Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is right to draw attention to the issues around Southern Health, which will have directly affected a number of her constituents. That organisation is being turned around. However, she is also right to say that too many people are travelling out of area for their treatment. We have record numbers of children’s beds commissioned, but in the end this is about the capacity of the system of trained psychiatrists, psychologists and therapists, which was why we announced the extra 21,000 posts.

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

On World Mental Health Day, may I thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for wearing yellow for #HelloYellow on behalf of our team?

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? [Official Report, 16 October 2017, Vol. 629, c. 4MC.]

[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. On top of that —she asked about money—we have committed an extra £1 billion a year by 2021 so that we can employ even more people. We are the first Government to admit that where we are now is not good enough. We want to be the best in the world; that is why we are investing to deliver that.

Autism Diagnosis

Baroness Keeley Excerpts

Wednesday 13th September 2017 Westminster Hall

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

It is an honour to speak with you in the Chair, Mr Howarth. I very much congratulate my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) on securing the debate. It is an important one because, as we have heard, diagnosis is the vital first step towards getting support for people with autism.

For children with autism, and their parents, getting a diagnosis is the first hurdle that they need to get over, to secure the support and education to which they are entitled. As my hon. Friend the Member for Enfield, Southgate mentioned, the NICE quality standard on autism recommends that people should wait no longer than three months once they are referred for their first diagnostic appointment. It is clear that people have to wait too long for a diagnosis of autism and that the waiting time can be gamed by delaying later appointments. Waiting to wait is not acceptable.

We heard that research has shown that waits can be two years for adults and three and a half years for children, but we have also heard of examples where things have taken much longer. We touched earlier on the Public Health England survey and the fact that in one local authority it is admitted that there are waits of 125 weeks. Hon. Members have spoken powerfully about long waiting times and their constituents’ experiences—and their own, in the case of my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds).

I was contacted by one of my hon. Friends who could not take part in the debate, and want briefly to refer to the experience of one of her constituents. When her son was 18 months old, he suddenly stopped talking. That was raised with the health visitor at the child’s two-year review. The health visitor almost did not make a referral to a speech and language therapist, saying that the criterion for referral was that a child could say fewer than 10 words. At that time, the little boy could say only one word: “No”. It took a nine-month wait to get a first appointment with a speech and language therapist. At the second appointment, six months later, she said she would refer the child to a paediatrician. In the end, it took almost two years to get a diagnosis of autistic spectrum disorder from the paediatrician and the speech and language therapist working together.

Since then, the child has been discharged from speech and language therapy, despite the fact that he is still not speaking. His parents have had to get therapy for him privately, paid for with his disability living allowance money. The child spent half his young lifetime—from age two to age four—without the support that he needed to help his development. The mother says she felt

“let down by the system”,

but also that their family was one of the lucky ones, because, as we have heard, other parents had to wait longer to get a diagnosis. The issue for her was

“the lack of availability of professionals…had we seen professionals when appointments were due I think it would halve the time to get a diagnosis”.

Delays in diagnosis can hinder the implementation of effective support and intervention strategies, but they can also—understandably—lead to parents losing confidence in healthcare professionals, particularly if they feel that appointments and waiting times are being gamed in the ways we have heard about. By contrast, surveys have shown that a positive diagnostic experience is associated with lower levels of stress and more effective coping strategies, which is what we are talking about giving to families, if waiting times for diagnosis can be cut. For adults with autism, a diagnosis can end years of feeling misunderstood and isolated. We have heard about an increased risk of suicide.

A number of Members raised the point that autism diagnosis waiting times are not currently collected as part of the mental health services data set. I understand that the National Autistic Society has worked with the Government on proposals to collect those data. Will the Minister confirm to the House today that the Government plan to commit to the routine recording of diagnosis waiting times from April 2018 and, importantly, tell us what plans they have to speed up the diagnosis process? NHS England does not currently collect data on the number of diagnoses or who is being diagnosed with autism. That makes it difficult to determine where there are gaps in diagnosis. The National Autistic Society says that between 75% and 80% of people who use their adult services are male. However, as my hon. Friend the Member for Enfield, Southgate said, there is concern that there is under-diagnosis of women and girls, who are not getting the support they need.

