Care Homes: CCTV

Caroline Dinenage Excerpts

Wednesday 5th September 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a pleasure to serve under your chairmanship, Sir David. I congratulate my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) on securing the debate. I welcome his well-thought-out and measured contribution to this incredibly important agenda. At its heart is a focus on our shared interest in safety and quality of care for those in residential settings. I thank other hon. Members who have contributed. Consensus has broken out widely in the Chamber, which is not entirely usual and is to be warmly welcomed.

I begin as other hon. Members have by paying tribute to those who work in adult social care. They do a brilliant job often in quite difficult and demanding circumstances, and sometimes with very frail and vulnerable people. Social care professionals work with great compassion and resilience and the vast majority of them treat those they care for with enormous dignity and respect.

Central to the effectiveness of care and support services that enable living well is the quality of those services. Everybody wants the very best care for their loved ones, but we do not know for sure what takes place when we leave a residential care home, which is understandably a concern to many people.

I listened to my right hon. and learned Friend’s arguments with interest. He makes them in his customary reasonable, compelling and persuasive manner. I agree that there are cases in which CCTV could be seen to be of benefit. The question we need to answer today is whether, in the Government’s pursuit of quality care, mandatory CCTV cameras are the answer.

Currently, there is no obligation on care homes to install CCTV cameras, but are they able to provide reassurance that care assistants and other staff are looking after our relatives in the way that we would wish? I do not think there is a single answer to making sure that abuse is eliminated and care is delivered in the best way possible. Some providers may reap significant benefits from using surveillance. Certainly, campaigners such as my right hon. and learned Friend’s constituent, Ms Connery, have collected great examples of it working very well to safeguard vulnerable residents. I can see how surveillance systems can be used as part of the appropriate deprivation of an individual’s liberty. With appropriate safeguarding, CCTV could be used to monitor and identify whether a person living with dementia is attempting to leave a care home, for example.

[Mr Grieve]

I am grateful for the spirit in which the Minister is responding to the debate. As we have examples of what appears to be good practice—it is possible that one is being misled by the examples, which we have to bear in mind—I would be interested to know whether the Government, as well as the CQC, are assessing those companies that are voluntarily using CCTV in common parts and their results so that we can be better informed as to its success or otherwise.

[Caroline Dinenage]

We have not done that to date, but we would be very happy to see the valuable evidence that my right hon. and learned Friend says people have been collecting.

The hon. Members for Burnley (Julie Cooper) and for North Ayrshire and Arran (Patricia Gibson) raised the concern that CCTV has the potential to be intrusive in people’s lives, not only for those who live in such homes but for their friends and families, the staff and people who come to visit. As they both said probably more articulately than I can, we have to keep at the back of our mind at all times that these are people’s homes. Given the huge rise in the amount of care that is delivered in individual homes rather than in residential settings, there is also the concerning question of whether there would be pressure to install cameras in the homes of people who receive domiciliary care if CCTV is made compulsory for care homes, which would be a step into a whole new world.

I move on to this part of my speech with some trepidation, given that I am speaking to a former Attorney General. There are complications with the legal aspects of his proposal. I am not a learned Member of Parliament by any stretch of the imagination, but there could be an administrative and financial burden on care homes, many of which are small businesses with very few administrative staff. In 2014, the Care Quality Commission published “Using Surveillance: Information for providers of health and social care on using surveillance to monitor services”. It was aimed at the public, inspectors and providers who are considering or already using surveillance systems. That guidance will be refreshed later this year.

The legal framework requires that any use of surveillance in care services must be lawful, fair and proportionate, and for purposes that support the delivery of safe, effective, compassionate and high-quality care. Providers considering using surveillance, particularly covert surveillance, must bear in mind the potential impact on the bond of trust with people who use their service.

[Mr Grieve]

I have to make it absolutely clear that I was not suggesting covert surveillance. I have been quite plain about this. As I understand it, the homes that have introduced it have done so overtly; the common parts are covered by CCTV and anybody who comes into the home understands that. I am not recommending a form of covert surveillance. I can see how that could be open to considerable abuse and lots of difficulties, and I strongly urge the Minister and her Department to steer well clear of that legal minefield.

[Caroline Dinenage]

I thank my right hon. and learned Friend for that legal advice, which would probably have cost me a fortune in the outside world. I am grateful for that clarification. The provider should consult those affected on the use of surveillance wherever it is possible to do so. It would have to meet the cost not simply of the equipment and the monitoring of it if it is done by a third party, but of the training, staff time, legal advice and consultation activity. There is no point in having such a system unless it is monitored and routinely checked.

The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke compellingly about early years settings. I have experience of that, not just as the former early years Minister but as a mother who has been in exactly the situation that she mentioned. It certainly rings bells with me—leaving children screaming their heads off, and five minutes later being told they are all perfectly fine. As she says, that can be very comforting for parents. CCTV is not compulsory in early years settings either, but there are many similarities between the two sectors: they are both predominantly run by private companies. I hope that early years and residential care businesses see the benefits.

I have an apology to make to the hon. Lady. She asked about the letter that we sent, which suggested it might have to be up to the Ministry of Justice to change the law. That was incorrect, and we have subsequently sent her a letter clarifying that. I apologise.

Ultimately, CCTV can have benefits, but it simply cannot be a substitute for well-supported, well-trained staff and excellent management. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure

“the services they commission are safe, effective and of high quality”.

We also expect those providing the service, local authorities and the Care Quality Commission to take swift action where anyone alleges poor care, neglect or abuse. We have backed that up with more than £9 billion of investment in the sector in the past three years,[Official Report, 11 October 2018, Vol. 647, c. 4MC.] which equates to an 8% increase in funding. That incredible amount of money highlights the challenge we face in the sector.

[Julie Cooper]

Does the Minister not accept that, as a result of cuts to local authority funding, there has been a reduction equivalent to £6.3 billion of spending in the sector?

[Caroline Dinenage]

I accept that there were cuts to local government funding during the time of the recession that we all endured. That was incredibly regrettable, but was one of those very difficult decisions that Governments have to take.[Official Report, 11 October 2018, Vol. 647, c. 4MC.] In the last three years, we have increased funding by £9.4 billion, which equates to an 8% increase. It demonstrates the challenge of this ageing population—people are living longer with much more complex needs, and many vulnerable people need an enormous amount of support and care. It is an enormous amount of money, and yet we still see the sector facing great challenges and stress, which is why we have a Green Paper coming out later this year. We hope it will help address the sustainability of the adult social care sector. Successive Governments have wrestled with this incredibly challenging issue, and we need to find a long-term solution.

We expect serious allegations of abuse and neglect to be thoroughly investigated and prosecutions to be brought where that is warranted. The abuse of people who depend on care services is completely unacceptable and we are determined to stamp it out. That is why we introduced the new wilful neglect offence, which came into force in April 2015. The hon. Member for North Ayrshire and Arran said that we must get the very best quality of staff into this demanding and challenging profession. I could not agree with her more. We have made changes to help services recruit people with the right values and skills, and introduced a care certificate for frontline staff to ensure older and vulnerable people receive the high-quality care they deserve.

The Department for Health and Social Care has commissioned and funded Skills for Health, Skills for Care and Health Education England to develop a dementia core skills education and training framework, which is very important to me. There is also a fit-and-proper-person test to hold directors to account for care. Let us not forget that 82% of adult social care providers are rated as good or outstanding as of August 2018, according the Care Quality Commission. That is a testament to the many hundreds of thousands of hard-working and committed professionals working in care, to whom we owe a debt of gratitude. Surely the best way of building on that is not to say to them, “We’re watching you in case you do the job wrong,” but rather to say, “How can we support you to do the job better? How can we invest in skills training, continuous professional development, great management and more staff on better wages?”

