Health: Learning Disability and Autism Training

Debate between Baroness Watkins of Tavistock and Baroness Blackwood of North Oxford

Monday 10th February 2020 Lords Chamber

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

My Lords, I thank all noble Lords who took part in this short debate. In particular, I thank the noble Baroness, Lady Hollins, for her Question, which has allowed us to have this important and moving debate, and for her dedication to this issue; she said that she has been working on it for more than four decades. She has certainly gained this House’s unremitting respect for her work. In particular, I thank her for her vital work as independent chairperson for the care and treatment reviews of people with a learning disability and autistic people in long-term segregation. That work could not be more important, and her contribution in that respect is invaluable.

Noble Lords will know—they have demonstrated this—that the care and treatment of people with learning disabilities and autistic people has come under intense scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society—and rightly so. Tonight’s debate has been part of that. Everybody should receive the same high-quality care, whether or not they have a learning disability or are autistic. Despite this, as has been said, there remain serious disparities in the quality of care and support that they receive. As has also been said, evidence shows that they can experience poorer health and die sooner than the population as a whole. We must change that.

As the noble Baroness, Lady Hollins, rightly said, these disparities can arise as a result of health and social care professionals lacking the training or experience—or, sometimes, just the confidence—to deliver effective and compassionate care. I have no doubt that staff want to support everyone, including people with a learning disability or autism, to the best of their ability. Like the noble Lord, Lord Wigley, I pay tribute to Mencap’s survey for its Treat Me Well campaign, which found that almost half of staff responding thought that a lack of training on learning disability might be contributing to avoidable deaths and that two-thirds of staff wanted more training focused on learning disability. We are listening to that.

As noble Lords are aware, last year DHSC consulted on proposals for mandatory learning disability and autism training. The consultation was in response to the Learning Disabilities Mortality Review programme’s second annual report, which recommended the introduction of mandatory training. A common theme in the deaths reviewed by the programme was, as has been pointed out, the need for better training and awareness of learning disability. The same is true of autism. We published our response to the consultation in November, setting out our plan to introduce the Oliver McGowan mandatory learning disability and autism training across the health and social care system. The training is named in memory of Oliver McGowan in recognition of his family’s tireless campaigning—including a previous debate on this matter—for better training for staff.

In future, we want all health and care professionals, before starting their career or through continuing professional development—a point made by the noble Lord, Lord Addington—to undertake learning disability and autism training, covering common core elements so that we can be confident that there is consistency across education and training curricula. We are working with professional bodies and the devolved Administrations to align syllabuses and training requirements with the learning disability and autism capability frameworks at the earliest opportunity.

We have committed £1.4 million to develop and test, during 2020-21, a package of learning disability and autism training in a range of health and social settings to help us better to understand the implications of mandatory training and the associated costs before wider rollout in 2021. I assure the House that the training will involve people with lived experience at every stage throughout its design and delivery, which I know is critical to its success.

We are also clear that, to realise fully the benefits of this training, it must be mandatory. We will undertake a number of actions, recognising that different approaches will be needed for different staff groups to make sure that it is effective. These will include proposed changes to secondary legislation to ensure that providers who carry out regulated activities ensure that staff receive training that is appropriate to their roles. We will also explore options for those working in non-regulated activities.

I will just pick up on a few of the specific points raised. The first is e-learning, raised by the noble Baronesses, Lady Hollins, Lady Watkins and Lady Thornton. In the consultation on mandatory training, we heard very clearly that having a face-to-face component is important. We will consider how to build this in in an appropriate way as we develop and trial the training package. We are currently developing the specifications for trial and evaluation.

In response to the question about the timeframe from the noble Lord, Lord Addington, and the noble Baroness, Lady Thornton, the strategic oversight group met for the first time last week. We will publish invitations to tender later this month, and will then seek to appoint and sign contracts with suitable training and evaluation partners in April. We will commission and publish an evaluation of the training package by March 2021 to inform a wider rollout of mandatory training across the system. I hope that is reassuring. Of course, we will seek to learn best practice from anyone we think can help us; this will include the devolved nations, which I hope is reassuring for the noble Lord, Lord Wigley.

