Learning Disabilities: Transforming Care

Baroness Brinton Excerpts

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

This is an area of healthcare about which I am least informed, so I would very much like to do that.

[Baroness Brinton (LD)]

My Lords, Sir Stephen Bubb’s update report also said that the review was going forward very slowly. The Minister has also referred to this. What is the new timetable for the full implementation of the Bubb report?

[Lord Prior of Brampton]

It is a three-year timetable. The intention is to reduce the number of in-patient hospital beds by between 35% and 50%, as I said. There will be a review at the end of the three years to see whether that can be taken further. The truth is that progress seems painfully slow until you look back to where we have come from. We have come a long way over the last 20 years, but nothing like far enough or fast enough. An old Chinese proverb says that it is better to light one candle than curse the darkness. We are making progress, but it could be quicker.

Mental Health: Ensuring Equal Access to Mental and Physical Healthcare

Baroness Brinton Excerpts

Thursday 26th May 2016 Lords Chamber

Moved by

[Baroness Brinton]

That this House takes note of the recommendations of the Five Year Forward Review for Mental Health and the case for ensuring equal access to mental and physical healthcare.

[Baroness Brinton (LD)]

My Lords, I am grateful to have this debate on the importance of mental health and look forward to hearing contributions from your Lordships.

Although attitudes are changing, some people still think that mental illness does not affect them or us, but it does. One in four of us will have a mental illness at some time in our lives. We will all have someone close to us who has experience of mental health issues—I know I have—but there is also a wider cost to society. The cost of mental illness to the economy is estimated at £105 billion a year and the employment rate of people with severe and enduring mental health problems stands at just 7%. The effect on our National Health Service is substantial, too. People with mental health illness have over three times more A&E attendances than those without, and are five times more likely to be admitted to acute service hospitals. Of particular importance is the fact that more than one-third of GP consultations are related to mental health. Nine out of every 10 people who either attempt or die by suicide already have a record of suffering from mental illness.

Between 2011 and 2014, there was a 33% rise in the number of mental health-related incidents dealt with by the police and a worrying increase in people with mental illness being held in police cells due to lack of appropriate NHS bed provision. Last November, it was reported that a 16 year-old girl was held in a secure police cell for 48 hours in Torbay because there was no acute mental health bed anywhere to be found. Imagine if that were your underage daughter, niece or granddaughter in severe distress, having committed no crime, in an alien criminal justice environment. But there was also a consequence for the acute hospital, as a nurse had to be with her the entire time, costing the hospital substantially more than the provision of an emergency bed. Sadly, this is not an isolated incident and inquest after inquest asks for action, but until there are effective weekend crisis services I fear that nothing will change.

The independent Mental Health Task Force Report, The Five Year Forward View for Mental Health, published this February, sets out the crisis in our mental health provision and makes many recommendations. The task force, chaired by Paul Farmer, also points out that this goes way beyond NHS provision. People with mental health problems need,

“to have a decent place to live, a job or good quality relationships in their local communities”,

and the wider inequalities of mental illness must also be tackled. Mental health problems affect disproportionately those living in poverty as well as black, Asian and minority ethnic people, and their involvement in the criminal justice system before they get access to health support and treatment is shocking and a shameful reflection on our society.

The report makes many recommendations but for Liberal Democrats there are some important core themes which we also had in our manifesto last year, and these remain key priorities for us. First, there needs to be comprehensive access to waiting times and standards in mental health, giving people the right to treatment in exactly the same way as for those with physical conditions. In coalition government, the Liberal Democrats introduced the first ever maximum waiting times in mental health for conditions such as depression, anxiety and psychosis. This was the first part of a vision for comprehensive waiting-time standards, championed in government by Norman Lamb MP, then Minister for mental health, who has continued his fight for these standards ever since.

Secondly, there must be 24-hour access to mental health crisis care seven days a week and this must be funded properly so that crisis resolution teams and home treatment teams can offer a real alternative to hospital admission, which is both better for the patient and, in the long run, cheaper for the NHS. The task force acknowledged the crisis care concordat joint agreement in February 2014, which describes how police, mental health services, social work services and ambulance professionals should work together to help people going through a mental health crisis.

