Respite Care for Vulnerable Adults: Teesside

Caroline Dinenage Excerpts

Monday 12th March 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I am grateful to the hon. Member for Stockton North (Alex Cunningham) for raising his concerns this evening, and indeed to his colleagues, the hon. Members for Stockton South (Dr Williams) and for Redcar (Anna Turley). They have stated the justifiable concerns of their constituents powerfully and articulately. Whenever change is afoot, people have a tendency to feel concerned, and it is absolutely right that those concerns are articulated.

Supporting the most vulnerable in our society—those with complex needs, those with autism and those with learning disabilities—is one of the most important but exacting tasks that health and social care commissioners face. It is a task that must be undertaken with a genuine desire to get the very best outcomes not only for those who need support, but for those who care for them.

It is important to remember that many of the services that we are discussing today are focused on people with autism and learning disabilities—conditions that can manifest with very different requirements. They may need care and help ranging from routine, occasional help in the home to full-time personal support, with perhaps two or more people at a time providing that personal assistance.

Our mandate to NHS England includes a clear objective to improve outcomes for people with autism or learning disabilities. That means making sure that they are fully supported in the community, that hospital admissions are reduced and that they have the opportunity to live an ordinary life. Building the right support is our plan to use concerted local action to deliver that community support and to reduce the number of in-patients by March 2019.

We know that respite services are extremely important and a significant element of community-based support. They benefit not only the individual receiving that care, but their family and carers. Members have spoken very powerfully about that tonight. The hon. Member for Stockton North rightly points out that family carers in particular play an invaluable role—a role that is often unsung and undervalued. Often, they do so not out of a sense of duty or compassion, but out of pure love, and they deserve nothing other than our unbridled respect and our thanks. He asked me about the work that we are doing to support carers. They will of course be an integral part of our thinking in the Government Green Paper on social care that will be produced later in the year. In the interim period, we have a carers’ action plan, which I care passionately about and which will set out some short-term steps that we want to introduce to support carers and their valuable work more fully.

[Alex Cunningham]

It is very clear that the Minister gets this, and I admire the way in which she is putting her argument across, but this is also about resource. I am very concerned about the current problem on Teesside, but in the longer term young people in their 20s are coming through the system and approaching 30. These are children who in a previous generation would never have survived, and they are going to need more and more services. More children are becoming adults who will require more provision. What are the Government doing in terms of longer-term planning?

[Caroline Dinenage]

The hon. Gentleman articulates a real issue with which we have to contend. That is why we have increased NHS spending every single year since 2010, so that our NHS now has about £13 billion more to spend on caring for people than it had in 2010. That goes to the heart of the issue that he has identified. We need to ensure that care, particularly respite care, is responsive to the needs of individuals. That implies both a need to assess and determine the right kind of support, and a need for flexibility to allow for personal choice, as I believe is being looked at in Teesside.

Some needs may be best met through a stay in a suitable service that provides overnight beds, with appropriately trained staff to support people’s individual care needs, but that may not be true for everybody. Those with less severe physical or learning disabilities may find that action in the community is more desirable and appropriate for them—for example a visit, leisure activity or even visiting family members with the right personal support. We do not want those opportunities to be written off for them because we have a very restrictive system, which is why it is right that commissioners have the means to seek new approaches and to be flexible in how they meet people’s needs. I understand that the intention in North Tees is exactly that, but it must be based on suitable engagement, as the hon. Gentleman said, to assess people’s individual needs.

Having listened to hon. Members’ comments, I understand their concern that not everyone can currently access respite services and that these services may not be flexible enough. Local commissioners are rightly looking to change respite provision. The hon. Gentleman will understand that it is not customary for a Minister to comment in detail on specific commissioning decisions or on the extent to which there was appropriate consultation, unless that is part of a formal review process. I understand that the local CCG has consulted on the proposals for 10 weeks and is now in the process of designing the service.

[Alex Cunningham]

Does the Minister recognise that the CCG has acknowledged that it will have to get more people into the system, so the service will be diluted? Having recognised that, what can she do about it?

[Caroline Dinenage]

As I have already said, it is up to CCGs to commission the local services that they feel are appropriate in their local communities. It is not for the Government to force a top-down diktat on how they need to spend their resources. I understand that local councils are, quite rightly, scrutinising the proposals right now. This is an important means of quality assurance and is informed by local people with local knowledge. I hope that the hon. Gentleman will find some reassurance in that. However, although it is right that service reconfigurations are considered locally and are not driven from the top down, any significant changes to services are subject to the Government’s four tests. The changes should demonstrate support from clinical commissioners, strengthened public and patient engagement, clarity on the clinical evidence base, and support for patient choice.

There is a clear set of expectations in relation to the provision of respite care and the role of commissioners. Alongside provisions in the National Health Service Act 2006, all CCGs must secure services to meet the needs of their population to a reasonable extent. Respite care may be routinely commissioned or made available as part of a package of NHS continuing healthcare, and is often also provided as part of social care. The Care Act 2014 requires that where an adult or carer appears to have care and support needs, the local authority must carry out an assessment and meet any need where the person has met the eligibility criteria.

[Alex Cunningham]

The scrutiny groups on Teesside—at least some of them—are thinking of referring the matter to the Secretary of State. What happens when it is referred, and what can the Government do then?

--- Later in debate ---

[Caroline Dinenage]

That will of course be a matter for the Secretary of State, who will deal with it in the appropriate way.

The Care Act also requires local authorities to take a preventive approach to addressing people’s needs in taking steps to intervene early to prevent or delay any worsening of an adult’s need for care and support. This would of course include the carers about whom the hon. Gentleman and his colleagues care so passionately. It is really important to allow carers to take the respite that we have spoken about.

The hon. Gentleman might be interested to know that the Autism Act 2009 requires the Government to have a regularly reviewed autism strategy and to issue guidance to local authorities, NHS bodies, and foundation trusts. In addition, the Children and Families Act 2014 introduced a new statutory framework for children with special educational needs and disabilities. This gives commissioners very clear responsibilities towards those with learning disabilities and autism, including those who may be affected by the review on Teesside.

[Jim Shannon]

I think that everyone in this Chamber will have a knowledge of autism. The Minister will be aware that we have an excellent autism strategy in Northern Ireland, and there is also a very good strategy in Wales. Has she had a chance to check out both those strategies in order perhaps to introduce them, in full, to England?

--- Later in debate ---

[Caroline Dinenage]

I have not, but now that the hon. Gentleman has recommended that to me, I will certainly look into it.

It is really important that commissioners have the prerogative to make a local determination of what constitutes the right services. We have set clear expectations for how health and social care meets people’s need for support and families’ and carers’ needs for respite. We can close the gap between the outcomes for those who are most vulnerable and those without complex needs, but it has to be via a combination of setting national expectations alongside a local approach to delivering the necessary services. The NHS has a responsibility to ensure that people have access to the best and safest healthcare possible. This means that it must plan ahead and look at how best to secure safe and sustainable NHS healthcare provision, and provide flexible approaches to meet the widest range of needs.

That is what we hope to see in action in Teesside. I understand that any change to local services for vulnerable people must be viewed with a degree of apprehension. However, considering the assurances given locally by commissioners, the process they have undertaken, and the overall aim of providing a more flexible set of options for respite care that moves away from a very medical model, I am hopeful that these changes will be of benefit to the people who most need these services.

Question put and agreed to.