Unpaid Carers: Support

Baroness Blackwood of North Oxford Excerpts

Thursday 13th June 2019 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what steps they are taking to ensure that unpaid carers receive the support to which they are entitled.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we are committed to supporting carers to provide care in ways that protect and preserve their own health and well-being. Last June, we published the Carers Action Plan, a cross-government programme of targeted work. This included a £5 million carers innovation fund, to encourage innovative and creative ways of supporting carers. We are also working with local government on a sector-led improvement programme of work focused on implementing the carers Act duties for carers.

[Baroness Brinton (LD)]

I thank the Minister for her Answer. As Carers Week draws to a close, I point out that we owe a great debt of gratitude to the 6.5 million carers in the country who save us more than £100 billion a year, given the costs that we would otherwise have to bear. The problem is that nearly three-quarters of those carers say that they suffer mental health stress as a result of their caring duties, and over 60% say that they have physical health problems. Will the overdue Green Paper on social care put sustainable funding in place to properly provide support for carers and ensure speedy access to health services for them?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question. I suspect that the majority of noble Lords have not only been carers themselves but have benefited from caring. I would not be standing here myself were it not for the caring support of my own family. We should pay tribute to carers up and down the country, without whom we would not have a sustainable health and care system. I assure the noble Baroness that proposals for putting in place sustainable funding to support carers, and considering their employment status, are part of the work that is going on in implementing the long-term plan and preparing the social care Green Paper. I hope that reassures her.

[Baroness Wheeler (Lab)]

My Lords, a growing number of older people are providing unpaid care while trying to manage their own health and care needs, in many cases co-caring for each other with partners, adults or children with learning difficulties. In particular, there is an alarming increase in the number of carers aged 85 and over, who are more likely than other carers to be caring round the clock, be suffering anxiety and be in poor health themselves. What are the Government doing to ensure that these carers are getting the vital social and community help they need? Are they still the priority, as was promised in the NHS five-year forward view?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. She is absolutely right that we need to ensure that we target support at those who need it most, but that we also identify those who are carers within the community, because of the burden that we know caring can impose on the health of those who are caring. That is why the Carers Trust has been undertaking research into best practice in identifying carers and targeting support. It is also why the Department of Health and Social Care has been working with local government on a sector-led improvement programme of work focused on the implementation of the carers Act duty for carers. We have just begun phase 1 of this and we are implementing phase 2 to ensure that best practice is disseminated across the system, so we can deliver on the commitments we made within the carers plan.

[The Lord Bishop of St Albans]

My Lords, I am sure that we all want to encourage stronger family and community life, which is the very bedrock of healthy societies, but there is one group in particular that needs help and that is the 166,000 underage carers in England. Research by the Children’s Society suggests that that is just the tip of the iceberg—indeed, a huge underestimate. Many of these young people do not realise that they classify as carers: it is just what they have had to deal with. In many cases it is affecting their schooling and mental health. What are Her Majesty’s Government able to do to help and support underage carers in particular?

[Baroness Blackwood of North Oxford]

The right reverend Prelate is quite right to identify this as a crucial issue. The Government believe that children should be protected from inappropriate and excessive caring responsibilities. We changed the law to improve the way that young carers are identified, and we are supporting schools to support carers and working with the Carers Trust to identify and spread best practice. Just today, working with the Children’s Society, which he rightly says has led this project to identify and disseminate best practice, guidance and resources will be published to enable young adult carers to make positive transitions between the ages of 16 and 24. We hope that this will improve the outcomes that young carers experience.

[Baroness Manzoor (Con)]

My Lords, I am delighted by the Carers Action Plan, which is a very important piece of work for many thousands of carers in the country. Can my noble friend say exactly what progress is being made in implementing this plan and how success will be measured?

[Baroness Blackwood of North Oxford]

I thank my noble friend for this important question. The Carers Action Plan was a real step in the right direction. It has 64 action points and good progress has been made. There will be a progress report in July. Some key steps in it are promoting best practice for local authorities, clinical commissioning groups and other providers in order to give carers much-needed breaks and respite care, which can be the difference between coping and not coping; and providing carer-confident benchmarks for employers who can identify carers within their systems and give them the support they need. Of course, there is also the work I have already mentioned: the £5 million carers innovation fund to find more creative and innovative ways to support carers, who are so crucial to our health and care system.

[Lord Patel (CB)]

My Lords, does the Minister agree that any future proposals for the funding of social care need to be sustainable? Any proposal that requires the burden to fall on those who need social care or their families will not be sustainable and will therefore require contributions from wider society.

[Baroness Blackwood of North Oxford]

I completely agree with the noble Lord, Lord Patel, who is absolutely right that we must ensure that we sustainably fund social care. The Government have provided £3.9 billion more in dedicated social care funding, but we recognise that there is a need for a sustainable financial footing for social care as a whole, which is what we are working towards with the spending review. Nevertheless, carers will continue to play an important part in our healthcare system, as they do within our society. Many people consider that they are making a rewarding and important contribution within their family and community, and we must be grateful to them for that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the implication of what the noble Baroness has just said is that the work around the Green Paper on a sustainable mechanism for funding long-term care is focused on the medium and long term. If that is so—and I think the Minister could say something about the actual remit of the work—the question then arises, what about the short term? We know that the money she talked about is a drop in the ocean compared to the money that has been taken away from social care, alongside the increasing demographic pressures. Can she tell me whether, as part of the spending review, which I assume will occur at some point, the immediate pressures are also going to be taken care of?

[Baroness Blackwood of North Oxford]

The noble Lord will know that the spending review has not yet started, so I cannot tell him what is happening in the negotiations. What I can tell him about is the work that has already gone on to improve social care funding: giving local authorities access to around £10 billion more in dedicated funding for social care from 2017-18 to 2019-20; an additional £410 million of new money to improve social care for older people, people with disabilities and children; and £240 million more for winter pressures. However, the noble Lord is absolutely right that it is no good improving the medium to long-term outlook for social care if we do not ensure that we also address the immediate challenges that it faces.

[Baroness Thomas of Winchester (LD)]

My Lords, the right reverend Prelate mentioned one group of carers. I would like to ask about those from the BME community, many of whom do not know about the benefits to which they would be entitled—the carer’s allowance, for example, and even the national insurance waivers that come with it. What are the Government proactively doing to support them?

[Baroness Blackwood of North Oxford]

This is a really important question, because the carer’s allowance has increased and is available as a non-means-tested support. I can reveal today that one of the key issues that is being looked at as part of the social care Green Paper is ensuring that financial support and employment status for carers are clearer, so that they can access all the support they are entitled to, but also to try to make things simpler.

[Lord Kirkhope of Harrogate (Con)]

I declare an interest as a former Mental Health Act commissioner. While we are talking about carers, there is a considerable number of people who are caring for members of their family who have been suffering from mental illness and are now in the community. Would my noble friend not agree that we should be more concerned to give assistance there as well, rather than merely to those who care for people with physical ailments?

[Baroness Blackwood of North Oxford]

The burden of ill health, anxiety and depression is an important issue that has been clearly identified, and it can be caused by caring for a loved one. There is specific evidence about the threshold at which the number of hours spent caring causes such challenges. My noble friend is right that we should not only identify those who are caring but signpost them clearly to the support available for carers and make sure that they can access that care easily.

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2019

Baroness Blackwood of North Oxford Excerpts

Monday 10th June 2019 Lords Chamber

[Baroness Jolly]

My noble friend makes a very good point. The majority of people who work in the sector are care workers on the basic minimum wage, or something related to that. What we are discussing this evening is nursing care which will be paid at a union rate; nevertheless, it is stretching the sector.

The Minister knows about the shortage of nurses, and the noble Baroness, Lady Thornton, spoke about the shortage of care workers. Why do we have restrictions on agency nurses’ nursing hours of 10% of the total? Clearly, we cannot have agency nurses covering the whole thing; everyone across both health and social care frets about agency nursing and its expense over and above that of paying for directly employed people. But what is a nursing home to do if there are no salaried nurses available? Is the 10% smoothed over a month or a year? Is this realistic? How realistic is it for less than 10% of nursing hours to be delivered by the agency? This will be locally variable—relatively straightforward, perhaps, in city settings but where my noble friend and I live in Cornwall, people such as agency nurses are like hens’ teeth. This is not straightforward, and I am not convinced that it is absolutely workable.

This measure looks hurried, but I suppose any increase is welcome. I await the Minister’s response to some of the comments that I have made and those of the noble Baroness, Lady Thornton.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I open with an apology for the state of my voice. I shall do my utmost to make myself heard and make it to the end of my speech. If I do not manage to answer all the points made, I shall write not only to the two noble Baronesses who have raised questions but to all those present in the debate, and will place a copy of that letter in the Library.

I would also like to identify myself with the points raised by the noble Baroness, Lady Thornton, regarding Carers Week, and to pay tribute to all those carers in this country who make tremendous sacrifices for those they care for. We should all thank them for the work they do. Our system would not cope without them; we should all be very grateful.

I turn to the questions that have been raised. NHS funded nursing care is of course an incredibly important part of the health and care system, supporting the provision of nursing care in nursing homes. The NHS funded nursing care rate plays the important role of ensuring that neither individuals nor local authorities have to pay for nursing care, which is the responsibility of the NHS. My department is seeking to ensure that nursing home providers are paid a fair rate for employing registered nurses, so that nursing care can be provided to all who need it. On the point that was just raised, it is helpful to know that the average pay for registered nurses in the independent sector has now risen from £23,400 to £29,400, so that is the benchmark we are talking about.

