as an important part of our proposals, but the burden should not just be dumped on them. Carers should be partners in care, and they should be supported so that they have a life of their own. It is said that the only numbers put on the Conservative party’s proposals for a dementia tax in its manifesto were the page numbers. The Labour party has produced the document I have here—“Funding Britain’s Future”—and a fully costed manifesto. If the hon. Gentleman has a bit more time for reading, I advise him to go to our manifesto and to look at how we laid out the options. We laid them out; we did not get into a mess, as the Conservative party did, and try to change things after four days. We will take this issue forward; we will not kick it into the long grass, as the Conservative party is trying to do.

[Rachel Maclean (Redditch) (Con)]

Will the hon. Lady give way?

[Barbara Keeley]

No, I am just going to finish.

Our motion asks for action to make sure the care sector gets the urgent funding it needs to prevent collapse. It would also ensure that hard-pressed councils are not penalised for failing to meet unrealistic targets for delayed transfers of care.

--- Later in debate ---

[Jackie Doyle-Price]

I could not agree more. I share my right hon. Friend’s support for the hon. Lady’s comments. There are still many opportunities to get working-age adults with disabilities into work. We have set ourselves a target of getting 1 million more people with disabilities into work, and we are very committed to doing that.

In response to the point made by the hon. Member for Worsley and Eccles South in her opening remarks, yes, much of the debate has focused on how we care for the elderly, but, as she and the whole House will be aware, support for working-age adults is becoming an increasingly big proportion of local authority spending in this area, and it is very important that we focus on it. Alongside the preparations we are making for consultation in the new year, we have a parallel work stream looking specifically at working-age adults, because some of the solutions will be similar and some will be different.

[Barbara Keeley]

It is very important that we have got to this point today, because very many organisations and individuals have been worried for months about that. In the Queen’s Speech and in letters the Minister has sent to me, the talk has been of a consultation on social care for older people. The wording needs to change if that is to encompass, as it should, working-age people with disabilities or learning disabilities. Let us stop focusing just on older people. If she would stop doing that in letters and we could have clarity on this, it would be helpful. I also wonder why there has to be a separate work stream.

[Jackie Doyle-Price]

There needs to be a separate work stream because it is connected to the desire to get more people into work, but the two programmes are working in parallel. As I said, today is a great opportunity to get that on the record. Certainly, it has been very much a focus of my conversations with voluntary groups in the sector.

--- Later in debate ---

[Jackie Doyle-Price]

I must make some progress, because I have taken many interventions. I do apologise.

Adult social care funding is made up of Government grant, council tax and business rates. The better care fund, which was announced in 2013, has further helped to join up health and care services so that people can manage their own health and wellbeing and live independently in their communities for as long as possible. The 2015 spending review introduced an adult social care precept that enabled councils to raise council tax specifically to support social care services. By 2019-20, that could raise up to £1.8 billion extra for councils each year. As a further boost to social care, the Chancellor announced in the Budget earlier this year that local authorities in England will receive an additional £2 billion for social care over the next three years. This year, £1 billion has been provided to ensure that councils can fund more care packages immediately. The additional money means that local authorities in England will receive an estimated increase of £9.25 billion in the dedicated money available for social care over the next three years. Statistics produced today show that spending on adult social care increased in real terms last year by 1.5% thanks, in part, to the precept.

[Barbara Keeley]

This is an important point. Our motion mentions the need to close the funding gap, which is not £1 billion but £1.9 billion. So £900 million is still not covered, and that is what councils are struggling with. The Minister makes the point about extra funding being raised from local taxation. Does she accept that there is still a funding gap, which means that people cannot be paid the national living wage? We are going to struggle all the way through winter unless the Government accept the existence of that gap and work to close it.

[Jackie Doyle-Price]

I do not accept that. Let us recognise that this has been hard in the past. We have made money available in recent years, but we know that local authorities have faced challenges. As one local authority put it to me, however, austerity has been the mother of invention, and I congratulate local authorities on the efforts that they have made. [Interruption.] That came from a local authority leader, and I agree that local authorities have shown considerable initiative by implementing savings. As for the national minimum wage, it is enforceable, so I do not accept the hon. Lady’s point at all.

[Barbara Keeley]

Does the Minister accept that the Government are providing less funding for social care than they were in 2010? She can check that with NHS Digital. The funding is less in real terms. It does not matter that it has increased this year because of the social care levy; it is less. Given the complexity of the issue and the growing demographic challenge, it is clear why we have this gap.

--- Later in debate ---

[Jackie Doyle-Price]

I reject the suggestion that there will be any kind of fine. The £22 million that the hon. Lady talks about will be retained for spending within Leicestershire. That funding has been allocated for a specific purpose, and where local authorities are not showing the improvement that we expect, we will work collaboratively with them and advise them how best to use that money.

Let me put on record exactly what we are going to do. There is significant variation in performance across local areas. We know that 41 health and wellbeing boards are collectively responsible for 56.4% of adult social care delayed transfers of care. That cannot be right, when other local authority areas have none. In particular, Newcastle has no adult social care delayed transfers of care, and if it can do that, other areas can as well, provided we have good partnerships and good leadership. I trust that I have demonstrated the extent to which the Government are supportive of the best performing systems where local government and the NHS are working together to tackle this challenge. However, we are clear that we must make much faster and more significant progress in advance of winter to help to free up hospital beds for the sickest patients and to reduce pressures on our A&E departments.

It is right that there should be consequences for those who fail to improve. Earlier this month, we wrote to all local authority areas informing them that if their performance did not improve, the Government may direct the spending of the poorest performers—it is not a fine—and we reserve the right to review allocations. It is important to note that the allocations will remain with local government to be spent on adult social care. It is not a fine; this is about making sure that public money delivers the intended outcomes.

