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.

Terminal Illnesses: Continuing Healthcare

Caroline Dinenage Excerpts

Wednesday 13th June 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is an absolute pleasure to serve under your stewardship, Ms McDonagh. I start by congratulating the hon. Member for Islwyn (Chris Evans) on securing this important debate on NHS continuing healthcare. I pay tribute to him for the inspiring work he does on the all-party parliamentary group on motor neurone disease. I also pay tribute, like him, not only to those who suffer from this very cruel illness, but to those who provide the unstinting care and compassion to loved ones who go through that horrible experience.

One of my first experiences as a Member of Parliament was helping a constituent who had motor neurone disease to get her continuing healthcare package to kick in during a very difficult part of her life. I am completely aware of the people to whom the hon. Gentleman refers. I met a few carers for people with motor neurone disease earlier this week, as part of carers week. As ever, I was completely overwhelmed by their incredible sense of duty and the commitment that they give to those for whom they care.

The hon. Gentleman is right to ask for further clarity on the issues he raised, and I hope that today I can provide him with some reassurance on those issues about which he is most concerned. We know that continuing healthcare is provided to some of the people with the highest and most complex health and care needs in the country, and they deserve our support. Of course, the nature of the situation presents some challenges. The hon. Gentleman made some valid points about the current issues facing the NHS continuing healthcare system, including some of the issues raised in the Public Accounts Committee earlier this year. I will set about trying to address them all, and will drop him a line afterwards about anything that I miss out.

Decisions about NHS continuing healthcare are important because they have a very big impact on people’s lives. It is right that there is a careful and considered decision-making process in place. The hon. Gentleman talked about people not being aware of continuing healthcare, which was a really good point. It is fundamental that we raise awareness of continuing healthcare and ensure that those who are entitled to it during a particularly difficult period of their lives claim it. Work on that by NHS England and the Department of Health and Social Care is under way, and will be announced later this summer, as we have confirmed to the Public Accounts Committee.

My Department is responsible for the NHS continuing healthcare national framework, which the hon. Gentleman mentioned. An updated version of the framework was published on 1 March, and will be implemented on 1 October this year. The revised framework follows an extensive period of external engagement with stakeholders and patient representative groups, including the Continuing Healthcare Alliance and those working within the NHS and local government. The update incorporates a new structure, which is intended to provide clarity, reflect legislative changes such as the Care Act 2014, and include minor clarifications on some policy areas. It is really important to underline that none of the changes is intended to alter the eligibility criteria for NHS continuing healthcare or the extent of the service provided by the NHS.

The hon. Gentleman mentioned progress and the next steps on the NHS continuing healthcare assessment tools. As set out in the Government’s response to the Public Accounts Committee, my Department is working very closely with NHS England to review the NHS continuing healthcare checklist tool. That work is due to report by this autumn. However, we know that those changes alone are not enough to deliver all the necessary improvements, particularly on some issues such as the variation in eligibility criteria, which the hon. Gentleman highlighted. That is why we are working very closely to support NHS England with their NHS continuing healthcare improvement programme.

It is important to be clear that there will always be some variation in NHS continuing healthcare eligibility rates. Such variation can be due to a wide variety of reasons, including the age dispersion within the local population and variation between geographical areas in health needs. It is really important that NHS England is working to understand the unwarranted variation in eligibility rates between clinical commissioning groups, and helping them to apply the national framework more consistently. NHS England is also developing a pilot to test the feasibility and the cost of running a sustainable case-level audit of eligibility decisions across clinical commissioning groups, to provide that kind of assurance on consistency and fairness in the provision of NHS continuing healthcare, which we all know is utterly vital.

Another area that NHS England is working to improve is the length of the NHS continuing healthcare assessment process. A quality premium is now in place to incentivise clinical commissioning groups to carry out more than 80% of assessments within 28 days. There is, of course, also a fast track for those who need the service much quicker. Clinical commissioning groups with the highest numbers of delayed cases are required to establish improvement plans to set out key milestones and planned measures to improve.

The hon. Gentleman will be pleased to hear that progress is being made. The latest quarterly data shows that in the last quarter of 2017-18, 66% of assessments were completed within 28 days. That is still not good enough, but it is up from 58% at the beginning of the year. The number of clinical commissioning groups delivering the expected standard of 80% within 28 days has gone up from 52 to 87 so far this year. As I have said, there is steady progress, but more to do.

The hon. Gentleman raised the target of £855 million of efficiency savings that we are planning by 2021. It is really important that I make it absolutely clear that that is not a cut in spending, but a reduction in growth in spending. Spending will continue to rise in real terms, with a projected budget increase of almost 4% a year, and of 20% between 2015-16 and 2020-21. I think he will agree that that rate of growth would be the envy of many other areas of health and care spending—indeed, of many other Departments.

The eligibility threshold for NHS continuing healthcare has not changed. The assessment of needs by a multidisciplinary team, as well as the primary health need test that we set out in the national framework, must be adhered to when deciding on continuing healthcare eligibility. No financial considerations or efficiency programmes alter that. Any planned efficiencies are not predicated on changes to eligibility or on limiting the care packages available. Clinical commissioning groups have an absolute responsibility to ensure high-quality standards of care, and any reduction in the growth in spending must not affect that.

It is vital that we continue to work closely with NHS England, local authorities and key stakeholders to ensure that we keep improving the system for those who need it. I know that there is still work to do, as the hon. Gentleman has highlighted, but I hope that he can appreciate that the Government and NHS England are aware of the challenges that we face in the provision of NHS continuing healthcare. I hope that he is aware of my personal dedication to getting this right. I am confident that the steps we are taking to improve the system are the right ones and will deliver an improved experience for patients, families and carers.

Question put and agreed to.

Death Certification England and Wales: Reforms

Caroline Dinenage Excerpts

Monday 11th June 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

My noble Friend the Parliamentary Under-Secretary of State for Health and Social Care (Lord O’Shaughnessy) has made the following statement:

Between March and June 2016 the Government consulted on a package of reforms to the death certification process and the introduction of medical examiners. The reforms aim to improve engagement with the bereaved in the process of death certification and offer them an opportunity to raise any concerns, as well as improving the quality and accuracy of medical certificates of cause of death. Safeguards will be enhanced in the process to enable medical examiners to report matters of a clinical governance nature to support local learning and changes to practice and procedures.

As part of the drive to further improve patient safety, I have today published the Government’s response to consultation on the introduction of medical examiners and the reforms of death certification in England and Wales, and a copy is attached. This sets out the Government’s intention to introduce a system of medical examiners in England. The Welsh Government consulted separately in Wales.

Medical examiners are a key element of the death certification reforms, which, once in place, will deliver a more comprehensive system of assurances for all non-coronial deaths regardless of whether the deceased is buried or cremated. Medical examiners will be employed in the NHS system, ensuring lines of accountability are separate from NHS acute trusts but allowing for access to information in the sensitive and urgent timescales to register a death.

The response to the consultation demonstrates that there is widespread support for the aims of the reforms and for the introduction of medical examiners, but there were concerns about some aspects of the proposals. In particular concerns were raised about how the proposed model, based in local authorities, would work in practice and about the timeframes for implementing the system. Feedback on a proposed funding model was also received.

Since the Government consulted on the package of death certification reforms, events have moved on. New information about how a medical examiner system could be introduced has been generated by the Department of Health and Social Care’s (DHSC) medical examiner pilot sites and early adopters of the medical examiner system, as well as from the learning from deaths initiative.

There will be two stages to funding the ME system to enable its introduction while legislation is in progress. Initially, medical examiners will be funded through the existing fee for completing medical cremation forms, in combination with central Government funding for medical examiner work not covered by those fees. Following this interim period and when parliamentary time allows for the system to move to a statutory footing, the funding of the system will need to be revisited. The existing medical cremation forms and fees payable associated with those forms will continue to apply for the interim period.

The Government have proposed that all child deaths (up to age 18) be exempt from the cost associated with the medical examiner system. This aligns with the broader purpose of the Government’s recent announcement about steps to ensure that no bereaved family will have to pay for the essential costs of burying or cremating their child.

Attachment:

1. Response to consultation (180611 Government response to ME and death certification consultation.pdf)

Attachment can be viewed online at http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-06-11/HCWS755/

[HCWS755]

Carers Action Plan

Caroline Dinenage Excerpts

Tuesday 5th June 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

I am today publishing a “Carers Action Plan 2018-2020—Supporting carers today” in the week leading up to Carers Week (11 to 17 June).