The noble Baroness, Lady Thornton, raised the issue of the nursing care rate for 2019-20, which my department set in regulations in April. This was done, as she said, following the LaingBuisson report into the costs of providing NHS funded nursing care to nursing home providers, after further consideration by my department. Following this work, the rate has increased by 4.7%, which is a significant increase above inflation, as has been recognised. The efficiency expectation, which is regretted in tonight’s Motion, should be seen in the context not only of this above-inflation increase but in the context of the significant increase of 40% which came in 2016-17; that is part of the picture that the efficiency expectation was put in place to address.

It is only right at a time of continued and much-needed investment into nursing home providers—ensuring they are able to employ and retain registered nurses—that the Government and the NHS also expect those providers to deliver as efficient a service as possible and value for money to the taxpayer. The 4.7% increase in the nursing care rate for 2019-20 is a far larger increase than that being seen in the vast majority of prices across the wider public sector and NHS; this is because of the priority that we have set on that rate. For example, the NHS national tariff is increasing the majority of prices in the NHS by 2.7% for 2019-20. The national tariff has also asked most NHS providers to make efficiencies of 3.1% across 2018-19 and 2019-20, and the Government believe that while still getting an above-inflation increase, nursing home providers should be able to do the same.

The LaingBuisson report provided evidence showing that many nursing home providers are already delivering nursing care more efficiently than others, so there is variability in the system. The study shows wide variation in the cost of delivering nursing care, even when factors such as region or provider size are taken into account. Efficient providers surveyed were shown to deliver an hour of NHS funded nursing care for 18% less than others. Additionally, the study showed that nursing home providers are increasing their use of agency nurses, as has been discussed. An hour of agency nursing costs 47% more to providers, and so, obviously, to the NHS. We believe that providers can work to reduce the proportion of their workload covered by agency nurses, as we have required other parts of the NHS to do, in a sustainable way.

There is a need to ensure value for money in important NHS services and to maintain their sustainability. The Government believe that efficiencies can be made in relation to the rate this year—for example, in the use of agency nurses. However, this is still within the context of a significant and above-inflation increase to the nursing care rate. That is why we think that the rate set is achievable.

The noble Baroness, Lady Thornton, also raised the important issue of the need for a long-term funding settlement for social care and financial sustainability for the sector, as she has on more than one occasion in this Chamber. The Government have already given councils access to around £10 billion of additional dedicated funding for social care over this spending review period. This includes a £240 million adult social care winter fund for 2018-19, and again for 2019-20, to help local authorities. It is the biggest injection of funding for winter pressures that councils have ever received. As a result of the measures the Government have taken, funding available for adult social care is increasing by 8% in real terms from 2015-16 to 2019-20. Councils have responded by increasing their spending on social care, so the money has gone where it was supposed to, which is always encouraging.

Local authorities were also able to increase the average fees paid for older people’s residential and nursing care by 6.4% in 2017-18, which we believe brought more stability to the market. When we look into the detail of the figures we see that, while there has been a reduction in the number of care homes, the overall number of social care beds has remained broadly constant over the last nine years, with an increase in nursing beds and care home agencies. As in any market, there will be inevitable entries and exits of care organisations, but we feel that there is some consistency. It is more reassuring than it may appear on the surface.

As we have also discussed, social care funding for future years will be settled in the spending review, where the overall approach to funding of local government will be considered in the round. We are also looking ahead to ensure that the social care system is sustainable in the longer term so that we can continue to deliver as our society ages. This is why the Government have committed to publishing a Green Paper at the earliest opportunity, setting out proposals for reform.

I hope I have answered the majority of the questions raised by the noble Baronesses. If I have failed to respond to anything, I hope they will allow me to write.

[Baroness Thornton]

I thank the Minister for that answer. I am not completely convinced about the stability of the care home sector. I think we have some major problems coming down the line. Of course, like the noble Baroness, Lady Jolly, I welcome an increase in payment for nursing staff, because that is absolutely essential. However, we have to take seriously the issue of social care staff who work in homes or a domiciliary setting. They do not get the attention or esteem they deserve, or the training they need, and they are certainly not paid sufficiently, yet we still expect them to deliver the best possible service. This statutory instrument is not the place where that can be solved, but it amplifies the challenges we face here.

On that basis, I thank the Minister for getting through that answer without completely losing her voice. We heard everything she had to say. I beg leave to withdraw the Motion.

People with Learning Disabilities

Baroness Blackwood of North Oxford Excerpts

Thursday 6th June 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Baroness, Lady Thornton, for securing this serious and timely debate and I am very grateful to noble Lords for their informed contributions on a very sensitive matter. The care and treatment of people with learning disabilities and autistic people has rightly come under intense public scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society. Today’s debate provides an important opportunity to reflect on this crucial issue.

Nobody who watched the BBC’s “Panorama” programme on Whorlton Hall could have been anything but deeply shocked and disturbed by the abuse it exposed. The actions revealed by the programme, the abuse of vulnerable people in a setting where they should have been safe and well cared for, was truly appalling. We are very clear that people with learning disabilities and autistic people have the right to feel safe in their environment and to be treated with dignity and respect. As the noble Baroness, Lady Thornton, rightly said, Durham Constabulary is investigating and has so far arrested and questioned 10 members of staff about offences relating to abuse and neglect. We cannot comment on matters that might prejudice that process, but 16 members of staff have also been suspended and all patients have now been transferred out of the hospital and it is closed to new admissions. In addition, my right honourable friend the Secretary of State for Health and Social Care has asked the CQC to look in detail at its inspection and regulatory approach to Whorlton Hall to ensure that lessons are learned from what has happened in this case and in other cases that have gone before it. The CQC has commissioned independent reviews. The first is looking into how the organisation dealt with concerns raised by an inspector in a draft report prepared in 2015, as has already been mentioned; the second is a wider review of what could have been done differently or better in its regulation and inspection of Whorlton Hall between 2015 and 2019. The findings and recommendations of both reviews will be published. It is clear that opportunities to intervene were missed, and we must be open and transparent in getting to the bottom of why this happened.

The noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, mentioned the Children’s Commissioner’s report. She has also investigated the treatment of children with learning disabilities or autism in in-patient mental health hospitals. Her recently published report showed how too many children are still being admitted into secure hospitals, often a long way from their home, when they should be in their community, as well as being subject to restraint and seclusion. I will return to that in a moment. She warns that the current system of support is letting down some of the most vulnerable children in the country. We will consider her report extremely carefully.

I want to turn to points made by the noble Baroness, Lady Thornton, regarding private providers. Around half of the provision of specialist in-patient care is in the independent sector. This is carefully looked at by regulators and by the Government. At the moment, there is no evidence of a systemic difference between the quality of care and that of the NHS or voluntary providers. The care is NHS-commissioned and is subject to the same commissioner oversight, contractual provisions and regulation by the CQC. The same safeguards under the Mental Health Act also apply to protect the rights of patients. However, we keep this matter under careful review and will continue to do so.

I now turn to the important question that was raised about restrictive interventions, given the prominence they have been given in recent reports. It is important that we see a decrease in the use of such interventions. Data collection is not robust enough for us to make comparisons between years to see whether the use of restraint is rising, but it provides enough certainty for us to know that it is still used too much. We must minimise it and, where it is used, ensure that it is done safely and effectively, in line with the Positive and Proactive Care guidelines. Understandably, there is public concern about the use of restraint, prolonged seclusion and the segregation of people with mental health problems, a learning disability or autism.

In response to the case of Bethany, a young autistic woman who was held in seclusion at a hospital for far too long, my right honourable friend the Secretary of State for Health and Social Care has commissioned the CQC to undertake an in-depth thematic review of restrictive practices in health and care settings. The CQC published its interim findings and recommendations on 21 May and the Government have accepted them in full. The care of every hospital patient in long-term seclusion or segregation will be reviewed, and patients will have access to specialist independent advocates to support them and their families, as has been mentioned.

The model of care for autistic people and those with learning disabilities must be fit for purpose. We will convene an expert group to develop a new care model, taking the very best practice as the foundation. We will also strengthen the safeguards, working with the CQC to develop new regulatory arrangements for hospitals that use segregation. In addition, we will develop a new awareness-raising campaign, as has already been mentioned, so that no one will be “out of sight, out of mind”, as has too often been the case. We want to end inappropriate out-of-area placements and ensure that people are cared for as close to home as possible. Where out-of-area placements are essential, as they sometimes are for very specialist care, commissioners will need to visit children every six weeks and adults every eight weeks on site. I hope that that will improve the situation and reassure the House.

The noble Baroness, Lady Thornton, asked why the CQC registered new facilities that do not offer an appropriate model of care. The CQC has a set of stringent rules for registering the right support. It only registers a new learning disability service that meets the service model for building the right support. However, I am sure that, given the circumstances that have arisen, this will be looked at very carefully. The noble Lord, Lord Hunt, was right: given the situations that have arisen, there needs to be a holistic and systemic response.

Many of the actions that have been taken and which we have been debating began in 2014-15, and it is important that we see the progress that has been made since then. The Learning Disabilities Mortality Review Programme—the world’s only national programme looking into why people with learning disabilities die—was set up relatively recently. It has made some progress and has recommended specific steps to improve our response to those with learning disabilities in the community to ensure that they have a better quality of life. The noble Baroness, Lady Thornton, made that exact point when she talked about improved community support. That is why annual GP health checks for people with learning disabilities to help reduce recognised health inequalities is a commitment in the long-term plan, and it is why, over the next five years, national learning disability improvement standards will be implemented and will apply to all services funded by the NHS. That is one of the systemic requirements that will help to drive improvements through the system—something that I think has been missing from the response until now.