[Barbara Keeley]

Is the Minister saying that revising an allocation is not a fine? When an allocation is revised—presumably downwards, not upwards—that is a fine.

[Jackie Doyle-Price]

I am sorry, but that is not the case. The money will be retained by local government, but we will direct the spending to achieve the outcome the money is intended to deliver. That is exactly what we should do as a Government, and it is how we ensure value for money.

The health and care system has committed staff and managers up and down the country who are working every single day to deliver the best outcomes for people.

--- Later in debate ---

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

I am sure that all of us who have been out and about with care workers in our constituencies have found the experience not only informative but inspiring. I certainly had a brilliant experience when I went out and about with a care worker in my patch. I saw the enormous compassion in the care that she provided and how incredibly hard she worked. It was a tough job, but a rewarding one. As many Members have said, however, the work is not well enough paid, there is no career structure and there is not enough support for carers in their day-to-day work.

Everyone in the Chamber today recognises that the current system is not fair and not working. It is not fair that people can get care for free if they can stay living in their home, but if they have to go into a care home, they might be left with only £14,000 of savings. Most people would much rather be cared for at home, but that is not always possible. The present system therefore discriminates against those who cannot stay at home to be cared for, and that is simply not fair. We need to bear that in mind as we talk about potential solutions. Let us not pretend for a moment that the current system is fair.

The system is also not working. Around 30% of the people in hospital in my constituency do not need to be there. They would be better off out of hospital, but there is often no outside support available for them. Delayed transfers of care are an ongoing challenge. There are also people in care homes because of the shortage of domiciliary care. We have to address what is substantially a funding challenge: there is simply not enough money going into care.

The shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley), said that she was going to give us Labour’s solutions to the problem. I listened carefully to her speech, but I was disappointed that she spent only about one minute of her 24-minute speech talking about potential solutions. I am afraid that I did not really hear any solutions—

[Barbara Keeley]

Will the hon. Lady give way?

[Helen Whately]

I am really sorry, but I cannot take any interventions. I have been asked not to.

Most significantly, the hon. Lady does not have a plan for how to pay for all this. It all comes down to how we are going to pay for improving access to care, and the Labour party simply does not have a plan. As for cross-party working, that would be fantastic but judging by some of the language I have heard from Labour Members, I do not think that many of them are ready to work together on this. I encourage the Government to get on with the job of proposing a better, sustainably funded, care system so that our constituents can get the care that they need.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Communities and Local Government (Mr Marcus Jones)]

This has been a wide-ranging and important debate on one of the most important social issues and challenges we face in our country.

Delivering good-quality care for our most vulnerable people is a clear priority for this Government. To ensure local government has the resources to fund adult social care through to 2019-20, the Government have given councils access to £9.25 billion of dedicated funding for adult social care over the next three years.

Beyond the immediate term, there is also the need to address the challenges of social care for our ageing population. Therefore, the Government will bring forward proposals for consultation, to build widespread support for reform. The consultation will set out options to improve the social care system, put it on a more secure financial footing, support people and their families to prepare for old age, and address issues related to the quality of care and the variation in practice.

Overall, local government spent £14.9 billion in 2016-17 on adult social care—up by £500 million from 2015-16, and over £500 million more than budgeted for. This year, councils are budgeted to spend £15.6 billion.

The Government continue to provide local government with the additional resource it needs to deliver care. At the spring Budget, an additional £2 billion of funding in England was announced, of which £1 billion has been provided in 2017-18. That was in addition to the resource made available in the local government finance settlement, where we provided £240 million for adult social care. It was also in addition to the £2.5 billion put through local authorities in the improved better care fund.

Alongside Government funding, more flexibility has been provided. Local government has been able to raise more income through the adult social care precept, with the flexibility to increase it by 3% this year. That adult social care flexibility was subsequently used by 147 out of 152 social care authorities, with 109 using the full allocation, or close to the full allocation, of 3%. I should point out that it is also down to the Government that, overall, council tax remains lower in real terms than it was in 2010.

In terms of the integration of health and social care, we should remember that the better care fund is the first national mandatory integration policy. We should not shy away from the fact that integration is not easy, but the Government are supportive of the best-performing systems, where local government and the NHS work together to tackle the difficult issue of delayed transfers of care. We understand that delayed transfers of care are only one part of what authorities deal with to deliver social care in communities up and down the country, but we also understand that improving working between local government and the NHS is absolutely key to delivering better joined-up care for local people.

It is also right that, in November, we will consider a review of the 2018-19 allocations of social care funding provided at the spring Budget 2017 for areas that are not performing well. We expect that that would encompass only a small number of local authorities, although we are clear that the funding will remain with local government to be used for adult social care. We also favour, if needed, the option that places conditions on how a proportion of the 2018-19 funding is used to support an authority’s delayed transfer of care performance.

[Barbara Keeley]

Will the Minister give way?

[Mr Jones]

I will in a moment, but I want to make a little more progress and mention some of the people who have spoken in the debate.

The hon. Member for Denton and Reddish (Andrew Gwynne) finally hit the nail on the head right at the end of his speech in saying that we needed to approach this important, difficult and delicate subject in a non-partisan way. I was very disappointed, though, that 98% of his speech was spent on the politics of fear and, in some ways, misinformation. That was very much out of kilter with much of the debate across the House.

My hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, made some very important points. She was absolutely right first to pay tribute to careworkers and carers—that is absolutely the right thing for us to do. She mentioned the remuneration of care work, as did other hon. Members across the House. It is important to point out that careworking is an extremely important job. The national living wage, which was £5.93 an hour in 2010, is now £7.50 an hour, and lower-paid workers pay £1,200 less in income tax than they did in 2010. We are well on the path to rewarding careworkers far more than they have been in the past, although we would acknowledge that there is more to do.