The cross-government carers action plan is an essential step towards realising the Government’s commitment to value, recognise and support carers to provide care in a way that supports their own health and wellbeing, employment and other life chances.

The plan sets out a two-year programme of targeted work to support unpaid carers. It puts a focus on practical actions to support carers and gives visibility to the work already under way or planned within Government.

In 2016, the Government ran a call for evidence to seek the views and experiences of unpaid carers. A summary of the 6,800 responses received will be published alongside the plan. Their contributions have informed its development and content, helping us to focus actions around the following five themes:

Services and systems that work for carers

Employment and financial wellbeing

Supporting young carers

Recognising and supporting carers in the wider community and society

Building evidence and research to improve outcomes for carers

In this way, we will seek to build accessible carer-friendly communities and public services, promote innovative local projects and support carers to stay in work.

The Government recognise there is more to do and that is why the needs of carers will be central to the forthcoming Green Paper on care and support, as set out in the Secretary of Health’s speech in March.

The plan has been developed in close collaboration with Ministers and officials in other Government Departments including the Government Equalities Office, Department for Education, Department for Work and Pensions, Department for Business, Energy and Industrial Strategy and Department for Digital, Culture, Media and Sport.

The Government want to ensure that caring is a choice or responsibility that is always recognised and valued. The publication of this carers action plan today is an important part of that commitment.

“The Carers Action Plan 2018-2020 [for England] —Supporting carers today” is available as an attachment online and on gov.uk.

Attachments can be viewed online at:

https://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-06-05/HCWS732/

[HCWS732]

Accrington Victoria Walk-in Centre

Caroline Dinenage Excerpts

Wednesday 23rd May 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Hyndburn (Graham P. Jones) on securing the debate. He made a very powerful case on behalf of his constituents and very carefully set out the enormous strength of feeling in his constituency, as of course he should as the local Member of Parliament. I am grateful to him for articulating his case so powerfully.

Following a three-month public consultation, the East Lancashire clinical commissioning group made the decision to close Accrington walk-in centre from Sunday 17 June. Other services provided from the Accrington Victoria Community Hospital, such as the minor injuries unit, and X-ray and in-patient and out-patient services, are not affected by the changes and will of course remain available. I understand that there has in fact been a delay in the closure taking place, as the walk-in centre was due to close in the spring. However, following consultation, the CCG has decided to close Accrington walk-in centre on Sunday 17 June. This extension to the originally planned closure date was made to ensure that there is a smooth transition to the new models of care, once the walk-in centre closes.

East Lancashire CCG has implemented an extended access service in Hyndburn as a new model of service provision. This service is being provided under contract by a local GP provider organisation, the East Lancashire Union of GPs. The contract is for 12 months from 11 December 2017, and the extended access GP scheme in Hyndburn has been operating since December. It is important to note that while the extended access service in Hyndburn is a new model of service provision, it is not meant directly to replace the walk-in centre per se.

GP services are accessible to patients through their own GP practice from 8 am until 6.30 pm, Monday to Friday, as usual. Pre-bookable appointments will also be available in the new extended GP service after 6.30 pm on weekdays and at the weekend. These appointments will be booked through the patient’s own GP practice. This new model of extended GP access meets the principles that were tested and supported by local people through a formal consultation process. In addition, the NHS 111 service can signpost patients to the most appropriate services, including an appointment with an out-of-hours GP, if required. We understand and appreciate that this is a real change for patients who are used to being able to walk in and see a GP, rather than phoning up for an appointment.

[Graham P. Jones]

Does the Minister accept that the consultation had flaws, and will she look at that? Does she accept that replacing 88 hours in a walk-in centre with 18 and a half or 19 hours of extended GP opening hours is a reduction in GP access, which goes counter to what was said in the consultations run by me and the CCG?

[Caroline Dinenage]

I take on board what the hon. Gentleman says about the consultation and also the consultation that he ran on Facebook. I know how worrying it must be for local people when a service closes, but it is the responsibility of the local NHS to follow the Government’s guidelines. The Government’s four tests for any service change are that it should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. The Lancashire overview and scrutiny committee alone has the power to refer the decision to the Secretary of State or the Independent Reconfiguration Panel, and it was minded not to. That is the unfortunate situation.

Alongside improving and extending GP access, East Lancashire CCG has invested significant sums in social prescribing and care navigation. Those additional services are helping to guide patients and co-ordinate their journey through the health and care system to get the right help and support quickly.

There are benefits from the Hyndburn extended access service, including the provision of seven-day access to GP care, the addition of a minimum of 49 additional delivery hours per week, and 162 additional appointments per week. The facilities are linked to the out-of-hours service, with the ability to secure urgent GP appointments at weekends. I understand that that provision is for Hyndburn patients only until the walk-in centre closes in June, but it will then be expanded to cover patients from the wider east Lancashire area.

The extended access service run by the East Lancashire Union of GPs already has robust information-sharing arrangements in place with Hyndburn practices to ensure continuity of care for patients utilising an electronic record. That level of record sharing has not been available to patients attending the walk-in centre. The patient and public involvement network in Hyndburn has been fully consulted, and has assisted in the production of communication materials to ensure that local patients have been informed of the changes and have the information they need to direct them to the most appropriate service for their health needs.

The extended access service will have the ability to generate electronic referrals that core GP practices can review and progress. The service will collate monthly data, including patient profiles and the reasons why people access the service, to shape service redesign and help to build a clear picture of patient health needs locally. That service will be delivered from an existing modern LIFT—local improvement finance trust—building, which is on a local bus route and easily accessible to the public. Use of the service has been building progressively and is being closely monitored by the CCG.

I thank the hon. Gentleman again for bringing this debate to the House and for his ongoing support for his constituents in Hyndburn.

Question put and agreed to.

Helen and Douglas House Hospice

Caroline Dinenage Excerpts

Friday 11th May 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing a debate on this really important matter. As MPs, we are all aware of the crucial role that hospices play in supporting our local communities at a time of need. That is a testament to the dedication of staff, the incredible efforts of volunteers and the amazing feats of fundraisers, many of whom have been inspired by hospices’ incredible support to their loved ones in the last days of their life, or the respite care that children’s hospices often give. Hospices step up to deliver amazing care at some of the toughest times of life, and I pay tribute to all of them. I totally understand the concerns that the hon. Lady raises and share many of them myself.

Hospices across England have been delivering exceptional end-of-life care and supporting their local communities for many years. A testament to that is the fact that the Care Quality Commission’s “State of Care” report, which was published in October 2017, showed that 70% of hospices are rated as good and 25% as outstanding—the figures are higher than those for any other secondary care service in the country.

In 2017, Helen and Douglas House was rated as good by the CQC. Like the hon. Lady, I congratulate its incredible hard-working staff and volunteers on ensuring that children and young people get the personalised care and support that they need and deserve, both at the hospice and through its outreach services. In the same year, I understand that Helen and Douglas House raised an impressive £8.8 million through fundraising and trading activities. That was £300,000 more than the previous year, which shows its value to the local community.

Historically, the hospice movement was established from charitable and philanthropic donations, so the vast majority of hospices are primarily funded through charity, but they receive statutory funding from clinical commissioning groups, and in some cases from the Government, for providing local services. According to its annual report and accounts, Helen and Douglas House received more than £500,000 of statutory funding in 2016-17, including £280,000 via NHS England’s children’s hospice grant, which is awarded annually.

I am aware of recent announcements by the hospice of plans to close Douglas House, which provides support to young adults between 16 and 35, and I recognise the concerns raised by the hon. Lady and her wider community. The fact that more than 40,000 people have signed a petition shows the strength of feeling in her local community, and it is important that young adults with life-limiting conditions can access the support and care they need. Of course the local community is desperate to hold on to that specific facility, but I am sure the hon. Lady welcomes, as I do, reassurance from Oxfordshire CCG that it is working with the hospice to ensure that local patients being cared for at Douglas House continue to receive the essential healthcare they need.

[Robert Courts]

I thank the Minister for her kind words, which are appreciated. Concern about this issue is felt all over Oxfordshire and throughout the wider south-east. Does she agree that it is important that the CCG continues to engage with all interested parties locally, including Members of Parliament, and that this underlines the importance of a close link between care and the NHS?

[Caroline Dinenage]

I believe that my hon. Friend has visited the hospice and I know that he works keenly on this subject. I totally understand the feelings of local people, and I feel strongly that CCGs need to engage with local communities and ensure that the services they commission meet local needs and support local people.