Likewise, the first generation of people diagnosed with autism are now reaching middle age. That means there is a generation of people for whom autism was not a diagnosable condition during their youth. There could be significant gaps in autism diagnosis among older people. We heard in the debate of a lady diagnosed only in her 40s, and it is important that our focus should not always be on children. I find it heart-rending to think about cases such as the one I outlined, but it can also be difficult for people get a diagnosis when they are older. NICE recently recommended the creation of an autism register so that we can identify areas where autism may be under-diagnosed. Does the Minister agree that such a register might help more autistic people get the diagnosis and the support that they are entitled to? Are there likely to be moves to create one?

An early diagnosis is important. Mental health conditions are more prevalent among people with autism than among the general population. A diagnosis can provide an understanding of why a child finds things difficult and, as in the case that I talked about, suddenly stops speaking. If there are signs of mental health issues or other problems, a diagnosis can make family and friends aware and open access to proper support. However, post-diagnosis support is not always there. A survey of parents with autistic children found that many are left with no support during and after the diagnostic process, and many are not signposted to other advice and help. That is clearly important; there is a feeling of their being warrior parents and battling parents. Let us stop their having to do that. Some are even left without a written report of their child’s diagnosis.

In the example that I outlined, the four-year-old child is still not speaking but has been discharged already from speech and language therapy services, and his parents can obtain therapy for him only privately. What plans are in place to ensure that people who receive a diagnosis have access to the services to which they are entitled, and which their children need? Let us, from now, help the warrior parents and battling parents, and all the people who need a diagnosis to move ahead with their lives.

Adult Social Care Funding

Baroness Keeley Excerpts

Thursday 6th July 2017 Commons Chamber

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

Does the Minister share my deep concern about the state of social care highlighted—

[Mr Speaker]

Order. What the hon. Lady needs to do is just ask the Minister for the statement on the matter, and then she follows with her substantive question when the Minister has given his response.

[Barbara Keeley]

(Urgent Question): To ask the Minister to respond to the Care Quality Commission report on the state of adult social care and on issues of funding social care.

[Mr Speaker]

I call Minister Steve Brine.

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

Thank you, Mr Speaker—take two.

There are few things more important to any of us than the way in which the oldest and most vulnerable are cared for in our society. First, let me pay tribute to the 1.4 million people who work in the country’s social care sector. They support many of the most vulnerable people in our communities, often in the most difficult of circumstances. I am proud that we have done more than any Government before to improve the quality of social care, introducing a tough system of CQC ratings, new qualifications for care workers, and new standards to ensure that everyone receives the highest-quality support. I am heartened that today’s CQC report shows that even in a time of acute fiscal pressure, 79% of adult social care services are now providing good or outstanding care.

However, it is impossible to ignore the pressure that our ageing population and advances in medicine are putting on the system. We have seen the number of over-65s increase by nearly 1.2 million, or about 14%, over the past five years. Today’s CQC report shows that in some areas, it is completely unacceptable that standards in some settings are below those rightly expected by care users and their families. This Government view social care as a priority, which is why in the spring Budget this year we announced an additional £2 billion over the next three years for councils in England to spend on adult social care services. That means that, in total, councils will have access to £9.25 billion more dedicated funding for social care over the next three years—enough to increase social care spending in real terms. We have also been clear that later this year we will be consulting widely on the future of social care in this country to put it on a stable footing.

My right hon. Friend the Health Secretary updated the House on Monday about action he is taking to address delayed discharges from hospital in advance of this winter. Last year there were 2.25 million delayed discharges, up by 24.5% from 1.81 million in the previous year. The Government are clear that no one should stay in a hospital bed longer than necessary—it removes people’s dignity, reduces their quality of life, leads to poorer health and care outcomes for people and is more expensive, ultimately, for the taxpayer. Since February, there have been significant improvements in the health and care system, with a record decrease in month-on-month delayed discharges in April of this year.

However, we must make much faster and more significant progress well in advance of next winter to help free up hospital beds for the sickest patients and reduce pressures on accident and emergency departments. That is why we have introduced a further package of measures to support the NHS and local government in reducing delays. That package includes guidance, a performance dashboard, plans for local government and the NHS to deliver an equal share of the expectation to free up 2,500 hospital beds, and of course CQC reviews. We have also been clear that we will consider a review in November of the 2018-19 allocations of the social care funding provided at spring Budget 2017 for poorly performing areas. We have been clear that the Budget funding will all remain with local government, to be used for adult social care.