--- Later in debate ---

[Barbara Keeley]

If the Minister values care, would he comment on untrained members of the public being offered £1,000 a month to rent out rooms as an alternative to care for patients recovering from surgery? Do he and his Government support that, because it is frightening from a safeguarding point of view?

[Mr Jones]

It is important that we always have workers who are trained, and we are providing care in good-quality settings. We heard several times that 80% of our care homes are providing quality of care that is either good or outstanding.

My hon. Friend the Member for Totnes mentioned the integration of health and social care, and the importance of the health service in the context of the review that is going to be done. She spoke about future planning of the workforce, which is also very important.

The hon. Member for Leicester West (Liz Kendall) made some very sensible points and comments about the politics of dealing with long-term funding of social care, and said that it does not serve people or their carers if we are partisan. Even so, she slipped into a bit of partisanship towards the end, showing how difficult this situation is. On the whole, however, she made some very sensible points.

My hon. Friend the Member for Erewash (Maggie Throup) was right to point out that this is a long-standing issue that many Governments over decades have ducked. She mentioned the situation in Derbyshire with her council, which seems to have been left a difficult legacy by its Labour predecessor. I am certainly willing to meet her to discuss that issue.

My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) mentioned the positive impact that the £2 billion of additional funding that was announced in the Budget for the adult social care precept has had in his area. He also made a sensible point about the potential for devolution to bring more integration between health and social care. My hon. Friend the Member for St Ives (Derek Thomas) said that health and social care is not just a responsibility for national Government because there is a responsibility on us all, particularly at a local level within the health service and in our local authorities.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised the importance of suitable accommodation to enable older people to live independently and help us to avoid many of the healthcare costs that we face. My hon. Friend the Member for Yeovil (Mr Fysh) mentioned the pressure that the national living wage puts on the system. It is quite right that we pay our careworkers more, and that is why we have given councils access to up to £9.25 billion of extra funding by 2020.

Many positive speeches were made during the debate, but unfortunately I have not got time to mention them all. The problems in social care have developed over many decades. The Government are absolutely right to recognise the challenges of adult social care and tackle them head-on. That is why we have provided further funding up to 2020. We need to address the issue, and that is why we will work across the sector to bring about change and a sustainable solution for the future so that the most vulnerable in our society can get the care that they deserve and need.

Question put and agreed to.

Resolved,

That this House notes the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home; further notes that this proposal would leave people with a maximum of only £100,000 of assets; calls on the Government to confirm its intention not to proceed with this commitment; and further calls on the Government to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care and to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.

[Barbara Keeley]

On a point of order, Madam Deputy Speaker. Again we see the Government refusing to vote on a motion—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I cannot hear what the hon. Lady at the Dispatch Box is saying, and she is speaking to me.

[Barbara Keeley]

Thank you, Madam Deputy Speaker. Again, we see the Government abstaining—refusing to vote on a motion tabled by the Opposition. This time, we have been debating vital issues: the funding crisis in social care and whether the Government will confirm their intention not to proceed with the policy for funding social care that they put forward, frightening people, during the general election.

My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) has just described this Government as the “weakest and most divided” for many years. May I ask you, Madam Deputy Speaker, whether it is in order for this weak and divided Government to pick and choose when they will vote on matters that are raised in this House?

[Madam Deputy Speaker]

The hon. Lady has taken this opportunity to make the points that she wishes to make, and the House has heard them. She knows, and the House knows, that the Government’s decision on what they answer, what Ministers say at the Dispatch Box and how individual Members of this House choose to vote—or not—are not matters for the Chair. We will have no more points of order on that; it is not a point of order.

Safeguarding Adults with Learning Disabilities

Baroness Keeley Excerpts

Tuesday 17th October 2017 Westminster Hall

[Catherine McKinnell]

That is an interesting suggestion. As a constituency MP, I work closely with the organisations I have mentioned so that I may correspond with and represent people with learning disabilities. There are local solutions and, potentially, national ways to support MPs. That is a good suggestion to ensure that those voices are heard in Parliament, and the intention of this debate is very much to give voice to some of the concerns. I am sure that other hon. Members are present for the very same reason.

The issues that I have outlined are just some of the frankly depressing ones faced by people with learning disabilities. Such issues were commented on by Mencap in its response to the Equality and Human Rights Commission report, “Being disabled in Britain: a journey less equal”, which was published earlier this year. In responding to the EHRC report back in April, Mencap commented:

“Rather than move forwards in the past 20 years this report shows how inadequate action and a constant stream of cuts have condemned disabled people to a life of poverty and inequality.

With the employment rate for people with a learning disability currently standing at less than 6% and with cuts to Employment Support Allowance coming into effect this week, it’s not hard to see why so many disabled people are struggling to find money for things as basic as food. People with a learning disability also face inadequate housing, poor access to health care and a society that misunderstands them.”

One challenge facing people with learning disabilities and their families is of course being able to access the right social care support at a time when adult social care budgets are at breaking point after years of punitive cuts to local authority funding since 2010, combined with rising cost pressures. The Local Government Association outlines that some 127,725 adults in England under the age of 65 were receiving long-term social care from their local council for a learning disability in 2015-16, meaning that about one third of councils’ annual social care spending, or approximately £5 billion, is used to support adults with learning disabilities.

The LGA also highlights, however, that the number of adults with a learning disability needing social care is set to rise by 3% a year, piling further pressure on local authority finances. Overall, councils face a £2.3 billion shortage in funding by 2020. I therefore strongly urge the Chancellor to address this issue next month as part of his autumn Budget, as well as the ongoing and serious concerns about the potential historic and future costs associated with sleep-ins, following the change in Government guidance on them, which have significant implications for the future provision of support to adults with learning disabilities.