[Mr Grieve]

I come back to my point: in the course of their life, a person might carry out a job under supervision—I used to as a pupil barrister—when somebody might watch what they are doing and tell them what they are doing wrong. One of the difficulties in some care homes is that that is not necessarily happening. I urge the Minister simply to factor in that the chain care homes that I cited were using CCTV not to pick up, punish and sack staff, but to improve the quality of the care. That is one of the things that impressed me the most about it.

[Caroline Dinenage]

My right. hon and learned Friend has made that point incredibly powerfully and I do not dispute for one second that there is value in that form of monitoring. Certain responsible employers might see that value and benefit from it. I still do not think that there is any substitute whatever for top-quality management carrying out that sort of monitoring and surveillance themselves, when done properly.

The Care Act 2014 places a duty on local authorities to promote their local market to ensure that all service users have a choice of high-quality services available. In 2015-16, nearly two thirds of service users reported that they were extremely or very satisfied with their care and support, which was consistent with the previous year and is testament to the work carried out at local level to deliver quality services. We cannot rest on our laurels: if two thirds of service users reported that they were extremely or very satisfied, a third did not. That is why the Department for Health and Social Care is working with the adult social care sector to implement Quality Matters, a shared commitment to take action to achieve high-quality adult social care for service users, families, carers and everyone working in the sector.

The compulsory use of CCTV cameras in the communal areas of care homes would require a change in the law, and it is not clear that that blanket approach would be proportionate or respect the needs and wishes of everyone who lives in a care home. There are undoubtedly cases in which better monitoring of staff would produce benefits, but without fuller evidence, the decision to install CCTV should remain one for the care home provider. I have been encouraged by the stories told by my right hon. and learned Friend about companies that found that installing CCTV brought tangible benefits. I encourage other providers to look at those kinds of examples if they are contemplating installing CCTV, and would certainly support them if they wished to do so.

The Government are absolutely committed to providing high-quality adult social care for service users, families, carers and everyone working in the sector, but at this stage we do not intend to make installing CCTV in care homes mandatory.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 24th July 2018 Commons Chamber

[Victoria Prentis (Banbury) (Con)]

3. What steps he is taking to improve safety in maternity care.

[The Minister for Care (Caroline Dinenage)]

Our national ambition is to halve the rates of stillbirths, neonatal and maternal deaths, and serious birth-related brain injuries by 2015. We are working with our partners to implement the maternity safety strategy, and new data shows that the stillbirth rate in 2017 was the lowest since records began in 1927.

[Victoria Prentis]

Our three children were all born in periods of extremely hot weather. I ask the House to think of the families of Banbury who have to travel for up to an hour and a half or even two hours, if they are lucky enough to have their own car, to Oxford to give birth in a full obstetric unit. May I encourage the Minister, in her drive to ensure that maternity care is safe, kind and close to home, to ask the new Secretary of State to visit us in Banbury soon so that he can assess the situation for himself?

[Caroline Dinenage]

I completely understand my hon. Friend’s concerns. She has been an incredibly strong advocate and campaigner on this very issue. As she knows, no permanent changes will be made until the work is carried out by the independent review panel, which is looking at attempts to recruit obstetric staff for her local services. I thank her very much for the offer of a visit; I am sure the Secretary of State will look at it very closely.

[Dr Paul Williams (Stockton South) (Lab)]

Dr Neal Russell volunteered to help in the fight against Ebola. Today he has returned his Ebola medal in protest at the healthcare hostile environment for migrants caused by a new charging regime, which has led to vulnerable pregnant women here in the UK being too afraid to get maternity healthcare. Will the Minister suspend her Department’s charging regime, pending the completion of a thorough and independent public health assessment?

[Caroline Dinenage]

That is incredibly sad news. We hate to hear of anybody who has done such incredible service in the pursuit of great healthcare around the world taking such drastic steps. We have an incredibly strong departmental ambition for NHS maternity to provide the safest, highest quality care in the world. That is something we will continue to aspire towards.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

The maternity unit at Harrogate Hospital is award winning due to the skills and compassion of its fantastic team. What action is my hon. Friend taking to encourage more people into maternity care and midwifery careers?

[Caroline Dinenage]

The Department’s maternity safety ambition plans are to train more than 3,000 extra midwives over the next four years. As part of that, we will be working with our partners to develop new training routes to become registered midwives so that, along with other roles in the NHS, maternity and midwifery can attract the best and retain the most talented staff.

[John Cryer (Leyton and Wanstead) (Lab)]

According to the Royal College of Midwives, the national shortage of midwives is running at nearly 4,000 and is particularly acute in areas like mine in east London, with its very high property prices and rising birth rates. How does the Minister intend to address that?

[Caroline Dinenage]

There are in fact 2,300 more midwives in the NHS than there were in 2010, but the hon. Gentleman makes a very good point. We want to continue to attract the best people into midwifery, which is why we are providing an extra £500,000 to the NHS to cover the clinical placement costs for 650 additional students in 2019-20.

[Nigel Huddleston (Mid Worcestershire) (Con)]

4. What steps he is taking to reduce rates of childhood obesity.

--- Later in debate ---

[Derek Thomas (St Ives) (Con)]

12. What steps his Department is taking to support families and patients affected by mistakes made in the healthcare system.

[The Minister for Care (Caroline Dinenage)]

Families and patients are at the heart of our work to improve patient safety, which is why all NHS organisations are subject to a statutory duty of candour and should be open and transparent with patients and families when things go wrong. Last week, the National Quality Board published new guidance for NHS trusts to help them better support, communicate and engage with bereaved families and carers.

[Derek Thomas]

I thank the Minister for that response, but since I was elected three years ago I have come across several examples of families who have lost loved ones who went to hospital for repeat interventions from the health service, yet died from undiagnosed conditions, many of which could have been avoided. The problem is that those families have found getting answers and finding anyone to accept responsibility fruitless, so what more can the Department do to help them?

[Caroline Dinenage]

My hon. Friend is right to raise that issue. Those who have lost loved ones in that way need answers when things go wrong. The recent bereavement guidance is clear that, when notified of a death, families and carers should be told that they can comment on the care of the person who has died and raise any concerns. From next year, medical examiners will offer greater scrutiny for the bereaved, increasing transparency and offering them the opportunity to raise concerns.

[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

In a recent report, Healthwatch Greenwich drew attention to the fact that many local GP practices are still wrongly refusing to register patients, often vulnerable ones, unless they have ID or proof of address. What more can the Minister do to ensure that each and every GP practice is following the Department’s guidance?

[Caroline Dinenage]

I am grateful to the hon. Gentleman for that question, and I will certainly look more closely at the issue.

[Andrew Percy (Brigg and Goole) (Con)]

13. What assessment he has made of the extent to which the draft Human Fertilisation and Embryology Act 2008 (Remedial) Order 2018 meets his Department’s policy objectives on equality.

--- Later in debate ---

[Anna Turley (Redcar) (Lab/Co-op)]

21. If he will ensure that funding for services commissioned by South Tees clinical commissioning group will not be reduced as a result of that group being placed in special measures.

[The Minister for Care (Caroline Dinenage)]

I reassure the hon. Lady that the level of funding allocated to South Tees CCG will not change as a result of the group being placed in special measures.

[Anna Turley]

I appreciate the Minister’s reply, but does she agree that, instead of dismissing this as a failure of bookkeeping, as her colleague in the Tees Valley has done, she should look carefully again at the rising demand in our area and at the unique challenges we face as a result of high levels of deprivation, ageing demographics and the economic shock we suffered three years ago? Will she look again at a fairer funding allocation to make sure that we can serve everyone’s needs in the Tees Valley?

[Caroline Dinenage]

The hon. Lady is absolutely right to raise this issue. Prevention is a key aspect of the new Secretary of State’s focus as the Department moves forward. NHS England will support all CCGs that are in special measures to return to financial balance. It also provides a bespoke package of support, along with a higher level of monitoring and oversight, to ensure that the money is always spent wisely.

[Patrick Grady (Glasgow North) (SNP)]

T2. If he will make a statement on his departmental responsibilities.