[Barbara Keeley]

I thank the Minister for that response, but I really must ask him whether he shares my deep concern about the state of adult social care, as highlighted by today’s report by the Care Quality Commission. Some 3,200 care services were rated as “requires improvement”, with more than 340 rated as “inadequate”. That means that some 92,000 vulnerable people are receiving poor care and some 10,000 people are receiving inadequate care. The picture is even worse in nursing homes, with one in three receiving the poorest ratings.

Does the Minister share my concern about safety, with one in four care locations failing on protecting people from abuse or avoidable harm? That means thousands of vulnerable people not getting prescribed medicines, being ignored when they ask for help and not having enough time for their home care visits.

The Labour party has repeatedly raised the damaging impacts of budget cuts, with more than £5 billion having been cut from social care since 2010. Does the Minister now accept that that has caused the crisis in care staffing, which is at the heart of the poor care that is being reported? Poor staffing levels and staff training are key factors in those providers with the poorest ratings.

In his written ministerial statement earlier this week, the Secretary of State suggested that the £2 billion allocated in the spring Budget to local councils for social care, to which the Minister has just referred, will now be dependent on performance against targets for delayed transfer of care. That means that some councils could lose funding that they have already planned to spend. Does the Minister accept that threatening local councils with the loss of planned funding could lead to a worsening of the quality and safety issues highlighted today? With social care in crisis, this is not the time to be threatening joint working with local councils, so will he reverse that threat and match the Labour pledge of an extra £8 billion for social care, including an extra £1 billion this year?

[Steve Brine]

I thank the hon. Lady for that response. This subject was much discussed during the general election, and I think it will be greatly discussed during this Parliament.

Nobody is making any threats. The Government are very supportive of the best-performing systems, where local government and the NHS work together to tackle the challenge of delayed transfers of care. We have said that, depending on performance, we will consider a review in November of the 2018-19 allocations of social care funding provided in the spring Budget for areas that are poorly performing. As I have said, that funding will all remain with local government, to be used for social care.

Obviously, we recognise that there are real pressures in the system. That was why we responded—I think the hon. Lady’s party was pleased with this at the time—with an additional £2 billion for social care in this year’s Budget. We have also given councils the chance to raise the council tax precept. My authority, Hampshire, has done that, and I think that has been well received.

Turning to the actual report, it would be easy to duck all of this. Dare I say that I hope we can conduct this debate in a sensible spirit? People out there working in the system who want to pass the mum test, as was said this morning, want us to do that and are watching things closely. Of course, it would be easy to bury our heads in the sand, but let us remember that had we had the rigorous inspection regime that the Secretary of State put in place earlier, a lot of problems, including those in the hospital sector when the hon. Lady’s party was in government, would not have been heard of. We know about the current situation only because of the inspection regime that has been put in place.

The CQC report found a number of things, and obviously we will digest it over the days and weeks ahead. It found that the adult social care sector performed best in how caring its services are: 92% of services were rated good and 3% outstanding. We can kick this issue around all we like, but today’s report shows exactly why we introduced the inspection regime. It is uncovering the care that is good—the vast majority of it—and it is also uncovering the care that is not, which is where we want to help and support local authorities to make sure that improvements are made for the people we represent.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 4th July 2017 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

My hon. Friend and other Leicestershire MPs have made their views very clear to me. I hosted a number of them, from both sides of the House, to discuss this issue. He is aware that the public consultation on congenital heart disease services continues until 17 July. Obviously, we will take all the comments made into account when we come to the conclusions from that report.

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

Today is the sixth anniversary of the publication of the Dilnot commission’s report on the funding of social care. In those six years, Ministers have legislated for a cap and a floor on care costs, and then abandoned those measures. They brought forward disastrous proposals in their manifesto for what became known as the “dementia tax”, and they appear to have abandoned those measures, too. Will the Secretary of State confirm that those policies have indeed been abandoned? Will he tell me, and more than 1 million people with unmet care needs, when he expects to have some new proposals for reform?

[Mr Hunt]

I have great respect for the hon. Lady, because she campaigns consistently on this issue, but I do not think that what she says is a fair reflection of what has happened. In the last year of the previous Labour Government, 45,000 people had to sell their home to pay for their care costs, whereas this Government have made it the law that no one has to sell their home. There is more work to do, but we have made important progress and will continue to do so.