Furthermore, NHS England and NHS Digital are working to include a digital flag in the records of people with a learning disability or autism so that information can be shared across health and care records and organisations. In the NHS Long Term Plan we have committed to implement this by 2023-24. It is another systemic response that should create a significant improvement. In addition, people with a learning disability or autism, or those with the most complex needs, will have a designated keyworker. These will initially be provided to children and young people who are in-patients or at risk of being admitted to hospital. All these improvements should make a significant difference, as will the review of the autism strategy, which is well overdue.

The noble Baroness, Lady Lane-Fox, is absolutely right that augmented rather than artificial intelligence—people plus tech—has the potential to completely transform the health of this nation. I thank her for an inspirational contribution. She will be pleased to hear that we have now completed rolling out wi-fi across the GP network and that we are well on the way with the secondary care system. She is right about skills being essential to driving digital transformation across the system, and that is why we set up the NHS Digital Academy. However, we recognise that more needs to be done. Investment was one of the core elements of the Patient Capital Review. We want to drive that forward and I would very much like to hear the noble Baroness’s proposals for it.

On the Transforming Care programme, although hospital might be the right environment for a small number of people with learning disabilities or autistic people at a given point in time, everyone should have the opportunity to live in the community. When people need in-patient support, it should be for the shortest time possible, of the highest quality and delivered in the safest settings where people are free from harm and abuse. The goal of the Transforming Care programme is to reduce the number of in-patients. We have reduced the number by 22%, and we are still fully committed to reducing it by at least 35% as soon as possible during 2019-20, as set out in the NHS Long Term Plan. That remains a commitment. Local areas will be expected to use some of the growing investment in primary care and community care services to meet that commitment.

I would like to respond to the point that was made about the number of child in-patients having doubled. In part this was because, we believe, commissioners did not correctly record children in the NHS Digital figures before 2015. We are checking the data and will respond later.

The noble Lord, Lord Hunt, was absolutely right about self-training, and that is why we have consulted on proposals to introduce mandatory training. Our plans to introduce mandatory training for all relevant health and care staff will go a long way to ensuring that more people receive the safe, compassionate and informed care that they are entitled to.

We will of course continue to work with all partners across government and across the health and social care system to consider any recommendations that can improve care for people with learning disabilities and to address the shameful inequalities that they experience. Every person has a right to effective, compassionate and dignified care. If you have a learning disability, these expectations should be no different.

NHS: Bullying

Baroness Blackwood of North Oxford Excerpts

Wednesday 5th June 2019 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty's Government what are the latest figures for bullying in the National Health Service; and what are their plans to reduce the level of such bullying.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government are committed to supporting NHS organisations in their responsibility to tackle bullying. Some 28.3% of staff responding to the 2018 NHS staff survey experienced bullying from patients, service users or the public, 3.2% from managers and 19.1% from colleagues. Through the NHS Social Partnership Forum’s collective call to action and commitments in the NHS people plan, the Government are working with these arm’s-length bodies, the royal colleges, the NHS national “freedom to speak up” guardian, NHS organisations and health unions to reduce levels of bullying for all staff, and they deserve our thanks for all their work.

[Lord Clark of Windermere (Lab)]

I thank the Minister for her Answer. As she indicated, the NHS depends entirely on the commitment and dedication of its staff. It is really appalling that 28% of them experienced bullying and harassment in the last year alone, as she said. Just 12 months ago, her predecessor as Minister told me that over 70,000 members of staff had suffered physical violence in the service, and those figures are three years old. That is indefensible. We need to protect these employees. Will she make it clear that physical attacks will simply not be tolerated? Will she upgrade the service’s register of violent and abusive patients, relatives and friends, and will she confirm that there will be zero tolerance against physical attacks on our NHS staff?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his Question and I share his outrage. We absolutely must have zero tolerance of violence against any NHS workers, wherever they work within the National Health Service. That is exactly why the Secretary of State made a commitment to the national NHS violence reduction strategy, which was launched on 31 October 2018. It will put in place arrangements to support trusts in their responsibilities to protect staff. The recommendations include improving governance, improving staff training and development, improving the work environment and better use of legislation, including the new Assaults on Emergency Workers (Offences) Act, which had its first conviction in November. That is a significant improvement, but we know that improving general morale and the workforce environment are important, which is why we published the people plan this week.

[Baroness Manzoor (Con)]

My Lords, zero tolerance is really important in a workplace, but what are the Government doing to ensure that more senior managers and clinicians do not sexually harass and bully more junior staff?

[Baroness Blackwood of North Oxford]

My noble friend is right that we must ensure that bullying, wherever it comes from, is reported. It is just as unacceptable that bullying should come from managers and senior people as from those below. As I said in my Answer, the reported level of bullying from managers is 3.2%. This is one reason why we have introduced the “freedom to speak up” guardian, so that NHS workers are free to speak up and feel that they can do so in a safe space.

[Baroness Watkins of Tavistock (CB)]

My Lords, the interim report by the noble Baroness, Lady Harding, on NHS staffing highlights persistent shortages of staff, particularly of registered nurses, in many parts of the NHS. To what extent does the Minister believe that bullying is associated with managers focusing on NHS targets without sufficient staff to deliver high-quality care?

[Baroness Blackwood of North Oxford]

The Interim NHS People Plan identified bullying and violence in the workplace as a key challenge that must be addressed, and identified some measures to address them. However, the noble Baroness is absolutely right that an underlying challenge is staffing, which is a major concern for the NHS workforce. The plan looks to address them in a serious and concerted way by recruiting more staff, retaining existing staff, and looking at innovative ways to entice former staff back into the NHS so that we reduce the pressure on the entire system. She will know that the plan includes commitments to recruit 40,000 more nurses over the next five years and to reduce the vacancy rate to 5% by 2028, down from the current 8%, and reiterates the commitment to recruit 5,000 more GPs on top of the 20,000 extra support staff to be recruited in the coming years.

[Baroness Brinton (LD)]

My Lords, in addition to the figures cited by the Minister at the beginning of this Question, it has also been revealed that a number of hospital trusts still use non-disclosure agreements effectively to gag people when there has been a resolution to an incident. What guidance do the Government provide to NHS England to ensure that so-called gagging clauses are used only on sensitive matters, such as any compensation payment, and absolutely not to stop whistleblowing?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that non-disclosure agreements cannot cover up bullying. All staff are free to speak up. Non-disclosure agreements should not be used for that purpose in any case. The Government have been very clear on this.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, I am sure noble Lords will recall my maiden speech 21 years ago, when I spoke about bullying in schools. One of the points that I made then, and I shall make again now, is that an answer to this problem is an independent hotline which people can ring to report misconduct of all kinds, not just bullying, so that organisations do not seek retribution for those who report misconduct.

[Baroness Blackwood of North Oxford]

I am afraid I was not here 21 years ago to hear the noble Lord’s maiden speech, but I shall look it up with utmost urgency upon leaving the Chamber and I thank him for his proposal. As the work moves from the interim people plan to the people plan, in which the work on bullying and the violence reduction strategy will be developed, I am sure that his proposal will be considered as a very sensible plan.

[Baroness Masham of Ilton (CB)]

My Lords, how seriously does the CQC take bullying and what does it do about it?

[Baroness Blackwood of North Oxford]

The CQC takes this extremely seriously. One proposal in the people plan is for the CQC’s scorecard to include a proper measure of a sustainable workforce, so that the new staff engagement metrics for the NHS oversight framework can be taken into account in the CQC’s well-led assessments during inspections, and that includes questions about bullying.

[Lord Lansley (Con)]

My Lords, I hope that my noble friend will agree that good leadership in the NHS is critical to removing a bullying culture. In that respect, might the Government support the NHS Leadership Academy to the extent that all aspiring chief executives in the NHS should themselves have gone through its Aspiring Chief Executive programme?

[Baroness Blackwood of North Oxford]

My noble friend, as ever, makes a very good point. Obviously there are a number of routes where leadership has been shown on this issue. In 2016 the Social Partnership Forum, which is chaired by Ministers but works across the system, gave a call to action, tasking employers and trade unions in all NHS organisations with working in partnership to create positive workplace cultures and to tackle bullying. In addition, recognising that no one organisation has the answer, royal colleges and others have joined together to create an alliance to tackle workplace bullying. They concluded that:

“Bullying behaviour is unacceptable. It is unprofessional and unnecessary. It affects the wellbeing of individuals and the teams within which they work”.


My noble friend’s proposal is another part of the picture. We need to come together across the system to tackle a completely unacceptable set of behaviours in the NHS—one that needs to be stamped out entirely.

Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019

Baroness Blackwood of North Oxford Excerpts

Tuesday 4th June 2019 Lords Chamber

Moved by

[Baroness Blackwood of North Oxford]

That the draft Regulations laid before the House on 8 April be approved.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, consumers in the UK benefit from a high standard of food and feed safety and quality. The Government are committed to ensuring that this high standard is maintained when the UK leaves the European Union. This instrument is crucial to meeting our objective to continue to protect public health from risks that may arise in connection with the consumption of food.

This instrument, which concerns food and feed law, is made under the powers in the European Union (Withdrawal) Act 2018 to make necessary amendments to UK regulations. The UK’s priority is to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. The instrument will correct deficiencies in certain regulations to ensure that the UK is prepared in the event that the UK leaves the EU without a deal.