Health and Social Care Update

Caroline Dinenage Excerpts

Monday 23rd July 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

The Learning Disabilities Mortality Review (LeDeR) published its second annual report on 4 May 2018, which covered the period from 1 July 2016 to 30 November 2017. The programme is led by the Norah Fry Centre for Disability Studies at the University of Bristol and commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England.

As I outlined to the House on 8 May (Official Report, 8 May 2018, Vol. 640, Col. 545), the report makes a series of national recommendations that are aimed at NHS England, as well as health and care commissioners and providers.

This Government are committed to reducing the health inequalities that people with learning disabilities face, and reducing the number of people with learning disabilities whose deaths may have been preventable with different health and care interventions.

There is already a considerable amount of work underway to address the issues raised in the second annual report of the LeDeR. The Department is working with NHS England and other system partners to agree meaningful actions to each of the nine recommendations, and our response to the report will be published after summer recess.

[HCWS906]

NHS Whistleblowers

Caroline Dinenage Excerpts

Wednesday 18th July 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your chairmanship, Mr Davies.

I start by thanking the hon. Member for Central Ayrshire (Dr Whitford) for bringing forward this important debate on a vital issue and for the keen interest she has shown in patient safety across the board. I always listen carefully to what she says, not only because her contributions come from her perspective as a clinician—something that should be incredibly valued—but because, as a Member, I respect the practical, constructive and calm way she presents information to the House. It always makes an enormous difference as a Minister when information is given in that way. I also thank her for the role she has played in the pre-legislative scrutiny of the health service safety investigations Bill—another piece of legislation we are introducing to ensure that our health systems are continually learning and making a difference when things go wrong.

I also put on the record my thanks to my hon. Friend the Member for Stirling (Stephen Kerr) for setting up the all-party parliamentary group on whistleblowers. I am delighted he has taken that step. There are all-party parliamentary groups on a range of different issues, and one often wonders where they are coming from. However, I welcome his wholeheartedly, and I am keen to hear its considered recommendations. I am also delighted that the new Secretary of State for Health and Social Care has already stated his commitment to the health and social care workforce. The work of my hon. Friend’s APPG will go to the heart of that.

The Government are committed to building a culture of openness and transparency in the NHS, which is part of achieving our goal of making it the safest healthcare system in the world. We need to make sure that people who work in the NHS feel safe to speak up. We want that to become routine, and it is a key part of our commitment to ensuring patient safety and improving the quality of services. The NHS should support and welcome all staff—be they permanent employees, agency workers, volunteers or other contracted staff—raising concerns, wherever they have them.

The importance of people in healthcare speaking up has been demonstrated by many brave champions of patient safety, such as Helene Donnelly at the Mid Staffordshire NHS Foundation Trust. It is through the bravery of Helene and those like her that we can fully recognise the changes that have to happen in our health and care services. As the hon. Member for Central Ayrshire has said today and in the past, people blowing the whistle is a sign that the system has failed somewhere earlier on—that something has gone wrong and has not been put right. We want a culture in which we do not need whistleblowers like Helene because stronger preventions and better patient safety measures are in place, because people feel confident to admit when something has gone wrong, and because people feel protected and supported and are willing to raise concerns in the workplace as a norm.

Hon. Members will know that I am the Member for Gosport. I have recused myself from speaking as a Minister on the situation there so that I can continue to represent my constituents in that case, which I have been involved in for the last eight years. However, the case amply demonstrated the risks of not listening to those who raise concerns. It is clear that much of the pain and suffering experienced by families could have been avoided had those whistleblowers been listened to earlier.

Speaking up and raising concerns should be routine in the NHS. As the hon. Lady said, whistleblowing legislation has been in place for 20 years, and all hon. Members have been vocal about its limitations. I am not averse to reviewing the legislation, and I am keen to hear any proposals that the new APPG and other Members feel would be appropriate. Evidence on the legislation’s effectiveness—or ineffectiveness—would be helpful. Hon. Members know that reviewing that legislation does not fall within the gift of either myself or the Department; the Department for Business, Energy and Industrial Strategy holds the control there. However, I am more than happy to speak to Ministers in that Department about this.

We are aware that improvements to our health and care system are needed to ensure that workers feel safe to speak up about problems. Responses to our call for evidence in 2013 highlighted that whistleblowers did not feel that way, which is why we legislated in the Small Business, Enterprise and Employment Act 2015 to require prescribed persons to produce an annual report on whistleblowing disclosures made to them by workers. The regulations to implement that reporting duty are now in place, and the prescribed persons’ first annual reports, covering 2017-18, are due to be published in the next few months. That is aimed at increasing public confidence that prescribed persons take whistleblowing disclosures seriously, through greater transparency about how they handle disclosures, and particularly that they investigate and take action where necessary.

[Dr Whitford]

The Minister mentions prescribed persons. The fact that Members are also prescribed persons shows how difficult and confusing it can be for whistleblowers to know where they should go. I suggest it would be difficult and confusing for an MP to know what to do with such information and where to go. I recognise that the NHS, as one of the major generators of these cases, perhaps needs its own structure. However, if we had an independent body that covered all other sectors, everyone who wants to blow the whistle would at least know where to go, because a lot do not at the moment. As my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) said, they may blow the whistle in the wrong way and to the wrong person, and they will suddenly not be covered by PIDA at all.

[Caroline Dinenage]

The hon. Lady makes a valid point, which we will take into consideration.

As the hon. Lady knows, the National Guardian’s Office was established in 2016, and the independent national guardian, Dr Henrietta Hughes, was appointed to support NHS whistleblowers and to improve the NHS reporting culture. The National Guardian’s Office also provides leadership, training and advice for a network of more than 750 “freedom to speak up” guardians based in all NHS trusts and foundation trusts. There have been more than 6,700 cases of speaking up in the last financial year. The National Guardian’s Office is looking to extend a network into primary care later this year.

The ability of the National Guardian’s Office to effectively engage the system is already helping it to make recommendations to trusts, arm’s length bodies, the Government and providers of services to the NHS to help drive this cultural change. Its role in the system is as an influencer of change, rather than an imposer of requirements. Organisations should rightly remain responsible for tackling their own cultural issues.

The NHS is one of the largest employers in the world and makes a large investment in its workers. We do not want to lose great people from the NHS because they face discrimination for doing the right thing. That is why we introduced protections from discrimination for people seeking NHS employment who are perceived to have previously blown the whistle. That regulation came into force in May and will support NHS Employers in being an exemplar to others in fostering a culture of openness and a willingness to report problems with care. Separately, we also extended the definition of “worker” within the whistleblowing statutory framework in the Employment Rights Act 1996 to include student nurses and student midwives, meaning that those people are now protected under the Act.

Aside from statutory protections, on 1 April 2016 NHS England and NHS Improvement published a single national integrated “speaking up” policy to provide clarity and consistency across the system. In March 2017, NHS England also launched the whistleblowing support scheme—a nationwide pilot to help workers in primary care who have spoken up. A similar pilot was launched in September 2017 by NHS Improvement for people who have made a disclosure in secondary care. The schemes offer a range of services to support people back into employment. It is too soon to say how the pilots are progressing and how effective they have been. The aim is to ensure that any future scheme is fit for purpose and meets the needs of people who require support after making a disclosure.

We have also made changes at the regulatory level of the health and care system to better protect whistleblowers. The CQC has a legal duty to report on whistleblowing disclosures, and it has revised the “well-led” domain of its inspection assessment framework to include how organisations are progressing with implementing the recommendations from “Freedom to Speak Up”. It is important to mention the link between an organisation’s CQC rating and how seriously it takes speaking up, with 100% of organisations rated as outstanding by the CQC having guardians who reported that speaking up is taken seriously in their organisation, in contrast with only 36% of trusts rated as inadequate.

NHS staff who are prepared to speak up are an important asset. We want NHS staff to feel confident that, when they speak up in the public interest, it will not have a negative impact on their career. Supporting those who speak up in the NHS is utterly crucial to achieving those aims.