With Douglas House planning to close from July, the hospice has been discussing with Oxfordshire CCG the future of Helen House, which provides hospice beds for children aged between nought and 18. Oxfordshire CCG wants to look at a more collaborative approach to end-of-life commissioning once its current contract for adult hospices finishes in September 2019. The hon. Lady spoke about how the hospice has been excluded for bidding for certain contracts because of the wide nature of what they entail, but the process allows smaller providers such as Helen and Douglas House to work with others to bid for contracts. In the meantime, Oxfordshire CCG is keen to pilot collaborative working with the hospice, which is why it has offered £100,000 for a pilot project until September 2019. Wider discussions are taking place between the hospice trustees and local partners, including Oxfordshire CCG, NHS England and Oxford University Hospitals NHS Foundation Trust, to examine future models of care and the longer-term sustainability of the hospice. NHS England has also been involved in those discussions.

Across England, there are 223 registered independent hospices and a very small number of public hospices that are run by NHS trusts. Around three quarters of those provide adult services, with the remainder caring for children and young people. Funding amounts vary among CCGs, but on average adult hospices receive approximately 30% of their overall funding from NHS sources. CCGs are responsible for determining the level of NHS-funded hospice care locally, and for ensuring that they meet the needs of their local populations.

In addition to NHS funding for locally commissioned services, in 2017-18 children’s hospice services received £11 million through the children’s hospice grant. This is awarded annually and administered by NHS England. Children’s hospices tend to receive smaller amounts of statutory funding because of the way they have developed and the services they provide, and the grant provides the additional support they need. Unlike adult hospices, which are focused on end-of-life care, children’s hospices can provide support through much of a child’s life. Children’s hospices encompass much more than clinical care, including family support, recreational support, respite care and so on.

In 2016, as I think the hon. Lady mentioned, the Government published the end-of-life care choice commitment, which encompasses a whole-system approach to transforming end-of-life care, placing the patient, and their choices, needs and preferences, at the heart of planning. That is so important. The Government and NHS England need to collaborate with partners in the voluntary sector, including key hospice and end-of-life care charities, to ensure that the quality and availability of services continues to improve, and that our end-of-life care commitment is delivered.

One key objective is to strengthen the provision of services in the community so that when people are approaching the end of their life, they can be supported to be wherever they choose to be—whether in their home, a hospice or a care home. Work is ongoing nationally—the hon. Lady talked about how we can join it up in local areas—to provide sustainability and transformation partnerships with the tailored information they need to address and enhance the services in their own areas. NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospices and their interventions in the community. Amazingly, there is very little evidence in this area, but these resources will build on the range of guidance and support provided by NHS England, Public Health England and our charitable partnerships.

It is very important—today’s debate underlines this—to be able to assess how effectively commissioners are working to improve their services, to measure progress and to improve accountability. We will soon have a new indicator in place, which is designed to measure how well patients are supported in the community. This will help to drive improvements in sustainability, which is the big issue in this case, as well as quality and choice. It is very clear that hospice care remains a key part of the Government’s vision for high-quality end-of-life and respite care both in Oxfordshire and throughout the rest of the country.

Question put and agreed to.

Health and Social Care

Caroline Dinenage Excerpts

Wednesday 9th May 2018 Ministerial Corrections

[Barbara Keeley]

The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was

“absolutely disgusted by the report”

and that the way it had been published at the beginning of a bank holiday weekend

“shows the disrespect and disregard”

there is for the scandalous position of people with learning disabilities shown in the report.

[Caroline Dinenage]

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened. [Official Report, 8 May 2018, Vol. 640, c. 546.]

Letter of correction from Caroline Dinenage:

An error has been identified in the answer given to the hon. Member for Worsley and Eccles South (Barbara Keeley) on 8 May 2018.

The correct answer should have been:

[Caroline Dinenage]

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not formally alert us to publication. We are investigating through NHS England and others why that happened.



The following is an extract from the Urgent Question answered by the Minister of State for Care on 8 May 2018.

[Liz McInnes (Heywood and Middleton) (Lab)]

The front page of the report is clearly dated December 2017, so will the Minister clarify and explain why, as she has stated today, her Department did not have sight of it prior to its publication?

[Caroline Dinenage]

I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document and the University of Bristol decided when it was going to be published. It was published on Friday without permission from or any kind of communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.

[Official Report, 8 May 2018, Vol. 640, c. 553.]

Letter of correction from Caroline Dinenage:

An error has been identified in the answer given to the hon. Member for Heywood and Middleton (Liz McInnes) on 8 May 2018.

The correct answer should have been:

[Caroline Dinenage]

I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document. NHS England and the University of Bristol decided when it was going to be published. It was published on Friday, without permission or official communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us from the university. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.

Learning Disabilities Mortality Review

Caroline Dinenage Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Speaker]

Order. There is a certain amount of chuntering from a sedentary position. The Secretary of State has been with us, but Minister Caroline Dinenage will answer the urgent question, and we look forward to her answer.

[The Minister for Care (Caroline Dinenage)]

The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths may have been preventable and have pledged to do so with different health and care interventions. The learning disabilities mortality review programme was established in June 2015; it was commissioned by NHS England to support local areas in England to review the deaths of people with a learning disability. Its aims were to identify common themes and learning points, and to provide support to local areas in their development of action plans to take forward the lessons learned.

On 4 May, the University of Bristol published its first annual report of the LeDeR programme, covering the period from July 2016 to November 2017. The report included 1,311 deaths that were notified to the programme and set out nine recommendations based on the 103 reviews completed in this period. The Government welcome the report’s recommendations and support NHS England’s funding of the programme for a further year at £1.4 million. We are already taking steps to address the concerns raised, but the early lessons from the programme will continue to feed into our work, and that of our partners, to reduce premature mortality and improve the quality of services for people with learning disabilities.

[Barbara Keeley]

Mr Speaker, I think it is disgraceful that the Secretary of State has just run out of the Chamber, rather than answering this question himself—it is disgraceful.

Seven years after Winterbourne View and five years since the avoidable death of Connor Sparrowhawk, the findings of the review show a much worse picture than previous reports about the early deaths of people with learning disabilities. One in eight of the deaths reviewed showed that there had been abuse, neglect, delays in treatment or gaps in care. Women with a learning disability are dying 29 years younger than the general population, and men with a learning disability are dying 23 years younger. Some 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% of the general population who had died by that age.

The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was

“absolutely disgusted by the report”

and that the way it had been published at the beginning of a bank holiday weekend

“shows the disrespect and disregard”

there is for the scandalous position of people with learning disabilities shown in the report.

Only 103 of 1,300 cases passed for review between July 2016 and November 2017 have been reviewed. That is a paltry number. The report cites a lack of local capacity, inadequate training for people completing mortality reviews and staff not having enough time away from their duties to complete a review.

If there are issues around capacity and training, what is NHS England doing to rectify this? Sir Stephen Bubb, who wrote the review into abuse at Winterbourne View, said this in response to the report:

“there can be no community more abused and neglected than people with learning disabilities and their families. How many more deaths before we tackle this injustice?”

Dr Sara Ryan said:

“things have actually got worse than they were 10 years ago”.

What action will the Government take to show the families of people with learning disabilities that their relatives’ lives do count?

[Caroline Dinenage]

I thank the hon. Lady for raising this issue; the report makes for very troubling reading.

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]

As the report clearly identifies, there is still more work to do, and we will work with partners to see how the recommendations may be implemented. We are committed to learning from every avoidable death to ensure that such terrible tragedies are avoided in the future. She mentions Dr Sara Ryan, whose son, Connor Sparrowhawk, died in such tragic circumstances in my own Southern Health Trust area. She and other parents like her are testimony to the incredible dedication of people who have worked so hard to get justice for their loved ones at a time when they feel least able to do so.

We have done several things already. We have introduced a new legal requirement so that from June every NHS trust will have to publish data on avoidable deaths, including for people with a learning disability, and provide evidence of learning and improvements. We are the first healthcare system in the world to publish estimates of how many people have died as a result of problems in their care. Learning from the review is also informing the development of the pathways of care published by NHS England and the RightCare programme, which is tailored to the needs of people with learning disabilities. Pathways on epilepsy, sepsis and respiratory conditions will be published later this year.

We have introduced the learning disability annual health checks scheme to help ensure that undiagnosed health conditions can be identified early. The uptake of preventive care has been promoted and improved, while the establishing of trust between doctors and patients is providing better continuity of care. We have also supported workforce development by commissioning the development of learning disabilities core skills education and training framework, which sets out the essential skills and knowledge for all staff involved in learning disability care.

As I said, the report makes for troubling reading, but we asked NHS England to commission it so that we might learn from these deaths and make sure that trusts up and down the country are better equipped to prevent them from happening in the future.