Amendments are limited to the necessary technical amendments to ensure that the legislation is operative on EU exit day. No policy changes are made through this instrument and we have no intention of making any at this point. While we continue preparations for an orderly withdrawal from the EU, it is the job of a responsible Government to prepare for all possible scenarios, including the potential outcome that we leave the EU without a deal. We are committed to ensuring that our legislation continues to function effectively and that public health remains protected in the event of no deal. It is for this scenario that this instrument has been laid.

This instrument will address a range of minor deficiencies in retained EU law relating to food and animal feed that have not been addressed in earlier instruments, and recent changes made to EU law that could not have been addressed in previous instruments. As in the case of previous statutory instruments recently presented to the House, I wish to make clear again that no policy changes are made through this instrument. It makes only the essential changes necessary to ensure we have an effective and fully operable statute book on exit day. Its primary purpose is to ensure that legislation continues to function effectively after exit day. These proposed amendments are critical to ensuring that there is minimal disruption to food controls in the event that we leave the EU without a deal.

This instrument also transfers powers to UK entities to support a UK regulatory regime. It will transfer responsibilities incumbent on the European Commission to Ministers in England, Wales, Scotland and the devolved authority in Northern Ireland. It also transfers responsibility for risk assessment from the European Food Safety Authority, EFSA, to the food safety authorities, the FSA and FSS. They will continue to deliver independent, open, transparent and science and evidence-based advice. In addition, this instrument changes references to the import of food and feed into the EU to references to the import of food and feed into the United Kingdom. The contents of this instrument cover several policy areas, and I will address these specific areas.

The health mark for carcasses of certain animals—such as cattle, pigs and sheep—and the identification mark for all foods of animal origin will change once the UK has left the EU, with the letters “EC” no longer used. The Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019 retain the requirement for the health and identification marks to contain either “UK” or “United Kingdom”. This instrument allows for the abbreviation “GB” to be used in the marks, as this is the International Organization for Standardization—ISO—two-letter country code for the United Kingdom.

The instrument also provides for a transitional period of 21 months after exit day during which UK food businesses can apply their current health and identification marks on carcasses and foods of animal origin respectively when placed on the UK domestic market. This transitional period will assist businesses by providing a smoother transition into the new requirements and permit them to use up existing labels and packaging.

The instrument also addresses deficiencies in retained EU law regarding trichinella testing requirements to ensure that these rules are fully enforceable, replacing references to EU institutions and bodies with appropriate UK bodies and authorities. EC regulation 2074/2005 is an EU tertiary implementing measure that provides certain technical and administrative refinements to the EU regulations for food products of animal origin. For example, it sets out specific rules on analytical methods and rules relating to fishery products used in the production of fish oil. The instrument will assign powers and responsibilities currently incumbent on EU entities to appropriate UK entities to ensure that this diverse regulation is fully operational. The model health certificates for imports of certain products of animal origin, such as fishery products, gelatin and collagen for human consumption, are amended so they can be used solely to import foods to the UK.

This instrument also amends the definition of “imports” within the existing legislation so that it is clear any new facilities approved by EU member states in the future would no longer be automatically approved for food imported into the UK. Without this instrument there could be a lack of clarity around the status of newly approved facilities. The instrument also includes provisions to set minimum charging rates for hygiene controls for fishery products by amending the Fishery Products (Official Controls Charges) (England) Regulations 2007. It updates provisions for these charges: for example, these rates are currently set in euros with an exchange rate to British pounds. It also updates the exchange rate from 2008, as it is now somewhat out of date and would not be in line with central DExEU and HMT guidance on amending outstanding references to euros. The current regulations are national and stipulate the necessary qualifications and experience required for an official control laboratory analyst in England. This instrument will not become completely inoperable on EU exit and can continue to be used to regulate qualifications of official analysts.

The proposed amendments address minor drafting errors in the previously laid Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019 which were identified by the JCSI. The FSA provided an undertaking to the JCSI that this deficiency would be addressed in its response. EU authorisation decisions relating to genetically modified food and feed have also come into force since the laying of the Genetically Modified Food and Feed (Amendment etc.) (EU Exit) Regulations 2019, which will implement retained EU law on exit day. This instrument introduces amendments to make these decisions fully operable by specifying the UK entity to which the authorisation holders must submit annual reports on activities set out in their environmental monitoring plans and to remove references to the European Community in connection with the register of authorised GM food and feed.

This instrument makes equivalent changes to the relevant Northern Ireland legislation to ensure that the body of Northern Ireland food law can function properly and is enforceable once the UK leaves the EU. It also inserts a definition of “Northern Ireland devolved authority” or, where appropriate, identifies the department that is the correct and appropriate authority, replacing references to EU institutions and bodies in various EU regulations. The amendments also include naming the relevant legislature for Northern Ireland where the regulation-making procedure is provided in various EU regulations.

Let me be clear: there are no new changes for food businesses introduced into how they are regulated and how they are run. The formal public consultation was carried out by the FSA covering changes to the UK health and identification marking, which received overwhelming support for the proposal. The instrument will provide continuity for businesses and protection of consumers’ interests, and ensure that enforcement of regulations can continue in the same way. The changes will ensure the retention of a robust system of controls which underpins UK businesses’ ability to trade both domestically and internationally. Devolved Administrations have provided their consent for this instrument, and have been engaged positively. It provides the necessary controls for food to continue to function effectively after exit day.

I urge noble Lords to support the amendments proposed in this instrument to ensure the continuation of effective food and feed safety and public health controls.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I too thank the Minister for outlining all the technical details of this SI. Of course, this instrument has been withdrawn from the Order Paper twice before. Some of the changes made since we originally saw it are small but crucial. We are lucky that they have been spotted, but that raises concerns for the industry that there may be others. Now that the leaving date has changed, are the Government planning on conducting additional scrutiny on the other SIs that are being rushed through this House to make sure that they are up to scratch? How do the Government intend to convey these changes to the relevant individuals and companies on whom they will impact?

I add my support to the question asked by the noble Baroness, Lady Thornton, about the capacity of the FSA. This is probably about the 16th time that we have asked the same question and we are still concerned about the capacity to replace all of the other measures.

Some of these changes reflect very recent EU law that has come into force, as the Minister mentioned, so what do the Government intend to do about any new EU law that might come into force between now and 31 October or whenever we happen to leave? Will these SI and the ones that preceded them have to be further amended if there are other changes to EU law?

The Minister mentioned that the system for minimum charging rates for hygiene controls of fishery products is somewhat out of date. Will the Government confirm whether they aim to change the pound-euro exchange rate from the 2008 level at which it is currently set? Although these charges, as we know, are rarely levied by local authorities, any change in the exchange rate, which could happen after Brexit, could have a big impact on the ability to pay of those against whom the charge is levied. We saw a big difference in the rate of the pound against the euro after the 2016 referendum, and the way in which we might, unfortunately, leave the EU, could have a similar serious effect on the exchange rate. What are the Government planning to do about those charges if there is such a big change in the exchange rate? Are they planning to bring it up to date from 10 or 11 years ago?

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for their important questions. We have been through a number of periods of scrutiny on FSA SIs between us, so I feel that we are old hands at this.

The noble Baronesses will know that leaving the EU does not change the FSA’s top priority, which is to ensure that UK food remains safe and is what it says it is. We are working hard with the FSA to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. That is one of the reasons for this SI.

The noble Baroness is right to identify that this is one of the ways that we are keeping up to date with EU changes in legislation while we remain part of the European Union, but of course once we have left we will be responsible for identifying how we want to proceed and whether we want to introduce our own legislation and additional food safety standards which mirror those in the EU or whether we want to go further. That is a commitment—excuse me, I am having a Theresa May moment—that has been made before.

I shall touch first on the issue raised by the noble Baroness, Lady Thornton, at the end of her remarks about trade. I want to nail that one if I can. We have debated this before. The UK is committed to maintaining the high standards of food and feed safety which we currently enjoy. I shall repeat a line which has been used by No. 10. We have always been clear that we will not lower our food standards as part of a future trade agreement. From day one, we are committed to having a robust and effective regulatory regime in place which will mean that business can continue as normal. For most food and feed businesses there will be no change in how they are regulated and how they manage. Leaving the EU does not affect that, regardless of comments that may have been made this week.

[Lord Davies of Stamford (Lab)]

Can we be clear that that very important undertaking she has just given the House also applies to animal welfare standards in the European Union and currently in this country?

[Baroness Blackwood of North Oxford]

That is obviously not my brief, but I know that those commitments have been made from this Dispatch Box and I am very happy to give the noble Lord that commitment.

I shall move on to the important questions that were raised regarding trichinella resources. We have brought in these amendments today because we recognise the importance of maintaining standards when it comes to trichinella testing. The Food Standards Agency’s spend on trichinella testing in financial year 2018-19 was £565,000, of which £275,000 was recovered through charges for official controls. The figure includes the cost of taking samples and of the UK’s trichinella national reference laboratory. The figure is approximate and is a proportion of the total cost of official controls applied across the food industry. The UK will maintain the requirements of EU food safety legislation after leaving and will not only maintain the standards applicable to most domestic and imported food but will also ensure that UK food businesses can continue to apply controls that are widely accepted by other countries. The FSA has made a commitment that it will ensure that there are the resources required to maintain those standards and the level of testing for trichinella control after exit.

I know that I have given these statistics to the noble Baroness before, but I can reassure her once again that an extra £14 million was provided to the FSA for 2018 in order to ensure extra funding and capacity for EU exit and an extra £16 million was provided for 2019-20. This has translated into an extra 140 staff who have been recruited. More than 90% of them are already in place. That is supported by an expanded role for the independent scientific advisory committees on food. It covers risk assessment, for which the FSA has an outstanding international reputation. It was strengthened by recruiting new experts, establishing three new expert groups and expanding its access to scientific experts, who can provide scientific advice, and to other scientific services in order to meet the potential need for increased risk assessments in future. This is part of the wider priority of the FSA to ensure that it can maintain its current commitments to promoting robust food standards nationally and internationally, protect consumer interests and facilitate international trade and ensure that consumers can have confidence in the food that they buy—to know that the food is what it says it is. I hope that reassures the noble Baroness on that point.