Social Care Funding: Resolution of the House 25 April 2018

Caroline Dinenage Excerpts

Wednesday 18th July 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

Today I would like to update the House on social care funding following the Opposition day debate of 25 April 2018.

We know that social care services are facing pressures from rising demand for care, and the Government have taken steps to support the sector. That is why we announced an additional £2 billion central Government funding for adult social care in the 2017 spring Budget. In total, Government have given councils access to up to £9.4 billion additional funding for social care from 2017-18 to 2019-20, including the 2018-19 local government finance settlement announcement of a £150 million adult social care support grant.

The action we have taken means that funding available for social care is increasing by 8% in real terms from 2015-16 to 2019-20.

This funding allows councils to support more people and sustain a diverse care market.

It is also helping to ease pressures on the NHS, including by supporting more people to be discharged from hospital and into care as soon as they are ready.

We have already seen a real difference to services across the country: social care related delayed transfers of care had been rising year on year from 2014 up to February 2017, but since taking action last year we have achieved a reduction of 40%. We are taking additional steps to ensure that those areas facing the greatest challenges improve services at the interface between social care and the NHS.

By passing the Care Act 2014, this Government established a national threshold that defines the care needs that local authorities must meet. This eliminates the postcode lottery of eligibility across England, and means that all councils have statutory duties to look after the vulnerable, elderly and disabled people in their area.

Last year local authorities in England advised over 500,000 people on how to access services to meet their care needs. This includes services provided by leisure, housing, transport and care providers as well as voluntary groups.

According to the Care Quality Commission, 81% of adult social care providers are good or outstanding—testament to the many hardworking and committed professionals working in care to whom we owe a huge debt of gratitude.

But still too many people experience care that is not of the quality we would all want for our own loved ones, and there is too much variation in quality and outcomes between different services and different parts of the country.

The Department of Health and Social Care is working with the adult social care sector to implement Quality Matters—a shared commitment to take action to achieve high quality adult social care for service users, families, carers and everyone working in the sector.

An ageing society means that we need to reach a longer-term sustainable settlement for social care. This is why the Government will publish a Green Paper on care and support to set out our proposals for reform.

The health and social care systems are two sides of the same coin, and decisions on future reforms must therefore be aligned. That is why we will now publish the Green Paper in the autumn, around the same time as the NHS plan. Social care funding will be agreed at the forthcoming spending review, alongside the rest of the local government settlement.

[HCWS872]

Transforming Care Programme

Caroline Dinenage Excerpts

Thursday 5th July 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this really important debate. I thank him for his continuing hard work and commitment, both within this place and outside, in championing the interests of people with a learning disability. As a Minister in the coalition, he was a driving force on this issue, particularly following the Winterbourne View scandal.

On a personal note, I also thank the right hon. Gentleman for the work that he did in commissioning an investigation into the tragedies at Gosport War Memorial Hospital. As a Health Minister, I have had to recuse myself from speaking about that because I am also the local Member of Parliament, but I want to put on record my gratitude to him for the work that he did. In many ways, there are parallels with what we are talking about today: families whose voices have not been heard; families who do not necessarily feel that they have been listened to. We all have to look at how we can learn the lessons from cases like Winterbourne View and how we stop other families suffering in the same way.

I thank other Members from across the House for participating in the debate. I am so sorry that there are not more of them, because this is a really important issue. I have met many of the Members here today to discuss their concerns. I will always be available to do that at another point if they would wish me to do so. They have asked me lots of questions. I will do my best to answer as many of them as I can in the time that you have permitted me, Madam Deputy Speaker. If I fail to do that, I will write to the Members concerned.

[Madam Deputy Speaker (Dame Eleanor Laing)]

For the sake of clarity, I should say to the Minister that I cannot limit her time, nor would I try to. In the current circumstances, she actually has an enormous amount of time, but I know that she will not try the patience of the House. I agree with her that a great many important questions have been raised, and I am sure she will wish, assiduously as ever, to answer them all. I will not interfere with the time that it takes her to do so.

[Caroline Dinenage]

That truly is good news, Madam Deputy Speaker. I will try not to go on, as my husband tells me I have a propensity to do. I will answer as many questions as I can. I may have misinterpreted some of them, and I may not be able to read the copious notes I have written, but I will write to Members if I do not get to their points.

We can all agree that people with a learning disability and/or autism have the right to the same opportunities as everyone else to live satisfying and valued lives and to be treated with dignity and respect; that goes for their families, too. As good and as necessary as in-patient care can be—we have heard examples of how it has changed people’s lives—we know that people with a learning disability should have the opportunity to live at home, to develop and maintain relationships and to get the support they need to live healthy, safe and rewarding lives in their own local communities.

The mandate to NHS England—the list of “must dos” for the NHS—set by the Government every year includes the following clear objective:

“We expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and support them to live full, healthy and independent lives.”

The transforming care programme is at the heart of that commitment. It is a partnership across local government and the NHS to transform the care, support and treatment available to enable people with a learning disability, autism or both to lead the lives of their choosing with and in their local community.

Through the national transformation plan, “Building the Right Support”, we have an ambitious and comprehensive plan to bring councils and clinical commissioning groups together in transforming care partnerships to plan and provide services across their areas; to use funding in new ways, including through pooling budgets, which I will talk about in a moment; and to ensure that people and their families have a clear idea of what they should expect from those agencies through the national service model. Key to all that has been building the right support in the community so that people do not need to go to hospital in the first place and those who are already there can move out.

Members have raised concerns today about the progress made under the transforming care programme. I can reassure them that progress continues to be made, but I will commit to take forward most seriously all the concerns raised today. The number of in-patients continues to decrease, and it is down to 2,400. NHS England has been clear that it is fully committed to meeting the ambition to reduce the number of in-patients by at least 35% by next March. It has talked about the intention to close around 900 learning disability beds. I entirely take the point made by the hon. Member for Dulwich and West Norwood (Helen Hayes) that focusing on the number of beds misses the point, and that it must be about ensuring that community provision and support are available to enable people to make that move, rather than the fact that beds are closing.

[Norman Lamb]

I appreciate the Minister being willing to write to us after the debate with anything she is not able to cover. Does she understand the concern that a headlong rush to meet the target because we are getting close to the deadline without proper arrangements in place could be disastrous for individuals? If the target is not achieved, that is better than a complete failure, with readmissions after failed discharges. The focus on detail in every case is critical.

[Caroline Dinenage]

I completely agree with the right hon. Gentleman. I do not want to have concerns about safe discharge, and that is why we look at that in care and treatment reviews. More than 7,000 of those reviews have been carried out, to reduce the time that people stay in hospital and improve the quality of care they receive while in hospital. Essentially, they are a step towards ensuring that community provision is available before people are allowed to leave hospital. The latest data show that the proportion of in-patients reported as never having had a care and treatment review was 8%, down from 47% in January 2016.

[Norman Lamb]

It should be 0%.

[Caroline Dinenage]

Absolutely, it should be 0%. As the right hon. Gentleman knows, that is what we are working towards.

[Dame Cheryl Gillan]

I appreciate that this is quite a complex area, but I have looked at some of the transition times. Dimensions—I mentioned it earlier—has estimated that its average transition time per patient is 12.5 months, which I believe is below the usual transition time. Does the Minister feel that this length of time will inhibit her from reaching her targets in 2019? Is there anything we can do to reduce the time, or does that length of time need to be taken?

[Caroline Dinenage]

My right hon. Friend makes an excellent point. NHS England says it is confident of hitting these targets and it will be doing all it can to ensure that that happens, but that must not be at the cost of treating people with the right levels of care or of having the right provision in place. This is also about keeping people out of the hospital setting in the first place.

The number of people receiving community or pre-admission care, education and treatment reviews also continues to improve, with 42% more undertaken in 2017-18 than in the previous year, of which 79% led to a decision not to admit somebody to in-patient care.