I will just pick up on the question raised by the noble Baroness, Lady Watkins, regarding workforce, which will of course be critical to making sure that this is effective. In addition to our new maintenance grant funding for eligible pre-registration nursing, midwifery and allied health students, we announced additional payments of £1,000 for new students who study in challenged specialisms, which would include learning disability specialisms. I think that answers the question she raised.

On the question regarding the review of the Mental Health Act raised by the noble Baroness, Lady Hollins, this was completed in December 2018 and its findings were clear that we need to modernise the Mental Health Act to ensure that patients are not detained longer than absolutely necessary. We have said we will bring forward a White Paper in the coming months. We intend to pave the way for a reform of the Act and tackle the issues raised in that review to ensure that people subject to the Act are treated with dignity and respect. The intention is to ensure that we provide more patient choice and autonomy and enable patients to set out in advance their care and treatment preferences, and also to improve the process of detention, care and treatment. I hope that is reassuring. The reason for doing it in this White Paper process is because of some of the complexities around the legislation and to ensure that there is appropriate pre-legislative scrutiny.

[Baroness Watkins of Tavistock]

I would just like to clarify that my question about funding for the maintenance support was not about whether it applies to the learning disability group but whether it will apply for all five years of intakes of this Parliament.

Coronavirus

Debate between Baroness Watkins of Tavistock and Baroness Blackwood of North Oxford

Monday 3rd February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord will not be surprised to hear that it is important to put the public health response first and foremost when it comes to a risk of this kind, and that is exactly what is happening in this case. The actions that the UK has taken in this regard have been appropriate, proportionate and commensurate with the data and evidence that have come forward, and they are based on clinical evidence. Having said that, he is absolutely right that an economic impact as a result of quarantine measures taken by China and others cannot be avoided, and it is right that we should consider the impact for UK businesses. I am sure that consideration will be given to what can be done about that.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister define what she means by mainland China? I asked a question about Hong Kong last week and I note from the Foreign Office website that the Hong Kong Government have announced that all border crossings with mainline China will close at midnight tonight, Hong Kong time, which is an excellent idea in terms of containment. I am also aware that people who work for international companies in Hong Kong have been told to work from home for a minimum of two weeks from last Friday—three days ago. What will we do about people coming to our borders from Hong Kong in the immediate future?

[Baroness Blackwood of North Oxford]

The noble Baroness asked that question last time and I did not forget. At the moment, Foreign Office travel advice is that anyone who has travelled to the UK from anywhere in China other than Wuhan or Hubei province, but not including Macau and Hong Kong, in the past 14 days and has developed symptoms should immediately self-isolate, even if symptoms are minor, and call NHS 111. Macau and Hong Kong are not included because those territories do not have evidence of sustained community transmission, as has been observed in mainland China, to date. They are therefore not currently included in the same travel advice as mainland China. However, the epidemiological situation in Hong Kong and Macau, as indeed in the rest of the region, is kept under constant review and will be considered in travel advice as we go forward, and reported to this House accordingly.

Wuhan Novel Coronavirus: UK Citizens

Debate between Baroness Watkins of Tavistock and Baroness Blackwood of North Oxford

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. At the moment, there are 5,974 cases in mainland China and 6,064 cases globally, and there have been 132 deaths. It is important to understand that coronavirus is a large family of viruses, ranging from the common cold to much more severe diseases, such as MERS. The data we have puts the mortality rate at about 3%, so the risk is comparatively low compared with SARS and MERS. I just want to say that at this point.