The noble Baroness asked about official controls charges for fishery products. This was also raised by the noble Baroness, Lady Walmsley. She is absolutely right regarding the exchange rate, and that is why we are updating the provisions for these charges so that they are in line with the more sensitive DExEU and HMT guidance on amending outstanding references to euros. The instrument does two things. First, it adjusts for the fact that in the future European Union member states will become third countries for the purposes of these charges. Therefore, we can no longer offer the European Union differential treatment in terms of costs levied for hygiene controls performed on directly landed consignments of fishery products. Secondly, as I have said, it addresses the references to euros. The Government do not anticipate any increase in the extent to which these charges are levied by local authorities in England after the UK exits the EU. It is currently reported to be a very low rate. As such, we believe that food business operators in England are not expected to face any extra costs. We will expect local authorities to keep it under review, but we anticipate that it will remain low. I hope that reassures the noble Baronesses.

I hope that I answered the questions from the noble Baroness, Lady Walmsley, about the way in which risk assessment is done in my earlier answer about the increasing staffing that has become available through the increased investment in the FSA to prepare for EU exit and strengthen its risk assessment capability. On her question about how decisions are made, obviously there will be some ministerial involvement but it is important to say that maintaining the UK’s high food standards is a top priority for the Government. Part of that is to continue the long-standing commitment to openness and transparency and evidence-based decision-making from the FSA. Food safety authorities will publish the advice they provide to Ministers as well as the evidence and analysis it is based on so that stakeholders can see the basis on which decisions are made. I hope that that reassures the noble Baroness.

On the final point about devolved Administrations, raised by the noble Baroness, Lady Thornton, Scotland, Wales and Northern Ireland have provided their consent to these instruments. They have been closely involved in the development of them. The principles and rules that are set out in retained legislation and which these SIs will correct are intended to ensure the same level of food and feed safety and protection throughout the UK and the free flow of trade within it and—exactly as she said—to ensure clear lines of communication, engagement and co-operation between all four nations so we can, as has been said, pick up on any risks throughout the four nations. The FSA has a very close working relationship with the Administrations of Scotland, Wales and Northern Ireland, and we are confident that, in practice, it will be possible to make arrangements to operate a framework for food and feed safety and regulation across all four Administrations.

In conclusion, I thank noble Lords for their contributions to this debate and ask for their support.

Motion agreed.

Children: Gaming

Baroness Blackwood of North Oxford Excerpts

Thursday 23rd May 2019 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what plans they have to sponsor research into the benefits of gaming for children’s mental health and wellbeing.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the department funds research through the National Institute for Health Research. The NIHR spend on mental health research for 2017-18 was £74.8 million, the highest ever. The NIHR welcomes funding applications for research into any aspect of human health. Existing research has shown some positive impacts of gaming—such as cognitive, emotional, motivational and social benefits—but has also shown that a small number of young people’s gaming can become harmful.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for that reply. Yes, gaming can be harmful, and this Question is about gaming, not gambling. There is increasing evidence that gaming can help children in a whole variety of ways, particularly with mental health problems, yet little research is being done and the Minister did not really give a great list of what is happening with that. I wonder whether she could try to give more information about the scale of it and see whether we can try to persuade the internet companies to get more involved and to use their funding to start producing games of goodness and benefit to children rather than negative ones. She reported recently that there had been a summit at which the Secretary of State spoke to the internet companies. I wonder whether she will look into the possibility that, when the next meeting takes place with him or his colleagues, this item will be on the agenda and those companies will be encouraged to participate jointly in providing games of good to the country.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. He is absolutely right that gaming can have positive effects; there are some areas in which the UK Government are funding research into this. In partnership with industry, NHS England is funding work to develop and test how immersive gaming technology can be used to increase therapy adherence and tackle children’s anxiety. He is absolutely right that, following the Secretary of State’s social media summit, a partnership between industry and the Samaritans was formed. I shall certainly raise his proposal with the Secretary of State. The NIHR is also funding research to develop and evaluate therapy that uses virtual reality technology to treat patients with psychosis. The noble Lord is absolutely right that more can and should be done in this area, and I shall take that point away with me.

[Lord Kirkhope of Harrogate (Con)]

Does my noble friend not agree with me, though, that we should deal with this extremely carefully? I am aware of a number of cases in which children have become obsessed with gaming. In desperation, parents have been in touch with their representatives and medical advisers to try to deal with the effect of the psychosis that results from the obsession with gaming among quite a lot of young people. Can she therefore make sure that, however she looks at the positive effects in certain cases, she also fully recognises the dangers of an open approach to this?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. Hundreds of millions of people globally play videogames, and for the majority it is a positive recreational activity. He is right, however, that there is some evidence of a moderate correlation between gaming and depression and anxiety symptoms in young adults, and evidence that exposure to violent gaming can have an impact on sleep and mood. However, that is dependent on the nature and duration of gaming. We also support the WHO’s classification, which identifies addiction within the classification of diseases. The CMO said in her evidence review, however, that there is insufficient evidence to support a specific evidence-based guideline on screen time. That is why we support more applications to the NIHR for research so that we can have a better understanding of the impact of gaming on young people. We would encourage anyone who is concerned to contact their GP.

[Baroness Walmsley (LD)]

My Lords, as the noble Lord, Lord Brooke, said, this is about gaming, not gambling. Although some games can indeed be beneficial, some of them have covert elements of gambling in them such as loop boxes. Will the Minister assure the House that the PSHE curriculum in schools will cover elements of gambling, including those hidden in otherwise innocuous activities such as gaming? How do parents find out which are beneficial and which are the harmful ones?

[Baroness Blackwood of North Oxford]

My Lords, the noble Baroness is absolutely right, as ever, on this point. There is a challenge for parents and young people to be more educated and more critically engaged with online harms. The Online Harms White Paper is out for consultation until 1 July and I encourage all Members of this House to engage with that consultation. It is about setting clear responsibilities for tech companies to keep UK citizens safe but also about thinking about how teachers, parents and young people can get the best out of their engagement with the internet. To encourage the noble Baroness, our children and young people’s mental health Green Paper addresses these issues and we shall make sure that we drive that agenda forward.

[The Lord Bishop of Ely]

My Lords, there has been much conversation already about research into gaming addiction among young people. My right reverend friend the Bishop of St Albans raised the issue of a mandatory pause function following calls from healthcare providers. As that was raised again in conversation and discussion around the Online Harms White Paper, will the Minister confirm that the Government are assessing the value of this function?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I thank the right reverend Prelate for his question. He is absolutely right that it is one of the issues that will be considered with the Online Harms White Paper. I encourage him and his colleagues to engage with the consultation. It is a very important part of that consultation and something we should consider very carefully.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Government carefully consider encouraging NHS innovation to invest, with other independent companies, in developing games to promote healthy lifestyles in children? In particular, there could be a game that would attract children who are prone to obesity associated with mental health problems to get them engaged in health promotion programmes and associated healthy activities—innovative action research rather than pure research.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right on that point. Emerging augmented reality and VR markets should be encouraged to offer these opportunities. Interesting evidence emerged from the AR game “Pokémon Go”, which encouraged many young people to go out walking and exploring, for example, and we have programmes that are investing in promoting exactly that kind of innovation. We also have the video games tax relief, which has benefited projects such as Eye Gaze Games, a series of games for children with mobility problems. We would like to continue investing in such programmes, which give the particular benefits that the Government would like encourage.

Social Workers: Recruitment and Retention

Baroness Blackwood of North Oxford Excerpts

Thursday 16th May 2019 Lords Chamber

[Baroness Donaghy]

To ask Her Majesty’s Government what is their strategy for increasing the number of social workers and improving their retention rate.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government remain committed to supporting local authorities and other social work employers to meet their duties regarding social work workforce planning and helping them to understand best practice in recruiting, retaining and developing staff. We have invested over £1.2 billion since 2010 in supporting both mainstream and fast-track qualifying routes into the profession, and our improvements to the supervision and leadership that social workers receive support people to remain and progress in social work.

[Baroness Donaghy (Lab)]

I thank the Minister for that Answer but I do not think that they can fulfil their requirements or their responsibilities. Particularly for directly employed local authority social workers, workloads must be at red on the risk register and must have been like that for some years. Stress levels, staff shortages and the inability of some areas to recruit—there is a 26% vacancy rate in London—indicate that this must have a much higher priority than this Government are prepared to give. Will she give some more practical answers on how to stop the increasing numbers of social workers leaving the profession, how to recruit more—there has been a 6% drop—and how to get some support for a very pressed service?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for what is a very important Question. She is absolutely right that we have to ensure that we recruit and retain the social work workforce: it is vital and, like any employers, local authorities are responsible for ensuring that they have the right staff with the right skills. The Government also recognise that we have a role in supporting them. That is why we provide financial support to students who qualify as social workers. We make sure that those entering social work receive the best training possible, with some new programmes to support those who are newly qualified, such as the assessed supported year in employment, so that those who come in with quite a significant workload can be supported in their first year. We understand that high caseloads can be a challenge. Local authorities are responsible for the recruitment and deployment of social workers, but we work with them to think about how they can best manage the delivery of services and make caseloads manageable so that we retain those social workers who are vital to delivering care and support for some of the most vulnerable in our society.