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

Every preventable death brings personal tragedy, as was highlighted in a 2016 report by Autistica, the autism charity, entitled “Personal tragedies, public crisis”. Autistic adults with a learning disability are 40 times more likely to die prematurely. That is why I welcomed the Government’s announcement in March that reducing the gap in life expectancy for autistic people was one of the top autism priorities in the “Think Autism” strategy governance refresh under provisions in the Autism Act 2009. How will the Minister implement those provisions?

[Caroline Dinenage]

I pay tribute to my right hon. Friend, whose incredible work over many years campaigning on behalf of autistic people up and down the country has made a magnificent difference. She is right to raise this issue. It is of course unacceptable that people with autism have poorer health outcomes, and we are determined to address this. I meet regularly with representative groups and we take on board all their comments about how they would like to see the situation improved.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The report makes tragic reading. Some of our most vulnerable citizens are four times more likely to die prematurely than the general population, and there have been many avoidable deaths because of systemic failures. The situation cannot continue.

Let me ask the Minister three questions. First, will she look at the Scottish patient safety programme, a national programme that has been running since 2008 and is achieving good outcomes? Secondly, given that the Health and Social Care Committee has heard that learning disability nurses are very scarce, will she redouble the efforts to ensure that training for and recruitment to those roles are prioritised? Picking up symptoms early may be crucial to the prevention of morbidity. Thirdly, staff turnaround in social care is a real issue. Social care staff who know a client well, and can notice early changes such as signs of illness and report them timeously to ensure prevention, are crucial, and consistency in care is therefore critical. How will that be addressed?

[Caroline Dinenage]

The hon. Lady is right to raise those points. The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths might have been preventable had there been different health and care interventions. That is why we set up the learning from deaths programme, and have commissioned an investigation of the issue. We are determined not only to learn from every single one of these tragic and avoidable deaths, but to share that learning with those in trusts up and down the country so that they can take a clear look at what is going on under their noses, and ensure that the terrible incidents that we have seen in the past do not happen again.

The hon. Lady was wise to raise the issue of training. It is important to have specialist practitioners, but it is also important to ensure that all healthcare staff, throughout the country, have the training that they need in order to recognise and support the needs of people with learning disabilities. That is something that we have done very successfully with dementia: we record the number of staff in the country who have received tier 1 and tier 2 training, and we are looking into how we can extend that to address the issues of people with learning disabilities.

[Theresa Villiers (Chipping Barnet) (Con)]

In learning lessons from these truly horrific cases, will the Minister commit herself to working closely with the charities that do such incredible work to support people with learning disabilities and their families?

[Caroline Dinenage]

My right hon. Friend is absolutely right. Charities and voluntary organisations all over the country do remarkable work, supporting not only people with learning disabilities but their families and their carers, for whom instances involving their health and wellbeing can be incredibly distressing.

[Sir Vince Cable (Twickenham) (LD)]

The Minister’s statement quite properly focused on hospitals, but does she acknowledge that charities dealing with people with learning disabilities will be among the worst affected by the £400 million back-pay charge? Will she try to ensure that the Government absorb that cost, so that the improvements in hospitals are not upset by a deterioration outside, in communities?

[Caroline Dinenage]

We are looking very carefully at the issue of sleep-ins, and are communicating with social care providers and others. It is important to recognise that we need to support not only the sector as a whole, but the many low-paid workers within it. We will present more proposals on sleep-ins shortly.

[Mrs Maria Miller (Basingstoke) (Con)]

The biggest challenge that many learning-disabled people have is simply making their voices heard. Their legal entitlement to advocacy is not always upheld by health professionals, who often misunderstand that entitlement. Will the Minister look into the commissioning of advocacy services, and, indeed, the understanding of the Equality Act 2010 among NHS staff, to ensure that more learning-disabled people have access to organisations such as Speakeasy Advocacy in Basingstoke, which supports more than 600 people with learning disabilities in north Hampshire, helping to give them the voice that they so badly need?

[Caroline Dinenage]

My right hon. Friend is a fantastic champion for equality issues in her role as Chair of the Women and Equalities Committee. I take on board everything that she has said, and I will certainly look more closely at the issue that she has raised.

[Liz Kendall (Leicester West) (Lab)]

The true disgrace is that none of this is new and we have been here before. Five years ago the Government set out their promises to tackle this appalling death by indifference, yet we have seen no progress. Can the Minister tell me how many hospitals regularly ask the four questions on treatment of people with learning disabilities set out by Sir Mike Richards, how many clinical commissioning groups check and monitor how many health checks and health plans people have in place, and what Health Education England has done to put the training in place to try to start turning the tide on this appalling situation?

[Caroline Dinenage]

The hon. Lady is right that this issue was identified a few years ago. The report was commissioned in 2015 and has been in the making since then. There was a Care Quality Commission report in 2016 which concluded that bereaved families do not often experience openness and transparency. Everything we have done up until this point—the mortality review, the learning from deaths programme and all the other things we have put in place with regard to the transforming care programme and annual health checks—is geared towards addressing this very issue.

[Dr Sarah Wollaston (Totnes) (Con)]

The learning disabilities mortality review programme sets out the stark and unacceptable health inequalities faced by those with learning disability, and I welcome the steps the Minister has set out today. May I press her further, however, on the point about workforce shortfall? What is she going to do not only about recruitment, but about retention of the vital workforce in both health and social care?

[Caroline Dinenage]

My hon. Friend is absolutely right that the workforce in our health and social care system is absolutely fundamental to the way we look after people in our country. We must be able to attract, recruit, retain and bring back into the system people who have left it. We are currently compiling a workforce strategy jointly between Skills for Care and Health Education England, and it will be reporting later in the year.

[Melanie Onn (Great Grimsby) (Lab)]

Parents come to me all the time expressing their grave concerns about what will happen to their children with learning difficulties and disabilities if they are not around to support them. In my constituency I have had reports of instances of bullying from other people in the community, of targeting by drug dealers and of exploitation by private companies such as mobile phone providers and utility companies, and that there are difficulties accessing mental health support. If the Minister is truly keen to show the Government’s desire to improve on the current appalling state of affairs, do not early support and state responsibilities need to be looked at more closely as well?

[Caroline Dinenage]

The hon. Lady is right to make the point more broadly, rather than just about the healthcare outcomes for people with learning disabilities. We need to look at how we protect people more broadly, and this issue must particularly be a terrible worry for the ageing parents. I take on board what the hon. Lady said, and we will definitely feed it into the system to see what more we can do in support.

[Sir Desmond Swayne (New Forest West) (Con)]

What should the CQC be doing that it is not doing already?

--- Later in debate ---

[Caroline Dinenage]

The CQC conducted an inquiry into this issue in 2016 and has a responsibility to check local healthcare provision to ensure it is up to speed. When local trusts start publishing their learning from deaths data from June, the CQC will be able to inspect them on how they bring the data forward and to judge them on that information.

[Mr Ivan Lewis (Bury South) (Ind)]

Societies and Governments should be judged by how they treat the most vulnerable. As well as avoidable deaths of people with learning disability, we have savage cuts to services across the country, so they have no constructive positive activities to participate in, and we have a complete dearth of employment opportunities now for people with learning disabilities. I started my working life 36 years ago working with people with learning disabilities, and we made tremendous progress over a 20-year period. It is a source of tremendous sadness that we have gone backwards in the last 10 years in the support that such people and their families are receiving. It is shameful. We need a cross-Government approach and we need action, not strategies.

[Caroline Dinenage]

It is sad that the hon. Gentleman has sought to politicise this issue. It is nothing to do with funding cuts or cost-saving measures. We have actually invested more money into this programme. We are the first Government in the world to publish a learning from deaths programme so that healthcare trusts are held accountable and have to publish their data on people who die unnecessarily in their care. Making short-sighted party political points is therefore very unfair and does not get to the heart of the issue, which is about supporting people with learning disabilities and making sure that their health outcomes are the same as those of the population as a whole.

[Mr Mark Harper (Forest of Dean) (Con)]

The all-party parliamentary group on learning disability, which I have the honour to chair, will be looking at this area of policy later this year. Mencap, which provides the group’s secretariat, has a Treat Me Well campaign, which is about improving the position, and I know it is keen to work with the NHS. Drawing on some of the other questions, may I ask the Minister what she can do to get the NHS and all the providers to act with a real sense of urgency in making improvements in this regard with the speed that we would like?