In terms of wider travel advice, the FCO is now advising against all travel to Hubei province and all non-essential travel to China, and is advising British citizens to leave if they are able to do so. Wider public health advice for those travelling around the region can be seen on the Public Health England website. It is very clear and detailed. Any further advice on travel can be seen on the Foreign Office website. We are co-ordinating very closely; indeed, there was a COBRA meeting on this issue just yesterday.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister clarify that Public Health England is working closely with the other three public health departments in the UK and is taking the lead on this for people who are returning? Further, what is our strategy for Hong Kong, where nurses have said today that they will go on strike unless the borders between mainland China and Hong Kong are closed in order to protect the population?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: all the public health authorities across the United Kingdom will work closely together to ensure clear co-ordination, as always happens on public health issues. On Hong Kong, we will be discussing those issues through the WHO, which met yesterday to consider whether WN-CoV should be declared a public health emergency of international concern. It did not declare a PHEIC yesterday, but it will meet again. If it does declare a PHEIC, we will of course review our recommendations. However, we should be confident about the actions that we have taken. They are measured, proportionate and based on the highest level of scientific and clinical advice available at this stage of the outbreak from the Chief Medical Officer and Public Health England. We will keep the situation under continuous review and report to the House as it develops.

NHS and Social Care: Staffing

Debate between Baroness Watkins of Tavistock and Baroness Blackwood of North Oxford

Wednesday 15th January 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare my interests as a nurse, as set out in the register.

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

My Lords, patient safety is paramount. We expect health and social care providers to deploy sufficient numbers of suitably qualified, skilled and experienced staff at all times. The NHS People Plan aims to ensure a sustainable overall balance between supply and demand across all staff groups. This Parliament will see the people plan deliver 50,000 more nurses by 2025, a further 6,000 doctors in general practice and 6,000 more primary care professionals, all of which will support safe staffing and better care.

[Baroness Watkins of Tavistock]

I thank the Minister for her reply and particularly commend the NHS People Plan, yet evidence suggests that urgent action is needed to address the shortages in social care as well as healthcare. Many older people with dementia are failed by our social care system, in part due to costs and the availability of suitable staff. It is vital that the Government resolve the future of social care funding. Without certainty on funding, employers cannot invest in and plan for the future workforce. Dignity in care will be achieved only with rapid, proactive planning. Can the Minister explain the potential delay to the cross-party talks about funding for social care and what approach will be taken to ensure that proper staffing in social care is available during this Parliament?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question and pay credit to the work she has done in this area. She is absolutely right that we have to make urgent progress in delivering a sustainable social care solution. In the first instance, we have given councils up to £3.9 billion of additional funding in 2019-20, and the Prime Minister has been clear that he wants to see cross-party consensus on a sustainable way forward this year. I look forward to seeing progress made as swiftly as possible and hope that we will see work across this House on it, as I know this place takes the issue very seriously. In addition, we have run a national adult social care recruitment campaign to raise the profile of adult social care and encourage applicants. This has been successful; we have seen a 23% increase in the number of vacancies advertised on the DWP’s “Findajob” platform, which is improving the situation in the short term.

NHS: Nurses

Debate between Baroness Watkins of Tavistock and Baroness Blackwood of North Oxford

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I always take very careful note of proposals from my noble friend. At the moment, that is not under consideration, but it will certainly be looked into. As the entry salaries rise, it is more likely that student loans will be repaid, but what is important at this stage is that we attract the most nurses into the profession. At the moment students are able to access student loan funding for maintenance as well as the non-repayable funding from the DHSC, which means that we will meet our target of 50,000 more nurses by 2025, which is what we need to be able to deliver a sustainable NHS.

[Baroness Watkins of Tavistock (CB)]

My Lords, could the Minister provide an estimate of the number of people the Government expect to recruit from countries where the nurse-to-population ratio is already inadequate? If this is morally right and what we need to do, how can we ensure that some of our overseas aid budgets through DfID are used to increase nurse training in countries that we will recruit nurses from?

[Baroness Blackwood of North Oxford]

The noble Baroness is very expert in this area. I cannot give her specific numbers on specific recruitment from individual countries; I do not know which specific countries she is asking about. I can tell her that the recruitment of nurses from overseas non-EU territories has increased by 156% in recent years; as the daughter of a South African nurse, I can also tell her that this is a long-term pattern and has been good for the NHS. However, we must also make sure that we invest in many of those nations as we do through the overseas budget, which is part of the department’s healthcare priority. I would be happy to write to her with details.