[Baroness Manzoor (Con)]

My Lords, social work can be a very rewarding career but it can also be very stressful, as has been said, so can my noble friend say exactly how we are supporting young graduate social workers? She said a bit about that but how, in their first, second and third year, can we actually retain them?

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right that social workers do vital jobs and that it is an attractive career choice. More than 4,000 students enrol in social work courses every year, and we have introduced a fast-track graduate programme that has brought 2,000 more into the social work programme. However, it will work only if we retain those within the system, so we have developed some post-qualifying standards for social workers at key stages of their career to create a consistent, practice-based career progression. In particular, we have introduced the assessed year in the workforce to provide that key level of support in the first year, so that those who experience the shock of the caseload in their first year have the support that they need to remain in the profession and develop the key skills to be able to manage that workload.

[Baroness Butler-Sloss (CB)]

My Lords, as a former family judge, I have worked very closely with social workers. Will the Minister consider the aspect of lack of respect and status? If they were given a better status, they would be much easier to recruit and retain.

[Baroness Blackwood of North Oxford]

The noble and learned Baroness makes an excellent point. Social workers play a crucial role in our society and should have the respect and status they deserve. One way in which that can be achieved is through the increasing professional standards being brought into the service. As I have said, these include key reforms such as improving leadership and providing high-quality continuous professional development, through which we seek to improve the quality of social workers’ professional lives while raising standards and recognition for the profession.

[Baroness Jolly (LD)]

My Lords, the named social worker programme demonstrates a new way to support particularly vulnerable people. Social workers and their clients felt more confident and supported; social workers felt more job satisfaction, and we have just heard how important that is. What plans are there to expand this programme to more areas?

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: that is a vital part of the programme. It is part of a wider suite of programmes that have been introduced so that we can bring individuals into social work at different points within the system. This has included the new social work degree apprenticeship scheme and, as I have said, we have 4,000 a year entering the normal degree programme. We have also introduced the fast-track training programme for high-potential graduates and the Think Ahead graduate programme for mental health social work. We are trying to attack this challenge from all angles, as well as guaranteeing that we retain those in the system through continuous professional development. This will ensure that it is a rewarding profession, as she rightly says, but also one in which people feel supported and that they have the skills to deliver for the most vulnerable in our community.

[Baroness Wheeler (Lab)]

My Lords, the Minister said earlier this week that the need to ensure that we recruit, retain and build on workforce development will be at the heart of the social care Green Paper when it arrives. Has she anything further to say about when we will actually get the Green Paper, other than that it will be very important? In view of the chronic problems of low morale, inadequate pay in the face of unmanageable caseloads and resulting problems in providing key services to vulnerable people, as we have heard about today, can she assure the House that making sure that social care work is valued is recognised as a top priority in the Green Paper?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that we discussed this two days ago. I am happy to reassure her that social work and the social care workforce will be core not only to the social work Green Paper but to the workforce strategy, which will come forward imminently. She is absolutely right that we must ensure that we have the right models to retain and recruit the social care workforce, but we must also have the right funding. That is one reason why the Government have invested £9.4 billion in social work over the last few years, why we have to make sure that we integrate the long-term plan and the social care Green Paper alongside the funding settlement for local authority funding, and partly why we are working in the way we are to bring these papers forward.

Mental Health of Children and Young Adults

Baroness Blackwood of North Oxford Excerpts

Thursday 16th May 2019 Lords Chamber

[Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Baroness, Lady Royall, for introducing this debate and giving us the opportunity to discuss such an important issue during Mental Health Awareness Week. She spoke movingly and importantly. We have had an extraordinary debate today, with many personal reflections; it is an incredibly valuable contribution to this week. I also thank those who have asked the huge range of questions which I am now tasked with trying to respond to in less than 20 minutes. I hope your Lordships will forgive me if I do not cover each one; I will write on those points I am not able to cover today.

The noble Baroness, Lady Royall, is absolutely right when she says that, unfortunately, it remains true that many young people who seek help for their mental health find it difficult to access the right support at the right time. This is wrong, and we need to work harder and faster to get it right.

I would like to start by responding to a point about data, made by the noble Lord, Lord Storey. We have recently improved the available data in two key areas, with a significant prevalence survey on mental health in young people that was done in 2018 with 9,117 children and young people aged between 2 and 19. It showed that the prevalence of mental health diagnosis has increased by 1.1% since the previous survey, and that 25.2% of young people with a diagnosable disorder report having been in contact with NHS mental health specialist services in the last year. This is important, because the previous prevalence survey was 10 years old, and during that period social media has intervened, which we expected to have had a significant effect. The CMO then did a review which created evidence-based guidelines on screen time—an important intervention. In addition, we have brought in the dashboard to track data at a local level and the implementation of various standards which we have brought in.

This is a huge improvement on the level of data and tracking that we have on mental health within the community and the performance of our mental health trusts compared to the last time I was in the post. Therefore, I would like to reassure the noble Lord on the point about data. It is not where we would like it to be, but it is still a significant step forward. I wanted to start on that, because you cannot talk about policy and where we are if you do not have the data to know about it. That is why I want to talk about where we have come to before I talk about where we need to go.

We are on track to meet the commitment to improving access that we made in the five-year forward view, and to have 70,000 more children and young people accessing treatment each year by 2020-21 compared to the 2014-15 baseline. We have introduced the first-ever access and waiting time standards for mental health services. For young people experiencing their first episode of psychosis, we have a target for early intervention to ensure that treatment begins within two weeks for more than 50%. Nationally, the NHS is exceeding this: over 75% of patients started treatment within two weeks in March 2019. We have also set a target for 95% of children and young people with eating disorders—which have been on the increase—to access treatment, with a one-week referral for urgent cases and four weeks for routine cases by next year. Nationally, we are on track to meet this, with the most recent data showing that over 82% of patients started routine treatment within four weeks. We need to pay tribute to those who work incredibly hard within the mental health system and are making some very difficult changes to achieve this, coming from what was a very low base. It is important to pay tribute to them for their achievements.

I would like to move on to some questions put to me by the noble Baroness, Lady Royall, about crisis care, before moving on to those from the noble Baroness, Lady Thornton, about out-of-area placements and the private sector. The noble Baroness, Lady Royall, is absolutely right that we need to improve access to crisis care for those young people who need it most. A commitment has been made that we will invest £400 million in 24/7 crisis resolution home treatment teams in every local area by next year, and £249 million in mental health teams in A&E departments to improve the system. The long-term plan makes a commitment to ensure timely, universal mental health crisis care for everyone, including young people, and to drive out the variability which we recognise exists for them.

We also recognise the concerns raised by the noble Baroness, Lady Thornton, about out-of-area placements. We have made a commitment that inappropriate out-of-area placements must come to an end. Where there are specialist cases, a young person will need to travel, but we want in-patient stays to be as close to home as possible and to avoid inappropriate stays. For that reason, we have introduced the accelerated bed scheme, which has already created 117 new beds, with 69 new beds on the way. This is being done to reduce variability of access to in-patient care, but we also want to reduce that care by bringing in more prevention and earlier access to lower-level care, such as that pointed out by the noble Lord, Lord Layard. I shall return to the point that he made.

We are very concerned about the recent reports of failings within mental health care, which the noble Baroness raised. She is absolutely right that all providers of NHS services, whether NHS or private, must abide by the same high standards. Where this is not the case, we are ensuring that the NHS looks into the circumstances and considers what action should be taken. Private providers play an important role in the provision of children’s mental health services, but these must be safe and of high quality. We have tough regulators to ensure that that happens.

I will move on now to the points made on early intervention by the noble Baroness, Lady Royall, and the noble Earl, Lord Listowel, who is not in place.

[Baroness Thornton]

He is there.

[Baroness Blackwood of North Oxford]

I apologise—perhaps the noble Earl is sitting low in his seat.

They are absolutely right that prevention and early intervention are crucial. We prioritised improving perinatal mental health when I was previously the Mental Health Minister for exactly that reason. The noble Earl put it so eloquently: it is vital for newborns to form that early attachment with their mother and father. We must also consider the role played by the wider family, as those on our own Benches have put it. From 2020-21, we have put in place increased access to perinatal mental health services in all areas for at least 30,000 women, backed by £365 million in funding, as part of the five-year forward view for mental health. The long-term plan will also go further, with a commitment to increase evidence-based care for women with severe perinatal mental health difficulties and a personality disorder diagnosis, to benefit an initial 24,000 women per year by 2020-21. That is reassuring, but we also need to ensure that it carries on beyond the early years and into the school years—a point made by a number of your Lordships.

I recognise the impatience surrounding the Green Paper, but I would like to clarify a few points. The commitment within the Green Paper is to have a pilot, for 25 schools in the first instance, but it is then to incentivise every school and college to identify and train a designated senior lead for mental health to create new mental health support teams in and near schools and colleges. We are starting by piloting so that we can work out what the best design is and then move it across to all schools. The idea is not to have variability but to drive it through the whole system. While I recognise the frustration with rolling out these proposals in a phased way, it is a very ambitious commitment. We need to recruit and retain a workforce numbering in the thousands for the mental health support teams alone. We cannot do that overnight, given that there are over 20,000 schools and colleges. To roll out a fifth to a quarter of these by 2022-23 is already a challenging target. We must ensure that we train that workforce in an appropriate way to meet the challenges they will face.

