Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to tackle closed cultures in inpatient settings for people with learning disabilities and autistic people.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
Health and care providers have a responsibility to prevent and detect closed cultures and their systems for setting and monitoring culture and encouraging staff to speak up.
The Care Quality Commission (CQC) has developed ‘Right support, right care, right culture’ guidance for services for people with a learning disability and autistic people which outlines the importance of ensuring a service’s model of care, policies and procedures are in line with the current best practice.
The CQC has increased its scrutiny and oversight of providers of support for people with a learning disability and autistic people. The CQC uses both the guidance and observation when regulating registered services, including the monitoring, assessing and inspecting of such services. As a result, the CQC has identified more closed cultures and has taken enforcement action to protect people.
NHS England has also established a three year quality improvement programme which seeks to tackle the root causes of unsafe, poor-quality inpatient care in mental health, learning disability and autism settings.
We are considering what else may also be needed to address quality wider issues for mental health inpatient care.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the potential merits of conducing cross-departmental review on the use restrictive practices for children with special educational needs and disabilities.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
No specific assessment has been made. However, the Government states that restrictive practices should only ever be used as a last resort, using the least restrictive option, when all attempts to de-escalate a situation have been employed.
The Department for Education has commenced a programme of work to minimise instances of the use of reasonable force and restraint in all schools, starting with extensive evidence gathering in early 2023, including a public call for evidence. The call for evidence will help inform revisions to the current guidance, use of reasonable force in schools, to provide school staff with advice on alternative and preventative strategies to using reasonable force or restrictive practices, as well as guidance on when and how it is appropriate to do so. This will empower school staff with a range of safe and effective approaches when dealing with extremely challenging situations. The Department for Education will ensure that the updated guidance will consider the age and needs of all pupils, including those with special educational needs and disabilities.
We welcomed the Care Quality Commission, Out of sight – who cares?, report into restraint, seclusion, and segregation. Although this report did not focus specifically on children it did include findings from some children’s services. We published our response in July 2021, in which we accepted in full or in principle all recommendations.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what discussions he has had with the Care Quality Commission on reducing the number of inpatient wards for people with learning disabilities and autistic people rated as inadequate.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
Ministers and officials regularly discuss a range of matters with the Care Quality Commission (CQC) including making improvements to services that are rated inadequate by the CQC.
The Government, cross-system Building the Right Support Delivery Board, chaired by the Parliamentary Under Secretary of State for Mental Health and Women’s Health Strategy, is responsible for monitoring progress on the commitments in the Building the Right Support Action Plan. The CQC are members of the Delivery Board and attend the meetings which are held quarterly. The Delivery Board will continue to discuss and monitor progress on the commitment in the Action Plan to avoid people with a learning disability and autistic people being admitted to hospital settings rated inadequate by the CQC and on actions to improve the quality of care these individuals receive in inpatient settings.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what proportion of NHS continuing healthcare funding is spent on learning disability and autism.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
The information requested is not collected centrally. Determination of NHS continuing healthcare eligibility is based on a comprehensive assessment of care needs rather than any specific medical condition, disease or diagnosis.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what recent assessment he has made of the quality and effectiveness of Care (Education) and Treatment Reviews.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
We are committed to the ongoing monitoring of the quality and effectiveness of Care (Education) and Treatment Reviews (C(E)TRs).
NHS England has recently asked the National Institute for Health and Care Research (NIHR) to commission a national study to consider this in more detail for both community and inpatient C(E)TRs.
NHS England monitor C(E)TR adherence using Assuring Transformation Data in line with the frequency standards set out in the C(E)TR policy. This includes whether the person is reported as having a community C(E)TR before admission, or a post-admission C(E)TR on admission. It also records whether people in hospital have had their most recent C(E)TR within the timescale set out in the policy, three months for children and young people, six months for adults in acute settings and 12 months for adults in secure settings.
NHS England will shortly be publishing the refreshed Dynamic Support Register and C(E)TR policy.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the RedQuadrant report entitled Building the Right Support: An analysis of funding flows published on 14 June 2022, what assessment he has made of the potential merits of providing ring-fenced funding for preventative and crisis support.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
No specific assessment has been made.
The Government has a long-standing policy to provide funding to local authorities on a non-ringfenced basis. It is considered more efficient for local authorities to manage funding according to local priorities, rather than central Government trying to control every spending decision.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how much the Government has spent on developing community services for autistic people and people with learning disabilities since (a) the publication of the Building the Right Support National Plan in 2015 and (b) the Care Quality Commission’s report on Winterbourne View in 2011.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
The information requested is not held centrally in the format requested.
The following table shows NHS England’s national investment since 2019/20 to support the NHS Long Term Plan commitments for people with a learning disability and autistic people. These include the development of community health services which will help people to live in the community, help prevent people going into mental health hospitals and support timely discharge.
| 2019/20 budget | 2020/21 budget | 2021/22 budget | 2022/23 budget |
Community services | £17 million | £20 million | £62 million | £51 million |
Children and young people keyworkers | £0 million | £3 million | £14 million | £29 million |
Source: NHS England
Note: Community Services includes:
- Community development Care (Education);
- Treatment Reviews Learning from Lives and Deaths – people with a learning disability and autistic people (LeDeR); and
- Diagnostic pathway for autistic children and young people.
The following table shows the national Funding Transfer Agreement (FTA) funding which supports the discharge of long stay patients into the community.
| 2019/20 budget | 2020/21 budget | 2021/22 budget | 2022/23 budget |
FTA funding | £80 million | £83 million | £84 million | £84 million |
Source: NHS England
The Building the Right Support Delivery Board has set up a task and finish group to look at how to improve national oversight of NHS and local authority spend related to Building the Right Support.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many (a) autistic people and (b) people with learning disabilities were in long-term segregation on 6 December 2022.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
This information is not held in the format requested. However, as of 9 September 2022, there were 114 autistic people and those with a learning disability in long-term segregation in inpatient settings, using the Care Quality Commission’s definition.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if his Department will make an assessment of the potential merits of requiring Integrated Care Boards to publish plans for meeting the commitments relating to community provision for (a) autistic people and (b) people with learning disabilities set out in the Building the Right Support Action Plan, published on 19 August 2022.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
There are no current plans to make an assessment.
Each integrated care board implements a five year joint forward plan with partner trusts and Foundation Trusts. This will include the needs of the entire local population, including people with a learning disability and autistic people.
The NHS Long Term Plan 2019 sets out our commitment to invest in intensive, crisis and forensic community support to support more people with a learning disability and autistic people to receive personalised care in the community, closer to home, and reduce preventable admissions to inpatient services. Every local health system will be expected to use some of this growing community health services investment to have a seven day specialist multidisciplinary service and crisis care.
To support our approach of devolving power, the government has set up the Hewitt Review to consider the balance between integrated care system accountability, targets, and performance.
Asked by: Barbara Keeley (Labour - Worsley and Eccles South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many (a) autistic people and (b) people with learning disabilities were placed in an inpatient unit rated as inadequate by the Care Quality Commission in the last 12 months.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
This information is not held centrally. However, as of 31 October 2022 there were 170 people with a learning disability and autistic people in hospital settings with a rating of inadequate listed by the Care Quality Commission. Many of these patients will have been placed in these sites prior to the inadequate rating.