Behind every strategy and behind the statistics there are personal tragedies. In April this year an inquest heard how 17 year-old John Partridge, a talented young musician, was allowed to discharge himself from Derriford Hospital in Plymouth because the inexperienced junior doctor had no mental health consultant to turn to for advice, and crisis mental health services for 16 to 18 year-olds were not available over the weekend. Despite his history of self-harm and attempted suicide, he was not even assessed in person. He was treated as an adult and permitted to discharge himself.

I believe that, as in physical health, there should be “never events” in mental health. In physical health the list includes operating on the wrong limb or leaving a foreign object in a patient after surgery. There is one current mental health never event, and it is important: the failure to install functional collapsible shower or curtain rails. However, the definition of mental health never events must surely be extended so that someone with a history of self-harm and attempted suicide must be seen and supported and not discharged until a senior psychiatric clinician is confident that it is the right thing to do. I hope the Minister can confirm that the “never” list will be expanded to include suicide risk immediately after leaving mental health care.

Thirdly, the practice of sending acutely ill patients long distances for treatment should be stopped as quickly as possible. In February this year it was estimated that 500 patients a month were being taken more than 30 miles, and some more than 100 miles, to the nearest available bed. Norman Lamb, my noble friends Lady Tyler and Lady Walmsley, I and many others have also made repeated requests for this practice to end. The noble Lord, Lord Crisp, who led the Commission on Acute Adult Psychiatric Care, found that there are major problems both in admission to psychiatric wards and in providing alternative care and treatment in the community. One of the commission’s key recommendations is that the practice of sending acutely ill patients long distances for non-specialist mental health treatment should be phased out by October 2017. Can the Minister confirm that the Government and the NHS will be accepting this recommendation in full and that the practice will indeed end by October next year?

I ask the Minister to update your Lordships’ House on the progress of the five-year forward view task force implementation plan. Time and funds are running out and I know that many providers are keen to hear the Government’s view. The Government’s commitment to an extra £1 billion to meet the report’s recommendations after the launch is welcome but this will not be enough to deliver the report’s recommendations. Even more worrying, it seems that the funding may come from the additional £8 billion the Government have already pledged to deliver the general five-year plan, meaning that mental health will not receive any more than it would have got on the basis of its historical and deeply inadequate share of resources—about 13% of the total NHS budget, despite accounting for around a quarter of the national burden of disease. A figure of 13% is neither parity of esteem nor parity of resource.

Worse, the report Funding Mental Health at Local Level: Unpicking the Variation, published by NHS Providers a week ago, raised serious concerns that the necessary investment is not reaching many local areas and services. This is despite recent funding commitments such as the £1.25 billion five-year CAMHS investment announced by the coalition Government in the March 2015 Budget. The report says that, “Only half”—just over half—

“of providers reported that they had received a real terms increase in funding of their services in 2015/16”.

In addition:

“Only a quarter … of providers were confident that their commissioners were going to increase the value of their contracts for 2016/17”.

There is also confusion over,

“what it means to implement parity of esteem”,

including,

“confusion over what services should be covered, and how much investment should be made”.

Furthermore:

“Over 90% of providers and 60% of commissioners were not confident that the £1 billion additional investment recommended by the mental health taskforce”—

for CAMHS—

“will be sufficient to meet the challenges faced by … services”.

At the heart of the problem is the inclusion of additional funding in the commissioner’s baseline allocations. The many competing claims on the additional money given to commissioners makes it more challenging to ensure that the funds are not diverted to other priorities but are used for the intended purpose of delivering much-needed improvements to mental health services.

These findings support a previous analysis by the BBC, which found that the £143 million investment in CAMHS was not reaching front-line services. The Mental Health Network expressed suspicions that the funding was being diverted to other services. CCGs and mental health providers have expressed support for the ring-fencing of additional resources for mental health. Some mechanism is required to ensure that funding gets through. Can the Minister inform the House which financial resources will be provided for mental health services and what guarantees there are that this funding will be ring-fenced, reach front-line services and be transparent and accountable?

One in 10 children between the ages of five and 16 suffers from a diagnosable mental health condition, and there is now substantial evidence to show that three-quarters of mental health problems start before the age of 18. It is, therefore, an absolute moral and economic responsibility for us to ensure that children and young people get the help they need as soon as possible, and in the right place and at the right time.