I will also respond to the eloquent words of the noble Baroness, Lady McIntosh, and the moving experience which she spoke of. She is right that I do not speak for the Department for Education, but the thing about being at the Dispatch Box is that I can say whatever I like; once I am up here, they cannot pull me down. As she said, I speak as a former music graduate of Somerville, and I believe strongly in the importance of the arts, and in particular music, for education and mental health. I back her entirely on its importance for social prescribing as well. I will advocate strongly for that in this role. I agree with the noble Baroness that it is extremely important that young people’s experience should be safe, inspiring and nurturing. We should all be pushing in our roles for more joy within our society.

I know that I will run out of time quite quickly, so I will move on. I would like to talk a little about the work we have been delivering for university students. This key aspect has arisen on a number of occasions, and I know that the mental health of young people in universities is vital. Noble Lords will be pleased to hear that NHS England and Universities UK are working together on a programme to support and improve mental health at universities through Universities UK’s StepChange programme, which calls on higher education leaders to adopt mental health as a strategic priority and to take a whole-institution approach to mental health. As part of this programme, the Government are actively backing the introduction of a sector-led university mental health charter, which will drive up standards in promoting student and staff mental health and well-being.

NHS England is also working closely with Universities UK through its mental health in higher education programme to improve welfare services and access to mental health services for the student population, including focusing on suicide reduction while improving access to psychological therapies. There is funding attached to this and I am happy to meet with the noble Baroness if she would like to discuss that further, as it is a vital part of the picture.

I will move on to the questions raised regarding stigma and social media, which are crucial if we are to have a preventive approach to the situation we find ourselves in. The noble Baroness, Lady Massey, and the noble Lord, Lord Bragg, spoke incisively on this issue. We are committed to eliminating the stigma around mental health and are providing £20 million in funding to the Time to Change national anti-stigma campaign, which has been hugely successful. As the noble Baroness rightly said, it involved high-profile individuals who cut through the noise that often comes at young people every day. The campaign aims to improve social attitudes towards mental health, including promoting the importance of well-being in all areas.

However, we should also think about one area that did not get aired within the debate, and that is those who face double stigma when they have a chronic condition. As I think was raised by the noble Baroness, Lady Tyler, there are those have learning disabilities and mental ill-health. It is challenging for them to navigate their way through the system. Public Health England is delivering a £15 million national health campaign called Every Mind Matters, with the aim to equip 1 million people to be better informed to look after their own mental health. This will be of huge benefit going forward.

It is important that we do not imply, in this place, that everybody who suffers from mental ill-health will end up in the criminal justice system. I do not believe that is the case.

I also point out that this Government have been committed to addressing the agenda of social media and the harms it can produce, even though it is beneficial in other areas when it is used as an effective tool. That is why the Secretary of State has not only taken this on as a personal commitment in the round tables he has held with internet companies, but we are also bringing forward the online harms White Paper. The noble Lord, Lord Haskel, was right when he said that we have to make sure this has teeth. That is why there are commitments to bring forward a new regulator under it and why the CMO brought forward recommendations on screen time.

None of this is relevant if we do not have the workforce and funding that we need. I am pleased that NHS funding for young people has increased. I was concerned to hear the noble Lord, Lord Bradley, and his comments about reduced funding. The information I have is that children’s mental health funding is increasing. It has gone up from £516 million in 2015-16 to £687.2 million in 2017-18. Planned spend next year is £727.3 million, an increase of 5.8% compared to the previous year. This will be monitored with the investment standard and dashboard. I am happy to follow this up with the noble Lord, but I believe that NHS funding for mental health is increasing and at a faster rate than overall NHS funding. We are tracking this and ensuring that local CCGs stick to that commitment. This transformative investment will ensure that more young people receive the mental health support they need.

I finally turn to the questions about suicide prevention, which was movingly spoken about by the noble Lord, Lord Giddens, and others. The noble Lord is right that we have an excellent suicide prevention strategy. It must be based on accurate data. It is challenging to ensure we have that data, but I have a great deal of confidence in Public Health England working with local authorities to ensure we raise the standards of that work. Understanding the reasons for suicide is complex. Suicides among children are relatively rare, but each is an appalling tragedy, so we must work with every ounce of our abilities to move forward and make that better.

I am proud that we recently increased the amount of research funding for mental health, by a record amount, to £74.8 million. This will play an important role in helping us understand the sources of all forms of mental ill-health, including those that drive individuals to suicide.

While I am sure that noble Lords feel there are other areas I could have covered, and would like answers to other aspects, I hope that, by pointing out the areas of rising investment today and that we are improving access and waiting times, I have communicated to you that the Government are genuinely working across all departments to ensure that we see this as a priority agenda. I have demonstrated that we understand that we still face significant challenges. While we are impatient for faster improvement, there can be no question of our commitment to a brighter, healthier and more joyful future for our children and young people.

I was deeply moved to hear the words of the noble Lord, Lord Bragg, his testimony of his own experience some years ago and how different he feels things are today. Each of us still feels frustrated by how far we still have to come and how many things we still have to deliver to give our children the services that they deserve. I cannot think of a better way to close than by repeating some of the comments that he gave in his speech. We are only as good as the way we treat the weakest among us. There is a long way to go, but we are now on the road. If we can make as much progress in the next 20 years as we have in the last 20 years, we can give young people the stigma-free lives that they deserve.

Learning Disabilities Mortality Review

Baroness Blackwood of North Oxford Excerpts

Wednesday 15th May 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, with the leave of the House, I shall now repeat as a Statement the response given to an Urgent Question on the learning disabilities mortality review originally made by my honourable friend the Minister of State for Care in the other place. The response was as follows:

“Mr Speaker, I should like to start by restating our commitment to reducing the number of preventable deaths among those of our population with a learning disability and to address the persistent health inequalities that they experience. It is completely unacceptable that people in our country with a learning disability, and indeed autism, can expect a shorter life than the rest of the population as a whole.

Each and every death that might have been prevented is an absolute tragedy. We must not compound that tragedy by failing to learn lessons we can that might improve the care that is provided in the future. That is why the Government in the first place asked NHS England to commission the learning disability mortality programme, known as LeDeR.

The principle behind it is a relentless determination to learn from these deaths and to put in place changes to the way that care is organised, provided and experienced to make a real difference both locally and nationally. It means challenging often deep-rooted, systematic cultural issues that have existed for decades. It is driven by the fact that we are clear that the quality of care offered to people with a learning disability sometimes falls very short of the standards we expect—and that is simply not good enough.

The existence of the LeDeR programme testifies to our commitment to address that. It is so that people with a learning disability can access the very best possible care and support. The annual reports published by the LeDeR programme and the recommendations it makes, to which we respond, are a key part of this.

Over the weekend, the media reported on the findings of a draft of the third annual LeDeR report, which is due to be published shortly, and in making this Statement I record my deep regret at this apparent leak. It is also my regret that Her Majesty’s Opposition should table a UQ based on leaks, and indeed that the Speaker’s Office should see fit to grant it. I have committed in the past, and I will commit once again, to bring the final report before Parliament on the day of publication, which we are told by NHS England will be in the next few weeks. I know that honourable Members will feel as concerned as I do by some of the things that have been leaked in the report, which I shall be very happy to discuss in more detail when the report is fully published”.

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. I just make the obvious point that the Government have had the draft report since 1 March, and if they had published it in a reasonable time it might not have leaked.

I am sure that we can all agree that people with a learning disability have worse physical and mental health than people without a learning disability, and that the Confidential Inquiry into Premature Deaths of People with Learning Disabilities found that the average age of death from different levels of impairment was between 46 and 67 years, which is massively below the average lifespan for those without a learning disability. I look forward to the report, which the Government have told us that we will soon see.

Will the Minister now say that it is always unacceptable for learning disability to be given as a reason for not resuscitating someone? For this programme to work properly, does she agree that it needs to be resourced so that it can consider all reported cases in a timely manner? I suggest to her that many families feel that the review is the NHS marking its own homework, and that what is required here is a truly independent national body to review the premature deaths of people with learning disabilities.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important questions. On her first point, which is that the Government have had the report since March, I should like to be very clear that this is not a government report; it is an independent report from the University of Bristol. It is free to publish it when it is ready, although it was commissioned by NHS England, so the Government are not in control of the timetable for publishing it.

The noble Baroness is 100% right, however, on her point about “do not resuscitate” orders. The reports that we have heard that disabilities such as Down’s syndrome are being used by some doctors as a reason not to resuscitate are entirely unacceptable. We are taking immediate action and a letter will be sent to health professionals to make clear that that is not an acceptable reason to put in place a “do not resuscitate” order. On her last point about resourcing and the effectiveness of the LeDeR programme, progress has been made in implementing it: 15 out of 24 of the recommendations have already been completed, and in others we are making real progress. NHS England has trained more than 2,100 experts to carry out reviews, 1,500 reviews have been completed and a further 1,500 are in progress, but I have no doubt that given the situation in which we find ourselves, questions will be taken into account by NHS England and the department.

[Baroness Jolly (LD)]

My Lords, I should declare my interests. I am chairman of Hft, a learning disability charity which cares for more than 2,000 adults. I thank the Minister for repeating the Statement and understand the limitation of her responses, but I am not sure that the Secretary of State’s words will console parents and other relatives of someone with a learning disability. If the Secretary of State were to take immediate action on any part of the leaked report, I should like it to be on the issue that the noble Baroness, Lady Thornton, just raised about “do not resuscitate” orders.

No one dies from a learning disability or Down’s syndrome. The reason for the annual report is to identify why people with learning disability die much earlier than the population average. Why and how well-trained doctors do not know and appreciate that appals me. Can the Minister put a note in the Secretary of State’s in-tray to suggest that this might be an area to look at urgently and remedy quickly? Can she ask him to ensure that all doctors in training learn to care for people with a learning disability, and that that is regularly refreshed as part of their ongoing professional development? Will she flag up to him that I look forward to discussing the report with him as soon as it is finally published?