[Dame Cheryl Gillan]

I do not know whether the Minister will accept this, but I would have thought that everybody involved in this debate actually preferred us not to aim for a target that might not be reachable, because it is the quality of the outcomes and successful transitions that we are looking for. Will she be flexible enough to say, on looking at this again, that if we cannot achieve the targets by 2019, she will allow the timeframe to drop out of the picture? It is more important to have a successful transition, with the right length of time for somebody to transition, than to hit what might be an unattainable target.

--- Later in debate ---

[Caroline Dinenage]

I agree with my right hon. Friend that there is absolutely no point in having arbitrary targets that do not actually deliver the quality we are aiming for. As we all know from political history, targets for the sake of it have not always necessarily worked out in the way intended.

It is worth emphasising that this is a really special programme for people with very complex needs who require a very particular type of support. They also need to have their care reviewed and to have a bespoke package put in place, tailored to their needs, to allow them to live in the community. There is no one single intervention and no template for what care is needed because every person is different.

[Norman Lamb]

Will the Minister give way?

[Caroline Dinenage]

If I may make a little progress, I will definitely answer the right hon. Gentleman’s questions a bit later.

Care must be personalised, and it must be enduring. This can never be a case of rolling out a particular model of care across the country or seen as kicking off some kind of universal service.

To further accelerate discharge and the community service necessary to provide it, NHS England has transferred £50 million to clinical commissioning groups that are closing hospital beds so that they can invest in community alternatives. In addition, between 2015 and the end of the programme, NHS England will have invested over £50 million in transformation funding to support transforming care partnerships in putting in place the critical components of community support. This support includes community forensic teams, crisis prevention teams and teams focused on supporting children in the community.

Additionally, the Department of Health and Social Care has provided capital grants of over £23 million, which has been spent on housing to support people to return to live in the community or to prevent an admission to hospital. NHS England has a pipeline of further investments that it plans to deliver over the next year to support housing projects, to accelerate bed decommissioning and discharges and, most specifically and importantly, to develop community teams.

Members have expressed concern that once the transforming care programme ends in March 2019, action to support those with a learning disability and the most complex needs will also end, but I stress emphatically that that is not the case. NHS organisations and local authorities have come together to build on existing practice, and they have engaged with families and organisations to develop innovative plans to suit their areas. That must not stop. We are closing those beds permanently, and ensuring good-quality community provision is more important than ever. We should be crystal clear that the principles of building the right support will endure beyond March 2019. The philosophy is to change the way that we support people with learning disabilities for good.

[Norman Lamb]

rose—

[Caroline Dinenage]

Perhaps I can make a bit of progress and then I will come back to the right hon. Gentleman. We are not moving people from a hospital, where their outcomes are poor, into the community, just for them to be replaced in hospital by others. The transformation must be permanent, and we must consider what central support local areas need to ensure that that happens.

Hon. Members have been tempting me to talk about what will happen beyond March 2019, and to give a commitment on how the future of transforming care will look beyond that point. All delivery partners share a commitment to support the progress made by local partnerships to transform the choices available for local people, and to ensure that they are supported to lead fuller and more independent lives in their local communities. Plans are currently under way, and we will provide hon. Members with further updates once they have been finalised.

Transforming care is not the only area in which we seek to support those with a learning disability, and we are driving work to improve health and care outcomes across the board. It is an uncomfortable truth that mortality rates for people with a learning disability can be a measure of how well their care needs are being met. Following the publication of the report “Confidential Inquiry into premature deaths of people with learning disabilities” in 2013, we know that those with a learning disability die much earlier than those without, and too often for completely avoidable reasons. That is unforgivable.

In order to tackle that issue, in 2015 we established the learning disabilities mortality review programme, which requires consistent, local scrutiny across England into the deaths of anyone with a learning disability, so that action can be taken based on those findings. Like me, hon. Members will have been deeply concerned by the recent report from the University of Bristol, which leads that programme. The report highlights the persistence of inequalities faced by people with learning disabilities in their health and care. People with learning disabilities are still dying prematurely, and I was particularly alarmed and distressed to note that neglect, abuse, delays in treatment, and gaps in service provision played a part in one in eight of the deaths reviewed, which is unacceptable. The situation described in the report must change, and the Government will soon respond to its national recommendations in full. I am pleased, however, that we are not waiting for that publication to ensure that action is taken, and significant remedial actions are already under way.

I agree with the right hon. Gentleman that as well as implementation we must embed change and ensure that we never revert back—that is key and something I am determined to focus on. We need a relentless focus on improvement, and I am convinced that training is a key part of that. Local commissioners must use that learning and take appropriate remedial action in their own areas.

The NHS improvement learning disability standards published in June specify that an NHS trust should measure the service it provides against clearly defined standards, so as to identify improvements. We will collect information on every trust centrally, to monitor how well the needs of people with learning disabilities are being met.

Hon. Members mentioned workforce and training, and on 9 May we announced a £10 million fund for incentives for postgraduate students to go on to work in the fields of mental health and learning disabilities, as well as for those who go on to work in community nursing roles. We are considering the most effective way to implement an incentive scheme. Our response to the LeDeR report will address its clear recommendations on workforce training.

The right hon. Gentleman spoke about how we improve data. Clearly, with monthly data published on progress we are aiming for transparency. NHS Digital is working with the transforming care partnerships to make sure that we have high-quality data. The aim is for the mental health services dataset to be the main dataset in the future.

I was pleased that Members spoke with positivity about some of the outcomes for their constituents, albeit in some cases way too late. I am very grateful to my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) for talking about some of the transformational results of the work so far. We clearly need to see more of it. The right hon. Member for North Norfolk talked about what an incredible difference the Shared Lives scheme can make. My self-appointed best friend, an adult from my constituency with learning disabilities who sadly passed away last year, lived in a Shared Lives home. I saw what an incredible relationship she had with the family she lived with.

[Norman Lamb]

I am very grateful to the Minister for giving way. On that specific point, she will probably be aware that the development of Shared Lives is quite variable around the country. There are some regions where it has developed quite well and other regions where there is virtually nothing. The Government could give more resource to expand the programme, because that is the way that we really change lives, getting people out of institutions and giving them a fulfilling life.

[Caroline Dinenage]

I am very glad the right hon. Gentleman said that because as part of the Department of Health and Social Care legacy scheme we are providing £70,000 in this year for that sort of intermediate and reablement provision which Share Lives would come under. We should definitely be investing more in that.

I take very seriously the right hon. Gentleman’s point on conflicts of interest. We have to look at that very carefully, because it might imply that any clinician would be conflicted in making a clinical decision because they are employed by a trust. Providers are monitored by the CQC and doctors are of course subject to extremely rigorous professional registration, but I take what he says very seriously and I will look more closely at his concerns. I am very happy to meet him to discuss this issue further if he would like me to do so.

The right hon. Gentleman spoke about pooling resources. There are now formal mechanisms for that to take place, such as section 75 and the ways in which CCGs and local authorities can work together. That is the point of having transforming care partnerships’ commissioners working together.

The right hon. Gentleman spoke about the exclusion of families from decisions. That really upsets me and it really should not happen. There are legal duties, under the Mental Capacity Act 2005 and the Mental Health Act 2007, to have independent mental health advocates. I would be very keen to speak to him further about what more we can do to make sure that the legislation is having the desired effect.

My right hon. Friend the Member for Chesham and Amersham knows I am a massive fan of hers. She has probably done more to further the cause of individuals with autism and their families than anybody else in the history of this building. She spoke with great knowledge about autism and was absolutely right to point out that transforming care is not only about learning disabilities but people with autism. In Think Autism, the adult autism strategy, we set a programme of action across Government to support autistic people to lead fulfilling and independent lives where possible. We have recently refreshed the governance arrangements that will achieve greater traction and delivery of the required outcomes, better supporting autistic people to live healthy independent lives and participate in their local communities.