The Future in Mind: Promoting, Protecting and Improving our Children and Young People’s Mental Health report, launched a year ago last March, made some very clear recommendations about commissioning and improving access, about mental health support in schools and especially about ensuring that those from vulnerable and hard-to-reach backgrounds, including looked-after children, get urgent and bespoke help.

There are numerous stories about very long waiting times for referrals to CAMHS and considerable variance in different areas. The average waiting time in Gateshead is five times as long as that on Tyneside, just down the road. Some areas have referral rules that children must have “enduring suicidal ideation”—that is, they must have expressed suicidal thoughts on multiple occasions—before they are able to be seen. This is unacceptable. Children and young people need support much earlier.

In 2014, the Department for Education published statutory guidance to schools on supporting pupils with medical conditions. The guidance says:

“In addition to the educational impacts, there are social and emotional implications associated with medical conditions. Children may be self-conscious about their condition and some may be bullied or develop emotional disorders such as anxiety or depression around their medical condition”.

However, schools wanting to help their pupils who may be exhibiting mental health problems have their hands tied behind their back. Despite the continuing increase in the number of pupils across the country, the number of school nurses is reducing. Many schools see their school nurse only briefly—once a week or, worse, once a fortnight—so there cannot be effective dialogue between school nurse and staff, let alone school nurse and pupils. These cuts are continuing, especially with the cuts in public health budgets.

What are the Government doing to ensure that school nurse places are being protected? What dialogue exists between the Department of Health and the Department for Education to ensure that the vital role of schools in identifying the need for early intervention can happen?

That brings us back full-circle to the start of my contribution. First and foremost, resolving the crisis in mental health is a funding issue. Do the Government understand that all the good work done by the Mental Health Taskforce and others in identifying the problems and making recommendations to solve them will come to naught without a real-terms funding increase? Shifting money around will not do the job. Secondly, we will only solve the issues by real cross-departmental working.

What plans are there for true parity of esteem and a real cash injection into mental health services in both this year and the remainder of this Parliament? What cross-departmental working is happening at the moment? Without it, we will continue to hear of personal tragedies—lives wasted or ruined because our current mental health services are completely inadequately funded.

--- Later in debate ---

[Baroness Brinton]

My Lords, I thank everyone who has contributed to the debate, particularly to my noble friend Lord Oates for his personal story, which reminded us that strategies and data all come down to individuals. I am particularly grateful for his comments about children out of school, which is an interest that I have as well.

I am grateful to the noble Lord, Lord Crisp, for making sure that we remember that mental health issues are global, not just local, and I support his plea that DfID, too, should look at parity of esteem. I hope that the Minister will pass that on to DfID. I am grateful, too, to my noble friend Lady Tyler for her proposals for ring-fencing. I hope that the Minister will be able to address that in the reply to my noble friend. Despite the reassurances that the Minister has just given us, there is clearly real concern among providers, and even among some CCGs, that funding is not getting to front-line services. We need to be reassured that that will happen.

I am very grateful to the noble Lord, Lord Tunnicliffe, for talking about changing taboos, which is absolutely vital. We move at glacial speed on some things, and although progress is being made, if you talk to young people in particular, some major taboos are still there. Education and PHSE play an important role in helping our young people to understand how they might upset other people and in helping those young people who face difficulties to put their own experience in front of their friends and to be able to talk about it. The noble Lord, Lord Tunnicliffe, quoted Alistair Burt about rolling responses rather than one big response. I share his concern on that.

I am very grateful for the comments of the noble Lord, Lord Prior. Everybody who has taken part in this debate would completely understand that the noble Lord is certainly sympathetic to the issues about mental health, as I think is the Department of Health. But the funding issues remain, and I think we all look forward to receiving the details. Following his offer to hold the Government to account for delivering them, I also hope that he will be able to go back to the Treasury with the comments made in this debate to argue for further and specific resources. On that basis, I beg to move.

Motion agreed.

Mental Health Services

Baroness Brinton Excerpts

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

What I would say to people in the NHS is that the Government are committed to spending a lot more money—more money than has ever been spent before on mental health—so we are putting our money where our mouth is. We are the Government who signed up, with the Liberal Democrats, to putting parity of esteem in law in the 2012 Act, and we are absolutely committed to doing that. There is no ground for thinking that we are deprioritising mental health. The quality premium that NHS England uses to focus the attention of CCGs will change every year. It had mental health in it last year; it had other issues in it this year; and I hope that it will have mental health in it next year.