As I said, there is a particular reason that I secured this debate, which I have been trying to do so for several months. Undoubtedly, all Members of Parliament frequently have to handle very distressing issues, and I have dealt with a lot.

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

My hon. Friend is making a valiant attempt. This is a very difficult subject and she is talking about a very distressing and tragic case. To go back to the point about greater public awareness, I have been a Member for 12 years and have certainly never been offered any training about learning disabilities. There is so much to know and she has just given us a useful range of facts. I encourage the Minister to take away what my hon. Friend has just raised as things we should all know.

[Catherine McKinnell]

I thank my hon. Friend for her intervention. It is hard to imagine a more harrowing and disturbing case than that of Lee Irving. My thoughts remain very much with Lee’s family, particularly his mother, Bev, who I know is determined to ensure that something positive comes of her son’s death. I am sorry; I must do this subject the justice of staying composed. I am particularly conscious that Lee’s mother is watching this debate online in Newcastle and that having to relive what happened to her son clearly will always be upsetting. However, it is important that right hon. and hon. Members appreciate the gravity of this case.

Lee was a 24-year-old vulnerable young man with learning disabilities from the West Denton area of my constituency, who was tragically murdered in 2015. In the months leading up to his death, he was living on and off—perhaps existing would be a better word—with a group of people he had befriended and trusted, at their home in the Kenton Bar area of Newcastle. During that time, he was the victim of sustained abuse and exploitation. Lee’s mother, Bev, had reported him missing on three occasions in the weeks before his death, and indeed had alerted the authorities to where he was staying and of her serious concerns about Lee’s safety, given the previous behaviour of those individuals towards her son.

Tragically, Lee’s badly beaten body was found on 6 June 2015, dumped on a grass bank near the A1 in Newcastle, not far from the house he had been occupying with those who were accused of his murder. The cause of Lee’s death was given as respiratory failure due to multiple severe injuries that were inflicted upon him at the house in Kenton Bar between 28 May and 5 June 2015. The injuries included fractures to his nose and jaw, the fracture of 24 ribs and damage to underlying organs, after he had been drugged with a combination of morphine, Valium and buprenorphine—medication used by heroin addicts—which enabled his attackers to conduct sustained physical beatings against him. The four people responsible for Lee’s death also prevented him from receiving the urgent medical attention that he clearly required on several occasions.

Following Lee’s death, a safeguarding adults review was established to hear from the myriad organisations and agencies involved in providing support to Lee and his family during his short life. The review explains:

“The relationship between Lee Irving and his killers was described as one of subservience with Lee beholden to the primary perpetrator”—

James Wheatley—

“for drugs and shelter and where Lee looked up to the primary perpetrator and desperate to fit in tolerated continued violence and abuse. This coercion and drugging were used to control him, prevent him seeking help and over a period of time drawing him back to the house at 33 Studdon Walk.”

Indeed, Mencap has informed me of its concern that Lee’s case is not an isolated one, commenting:

“There are many examples, both reported and unreported, of people with a learning disability who have been abused physically and psychologically by people who they thought were friends. This has given rise to the phrase ‘mate crime’, where individuals take advantage of someone’s vulnerabilities, bullying them physically, psychologically or stealing money or possessions.”

I believe that the safeguarding adults review instigated after Lee’s death raises serious issues, not just for Newcastle, but about how we, as a wider society, support and safeguard adults with learning disabilities. Vida Morris, chair of the Newcastle Safeguarding Adults Board, said after the review had been published:

“Lee’s story will be used locally, regionally and nationally to improve safeguarding and protect vulnerable adults.”

That absolutely must be the case.

It is evident from the review that Lee’s vulnerabilities, which were the result of his learning disability, were clearly identified by a number of local agencies some years before and right up to his death. On six occasions between 2010 and 2014, different organisations considered the risk to Lee to be such as to merit formal multi-agency adult safeguarding written referrals. Examples of Lee’s known vulnerability include an assessment undertaken by Percy Hedley School when he was nearly 18, which described him as

“socially immature and impressionable, a very vulnerable young man who could not ignore people who are distracting him, naive in social situations, easily influenced by others, and unable to identify people’s motivations and intentions.”

The national probation service in Northumbria had numerous interactions with Lee, as he was arrested 30 times between May 2011 and March 2015 for various offences. In December 2012, Lee was sentenced to nine months’ imprisonment for the offences of burglary and theft, and was

“treated as an adult fully responsible for his own actions and able to understand the consequences of the measures imposed.”

Yet the year before, in 2011, the NPS carried out an assessment of Lee and identified that he was

“incredibly vulnerable to the influence and harmful behaviour of others he encounters; that he was financially vulnerable from others. In addition, he was assessed as being vulnerable in custody and in a hostel setting.”

A further NPS assessment stated:

“Lee seems to understand that he is being used and bullied but seems to put up with it rather than be rejected by his peers.”

Another commented:

“Lee is not aware of the risks that he places himself in e.g. spending time with homeless people, sleeping rough, sharing taxis with strangers and giving his clothes and money away. His level of Learning Disability means that he behaves in a way which is focussed on pleasing people, to develop acceptance within groups and possibly to gain kudos through offending for others.”

Despite those assessments, no safeguarding alert was raised by the NPS about Lee Irving during its interaction with him in 2011 and 2012.

An assessment carried out in 2010—five years before Lee’s death—under the Mental Capacity Act 2005 confirmed that Lee’s overall reasoning and thinking abilities were the same as or better than only 0.2% of adults his own age. In other words, Lee’s intellectual abilities placed him in the bottom 1% of adults his own age. There is also a concern that Lee’s intellectual ability may at times have been overestimated, because his relatively better verbal skills may have masked his deficits in other areas.