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right that this issue must be a top priority, and I assure her that the Secretary of State is taking it as such. I repeat that it is entirely inappropriate that disability of any kind—in particular, learning disability or Down’s syndrome—should ever be used as a reason for a DNR, and that NHS England will be writing to all doctors to remind them of this fact. It will be made absolutely clear.

The noble Baroness is right that there should be no reason for people with learning disability to have a different life expectancy. A commitment has already been made in the long-term plan to address those challenges, including increasing the uptake of annual GP health checks for people with learning disabilities to 75%, as it is recognised that physical care for those with learning disabilities is not as effective as it should be; creating a digital flag on patient records for all people with learning disabilities and autism by 2023; and reducing the number of in-patients with learning disabilities by half by 2024. We are increasing the pace with which we do that.

The noble Baroness’s last point, which is really important, concerns ensuring that all those working in the health system are trained to treat those with learning disabilities. A consultation on this matter has just closed and we will respond to that in the next two to three months.

[Lord Arbuthnot of Edrom (Con)]

My Lords, I thank my noble friend the Minister for her helpful answers so far. Is one of the problems that there is a contradiction between our natural desire to make sure that there is no variation in treatment or administration across the country and our equally natural desire to ensure that local people can make decisions on the basis of their local resources? Is there a sense that the Government cannot win?

[Baroness Blackwood of North Oxford]

In my view, there should be no variability in the quality of care that a person with learning disabilities receives in whatever part of the country they are in. That is exactly why the LeDeR was brought in, why we have brought in a care review to understand why there is variation, why we are bringing in support through training for those delivering care and why we are bringing in measures under the long-term plan: so that individuals can be identified and flagged up to healthcare professionals who, once they have the training, can apply it and bring in proper healthcare for individuals so that they do not see the life expectancy challenges in healthcare we have been seeing until now.

[Lord Wigley (PC)]

My Lords, I draw attention to my registered interests and involvement with Mencap and Mencap Wales. A moment ago, the Minister finished her answer by referring to the need for nurses to be trained, and to have the awareness and ability to deal with people with learning disabilities so as to mainstream what is happening. Can she assure us that some priority will be given to this issue? Until we get the lack of capacity sorted, we cannot make the reasonable adjustments that will solve the problem we are addressing.

[Baroness Blackwood of North Oxford]

I can say absolutely that priority will be given to this. The mandatory training consultation, which has just been completed, was published on 13 February. The consultation lasted eight weeks but such was the volume of responses to it that it was extended by a further month; it received more than 5,000 responses, which the department is currently going through. There has been a commitment to a response within two to three months. The Government are taking this extremely seriously.

[Lord O’Shaughnessy (Con)]

My Lords, I thank my noble friend for her answers and the commitment and empathy she has shown, but let us be clear: what we are describing is appalling. The fact that people with learning disabilities—Down’s syndrome, autism and the like—have shorter life expectancies is completely unacceptable. I know that the Government and the Minister personally are committed to doing something about that but I want to return to the issue of training. To change a culture, we need to change not just the curricula of people training to enter the profession but the attitudes of everybody already working in the caring profession who do not always take these issues seriously. I appreciate that my noble friend will not be able to give details ahead of the consultation response in two to three months’ time, but can she give a commitment that we will think about not only training—in medical colleges, on nursing courses and so on—but continuing professional development so that everybody who is likely to have contact with people with learning disabilities in a care setting will have the opportunity to retrain, to understand the needs of these people and to make sure that we provide them with the care they deserve?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. He is absolutely right: it is a disgrace that the reports demonstrate that too many people with learning disabilities are still dying prematurely and, all too often, for preventable reasons. We must ensure that we drive through the entire health system a change to make this come to an end. This is partly a matter of leadership, which is why it is absolutely right that Stephen Powis, the NHS England medical director, will write personally to doctors saying that it is not appropriate for DNRs to be based on disability and learning disabilities. It is why learning disabilities have been made a priority throughout the long-term plan and key programmes in the plan prioritise improving the physical healthcare of people with learning disabilities; that is important because it drives the issue up the priorities list of those working on an already busy schedule. It is also why the consultation on mandatory training will be brought forward as a matter of priority. Only when you have that combination of leadership, the practical healthcare programmes funded in the long-term plan and training will you get the culture change that my noble friend rightly identified as necessary.

Social Care: Green Paper

Baroness Blackwood of North Oxford Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the costs and effects of the delay in publishing their green paper on social care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Green Paper remains a priority for the Government, and we will publish it at the earliest opportunity. Despite the delay in publication, the Government are committed to improving adult social care. We recently launched our social care recruitment campaign, Every Day is Different, and continue to support the sector by distributing £12 million a year through the workforce development fund. The Government have also given councils access to up to £3.9 billion of funding for social care for 2019-20.

[Baroness Wheeler (Lab)]

My Lords, the Green Paper was first promised in 2017, when the Government said that,

“we cannot wait any longer—we need to get on with this”,—[Official Report, 6/7/17; col. 987.]

and pledged to publish by the end of that year. I remind the House that this was a year after they abandoned the Dilnot provisions on future care funding, which had cross-party support under the Care Act and were due to start in 2016. The Alzheimer’s Society has estimated that, over the past 26 months, there have been more than half a million delayed transfers of care for people affected by dementia; nearly 3 billion hours of unpaid care have been provided; and, at any one point, more than 120,000 people with dementia in England receive no help from social care or family carers. Emergency cash injections do not address the chronic underfunding of local services, change the eligibility criteria or help people plan for future care needs. When we finally get the Green Paper, can the Minister promise the House that it will address these issues and provide the major, immediate and long-term funding that is urgently needed?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for an extremely important question. I know that she will agree that decisions on future reforms must be aligned. That is precisely why the long-term plan and the upcoming social care Green Paper have been considered alongside each other. Some important measures within the long-term plan are already beginning to improve social care; for example, the enhanced health in care homes model, which will ensure stronger links between primary care networks and local care homes; the comprehensive model for personalised care, which will put the individual at the centre of services; and personal health budgets. However, the noble Baroness is also right that we have to make sure that we get funding reform right—that is why we have increased funding from £3.6 billion in 2018-19 to £3.9 billion in 2019-20. She is also right that we must ensure that we build on the carers action plan and put carers at the heart of social care. Finally, we must ensure that we recruit, retain and build on workforce development at the heart of the social care Green Paper. That is what we will do, and I look forward to the debates in this House when we bring it forward.

[Lord Forsyth of Drumlean (Con)]

My Lords, is my noble friend aware that the Economic Affairs Committee is conducting an inquiry at the moment into social care? One of the manifestly obvious conclusions is that we will not be able to address this important issue unless we are able to get a degree of consensus between the Opposition and the Government? Would it not be a good idea for the Opposition to take a constructive approach when the Green Paper is published?

[Baroness Blackwood of North Oxford]

I think that the noble Lord speaks for the whole House when he calls for consensus on social care. One reason why it is taking slightly longer to bring forward the plan is that we are doing a lot of work on consultation and collaboration to ensure that we produce a robust proposal which can command the support of the House and be delivered effectively and implemented well. The Government are committed to ensuring that everyone has access to the care and support they need, but we need to be clear that there should continue to be a principle of shared responsibility and that people should expect to contribute to their care as part of preparing for later life. The Green Paper will bring forward ideas for including an element of risk pooling in the system to help protect people from the highest costs. We look forward to support from the Opposition on those proposals.

[Baroness Brinton (LD)]

My Lords, in 2009 there was a proposal that we should all work together, cross-party, for social care, started by the then Labour Government. All three major parties signed up to it, and then one party withdrew, making it undeliverable—it was neither the Labour Party nor the Liberal Democrats. The Minister said all the warm words that we want to hear about support for health and social care integration, but the new Health for Care coalition of 19 major health organisations is very clear that, while it is doing all it can for social care services and the NHS working together, and integration is improving, it can go only so far when services are being placed under so much strain. It points out that we would need an annual increase of 3.9% to meet the needs of an ageing population and an increasing number of younger adults. Seven hundred days since the social care paper was first promised is too long: when will it actually be delivered?

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience for progress on this. She is absolutely right that there is no point in bringing forward the proposals if they are not properly costed and funded. That is exactly why these proposals have been developed in collaboration with the long-term plan and the social care plan. We have to ensure that the right funding for social care is agreed alongside the rest of the local government settlement at the forthcoming spending review. That is partly why this process is taking the route that it is.

[Lord Laming (CB)]

My Lords, I feel sure that the noble Baroness will agree that this has become an embarrassingly long-running saga. I am sure the whole House will agree that the people who depend upon these services are the most vulnerable in our society and have such high-dependency needs that they ought to have the security of knowing that their well-being and safety is being properly attended to. Will the noble Baroness use all her influence to make sure that these people get the security and peace of mind that they deserve?

[Baroness Blackwood of North Oxford]

I am absolutely delighted to offer the noble Lord my assurance that we will work as hard as we can to deliver the most effective and most deliverable Green Paper we can. He is absolutely right that the most vulnerable people within our society depend on the effectiveness not only of social care services but the integration of social care services with our public health services and the long-term plan. That is why it is encouraging that social care sits right at the heart of the long-term plan and why it is well integrated with the other commitments within the plan to improve outcomes for major diseases and including measures to support older people, through more personalised care and stronger community and primary care services. These will improve outcomes and reduce the demand on social care, and that is exactly the kind of holistic approach that we want to see.