[Baroness Brinton (LD)]

Parity of esteem has a very specific meaning and it is good news that some extra money has been coming into mental health services but, until mental health is a real priority and there is equal funding, particularly to take pressure off the acute sector, there remains a problem. Can the Minister please confirm that mental health will continue to benefit from additional funding next year, given the priorities set out in the mental health five-year forward view? It would be really reassuring to the House to know that at least there was continuing additional funding available.

[Lord Prior of Brampton]

I assure the House that, on the funding that the Government have agreed for children’s and young people’s mental health and adult mental health—in the light of the Prime Minister’s announcement in January, but particularly in the light of Paul Farmer’s report that came out six weeks ago —we are fully committed to meeting those obligations.

Wheelchair Users

Baroness Brinton Excerpts

Thursday 21st April 2016 Lords Chamber

[Lord Prior of Brampton]

I totally agree with my noble friend that there is an absolute need for greater uniformity and standardisation. The level of variation around the country is wholly unacceptable.

[Baroness Brinton (LD)]

My Lords, the NHS guidance on the website to people seeking a powered wheelchair says:

“Each service will have a strict criteria of eligibility. Usually the NHS services do not provide powered wheelchairs … for outdoor use only”.

Some areas, including mine, say that this means you get one only if you need to use it inside your own house. This does not mean independent living. When will the criteria be changed to ensure that if a powered wheelchair is needed for work purposes it will be provided?

[Lord Prior of Brampton]

As the noble Baroness knows, the criteria are local at the moment. The point of collecting the data and developing a tariff, which takes into account assessment, the equipment and repair and maintenance, is to have local commissioning against the national standard.

NHS: Mental Health Services

Baroness Brinton Excerpts

Monday 14th March 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, last week there was a well-publicised case of a young autistic man being held in secure mental health accommodation because there were no spaces in the appropriate autistic support facility. It transpires that the principal cause was that there was nowhere for the young people in the other unit to move to. Can the Minister explain what is happening with mental health services to avoid bed-blocking, in the same way as is happening with other social care?

[Lord Prior of Brampton]

On the particular case raised by the noble Baroness, the person involved will now come out of that accommodation. I think he has been an in-patient for six months but he is now due to come out of that place fairly soon. This issue is not confined to mental health. There are too many people who, if the right resources were available outside hospital, would be much better off being treated outside an institution than they are at the moment. We are doing our best to address this general concern, raised by Paul Farmer and his task force.

NHS: Junior Doctors’ Pay

Baroness Brinton Excerpts

Wednesday 27th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think the whole House will agree with the noble Lord that we all very much hope to avoid another strike. The Secretary of State has asked David Dalton, the very distinguished chief executive of Salford Royal—the noble Lord, Lord Turnberg, will know him extremely well—to head up those negotiations with the BMA, and we are very hopeful that a conclusion to this dispute will be reached before there is any more strike action.

[Baroness Brinton (LD)]

My Lords—

[Lord Winston (Lab)]

My Lords—

--- Later in debate ---

[Baroness Brinton]

I am very grateful to the noble Lord for giving way. Pay is only part of the problem for our doctors in this country at the moment. The NHS is increasingly kept afloat by overseas-trained doctors and over 40% of our hospital doctors are now from overseas. In certain specialities such as obstetrics and gynaecology the number is currently over 56%. Can the Minister say what the Government are doing to understand why some specialities struggle to attract enough UK-trained doctors, and, further, what they are doing to increase the number of medical training places for UK-based students?

[Lord Prior of Brampton]

The noble Baroness raises a very important point that we are highly dependent in a whole range of medical specialties on overseas doctors and of course overseas nurses as well. Health Education England is expanding the number of training places, in particular for GPs; we hope to have an extra 5,000 GPs in place by the end of this Parliament.

Health and Social Care: State Pension

Baroness Brinton Excerpts

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the NHS produced its five-year forward view 18 months ago, which called for additional spending in real terms from the Government over the five-year period of £8 billion. The Government have met that in full and are front-loading that investment, as the noble Lord knows, spending £3.8 billion in the forthcoming year. So the Government are fully supporting the NHS’s plan.