In March 2015, shortly before Lee’s death, a further Mental Capacity Act assessment was undertaken, at which both he and his family were present, after his family reported that he had returned to live with the people who were exploiting him. That assessment identified that he did not have the capacity to make decisions to keep himself safe when alone in the community. The assessment resulted in an exploration of supported living options, which were still being explored at the time of his death.

The safeguarding adults review notes:

“Throughout his long engagement with services Lee failed to attend nearly half his numerous appointments with various services. While in his early teenage years his family often ensured his attendance, when in his late teens, his family’s influence declined and his chaotic lifestyle led to less frequent attendance at appointments, making it…difficult for…agencies to deliver the care and support that Lee needed.”

I find it hard to understand why that behaviour did not set more alarm bells ringing about Lee’s welfare, given that his vulnerabilities were well documented.

The review further states that

“Lee’s life slid into a chaotic cycle of offending, being reported missing and associating with so called ‘friends’ who exploited him. In October 2014 a decision was taken to award Lee with a direct payment—giving him control of some of his monies in order to directly purchase services or other forms of support… later that control passed to Lee himself.”

Again, given the circumstances in which Lee was living and the fact that his mother was already reporting that he was being financially exploited, I find that hard to understand.

Tragically, given what was to happen later, the police actually attended the address at which Lee was being held between 28 May and 5 June 2015, when we know that Lee was inside the house and already injured. However, no search was conducted, despite Lee having been reported missing by his mother, her belief that he was at the house and the police being aware of the extensive criminal records of those living at the property, including for violent offences.

The safeguarding review notes:

“It is clear that all agencies tried hard to deliver a service to Lee and/or his family but on many occasions this was made difficult due to Lee’s lack of engagement and his determination to keep bad company…these efforts were not adequately co-ordinated or led by each of the main agencies…Throughout the long engagement with agencies the lead changed according to the circumstances…Therefore, no agency was able to take overall responsibility for co-ordination and leadership, however, as noted in the report agencies were in contact on a regular basis with each other.”

The review adds:

“Lee Irving was a difficult person to help. His reluctance to engage with services and his failure to attend appointments made it extremely difficult for agencies to support him and his family. Despite this, agencies persisted in their attempts to help and protect him. It is clear that all agencies approached Lee Irving with the best of intentions.”

I continue from the review:

“Many agencies were involved in Lee’s complex case over a lengthy period. They saw him in different ways according to their discipline and…many did not appreciate the risk attached to his lifestyle and disability. There were, however, clear indications of Lee Irving’s vulnerabilities and recorded Safeguarding Alerts pointing to the threats present at the house at 33 Studdon Walk where he lived latterly and where he was killed…his specific vulnerabilities were accurately identified. The cumulative effects of these risk factors were not, however, weighed or considered in a multi-agency forum when planning for his care.”

The review also made clear:

“Perhaps as a consequence of a lack of co-ordination a number of options for intervening in the case of Lee Irving were not considered. No legal advice was sought from agencies solicitors and the possibility of Court of Protection proceedings or other legal options”—

deprivation of liberty—

“were not pursued.”

Whether any of those options would have succeeded in intervening in Lee Irving’s decline and eventual death will never be known.

Extremely worryingly, the safeguarding adults review suggested that:

“The behaviour of Lee was perhaps interpreted by some professionals as consistent with his choice of an antisocial and criminal lifestyle. Whilst not held by all agencies this interpretation meant that his criminal conduct was not always considered as a symptom of his disability, increasing vulnerability or the exploitation that he was subject to.”

Of particular concern to Lee’s mother, Bev, following her son’s death, are the challenges that parents of adult children with learning difficulties face in continuing to be involved in decisions about their care. The safeguarding adults review outlined that Lee’s family

“described the difference in the way professionals were able to respond to Lee as an adult as being frustrating and difficult to understand…Lee was…classed as an adult while his mental capacity remained that of a child”.

It also recorded that, on Lee reaching adulthood, Lee’s family

“felt excluded from some of the key decisions about his care. They felt that some professionals excluded or disregarded them and that decisions about options for the ongoing care of their family member were made without their input. In particular, they express severe concern that despite their specific warnings about Lee’s living conditions at the home at Studdon Walk, the measures taken to protect him were unsuccessful.

In conclusion, the family felt that while more should have been done to protect Lee towards the end of his life such was Lee’s determination to place himself at risk that only secure accommodation would have protected him. Whilst they had resisted this option at the time, with the benefit of hindsight they recognise that other measures were unlikely to have succeeded.”

Indeed, following the publication of the review in June, Lee’s mother, Bev, commented:

“Nobody listened to each other, but my main concern was nobody listened to me. If I had been listened to, then my son would still be alive now. I had my son reported missing three times in the previous few weeks up until his death and they wouldn’t bring him back. They wouldn’t inform me where he was, which I find very, very hurtful. It’s disgusting.”

In response to that, the director of people at Newcastle City Council stated:

“I know that Lee’s family felt excluded from some of the decisions that were taken about his care and that their warnings about his living conditions were not acted upon effectively. For that we are truly sorry.”

The safeguarding adults review highlighted that Lee’s family “had two main recommendations” following their son’s death. First, that

“the move from Children’s to Adults’ services be better managed to ensure a smoother transition without loss of support and that services consider the capacity rather than the age of the individual.”

Secondly, that

“families remain part of the decision-making process in the case of vulnerable adults and be fully involved/consulted on ‘best interest’ and other decisions relating to family members.”

Bev Irving has explained that she hopes those changes will be made so that, in her words,

“Lee’s name can live on in the name of Lee’s law”.

I look forward to hearing the Minister’s response to the recommendations and whether the Government can act on them to help ensure that the lessons from Lee’s case are genuinely learned across the country.