[Caroline Dinenage]

My right hon. Friend is right to raise the Mencap report, because in many cases it reflects the recommendations that have been put forward in this particular report. The mandate to NHS England requires a reduction in the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and requests support for them to live full, healthy and independent lives. That is something that NHS England has a mandate to deliver, and we of course support it in doing that.

[Karin Smyth (Bristol South) (Lab)]

If it is a crime to politicise the vulnerability of some people and the Government’s cuts, I stand guilty as charged. Further to the question from my hon. Friend the Member for Leicester West (Liz Kendall), what we have seen since 2013 is the complete decimation of services working together on the ground. This is a local government and health issue locally, so may I press the Minister to tell us what action will be taken to make this happen at local level?

[Caroline Dinenage]

It is not about that. This is about inquiring into the deaths of people who have died in our care. Despite all the really difficult decisions we have had to make to deal with the financial challenges this country faced, which the hon. Lady’s party will be well aware of, we have made progress on this issue in terms of transforming care and the healthcare checks on people with learning disabilities, and this very report on the learning from deaths programme proves how absolutely committed we are to ensuring that not one single one of those deaths goes unrecognised or uninvestigated.

[John Howell (Henley) (Con)]

Surely the quicker integration of the NHS with social care across the board will help to solve some of these problems. Does the Minister agree with that?

[Caroline Dinenage]

Yes, my hon. Friend is absolutely right. The integration of health and social care services is absolutely vital, and that is why we are so delighted that we have renamed the Department as the Department of Health and Social Care. That has to be more than just a title; it has to be a statement of intent.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

Last October, I secured a Westminster Hall debate on supporting and safeguarding adults with learning disabilities, following the horrendous murder of my constituent, Lee Irving. Following that debate, what reassurance can the Minister give me that one of the major lessons coming out of that case—that families must be involved in the decision making about a person’s care—has been learned?

[Caroline Dinenage]

I thank the hon. Lady for raising that case. It was a truly horrible case. The Mental Capacity Act 2005 is all about making sure that we have care that is centred around the individual, and that parents’, families’ and carers’ thoughts are taken into consideration when making decisions about how we care for people.

[Victoria Prentis (Banbury) (Con)]

We can be confident that the right legal framework is now in place, with the Equality Act 2010 and the Health and Social Care Act 2012, but what further steps can the Minister take to ensure that those who work in NHS organisations are aware of them?

[Caroline Dinenage]

Of course it is the responsibility of individual employers to ensure that their staff are appropriately trained and competent to fulfil the responsibilities that we ask of them, but we have commissioned Health Education England, Skills for Health and Skills for Care to develop a learning disabilities core skills education and training framework, which sets out a tiered approach to that kind of training and how it needs to be improved.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

This review should shame us all. If we reflect on Sir Stephen Bubb’s final reports from two years ago in 2016, following a report he wrote in 2014 when there had been no progress, we can see that he put forward 10 recommendations. We have seen little or no progress on any of those recommendations. One of them recommended the introduction of the commissioner for learning disabilities, and we need that to happen if we are to see real progress and change. Will the Minister now take that important recommendation forward?

[Caroline Dinenage]

The hon. Lady is right to raise that, but I will point out that we commissioned the review to examine the situation. We are not running away from our responsibilities; we are standing up and facing them. We are allowing them to be entirely transparent and out there in the public domain for people to judge. The deaths that the report covered come from the period starting July 2016, so they are historical, but it is important that they are examined. The hon. Lady is right to mention the issue of the commissioner, and I will look at that.

[Kevin Foster (Torbay) (Con)]

While the review’s conclusions make difficult reading in some ways, it is welcome that it happened, given that it is a world first and that it gives us the chance to have this discussion. What work will be done with councils and other third sector partners on taking away some of the lessons that can be learned from the review?

[Caroline Dinenage]

My hon. Friend is right to say that this is the first time in the world that such a review has been done. We are the first to have a learning from deaths programme and a Healthcare Safety Investigation Branch, so we take such things incredibly seriously. The whole point of the learning disabilities mortality reviews is that the information will be disseminated to local trusts so that they can make plans to avoid such disastrous, tragic incidents happening in the future.

[Lilian Greenwood (Nottingham South) (Lab)]

The gap in life expectancy for people with learning disabilities is deeply troubling. Last week, and at Health questions earlier, the House discussed cancer screening and the need to improve screening opportunities. The Minister will know that screening participation rates among people with learning disabilities are far below those for the general population. What specific actions is she taking to address that gap?

[Caroline Dinenage]

The hon. Lady is right to raise the inequalities of diagnosis of conditions and illnesses for which catching them early can mean the difference between life and death. That is why we have introduced annual health checks for people with learning disabilities. They mark a huge step forward and will help to reduce recognised health inequalities and ensure that reasonably adjusted care needs are much better communicated to other NHS partners.

[Chris Skidmore (Kingswood) (Con)]

As a Bristol-area MP, I thank the University of Bristol for its rigorous review, which marks a milestone in increased transparency and in setting out appalling healthcare inequalities. I note with interest that the review recommends efforts to improve awareness of the signs of sepsis and pneumonia in patients with learning disabilities in the NHS. Will the Minister reassure the House that the NHS will take up that recommendation urgently?

--- Later in debate ---

[Caroline Dinenage]

Yes. Specific work on early detection of the symptoms of sepsis, pneumonia, constipation and epilepsy and on the effective use of the Mental Capacity Act 2005 in urgent care settings is already under way.

[Liz McInnes (Heywood and Middleton) (Lab)]

The front page of the report is clearly dated December 2017, so will the Minister clarify and explain why, as she has stated today, her Department did not have sight of it prior to its publication?

[Caroline Dinenage]

I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document and the University of Bristol decided when it was going to be published. It was published on Friday without permission from or any kind of communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

During my career as a paediatrician, I have seen huge improvements in the care of children and young people with severe and moderate learning disability, many of whom have survived into adulthood when that would not have been the case years ago. Owing to the association between severe and moderate learning disability and other medical problems that may limit someone’s lifespan, it is unlikely to ever be equal to that of the general population, but we should always ensure that the care of the most vulnerable in society is as good as it can be, and I welcome the steps that the Minister is taking to ensure that it is. Such people are cared for jointly in hospitals and in the community, so will she confirm that hospitals and community care will work together following such reviews?

[Caroline Dinenage]

This is something that my hon. Friend, as a healthcare professional, obviously knows an awful lot about. She is right that a person having the ability to communicate, understand and identify when they do not feel well is important. These annual health checks, which are available to children from the age of 14 and into adulthood, are important because they enable any healthcare issues to be disseminated and communicated much more effectively between different healthcare and other providers.

[Mike Amesbury (Weaver Vale) (Lab)]

Can the Minister guarantee that future publications of such sensitive reports will be done in a timely manner and given proper parliamentary scrutiny?

[Caroline Dinenage]

I will certainly put that request to NHS England. It was not in our interest for the report to be published on Friday. This is an independent review, but it would have been much better for us to have had foreknowledge of its publication. We would then have brought a statement to the House. We will pass on the hon. Gentleman’s comments to NHS England.

[Rachel Maclean (Redditch) (Con)]

Sepsis has already been mentioned by my hon. Friend the Member for Kingswood (Chris Skidmore). Is the Minister aware that the mortality rate for sepsis in the Worcestershire Acute Hospitals NHS Trust has experienced a remarkable turnaround from 49% above the national average to 26% below the national average? Will she look at some of the best practice that is down to the hard work of the doctors and nurses, the awareness-raising campaign and all the other education work happening in that hospital, and disseminate it more widely to benefit such patients?

[Caroline Dinenage]

I thank my hon. Friend for raising that important issue. Sepsis is a silent killer. If not identified early, it can lead to life-changing implications or death. She is right that we have made great steps in addressing sepsis. Only a couple of weeks ago, we launched a new e-learning tool to help healthcare professionals better identify the symptoms of sepsis, particularly in children, so they can tackle it early.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister has spoken a lot about being committed to improvements in this area. Does she think it is acceptable that she did not know a report in this important area was to be published on Friday? Why did she not come to make a statement today, rather than waiting to be summoned to the House by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)?

[Caroline Dinenage]

What is unacceptable is that people with learning disabilities have poorer health outcomes than the rest of the population, which is why NHS England commissioned this piece of work and why we are determined to address it.

[Kate Green (Stretford and Urmston) (Lab)]

What steps is the Minister taking to ensure that people with learning disabilities can confidently access good quality sexual health services? What work is she doing with her counterparts in the Department for Education to ensure that young people with learning disabilities receive excellent sex and relationships education?