[Baroness Brinton (LD)]

My Lords, there are two issues here. One is the short-term funding issue, and the noble Lord, Lord Hunt, is absolutely right to say that there is a crisis. Simon Stevens’s reference was about much more than just the pension; there are intergenerational fairness issues and a whole string of other things. My honourable friend in another place, Norman Lamb, suggested that there should be a cross-party commission to look at these issues, which cannot be resolved overnight. Is there progress on the Government accepting the principle of this cross-party commission and, if so, when might an announcement be made?

National Health Service

Baroness Brinton Excerpts

Thursday 14th January 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I, too, thank the noble Lord, Lord Turnberg, for securing this important debate. I also want to thank all the people who work in the NHS at the moment. We need to recognise that much of it works very well, despite the pressures which I am sure we will focus on during this debate.

My starting point is that the world is changing. With the demographic time bomb, a large increase in the older population and the conditions associated with that, comorbidities and the changes in the technology delivering medical services, our NHS is facing perhaps the biggest challenge of its time. That is before we even start to look at the financial allocation.

I, too, want to focus on public health. There are concerns about the £200 million in-year cuts which are impacting on the ability to help the public prevent their own need to call on the health service.

I congratulate the noble Lord, Lord Fowler, on the fantastic AIDS campaign. We need a public campaign on how to use the health service now. The number of people who bypass the GP and go straight to A&E, despite what has been done on this subject, is still appalling. Talk to any emergency doctors and they will tell you that there are plenty of people who they should not be seeing there.

The noble Lord is not the only person asking for a commission; my colleague Norman Lamb in another place has also said that we should have one on the entirety of health and social care, for all the reasons that noble Lords have mentioned. We have been talking for years about full integration, and I shall come on in a moment to an example of where I see one particular small project working very well.

Our NHS faces a much bigger crisis, and that is staffing—both nurses and doctors. Not only are we exporting a large number of them—over 5,000 doctors applied for certificates to work abroad, and many of them have gone—but I am not sure whether noble Lords are aware that UK doctors make up only 63.5% of doctors currently registered in the UK. That means that over one-third of our doctors have been foreign-trained. Some 91,000 of our nurses at the moment have trained abroad—that is, one in seven. It is an enormous number. We may have separate debates on how we do not train enough and how 10,000 nursing places have been lost. We have been thinking on a very short-term basis about medical education over the past five years, specifically since the removal of the SHAs. It is vital that we start to plan longer-term. Hiring doctors from abroad may work in the short term but often causes problems in their own areas and countries. While some trusts work closely with other countries—such as the West Hertforshire trust, which works with nursing schools in the Philippines—that is not universal.

My final point is about good integration. Hertfordshire is launching the Sloppy Slipper Swap this month, funded by the county council and the CCG. Some 4,000 people in Hertfordshire have trips and end up in hospital. Most of those are at home and are caused by poor footwear, so it is great to see a fully integrated campaign run by the libraries to ensure that people have access to education and a free pair of slippers, as well as advice about winter warmth. That is the sort of project that we need to see replicated throughout the country.

Four Seasons Group

Baroness Brinton Excerpts

Monday 11th January 2016 Lords Chamber

[Lord Prior of Brampton]

I fully agree. Our interest is in the residents in the homes. The CQC’s oversight regime is not intended to prop up a provider—that is an entirely different matter. My noble friend is absolutely right that when Southern Cross went into insolvency, very few homes—in fact, I do not think that any homes—closed as a direct result at the time; most of them carried on as going concerns.

[Baroness Brinton (LD)]

My Lords, is the Minister working with the Department of Health, the CQC and BIS to ensure that the new financial instrument, whereby an individual can invest in a single room in a care home for a guaranteed rent, protects the user of that room as much as it provides any yield for the investor? Evidence in the student sector has shown very mixed results. Students can move on elsewhere, but elderly care residents have nowhere else to go and their protection, and indeed the trading viability of a care home, could be affected if investors had to move out quickly.

[Lord Prior of Brampton]

My Lords, I could not see where the question was coming from. I am not fully briefed on the financial instrument that my noble friend—I am sorry; the noble Baroness—referred to. I will have to research it and get back to her.