There is one further aspect to the case that I find deeply concerning. James Wheatley was found guilty of murdering Lee in December 2016. His mother, Julie Mills, his then girlfriend, Nicole Lawrence, and Barry Imray, who also had learning disabilities, were found guilty of, or admitted to, conspiring to pervert the course of justice and causing or allowing the death of a vulnerable person. Wheatley was sentenced to a minimum 23-year term and the original sentences of Mills and Lawrence were increased after the Crown Prosecution Service successfully appealed them as being unduly lenient, with the support of the Solicitor General. I know that the family are grateful for that.

Both the CPS and Northumbria police believed that the multiple and horrific offences perpetrated against Lee were motivated by his disability. Indeed, the safeguarding adults review commenced with that view. However, the trial judge, in his sentencing remarks, told Wheatley that

“In order to reach the conclusion”

that the offence was aggravated by disability

“the statute requires me to be sure that, at the time of committing the offence or immediately before or after doing so, you demonstrated hostility towards Lee Irving based on his disability or that your offence was motivated by hostility towards persons who have this or any disability. I am not satisfied on either basis. Although your texts”

to one of the other accused

“show repeated use of the repellent word ‘spastic’, I am not able to infer that such language was used towards Lee Irving at the time or immediately before or after your murderous assault. Furthermore, in my judgment you were motivated in this offence not by hostility towards those with disability but by your vicious and bullying nature which particularly takes advantage of those who are unable or less able to resist.”

That calls into question whether the current legislation—section 146 of the Criminal Justice Act 2003, which provides for an aggravated sentence—is fit for purpose, as it is unclear how anyone could prove a disability hate crime under the threshold unless the perpetrator made such an admission. I raised this issue with the Solicitor General, to which I received a response that the judge’s

“finding that the offences were not motivated by hostility is a finding of fact. Such findings are incredibly difficult…to challenge on appeal to the Court of Appeal, since I need to satisfy the court not only that the judge was plainly wrong, but also that it is in the interests of justice to overturn his finding of fact.

My decision was that I would not succeed in overturning the finding of fact in this particular case. I only reached this conclusion after receiving advice from the leading counsel at trial, the CPS’ hate crime stakeholder manager, and a senior barrister who is a specialist in these kind of cases. I also looked at general advice from First Senior Treasury Counsel, the Government’s most senior barrister in criminal matters, on how to apply the hate crime provisions.”

I am aware that the CPS has recently published revised guidance setting out the factors to be taken into consideration when reviewing cases and prosecuting offences classified as disability hate crime. However, in Lee Irving’s case the issue was not with the police or CPS not recording or prosecuting the barbaric offences committed against him as disability hate crimes but that the judge could not be sure that, at the time of committing the offence, or immediately before or afterwards, the perpetrator demonstrated hostility towards Lee based on his disability, or that the offence was motivated by hostility towards people with disabilities—the threshold set in the existing legislation. That is concerning at a time when we know that disability hate crime is a significant issue.

Mencap highlights that some 73% of people with a learning disability and autism responding to a 2016 Dimensions survey said that they had experienced hate crime, while recorded hate crime based on disability has increased by 44% since last year. The true extent of the problem is being masked by people with a disability or learning disability who are too scared or do not feel able to report incidents. I strongly urge the Minister to ensure that the Government look at this issue again, in the light of Lee’s case, although I am conscious that it is not within her departmental remit.

I fully recognise that I have raised a number of wide-ranging issues this afternoon, many of which do not fall directly within the Minister’s portfolio. However, I am pleased to have been able to put on record the different, and very important, concerns that Lee’s mother has raised with me following her son’s death. Those ultimately responsible for Lee Irving’s horrific abuse and murder are now locked up in prison where they belong. Indeed, thanks to the intervention of the Solicitor General, some sentences were increased for being unduly lenient. However, the current legislation needs to be reviewed, because if Lee’s case could not be regarded as a disability hate crime, it is hard to know how the current threshold could be met.

I have also outlined how important it is for adults with learning disabilities to receive the right care and support to enable them to live independent lives where that is appropriate. However, I have real concerns about the issues raised by Lee’s case, and the fact that those charged with safeguarding Lee—an extremely vulnerable adult—did not get the balance right between independence and protection. Nor does it appear that the many agencies that interacted with Lee shared information with each other about his vulnerabilities, or properly listened to or acted on the concerns repeatedly raised by his family, which might have resulted in Lee still being here today.

It is critical that lessons are learned from Lee Irving’s case as quickly as possible, right across the country. I look forward to hearing from the Minister how she intends to ensure that that will be the case.

--- Later in debate ---

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

It is an honour to speak with you in the Chair, Mr Wilson. As other hon. Members have done, I congratulate my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell). It is usual to congratulate another Member on securing such an important debate, and she has been persistent in trying to secure this one; the dignified and passionate way in which she set out a deeply tragic case made it an important speech to listen to.

As my hon. Friend said, Lee Irving’s extreme vulnerability due to his learning disability was known about three years before the tragic murder of her constituent. It is disturbing that, despite knowing that, the national probation service did not raise an alarm or a safeguarding alert. As we heard, Lee was being treated as an adult, not a vulnerable adult. The failings highlighted by the safeguarding adults review in the case of Lee Irving included a failure to involve his family in decisions about his future. Mencap has also highlighted the fact that only 1% of hate crimes reported against disabled people result in prosecutions.

Mencap has also called for greater public awareness of learning disabilities. It is important that we have talked about that issue in this debate, and that we have realised that MPs do not have much training on it. Clearly, there is much to know, and many of us could help with that and bring about greater public awareness. I shall say more later about the Mental Capacity Act 2005 and the impact that it can have on the families of people with learning disabilities, and their ability to stay involved in decisions about vulnerable people such as Lee Irving. I share the view of my hon. Friend the Member for Newcastle upon Tyne North that lessons must be learned from his case. There is much to learn.