My right hon. Friend spoke about autism care pathways. NHS England is developing a framework of adult community mental health services which will include care for adults with comorbid neurodevelopmental disorders and/or learning disabilities, rather than the pathways planned and set out in the “Five Year Forward View” implementation plan. NHS England’s care pathway programme has evolved to take account of the current operational context and expert service user advice. The pathway is linear about discrete episodes of care, so is more appropriate for specific interventions undertaken by specialist teams.

My right hon. Friend spoke about the barriers that autistic people face in accessing mental health services. Trusts should already be ensuring that services are accessible to people with autism and that they have made reasonable adjustments to care pathways to ensure that people with learning disabilities and autism can access the highly personalised care and achieve the equality of outcome that we all want.

The hon. Member for Dulwich and West Norwood spoke about her constituent, Matthew Garnett. It was a great pleasure to meet the hon. Lady and Matthew’s mum, Isabelle, recently. I was very shocked to hear of Matthew’s experience and deeply upset to see the pictures of him at his lowest ebb, when he was suffering from the neglect that she spoke of. It was very distressing. I am pleased that the NHS is learning from this. The Marsh review into Matthew’s care has helped to shape a much more focused approach to the needs of children and young people who are at risk of slipping into the sort of crisis that she mentioned. The operational delivery group allows stakeholders, including young people, to shape policy.

[Helen Hayes]

The right hon. Member for North Norfolk (Norman Lamb) raised the issue of St Andrew’s in Northampton having been able to expand so significantly with the benefit of NHS funding—I cannot remember the exact percentage, but the percentage of funding that comes from the NHS for St Andrew’s is up in the eighties and nineties. Does she agree that this is not the right model and will she commit to looking at limiting the further expansion of private in-patient beds, when they are not what is needed for treating young people with autism and learning disability?

[Caroline Dinenage]

We can certainly look at what the hon. Lady suggests. I am pleased that the operational delivery group, which I just mentioned, allows stakeholders to shape policy and it is really good news that Isabelle Garnett, Matthew’s mum, is a major contributor to this and liaises with NHS England directly on its programme around children either in hospital or at risk of being admitted.

The right hon. Member for North Norfolk asked why the evaluation was cancelled. As he knows, an evaluation sponsored by NHS England is already under way, and the Department, having invited bids for its evaluation, was not satisfied that the proposals received were what was needed. That does not mean that we are not absolutely determined to critically review progress, particularly working with stakeholders and users.

The right hon. Gentleman spoke about the “No voice unheard, no right ignored” Green Paper. Although I am always ready to bow to his incredible knowledge in this field, it is not entirely true to say that the Green Paper went unheeded. Some of the recommendations were overtaken by changes in Government policy, and indeed, in Governments, but we have taken forward work such as the named social worker pilot and a review of the Mental Health Act. We have asked Professor Sir Simon Wessely, the chair of the independent review, to listen to people with direct experience of the Mental Health Act and this, of course, includes autistic people and their carers. He published his interim report to update the Government on his progress, which sets out specific issues that we must explore to look at how we can improve the scope of the Act.

The hon. Member for Dulwich and West Norwood also spoke about training for teachers in autism. The Department for Education has funded training and support for teachers through the Autism Education Trust. That is in early years, schools and further education, and so far, 175,000 staff have been trained.

[Dame Cheryl Gillan]

Does my hon. Friend also welcome the fact that from September this year in initial teacher training, the possibility of having a module on autism will now be included? It is something that we worked very hard for and the Department for Education responded. This is about not just the historical training, which is so important, but the future training that is coming on-stream from September this year.

[Caroline Dinenage]

My right hon. Friend is absolutely right to raise that, and I am sure that its introduction is in no small part down to her incredible work.

Society has failed people with learning disabilities for too many years. Our aim is to put things right. People are at the heart of the transforming care delivery programme. The priority is to provide safe, high-quality care that is appropriate for everyone. We will continue to work with our partners to ensure that people with learning disabilities have the opportunity to live as full and independent lives as possible.

[Norman Lamb]

I think I can safely say that the debate this afternoon has reflected quality rather than quantity. I am not referring to my own contribution, of course. We have focused on an important issue, and I am grateful that the Minister has treated it with the seriousness it deserves. I want quickly to highlight the key things that I think she needs to focus on, and I would be delighted to meet her to discuss them, perhaps together with the key organisations that I referred to at the start.

The Minister did not particularly focus on children in her response. If we are to have a system that works in a sustainable way in the long term, keeping children out of institutions will be key to solving the problem, particularly given that the numbers have doubled in the past few years and that we are going in the wrong direction. I particularly commend to her the brilliantly led Starfish programme in Norfolk as an exemplar of what can be done to keep people out of institutions.

On workforce training, I was pleased to hear about the money—£10 million, I think—for postgrads, but we also need training for the frontline staff in community settings who make the return to the community possible. A really important point was made about Alderwood and the experience of the constituents of the hon. Member for Dulwich and West Norwood (Helen Hayes). I also talked about Fauzia in this context. Training is needed in how autism affects individuals. It is not just about training in autism generally. Understanding the impact on an individual is what is so important, as is wider community training.

The Minister said that mechanisms were now in place to shift money across. What I do not understand is why that does not appear to be working effectively enough. If it is there, why is it not happening routinely? Why cannot the money just shift to a local authority to facilitate a much-needed community place? I am reassured that the work will continue after March next year, but it needs a national programme. I am afraid that it cannot just be left to localities. We know that there are some great places around the country doing amazing work, but others are falling well behind. There needs to be an inspiring national drive and the sense of an imperative that things have to change, wherever people live.

On the cross-departmental work and the taskforce to which the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) referred, we must recognise the importance of employment opportunities. So many people can work and can be paid in work, and that of course relieves the burden on the statutory services. Understanding that, and recognising that housing plays a vital part in this—

[Caroline Dinenage]

Will the right hon. Gentleman give way?

[Norman Lamb]

Am I allowed to give way, Madam Deputy Speaker? I am coming to the end of my response very soon—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Technically, no. The right hon. Gentleman has a strict two minutes to sum up at the end. However, I recognise that really important issues are being discussed here, and the Minister clearly has something to add. I am not creating a precedent here, but I am, unusually, allowing her to intervene.

[Caroline Dinenage]

I am grateful to you, Madam Deputy Speaker. My lack of understanding of the rules is clearly shining through quite beautifully here. I completely forgot to say earlier that we have an inter-ministerial group on disability in society which met for the first time yesterday, and I hope that it will go some way towards achieving some of the improvements that the right hon. Gentleman wants to see.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Caroline Dinenage Excerpts

Monday 2nd July 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I would like to start by welcoming the recent joint report from the Health and Social Care Committee and the Housing, Communities and Local Government Committee on long-term social care funding. I am extremely grateful for their incredibly collaborative approach to working on this report, which captures a number of important voices on the subject of social care funding, not least the citizens assembly. The Government will of course respond to the report fully in due course. I agree that it is time to set political differences aside in addressing these issues, and we welcome the involvement of parliamentarians from across the House, as well as that of leaders, professionals and experts from the health and care sector, in doing so.

This has been a wide-ranging report, which has mainly been constructive and collaborative. In the time left to me, I will try to cover as many points as I can, but if I do not get to some of them, I will write to the Members concerned. The Government recognise that demands on our health and social care systems continue to grow, as people live longer than ever before, often with multiple complex conditions. For that reason, we have increased the funding available to the NHS in real terms every year since 2010 and given councils access to up to £9.4 billion more dedicated funding for social care over three years.

My hon. Friend the Member for Totnes (Dr Wollaston) spoke about integration and how Torbay is a great shining beacon of integrated care. The Government also recognise that the health and social care systems are intimately linked, and we have set out our intention to pursue a major drive towards better integration in order to achieve person- centred, co-ordinated care. We are committed to increasing the NHS budget to ensure that patients can get the care they need in a financially sustainable system. Our NHS now has in real terms about £14 billion more to spend on caring for patients than it did in 2010-11. With our NHS funding at record levels, that means more patients are being treated, and more operations are being carried out than ever before, by more doctors and nurses; this represents more than 14,500 more doctors and almost 13,300 more nurses on our wards. But we recognise, as so many Members from across the House have said, that NHS and social care provision are two sides of the same coin.