Residential Care: Cost Cap

Baroness Brinton Excerpts

Thursday 10th December 2015 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I suspect that given the difficulties facing the social care sector at the moment, particularly the residential care sector, much of this debate will focus on viability and financial problems, so I want to start with a comment about quality. Yesterday was the first anniversary of my mother’s death. During most of the preceding 11 years, she was at home, but she was also in respite care and residential care, and the care taken by everybody involved—the social services department, the domiciliary care company, the residential homes, one of which was a very small provider with the other part of a much bigger scheme, the hospitals and the intermediate care—was fantastic. I cannot fault any of the support and care she had from the whole of Dorset and all the people who my family were involved with over that 11-year period. It is worth pointing that out because too often we hear of the problems, and it is right that we focus on making sure that care is of high quality, but if we do so by ignoring care where it is of high quality, we miss out on many people’s experiences.

Dilnot was a very important point in Parliament’s history because the three major parties came together to agree that we needed to move forward together. Social care had for many years been something of a Cinderella issue, but the aspirations of Dilnot were certainly enshrined in some of the Care Act and I am very pleased that the noble Lord, Lord Lansley, wants to mark Paul Burstow’s role as Minister in making sure that much of the detail about the quality of care and the support for carers has been noted.

The problems that much of the sector faces, particularly the residential care sector, are because of the perfect storm that we now face. Much of it is financial but it is not only that. Can the Minister identify where the savings from the non-implementation of the Dilnot report have gone? The noble Lord, Lord Lansley, said that the moment when it could have been funded from other resources has gone. From looking at the spending review and some of the initial statements about next year, I understand that we are talking about probably £700 million being identifiable from that preceding amount. What has happened to it and where has it gone? It is evident that local authorities and the Department of Health are going to face major problems because of the demographics and the pressure of making sure that there are spaces available at levels that the residential system can afford if it does not have extra funding.

The better care fund, which was created by the coalition, was a step in that direction. It was a good one in that it started to change the emphasis from hospital care to residential and community care. However, despite the increase we have heard about, it is back-loaded to 2018 and 2019 and will not help over the next two years. The system is currently in major crisis. The introduction of the national living wage is also going to cause real problems for private providers of residential homes. On the announcement of the national living wage, quoted companies saw a fall in their share value. Major providers have started disposing of large numbers of homes, because they are seriously worried about how they can trade, let alone make a profit. Finally, lenders to that sector have stopped lending, because the business model is bust. If that is the case, everything that the Government are trying to do through the better care fund will be useless. More and more people will be staying in hospital because there will not be the beds for them to go to.

The local authority social care directors estimate that the current local authority shortfall will be £4.3 billion by the end of this Parliament. It is not clear from the spending review that there will be enough to fund the national living wage or demography. We know that cumulative local authority budgets have been cut over recent years, but what is less well known is the result for those authorities with social care responsibility: five years ago 30% of their funding went on social care, while it is now 35% and increasing. As a result, they have had to face tightening eligibility thresholds quite substantially, so that now only those with the most severe need can get any help at all, forcing pressure back on the primary care sector and on hospital trusts.

Members who have been involved in these debates will know that earlier in the year I spoke about one poor pensioner in the north of England who was told quite clearly that one of her legs was social care and one of her legs was her GP. She ended up going back into hospital because the social care element was not able to maintain one of the legs. This resulted in an emergency bed because the primary care would not let the nurse look after the leg with the other problem because it was not its leg. That story is easy to laugh at, but when budgets are so tight and protected, it makes people behave in peculiar ways. We have to find ways around this problem.

I have another concern. Some care providers have been told by their local authorities that they should fund the basics, like sick pay and travel between work for those in the domiciliary sector, from the profits they make from self-funders—and that they should not be expected to carry that burden for either health or local authority-funded patients. This is unbelievably facile. We need to make sure that we understand the cost of funding a residential care place. If our public sector is asked to provide it—which it must be for those in need—the funds must be available.

Of course, the demography is increasing so even without the pressure that we are seeing the situation will undoubtedly get worse. In the last few seconds, therefore, I would like to talk about a parallel. If the pressure that we are seeing in this sector was evident to people on the nightly news in the way that we have seen flooding in the last few weeks, I suspect that the Treasury would act all too quickly in making sure that emergency funds were available.

In closing, I repeat my question to the Minister. At the very least, please can we be assured that the money that should have gone into Dilnot is passed straight through to the sector this year, not just some of it during this Parliament?