I want to mention the campaign Justice for LB, which was set up to campaign on learning disability issues following the tragic death of Connor Sparrowhawk while he was in the care of Southern Health NHS Foundation Trust. My hon. Friend the Member for Newcastle upon Tyne North touched on the case earlier. We have discussed issues at Southern Health a number of times in debates, because Members of the House have had deep concerns about the safety of the care and services provided by the trust. Connor Sparrowhawk was left to drown in a bath; and there were many other deaths. The Mazars investigation, commissioned by NHS England, looked at all deaths at the trust between April 2011 and March 2015. It found that during that period 10,306 people had died. Most deaths were expected, but 1,454 were not. The likelihood of an unexpected death being investigated by the trust depended on the type of patient. The most likely group of deaths to be investigated was deaths among adults with mental health problems, of which 30% were investigated. For those with a learning disability the figure was just 1%. Parents and families left bereaved and grieving want to see accountability, but too often they do not.

There has not, for example, been accountability at Southern Health NHS Foundation Trust. In fact, the opposite has happened. Last October, I asked the Health Secretary to investigate the way the Southern Health Trust created a sideways move, to an advisory role at the same salary, for Katrina Percy, the chief executive who was criticised for leading the trust through the time when it failed to investigate all those patient deaths. Six weeks later she resigned from that newly created advisory role and received a £190,000 salary pay-off that was signed off by the Department of Health and the Treasury. How does the Minister think that makes bereaved and grieving parents feel? Justice for LB called the pay-off “utterly disgraceful”, and I agree with that, but the Health Secretary would not investigate it.

Campaigns such as Justice for LB are asking that provision for people with learning disabilities should be an integral part of health and care services—not a specialist branch that can be ignored, as it appears to have been ignored at the trust in question. They believe that the law should be changed so that every unexpected death in a secure or locked unit is automatically investigated independently. It is also an important point of crossover with the case that my hon. Friend the Member for Newcastle upon Tyne North put so well today that they want to stop the Mental Capacity Act 2005 being used to distance families and isolate people—particularly young people.

The Justice for LB campaign, which obviously focuses on different issues from those relating to Lee Irving, has asked for a critical look to be taken at the system of inspection and regulation under which catastrophic events have happened—as they have: from Winterbourne View to the Southern Health NHS Foundation Trust there are too many. Sadly, failures carry on over many years. Last week, Southern Health NHS Foundation Trust was fined £125,000 after a prosecution in the case of a patient who fell from the roof of the mental health complex of Melbury Lodge in Winchester. The prosecution was brought following the injuries sustained by a patient known as Mr AB. Since 2010, a number of patients detained under the Mental Health Act 1983 had climbed onto the roof of Melbury Lodge in a bid to abscond. The trust’s own security review had recommended safety measures, including anti-climb guttering, but those improvements had not been made.

Mr AB had climbed on to the roof earlier, in March 2012, slipping twice and nearly falling before he was brought down. Three years later, he was admitted to Melbury Lodge again. His family were so worried that he might try again to abscond and climb on to the roof that they asked the staff to keep a close eye on him. However, in the early hours of a morning in December 2015, Mr AB again climbed on the roof of the lodge and fell to the ground, sustaining very serious neck injuries. Despite that accident, three more patients were able to gain access to the roof in February 2016, two months later, and one of them was injured.

The court was told that the trust had not taken action to deal with the risk as there was no money to spend on the remedial work. This is a trust that paid a consultancy firm more than £5 million for a contract originally tendered for £288,000, while another firm was awarded a contract for £600,000, for which it did not even have to bid. It makes things worse that both companies awarded contracts were run by former colleagues of the trust’s chief executive, Katrina Percy. Nearly £6 million of NHS funding went from that trust to a company called Talent Works, described as experts in culture and behaviour change. It is not good enough that an NHS trust spends £6 million on culture and behaviour change consultants when it cannot get the basics right and safeguard its patients or a young person put in its care.

Those events, and everything we have heard in the debate, leave us questions to answer, which I will put to the Minister. Why were only 1% of the unexpected deaths of people with learning disabilities at a trust such as Southern Health investigated? Why do only 1% of hate crimes against people with learning disabilities result in prosecutions? Parents from both campaigns for better safeguarding of people with learning disabilities urge us to stop the Mental Capacity Act being used to distance those families and isolate people, particularly young people.

My hon. Friend spoke powerfully of the need to give families of adult children with learning disabilities much clearer and increased rights over their adult child’s welfare. She highlighted well the horrific events that can occur when families do not remain part of the decision-making process. I will repeat, because they are important, the two recommendations of Lee Irving’s family. The first is that the move from children’s to adults’ services be better managed, to ensure a smoother transition without loss of support, and that services consider the capacity, rather than the age, of the individual. That was clearly an important factor in the case of Lee Irving. Secondly—and very importantly, because this matters to many families—they recommend that families remain part of the decision-making process in the case of vulnerable adults and are fully involved in and consulted on best interest and other decisions relating to family members.

In a dignified and passionate speech, my hon. Friend also argued convincingly of the need to introduce a new offence of disability hate crime, to send a clear message that what happened to Lee Irving will not be tolerated in 21st-century Britain. It is unusual to have such a small debate, but it has been worth while to lay out that case and make other points. We must continue to have an informed debate about the status of adults with learning disabilities as full citizens, but more important than anything is that we should listen to them and their families. We should remember the deeply disturbing words of Lee’s mother, Bev:

“nobody listened to me. If I had been listened to, then my son would still have been alive now.”

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I join everyone else in paying tribute to the dignified and passionate way in which the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) outlined her case. It is truly heartbreaking. Lee’s mother is watching today. She put her trust in the institutions of the state to care for her son, and we failed her. It should never have happened, and for that I am truly, truly sorry. I give the hon. Lady and Bev my commitment that I will take lessons from this. I hope the hon. Lady will act as my conscience in ensuring that I do so. The issues highlighted across the Chamber today need to be acted upon, to ensure that we do our best by all our constituents.