[Caroline Dinenage]

This is an important aspect, and I will get in touch with the hon. Lady with a more detailed answer to her question.

[Stephen Lloyd (Eastbourne) (LD)]

This is a shocking report, and its conclusions demean us all. A lot of people on both sides of the Chamber have asked the Minister and her Department to come up with some actions. Rather than just talking about it, will she commit today to coming back to the House with a specific action plan to prevent and change what has been an absolutely shocking situation for many decades?

[Caroline Dinenage]

The hon. Gentleman is right to say that this has been a shocking situation for many decades, which is exactly why this report was commissioned so that we can learn from past errors and identify how to stop them ever happening again. There are nine recommendations in this report, and we will work with NHS England on how to adopt every single one of them.

[Stephen Lloyd]

Will you bring it back to the House?

[Caroline Dinenage]

Of course.

Social Care Provision and the NHS

Caroline Dinenage Excerpts

Thursday 3rd May 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Dame Cheryl. I thank the hon. Member for High Peak (Ruth George) for securing the debate and setting out the issues so articulately. I congratulate her on making it to the debate, and I thank you, Dame Cheryl, for allowing it to take place. It would have been a great concern to us all if that had not happened.

As hon. Members will know, I am relatively new to my role as the Minister for Care in the Department of Health and Social Care. That is why I am really grateful for the chance to focus on the interface between social care and health, and to outline how integration is absolutely at the heart of what we do. The renaming of the Department of Health as the Department of Health and Social Care must be more than just a change of title; it must provide a sense of direction and a change of culture. We know that health and social care are umbilically linked, and that one is a key driver of the other.

We recognise that many of our challenges stem from the very good news that people are living longer, which is to be celebrated. Worldwide, the population aged 60 or above is growing faster than all other age groups. In developed countries the proportion of the population aged 65 and above is expected to rise by 10% over the next 40 years. That means that, in England, by 2026 the population aged 75 and above, which currently stands at 4.5 million, will rise by 1.5 million. By 2041 it will have nearly doubled.

People’s expectations and wishes are also changing. The traditional model of social care is based on care homes, but we know that increasingly people want care to be delivered in their own homes. We want to encourage people to live independently and healthily in their homes, where many people want to stay. We know that nine in 10 older people live in mainstream housing, and that only 500,000 of those homes are specifically designed for their needs. Adapting homes to make them more suitable is therefore incredibly important. The disabled facilities grant has a vital role to play. Home adaptations and investment can be incredibly effective. Not only do such adaptations allow people to lead independent healthy lives, but our analysis shows that for every £1 spent, more than £3 is recouped, mostly through savings to the health and care system. Housing that enables people to live independently and safely allows us to reduce the number of people who need to go into hospital or have other social care requirements.

We have to look at the way we provide and fund services for the long term. Complex conditions must be addressed, and we must move to a system in which care, whether social care or health care, is individually tailored to people’s needs. The hon. Member for Glenrothes (Peter Grant) put it beautifully when he talked about how we need to stop using social care and our health service as a political football. We need to champion where there is good practice, not just talk about where it is bad. We need to look at how we can produce much more person-centred care, where we address an individual’s needs. We need to celebrate the amazing places up and down our country where it is going right, and we need to support the incredible workforce in this country—both the informal workforce, and the dedicated hospital and social care workforce. A number of pieces of work are ongoing. As the hon. Gentleman said, we need to have the courage to tackle the difficult questions, and that is what is happening.

A number of key pieces of work are happening at the moment to address many of the issues that the hon. Member for High Peak raised. Many of those issues will be tackled in the forthcoming Green Paper. We have an ongoing workforce strategy that is taking place jointly between Health Education England and Skills for Care. In order to address the challenges of our ageing population, we need to attract more people into the workforce. We need to ensure that they are properly rewarded for their work, that there is continuous development within that work, and that we attract people from a much more diverse range of backgrounds.

As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, we also have a carers action plan, which is to be published shortly. She spoke about her constituent, Katy Styles.

[Barbara Keeley]

The person I was talking about is not a constituent; she is a national campaigner for the MND Association, and she has an e-petition. It is important to note that she is running a national campaign.

[Caroline Dinenage]

I am grateful to the hon. Lady for clarifying that. I would say to Katy Styles that the decision about whether it is called a strategy or an action plan was taken before I was in my role, but an action plan sounds to me like a much more positive thing.

Actions speak louder than words. We are talking about not just a sense of direction, but what we are doing and how we intend to do it. That is why the carers action plan will be a really important piece of work. I massively value the work of carers up and down the country—indeed, my mother was one—and I want to ensure that we properly recognise and reward what they do. We must be doing what we can, and not just through the Department of Health and Social Care but in collaboration with colleagues across Government, to help and support carers and ensure that the issues they face on a daily basis are tackled.

[Barbara Keeley]

It is worth clarifying this point while the Minister is talking about the action plan. I told her that I did that piece of work years ago on the first national carers strategy, which came out in 1999 and went right across Government. The difference I see is that that was signed by many Departments, with commitment from those Secretaries of State, but the action plans under the coalition, and those we have seen recently, are just signed by Social Care Ministers; they are very much smaller things. Departmental action plans are not the same as cross-Government national strategies, and I understand why carers feel that strongly.

[Caroline Dinenage]

The hon. Lady has a surprise coming—this action plan is signed by Ministers from across Government.

The hon. Member for High Peak raised cost pressures. We can all admit that local authority budgets have faced pressures in recent years. They account for about a quarter of public spending, so they have had a part to play in dealing with the historic deficit that we all know we inherited in 2010. That means that social care funding was inevitably impacted during the previous Parliaments. However, with the deficit now under control, we have turned a corner.

Thanks to a range of actions taken since 2015, the Government have given councils access to up to £9.4 billion of more dedicated funding for social care from 2017-18 to 2019-20. Local authorities are therefore now estimated to receive about an 8% real-terms increase in access to social care funding over the spending review. In Derbyshire, the hon. Lady’s local council has seen an increase of £33 million in adult social care funding from 2017-18 to £201.8 million, which is above the 8% figure—it is a 10.3% increase on the previous year. The Care Act 2014 places obligations on local authorities and the extra funding is designed to help them meet those obligations.

[Ruth George]

I did not want to turn the debate into a political tit-for-tat, but I do not want my constituents in Derbyshire to think that suddenly there is a £33 million increase and everything is rosy for social care. The council has seen its funding cut by £157 million over the past seven years. Unfortunately, that increase is a drop in the ocean. In particular, the rise in the cost of the living wage impacts on care costs. What the council is getting back is nothing like what it has lost.

[Caroline Dinenage]

I have already recognised the fact that all local authorities have had to make some really tough decisions. We know it has been difficult for everybody. Taking that action to control the deficit and get the country’s finances under control has meant that we have turned a corner and we are now beginning to put that funding back in. I do not think we can deny that there were years that were very difficult for all local authorities. There is dedicated funding in adult social care; the funding goes to a specific cause, which is really important, and allows local authorities to support and sustain a more diverse care market. It also goes on to help relieve pressure on the NHS, including by supporting more people to be discharged from hospital as soon as they are ready.

The money is already beginning to have an impact. Delays of transfers out of hospital due to adult social care hold-ups have reduced by more than a third over the past 12 months, freeing up 820 beds. A key tool in developing more and better out-of-hospital services is the better care fund, which is a mandatory, national programme for integrating health and social care. It joins up services so that they are designed around people’s needs, enabling them to manage their own wellbeing and to live as independently as possible. By mandating the pool of funds, the better care fund has helped to join up health and care services and incentivise local areas to work better together with increasing amounts of funds being used in that process. Some 90% of local leaders have reported that the better care fund has helped them to progress integration in their areas.

We know that the burden of care cannot and should not continue to fall simply on hospitals. We need to move care into the home and into the community. There are great examples of how that is working in practice up and down the country. Public Health England, the Chief Fire Officers Association, the Local Government Association, NHS England and Age UK already have a joint working approach to establish how local fire and rescue services, for example, can be commissioned to check on people in their homes, to check on the safety of people’s homes, and to check on things such as trip hazards—all things that can lead to people being admitted to hospital or needing the support of social care services. They work together to encourage joint working around intelligence-led early intervention and, in doing so, reduce preventable hospital admissions.

Evidence has indicated that longer hospital stays for older patients can lead to worse health outcomes and an increase in their care needs on discharge. We know that for a healthy older adult, 10 days of bed rest leads to a 14% reduction in leg and hip muscle strength and a 12% reduction in aerobic capacity, which is the equivalent of 10 years of their life, which is a massive incentive to make sure we get people back into their own homes and active as quickly as possible, in the interests of their own wellbeing.

I am particularly interested in understanding how intermediate care—step-up and step-down services—can reduce the impact of health crises on individuals. A relatively minor infection or a temporary worsening of a chronic condition should never spiral into a prolonged hospital stay with a detrimental impact on long-term quality of life. The real goal of integrating health and social care is not simply a benefit to the system, but an emphasis on person-centred care. We need multi-disciplinary teams working around a person to maximise the effectiveness of interventions, and therefore minimise disruption to the individual.

The hospital to home programme brings together practitioners across health and social care to develop solutions for more patient-centred care, focusing on how to keep people at home. It shows how urgent and emergency care services, community services, primary care and social care can all work together to make sure that people get the right care at the right time and, crucially, in the right place. That partnership goes through everything that local partners do, whether providing interlocking services or commissioning the right pattern of services.

How can we push forward these aims and create a sustainable settlement for social care? In March, the Secretary of State for Health and Social Care outlined seven principles for the Green Paper on care and support and for adult social care reform, and he put a key focus on the need to integrate services around the individual for a seamless, whole-person approach to both health and care. We have committed to publishing the Green Paper by the summer, and when it is published there will of course be a full public consultation, through which we want to seek the broadest possible range of views. I look forward to the contributions of Members under that national discussion.

[Dame Cheryl Gillan (in the Chair)]

The hon. Member for High Peak has a couple of minutes to wind up if she so wishes.

Social Care

Caroline Dinenage Excerpts

Wednesday 25th April 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for introducing the debate. We want this to be the best country in the world in which to grow old and in which people can face their third age knowing that they will be supported to live healthy, independent lives for longer and for as long as possible, with a choice of good-quality, affordable care that is there, should they need it. Today’s debate is a welcome opportunity to cover the action that this Government have taken to improve social care, highlighting a few examples where real progress has been made, as well as discussing our longer-term plans for the Green Paper, which will be published later this summer.

Most of all, however, I want to do something that the hon. Lady forgot to do, which is pay tribute to the extraordinary people—both the social care workforce and the informal carers—who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country.

[Barbara Keeley]

The Minister has just said that I did not pay tribute to informal carers. That is just not true. Everybody who knows me knows that I have never stopped paying tribute to informal carers, and I did so in my speech today. Please will the Minister not attribute comments to me that I did not make?

[Caroline Dinenage]

What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.

[Norman Lamb]

The hon. Lady is right to pay tribute to informal carers, and indeed to paid carers, but does she not feel uncomfortable with the fact that she and all her colleagues on the Conservative side legislated with us to introduce a cap, committed in 2015 to implement the cap, then abandoned it, thus abandoning the very informal carers she says she cares so much about?

[Caroline Dinenage]

We have not abandoned the cap. The Prime Minister said very clearly that we would continue to consult on the cap, and that will come forward as part of our plans for the Green Paper later in the year. We in this Chamber often hear about Labour’s recession and how it led to some hard decisions about public spending to get the country back on track, but we often forget—

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

rose—

[Caroline Dinenage]

Let me make a little progress, then I will happily take the hon. Lady’s intervention.

We often forget that we inherited not only difficult spending choices but a social care system that was on its knees because successive Governments—not just Labour—had failed to act. Labour acknowledged the problem in its 1997 manifesto, promising to find a solution. However, 13 years later, after one royal commission, two Green Papers and the 2007 spending review pledging to address the situation, Labour left office without delivering it. Worse than that, by the time Labour left office, despite the booming economy, council tax had doubled and every year 45,000 older people were forced to sell their home to pay for residential care costs.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Let us get back to the present day, because that is what we are debating. Disabled people of working age make up more than half of adult social care users. Given that the UN condemned the Government’s breaches of the convention on the rights of persons with disabilities, particularly article 19 on independent living, what does the Minister estimate to be the impact on independent living for disabled people of the cuts to social care?

[Caroline Dinenage]

If the hon. Lady will bear with me, I will come on to discuss that, but there will be a separate, parallel workstream on working-age adults, who account for over half of the spending—

[Barbara Keeley]

Why?

[Caroline Dinenage]

If the hon. Lady will give me the courtesy of allowing me to finish my comments, I will explain why in a moment.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) wondered why we are going back to the past and looking at Labour’s record, but Labour is asking people up and down the country to vote for them in the local elections, so they will rightly look at Labour’s record and at how it dealt with the social care crisis when it was in government. After 13 years of inactivity and bluster, people need to be able to make a choice based on historically accurate facts.

[Barbara Keeley]

Will the Minister give way?

[Caroline Dinenage]

The hon. Lady had plenty of time to make her comments, so I will make a little progress.

When the Conservative party formed the coalition Government in 2010, it is worth remembering that not only did we have to deal with the parlous state of the country’s finances, but we inherited a burning platform of social care. Of course, that meant taking difficult decisions in those early years, which were challenging times for local authorities.

[Karin Smyth]

Will the Minister give way on the cap?

[Caroline Dinenage]

I will be coming on to the cap later.

To give the Labour party its due, it recognised that we had difficult decisions to make. Had Labour stayed in government, it planned £52 billion-worth of cuts to local government budgets by 2015. However—enough of the history lessons—I intend to make progress and answer many of the shadow Minister’s questions.

[Several hon. Members rose—]

[Caroline Dinenage]

If hon. Members will bear with me, I will now make some progress.

The tough spending choices that we have made have paid dividends, meaning that we have turned a corner in recent years. That is why local government will be able to increase spending on adult social care in real terms in each of the next three years. Our population is growing, ageing and diversifying. At the same time, the money, means and methods that we deploy to serve their long-term health and care needs are under increasing pressure to deliver, and we need to address those issues now.

There is recognition across the House that even if we had an infinite amount of money to fix the problem, the system would need reform. We are taking steps to make the system more effective and to ensure that it better serves the needs of vulnerable people and society in general. That is why this summer’s Green Paper will complement those measures and ensure that our social care system is placed on a sustainable footing and will serve this nation for generations to come.

The Secretary of State recently outlined the seven key principles guiding our thinking on social care as we approach the Green Paper: quality, whole-person integrated care; control; workforce; supporting families and carers; a sustainable funding model for social care; and security for all. As I have said, this is not just about older people. The Green Paper will cover a range of issues that are common to all adults with care and support needs, but we are committed ensuring that any issues relating to social care that are specific to adults of working age are identified and given the right focus. Work on that is being led jointly by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government.

I will reflect on some of the Green Paper’s themes, but first I will highlight a couple of areas where real progress has been made. I have said that we know there is growing pressure on local authorities’ finances, but it simply is not true that this Government are failing to deal with or acknowledge the crisis.

[Yasmin Qureshi]

The Minister talks about trying to use finances appropriately. My local council has had a 54% cut to the funding that it receives from central Government, which is why it has a shortfall in funding for social care.

The Government have been able to find money to cut corporation tax, capital gains tax and inheritance tax, as well as £1 billion for the Democratic Unionist party. Are they really saying this is all about austerity and choices? Is it not really that the Government have different priorities from the Opposition?

[Caroline Dinenage]

I can honestly say with my hand on my heart that the Labour party does not have a monopoly on care or kindness.

I mentioned earlier that local authorities will receive a real-terms, above-inflation increase in their funding profile. We have announced significant dedicated funding for social care. The Opposition regularly seem to forget that we allocated an additional £2 billion to social care only a year ago, with a further £150 million this year. That means councils have access to £9.4 billion of dedicated funding.

[Thelma Walker]

Kirklees Council has had its funding cut by central Government by nearly £200 million. This year, it has raised its council tax by 5.9% to help pay for services. The three percentage points for social care come to £4.8 million, but there is a shortfall of £12 million a year. Can the Minister tell councillors where the rest of the money for social care should come from?

[Caroline Dinenage]

We are looking at the long-term sustainability of adult social care funding, and there will be more news in the Green Paper later this year. The last Labour Government had 13 years without dealing with the here and now, so I will take no lessons from them.

[Several hon. Members rose—]

[Caroline Dinenage]

I will make a bit of progress.

The shadow Minister asked about Allied Healthcare. She is right to raise that, and I am grateful that she has done so. As she said, Allied Healthcare announced last Thursday that it is proposing a company voluntary arrangement to its creditors. I want to talk about that specifically because people across the country will be concerned. I spoke to the chief executive officer last Thursday to emphasise the importance of continuity of care for everyone receiving its services, both in adult social care and primary care, and the company has made it clear that those who receive services from Allied Healthcare will continue to receive the same level of care and that their care plans will not change.

[Barbara Keeley]

I am glad the Minister has responded in that way, but I asked her how she would ensure that 150 councils can fulfil their statutory duty to provide care if that company goes bust. We need to know a bit more than that she has had verbal reassurance. Of course the chief executive, in his current position, will try to give her verbal reassurance but, under the CVA, the creditors have to be satisfied within four weeks. What is going to happen if this company goes bust? Is it going to be another Southern Cross?

[Caroline Dinenage]

I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are working up contingency plans to ensure individuals’ care and support needs continue to be met.

While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.

[Maria Caulfield]

My local East Sussex County Council is a rural authority, so for decades it has had 49% less funding per head of population, yet it has had the same pressures as the areas represented by Opposition Members. By working together with health services, my council has reduced delayed discharges by 38%. Will the Minister welcome the hard work of East Sussex County Council?

[Caroline Dinenage]

I do welcome it. I recognise the very hard work of local councils that have managed to reduce delayed transfers of care. Indeed, I also recognise the very hard-working NHS staff, such as my hon. Friend, who have also helped to make that a reality.

We know that the NHS is busier than ever before, with hospital admissions rising by 33% since 2007, yet we have set clear expectations for reducing delayed discharges. Despite these challenging circumstances, both the NHS and social care have been working hard to free up beds. Since February 2017, more than 1,600 beds per day have been freed up nationally. I need slightly to take exception to the way the hon. Member for Worsley and Eccles South described people being discharged before they are medically fit. If someone is experiencing a transfer of care that has been delayed, it is because a multi-agency team have already assessed them as being medically fit for discharge.

[John Redwood]

Following on from the point about the big variations in how much per head councils get, may I point out that some time ago West Berkshire and Wokingham were cut back because they were very efficient and doing a good job? Will the Minister make sure that in the new formula good conduct is taken into account and does not lead to penalties?

[Caroline Dinenage]

I will certainly take that into consideration.

[Barbara Keeley]

The Minister is just proving that she was not listening to what I was saying. What I said was that the British Red Cross has said that it had found innumerable cases where discharges have happened so quickly that people were discharged without the right amount of care, and that can just lead to a cycle of readmission. A constituent told me that, in the case of Salford Royal, which is an excellent hospital, she felt she had been “thrown out of hospital.” That is what she told me.

[Caroline Dinenage]

I very much thank the hon. Lady for that clarification.

Our funding increases have gone into initiatives such as the better care fund, which provides a mechanism for local authorities and clinical commissioning groups to pool budgets for the purposes of integrated care.

[Rachel Maclean (Redditch) (Con)]

Will the Minister give way?

[Caroline Dinenage]

I hope my hon. Friend will not mind, but I want to make a little progress. The fund has helped to join up health and care services so that people can manage their own health and wellbeing, and live independently in their communities for as long as possible.

Another area where we have made significant progress is quality and safeguarding. The Care Act 2014 placed adult safeguarding on a statutory footing for the first time and established a national threshold that defines the care needs that local authorities must meet. This eliminates the postcode lottery of eligibility across England. Last year, local authorities in England advised more than 500,000 people 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.

Everyone is entitled to, and deserves, quality care, and we are working to improve the terms and conditions for people accessing care, to ensure that their rights are protected.

[Norman Lamb]

On the sleep-in allowance, is it reasonable to expect providers to fund these back-pay claims, given that at the time the liability was incurred commissioners and providers entered contracts on the basis of what the Government said was right in terms of the minimum wage? When the Government change the position, surely it is not fair on organisations, private or third sector, retrospectively to expect them to pay.

[Caroline Dinenage]

I understand and share the right hon. Gentleman’s concerns on sleep-ins, and will be addressing this a little later in my comments.

We have established adult safeguarding boards to help to protect vulnerable adults in our society from abuse or exploitation. They can also act as an important source of advice and assistance for those using the adult safeguarding system. This Government also introduced the toughest system of care home inspection in the world. Eighty-one per cent. of adult social care providers are good or outstanding according to the CQC, which is a testament to the many hard-working and committed professionals working in care, to whom we owe a huge debt of gratitude. The CQC regime is already having a positive impact and 82% of providers who are rated as inadequate go on to improve.

Regardless of that, there is too much variation in the quality of care. Neighbouring local authorities can have radically different success rates on care quality and we are taking steps to address that. We are 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.

We welcome the Competition and Market Authority’s recent market study on care homes. It makes difficult reading, but we have welcomed it and as part of developing the Green Paper the Government are carefully looking at all the issues identified. What is more, we have published a package of measures to improve consumer protections in the social care sector after the CMA raised concerns about unfair consumer practices in homes, including the charging of unfair fees to residents and the lack of contractual and pricing transparency.

Those measures, which include working alongside industry to develop model contracts and supporting the CQC to better hold providers to account, aim to put the power back into the hands of residents and their families. We are clear, however, that if improvements are not seen we will look to change the law to strengthen protections so that people can be treated with the dignity and respect they deserve.

That leads me to the third aspect on which I want to focus. Ultimately, the social care workforce are the backbone of the care sector. We know that there are challenges and that is why we need to ensure that they are supported to deliver the best-quality care now and in the future. Part of that endeavour involves respecting not only the compassion and dedication of care workers but the vast range of skills they have. Alongside social workers, occupational therapists and nurses, we have many care workers who could benefit from or be inspired by new career progression ladders. We need to ensure that we have enough people within all those skilled roles to support individuals and families in living their best possible lives. That means ensuring that new routes into social care professions have as much variety and value as those developed by the NHS. Apprenticeships are part of that story. I am proud that in 2016-17 more than 90,000 social care apprentices began their training. That is up more than 40,000 compared with in 2010.

Of course, pay remains a constant and often emotive issue. Care workers deserve a wage that reflects the true value of their work. The national living wage is, in part, a reaction to that and the average salary for a care worker in the independent sector has gone up by 4%, with those full-time staff on the minimum wage seeing a pay rise of up to £2,000 since 2015. We are not complacent about the economic pressures faced by many in the system, but that is a good place to start.

A couple of hon. Members have spoken about sleep-ins and they are absolutely right to raise that. The Government are committed to creating an economy that works for everyone, ensuring that workers are paid fairly according to the law, including through the national minimum wage, but we recognise the pressure that has been placed on the sleep-in sector by historic liabilities for back pay. We are carefully exploring options to minimise any impact on the sector caused by this and have been engaging with the European Commission to ensure that any response would be legal. The Government will continue to work with representatives of the social care sector to strengthen the evidence base, building on the work we began over the summer. I will, of course, keep the House informed when we have made progress.

There are thousands of care workers in England, and we need many more, but it is true that we already have hundreds of thousands of carers out there—the unpaid hidden army of family, friends and community volunteers without whom the system would simply grind to a halt. We know that about 60% of us are likely to become carers at some stage in our lives. As it is today, one in eight of the adult population is a carer. That is why carers will be a fundamental part of the Green Paper. A sustainable settlement for social care will simply not be possible without focusing on the support we provide to them. Ahead of the Green Paper’s publication, we will shortly publish an action plan on carers, setting out a cross-Government programme of targeted work to support carers over the next couple of years.

Another principle that the Secretary of State has spoken about in the context of the Green Paper is control. We know that the greater control people have over their care, the better the outcomes. The only people who have a specific right to have a personal health budget are adults in receipt of NHS continuing healthcare or children receiving continuing care, which is why earlier this month we launched a consultation on extending the right to personal health budgets and integrated personal budgets to achieve better outcomes for those with the greatest ongoing social care needs as well as health needs. Those are some of the principles that are guiding the Green Paper. The goal is that, whatever a person’s age, they can be confident in our care and support system, not just for their own health and care needs but for those of the people close to them.

[Karin Smyth]

The 2015 Tory manifesto was very clear on the commitment and the assurances about the cap. The 2017 manifesto abandoned that. I think the Minister said earlier that it is still part of the Government’s considerations. Will she clarify from the Dispatch Box today what we are to expect in the Green Paper with regard to the cap?

[Caroline Dinenage]

The Prime Minister said last year in the general election that we would be consulting on the cap in due course and that will be part of the Green Paper. Building a sustainable care and support system will require some big decisions, but getting this right promises a better system in which everyone can have confidence, where people understand their responsibilities, can prepare for their future and know that the care that they receive will be to a high standard and help them to maintain their independence and well-being. The paper will set out options to put the social care system on a more secure footing and address issues to improve the quality of care and reduce the variation in practice.

[Several hon. Members rose—]