The long-term funding report mentions the current state of the social care system, and it is important to be clear about what the Government have already done to support local authorities in England. We understand the pressures on the system, which is why at the spring Budget in 2017 we gave councils access to £2 billion more funding. We are committed to creating a sustainable system of social care in England, which is why, as a starting point, the Government gave councils access to £9.4 billion more dedicated funding for social care over three years.

So many Members have set out the importance of early intervention to manage the demand for crucial health services and improve people’s wellbeing. The 2015 spending review made available £16 billion of funding for local authorities in England for public health. That was in addition to the money that the NHS spends on prevention, including our world-leading screening and immunisation programmes and the world’s first national diabetes prevention programme. Our investment is making a real difference, including to social care services throughout the country, with a 39.6% reduction in delayed transfers of care attributable to adult social care between February 2017 and April 2018.

We are taking additional steps to ensure that those areas that face the greatest challenges improve services at the interface between social care and the NHS. That includes the establishment of a series of local system reviews led by the Care Quality Commission, to evaluate the boundary between health and social care’s functionality. It is absolutely right that future social care funding is agreed alongside the rest of the local government settlement at the forthcoming spending review. The settlement will of course apply to older and working-age adults as well.

We recognise that an ageing society means that we need to reach a longer-term sustainable settlement for social care. An ageing society puts pressure on local authority budgets, on providers and on local services, which is why the Government have committed to publishing a Green Paper to outline our proposals for change. We recognise that decisions on future reforms of the NHS and social care must be aligned, which is precisely why we will publish the Green Paper at the same time as the NHS plan, to ensure that the system is sustainable going forward.

As the hon. Member for Sheffield South East (Mr Betts) so eloquently said, a priority for reform is making sure that people are better able to plan ahead and protect themselves against the highest care costs. It is not fair that some people in our society currently stand to lose the majority of the savings and wealth that they have built up over a lifetime. The Select Committees’ report highlights that issue powerfully.

Many Members spoke about the drive towards the integration of health and care services. The better care fund is our programme for joined-up health and care services, which will allow people to manage their own health and wellbeing and live independently in their communities for as long as possible. In 2015-16, some 90% of local area leaders said that the better care fund had already had a positive impact on integration locally. Nobody underestimates the pressures that local authorities and health providers are under, but working collaboratively, communicating better and avoiding duplication of effort is a good way to use resources.

In advance of the NHS’s 70th anniversary later this week, the Prime Minister announced her intention for the Government to work with the NHS to develop a 10-year plan for the future of the health service. That is underpinned by a five-year funding offer, which will see the NHS budget grow in real terms by more than £20 billion a year by 2023-24. That funding growth is significantly faster than for the economy as a whole and reinforces this Government’s commitment to the NHS as our top spending priority. Such intervention is possible only because of the difficult decisions that the Government took to get our nation’s finances back in order.

My hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) spoke about how we must be really honest about where the funding is coming from. My right hon. Friend the Prime Minister said that we will listen to views about how we will do that, and my right hon. Friend the Chancellor will set out the detail in due course.

In return for the new investment, the Government will now ask NHS leaders to produce a new 10-year plan, led by clinicians and supported by local health and care systems throughout the country. The plan will set a vision for the health service, ensuring that every penny is well spent and focused on improving outcomes for patients. We welcome parliamentarians’ continued contributions to informing the debate across health and social care. I commend the estimates to the House.

Adult Social Care: Long-term Funding

Caroline Dinenage Excerpts

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

Absolutely. The Committee did not discuss the ownership of care homes, but we did discuss the number of homes that had gone out of business or had been contracted back to local authorities. This is an ongoing and very real problem. We need not just a well-paid and well-trained workforce but viable care providers, so the money needs to be there for the providers as well as the workforce.

[The Minister for Care (Caroline Dinenage)]

I thank the Chairs, the members and the staff of both Committees, and congratulate them on producing an exceptional document. I also congratulate them on their extremely collaborative approach to their work, which is incredibly refreshing. For too long this issue has been used as a political football to be kicked around, but I am afraid it is too late for that now. We no longer have that luxury; we must reach a sufficient settlement. As other Members have pointed out, successive Governments have failed to address this issue. The Committees’ consultative, collaborative and constructive approach has been very positive and has been warmly welcomed, as, indeed, has been their engagement with the citizens’ assembly.

As has been made clear by the Secretary of State for Health and Social Care, we want to integrate plans for social care with the new NHS plan that the Prime Minister announced recently. It would not make sense to publish it before the NHS plan has even been drafted, so our Green Paper will be published at the same time as the plan. It will cover the Government’s proposals on a wide range of social care issues, including, but not limited to, the need for the social care market to be sustainable for the future. It will also build on policies such as our “Carers action plan”: we will, for example, consult on proposals to provide better support for unpaid carers.

The report will be incredibly valuable to our work. It will enhance our plans for the Green Paper, and will ensure that it can offer people a sustainable future and the knowledge that as they approach their later years, they will do so in security and safety and with quality provision.

[Mr Betts]

Again, I thank all the members and staff of the Committees for their work. The challenge now lies with the Government and with Ministers. There should not be any more long grass out there to kick things into. We want to see Government and Opposition working together and starting to make the difficult decisions that need to be made for the benefit of the people who need the care, both the elderly and those of working age.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 19th June 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

Commissioning high-quality health and social care services is a local responsibility. The Care Quality Commission monitors, inspects and regulates services that people with a learning disability may use. Where quality and safety standards are not met, it will take action.

[Kate Hollern]

The Association of Directors of Adult Social Services warned this week that social care services are on the verge of collapse. Despite the announcement of £20 billon yesterday, there was no mention of social care. Cuts of more than £7 billion have left hundreds of thousands of elderly and disabled people without adequate support. What specific measures are the Government taking to ensure that the elderly and disabled are receiving proper care?

[Caroline Dinenage]

Adult social care was mentioned yesterday, specifically in the news that we plan to bring together the way in which health and social care interoperate. We need more collaborative work between health and social care to reduce the amount of pressure that one puts upon the other. We have set out very clearly that we will produce a Green Paper later this year to address how we will tackle the challenges that we face in adult social care, and we will look at how we fund that.

[Julia Lopez (Hornchurch and Upminster) (Con)]

Providers of day care services for people with learning disabilities are not currently subject to an inspection regime. Will the Minister consider bringing such services within the scope of the Care Quality Commission to reassure families about quality and safeguarding issues?

[Caroline Dinenage]

My hon. Friend is absolutely right to draw attention to the fundamental importance of being reassured that all services that are provided are safe and reliable. Since the CQC has been looking at services up and down the country, it has brought to them a level of transparency and, indeed, quality. We keep under review the services that it regulates, and this is certainly something that we can discuss with it.

[Laura Smith (Crewe and Nantwich) (Lab)]

Will the Government end uncertainty for people with learning difficulties who need social care by funding the historical liabilities associated with the sleep-ins crisis?

[Caroline Dinenage]

We are aware of concerns in the sector with regard to sleep-ins and we are looking very carefully at the options. We have been developing the evidence base very carefully. We have been engaging with the European Commission, the sector and other Government Departments.

[John Howell (Henley) (Con)]

Oxford Health NHS Foundation Trust recently won a bid under the Beyond Places of Safety scheme to put in place IT support for users of learning disability services. Is that not a very useful way of taking forward such projects?

[Caroline Dinenage]

My hon. Friend makes an excellent point. It is vital that when we look at how to move forward with both our health and social care services, we are able to capture all the latest technology to ensure that we improve the experience for all our service users.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Much of the health and social care for people with learning disabilities in Plymouth is provided by Livewell Southwest, a social enterprise. The new pay increases for NHS staff will not be mapped over to social enterprise staff, so when they merge back into the NHS, we risk a two-tier workforce. Will the Minister consider extending the pay increases to support those who work with people with learning difficulties in the social enterprise sector so that we ensure that everyone doing the same job is paid the same amount?

[Caroline Dinenage]

The hon. Gentleman makes an excellent point. It would be terrible to see a health and social care sector in which people doing the same work are valued differently, so I will look carefully at the point he raises.

[Luke Graham (Ochil and South Perthshire) (Con)]

5. What steps his Department is taking to support UK life sciences and medical research.

--- Later in debate ---

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

14. What recent assessment he has made of the potential merits of including autism in NICE guidance on epilepsy.

[The Minister for Care (Caroline Dinenage)]

NICE is currently in the early stages of updating the clinical guidelines on the diagnosis and management of epilepsies in adults, and plan to go out to consultation on a draft scope in October this year.

[Dame Cheryl Gillan]

The UK’s autism research charity Autistica advises that up to 40% of people with epilepsies are, in fact, autistic, and that epileptic seizures are the leading cause of early death for autistic people with a learning disability. NICE guidance has never mentioned autism when referring to epilepsy, and autistic people have distinctive types of epilepsies that require different clinical approaches. Will the Minister please ensure that NICE includes autism in the guidelines on epilepsy?

[Caroline Dinenage]

At this stage, it is too early in the update process for NICE to say exactly what its guidance will cover. However, my right hon. Friend is chair of the all-party group on autism and vice-chair of the all-party group on epilepsy, and she was the driving force behind the Autism Act 2009. I think that NICE would do very well to heed her advice.

[Mr Speaker]

And that advice will be proffered on a very large number of occasions in this Chamber until the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) gets what she seeks—I think I can say that with not just confidence, but certainty.

--- Later in debate ---

[Afzal Khan (Manchester, Gorton) (Lab)]

T9. One of the biggest causes of regional health inequalities is the broken social care system, yet yesterday’s announcement postponed social care reforms again until the autumn. There is no end in sight for the overstretched and underfunded social care system, and without reforms to care, the extra money for the NHS will be wasted. Will the Minister bring up the timetable for those reforms before the care system collapses?

[The Minister for Care (Caroline Dinenage)]

The fundamental issue here is that we need a social care system that works hand in hand with our health services—the two are umbilically linked. The key plank of the new NHS 10-year plan must be the full integration of health and care services. It does not make sense to publish the Green Paper before the NHS plan has even been drafted. We will bring forward a Green Paper, but in the meantime, spending on adult social care has gone up by 8% this year.

[David Duguid (Banff and Buchan) (Con)]

Like many others, I welcome the announcement yesterday of the £20 billion investment in the NHS. Will my right hon. Friend join me in seeking assurances that the £2 billion extra for the Scottish Government shall be allocated to spending on the NHS in Scotland?

Complex Regional Pain Syndrome

Caroline Dinenage Excerpts

Tuesday 19th June 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for High Peak (Ruth George) on securing this debate on such an incredibly important issue. She has articulated quite beautifully the hell that people suffering from complex regional pain syndrome go through. The only thing that I can even slightly identify with is the pain of childbirth, but even after that it is unimaginable for us to conceive of the sort of day-by-day endurance and the relentless pain that people suffer. It is a devastating condition and can lead to an overwhelming impact on sufferers and their families, so I thank the hon. Lady for bringing this subject to the House.

The potentially extreme nature of the condition and its symptoms, some of which the hon. Lady described—the excruciating pain, burning, swelling and skin discolouration —can be totally disruptive to everyday living and destroy a person’s quality of life. She spoke very movingly about her constituent Victoria Abbott-Fleming, whose story is incredibly upsetting. I very much forward to meeting Victoria and assuring her that I will do everything I can to move forward on the issues that the hon. Lady mentioned. In circumstances in which extreme decisions have to be considered, high-quality care and support can sometimes make a huge difference to someone’s experience of our health and care services.

I hope that, as I am sure the hon. Lady intended, this debate will help to raise awareness of this very debilitating and extremely painful condition. It has actually been recognised as a medical condition for around 150 years, but problems remain with the diagnosis of CRPS in its very earliest stages. Diagnosis involves excluding a lot of other more common conditions—such as infection or things like rheumatoid arthritis—that can have similar symptoms, and the causes remain largely unknown. Precipitating factors can include injury or surgery, but there is no relationship to the severity of trauma and the development of the pain. In some cases, there is no precipitating trauma at all. It is considered likely that because of the complex nature of the condition, there is absolutely no one single cause. That means that it is difficult to estimate how prevalent CRPS is, as many cases may not have been correctly diagnosed in the first instance.

To improve public awareness, the NHS Choices website provides comprehensive advice on the causes, symptoms and treatment of CRPS. In addition to that, various charities work in this area. The hon. Lady mentioned Burning Nights, which was set up by her incredibly brave constituent; if someone is in unimaginable pain, I can only imagine what a comfort it is for them to be able to speak to or hear from somebody who has experienced it themselves. The charities do great work to support not only the patients who have the condition but their families.

As the hon. Lady says, general practice is where patients with CRPS are most likely to be seen in the first instance. CRPS is a key part of the GP curriculum; it is identified as a key area of clinical knowledge in the Royal College of General Practitioners’ applied knowledge test content guide. The test is a key part of GPs’ qualifying exams, and it ensures that they have the knowledge needed to work as a GP in the NHS.

To improve identification and management of the condition, in 2013 the Royal College of Physicians published best practice guidance for clinicians on the diagnosis, referral and management of CRPS. This guidance was developed with the involvement and endorsement of 21 key organisations involved with the care of people with CRPS, including the Royal College of General Practitioners, the British Orthopaedic Association, the British Pain Society, the British Society for Rehabilitation Medicine and so on.

The guidance, as the hon. Lady says, recommends prompt diagnosis and early treatment. This is to avoid the secondary physical problems associated with disuse of an affected limb and the incredible psychological consequences of living with undiagnosed chronic pain. It has been shown that an early referral to physiotherapy, for example, and encouraging gentle movement as early as possible, may prevent progression of the symptoms. Patients with CRPS are generally best managed in specialist pain management clinics.

[Ruth George]

Will the Minister look at the proposal to set up protocols in fracture clinics and clinics where carpal tunnel surgery is performed? Prevalence of CRPS following such surgery or an injury is particularly pronounced.

[Caroline Dinenage]

I will certainly look at that.

The hon. Lady mentioned delays in referral to a pain clinic, which is something that concerns me. Waiting times should be about 13 weeks once a GP has referred someone, but, as she says, some people wait longer. NHS England commissions the highly specialised pain management services for adults and children, and we will raise the issue with it. The National Institute for Health and Care Excellence has also published guidance for the pharmacological management of neuropathic pain, which includes CRPS. The guidance was updated earlier this year to reflect the latest available evidence.

Patients with CRPS will usually be managed through routine access to primary or secondary care. For patients with the most chronic and intractable pain, a referral can be made to a highly specialised pain service, commissioned by NHS England. Here, patients can receive multidisciplinary expert care and specialised treatment. Once diagnosed, patients can expect access to a range of other healthcare professionals for support and on-going treatment. This includes physiotherapists, occupational therapists, neurologists, a psychologist to help with the associated psychological problems caused by living with CRPS, and other healthcare professionals trained in pain relief.

The hon. Lady spoke about research. The National Institute for Health Research welcomes research funding applications for any aspect of human health, including CRPS. The CRPS UK clinical and research network was established in 2006. It is a research collaboration between a number of UK NHS trusts and academic institutions with an interest in the disorder. Its primary aim is to raise awareness and understanding among health professionals, patients and the general public. This year it is 10 years since the network established the CRPS registry, which now holds over 500 records and contributions and has contributed to seven different national and international research studies.

I thank the hon. Lady again for bringing this important debate to the House. I have attempted to answer as many of her questions as I can, but I will come back to her with anything that I have not covered. I hope that the debate has been helpful in raising the profile of this very difficult and distressing condition.

Question put and agreed to.