I was struck by the way that the hon. Lady talked more generally about people with learning disabilities. It is, frankly, the reason we all get involved in politics—we get involved in politics when we see the state failing and to make sure we do the best for everyone in society and for the people we can see being failed. I do not think that any group is failed more than people with learning disabilities. They have potential and the ability to live independently, but all too often they have been parked. My hon. Friends the Members for Henley (John Howell) and for North Swindon (Justin Tomlinson) outlined examples of where, with some support, people with learning disabilities can lead very productive lives, but it requires support and investment. Sadly, that is not always forthcoming, and without it, they are very vulnerable, as this tragic case all too clearly illustrates. We owe it to them and to ourselves, in order to make the best of society, to do all we can to help people with learning disabilities to live independent lives.

We need to do more to tackle the whole issue of prejudice. The hon. Member for Newcastle upon Tyne North said she has been very persistent in trying to secure this debate, but perhaps it is fitting that the debate is happening in the middle of National Hate Crime Awareness Week. That is the perfect backdrop against which to address her case. It is fair to say that we are still early in the day when it comes to hate crime prosecution. There is slowness in reporting all hate crime, and suddenly people have become more aware.

People with learning disabilities are generally victims of quite widely held prejudice. It is not just the fact that they are targeted because of their disability; the agencies that should support them do not necessarily give them the support they need because of their disability. We have seen across the board, in so many examples of abuse, that particular social groups who are not the best at representing themselves do not always get a fair deal at the hands of the organisations that support them. We should look at that under the umbrella of hate crime, but it is slightly different; it is about prejudice more generally that we can all help to tackle. It is a very real inequality that we are tackling.

Central to our job as Members of Parliament is supporting people who have been victims of maladministration and who are not getting enough support from the state. In many cases, that is people with learning disabilities. I have always found that some of the most rewarding work I do as a Member of Parliament is in supporting people with learning disabilities. It is also the most inspiring, and it is great to see the enthusiasm that my hon. Friend the Member for North Swindon referred to.

Unfortunately the Minister for Disabled People, Health and Work, my hon. Friend the Member for Portsmouth North (Penny Mordaunt), is no longer in her place, but the fact that she was here is testimony to her support for this work. We are very keen that people with learning disabilities receive more attention. I give the hon. Member for Newcastle upon Tyne North that commitment, and we will continue to engage with her as this work develops.

I agree with the hon. Lady that people with learning disabilities are among the most vulnerable in our society, and it is the responsibility of all of us to protect them from risk. I will not pretend that we have got this perfect—there is a hell of a lot more to do. There has been significant progress in identifying and managing risk, but it is not consistent, and there are too many occasions when it just does not happen.

The hon. Lady articulated clear views on a specific case of hate crime. She will appreciate that that falls outside my bailiwick, but I will make a few observations, in so far as I can without treading on other Departments’ toes. As she said, the judge concluded that hate was not a factor in the motivation behind the crime. That is a matter for the courts, and it is for them to interpret, but I come back to the issue of prejudice. That case throws up a number of issues that we all need to be more vigilant about. We know that people with learning disabilities are very vulnerable to bad people, and bad people will find vulnerable people to prey on. I am aware that young women with learning disabilities are often preyed upon sexually, which is a real hidden issue that we need to think about. There is also the whole issue of modern slavery. People with learning disabilities are often subject to that. In this case, Lee was obviously being exploited financially by the people who murdered him.

[Barbara Keeley]

I did not manage to raise the very important point that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) raised about the fact that Lee Irving was labelled as difficult to help and classed as an adult who could choose a lifestyle, with such tragic results. That has echoes of other forms of abuse because, as my hon. Friend so clearly pointed out to us, his intellectual skills and reasoning were at 0.2% of those of adults of his age. Why were agencies saying that he could choose that awful lifestyle, which ended up having such a tragic result?

[Jackie Doyle-Price]

I totally agree with the hon. Lady. As she says, we have seen that in other cases of abuse. We can look at Rotherham and how the agencies behaved there. It is almost as if there is a view that, “He’s a bad ’un; he doesn’t deserve protection.” That is absolutely not the case. We need to be thinking about the person in a very person-centred way. It was very clear that Lee had a learning disability and did not have the capacity to act as an adult, yet he was treated as one. That is one of the real lessons of this case.

With specific regard to the requests of the family, the whole area of transition is certainly of concern to me. We see this issue in relation not just to learning disabilities, but to mental health. In both cases, families are often completely unable to influence support or care for their loved one; they are utterly powerless because they are in the control of institutions. We need to be learning the very clear lessons there.

We need to raise awareness of hate crime against people with disabilities. Too often, we look at hate crime through the prisms of race and gender. To be honest, we look at hate crime through those prisms because it is the victim of a hate crime who will raise it as such and, frankly, people with disabilities are in less of a position to do so. That said, things are getting better. As I said, it is early days for the offence and prosecution of hate crime, but I am told that in the past year the police have recorded an additional 5,558 disability hate crimes; the number is up by 53%. That suggests that people are more inclined to report it and that the police are more inclined to identify hate crime due to disability, but we continue to monitor the situation and see what else needs to be done to protect the vulnerable.

Health

Baroness Keeley Excerpts

Monday 16th October 2017 Ministerial Corrections

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned.

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

The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence?

[Mr Hunt]

Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff.

[Official Report, 10 October 2017, Vol. 629, c. 143-45.]

Letter of correction from Mr Hunt:

Errors have been identified in the responses I gave to Questions to the Secretary of State for Health.

The correct responses should have been: