Draft Employment Rights Act 1996 (NHS Recruitment-Protected Disclosure) Regulations 2018
Caroline Dinenage Excerpts(6 years, 7 months ago)
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The Minister for Care (Caroline Dinenage)
I beg to move,
That the Committee has considered the draft Employment Rights Act 1996 (NHS Recruitment—Protected Disclosure) Regulations 2018.
It is a great pleasure to serve under your chairmanship, Ms Dorries. The draft regulations prohibit certain NHS employers from discriminating against job applicants who have disclosed certain information—often called whistleblowing. Applicants have a legal recourse should they feel they have been discriminated against, with appropriate remedies if their complaint is upheld. An NHS employer discriminates against an applicant if they reject the job application or otherwise treat them less favourably than other applicants.
We want to ensure that the NHS is the safest and most transparent healthcare service in the world. To achieve this, those who work in the NHS must feel safe speaking up and raising concerns at work, and confident that action will be taken without having a negative impact on their career or employment opportunities. The draft regulations will help to send a very clear message that openness, transparency and fairness should be the norm within the NHS. They will also increase the trust that patients, other service users and the wider public, have in the NHS.
We want NHS employers to be exemplars in fostering a culture of openness and willingness to report problems. We want an NHS in which lessons are learned, to provide the safest possible care for patients.
Caroline Dinenage
I am grateful to the hon. Gentleman for his support in this important matter. For too long, we have failed to protect those who are brave enough to speak out when others do not. We learned from the Mid Staffs case about what happens when there is a defensive culture and people cover up mistakes. We want to make the NHS the safest healthcare system in the world, so we must build a culture of openness and transparency. If we are to do that, healthcare professionals need to feel that they are safe to speak out about problems in the workplace. We want them to feel safe in raising problems, so that speaking out becomes the norm and not the exception. These important measures should ensure that staff can raise concerns, knowing that they are protected by the law and that their career in the NHS will not be damaged as a result of doing the right thing.
The hon. Gentleman asked a number of important questions and I will attempt to answer as many as I can, but I will respond in writing on any that I omit, if that is acceptable. We need the draft regulations, in addition to the Employment Rights Act 1996, to protect people from detriment when they have spoken up in the public interest when they reasonably believe that they witnessed wrongdoing. “Worker” has a wide meaning in this context: the original legislation does not include job applicants, so the draft regulations address that. In addition, they provide that discrimination against a job applicant by an NHS employer is actionable as a breach of statutory duty. That gives job applicants additional protection and includes the right to bring a claim in the civil courts for a breach of statutory duty—for example, to prevent discriminatory conduct.
The draft regulations also treat the discrimination of an applicant by a worker or agent of the prospective NHS employer as if it were discrimination by an NHS employer. NHS staff who are prepared to speak out are an important asset, and workers who have previously had the courage and the compassion to do this should also be considered a valuable asset by the NHS body that is considering whether to employ them. I am sure that the hon. Gentleman agrees.
The draft regulations give NHS job applicants a right to complain to an employment tribunal if they feel that they have been discriminated against. The draft regulations set out a timeframe of three months, as he identified: that is consistent with the time limit for employment claims generally. The draft regulations also make it clear that, in the case of a decision by an NHS employer not to employ or appoint an applicant, the three-month time limit starts from the date that the decision was communicated to the applicant and not the time that the decision was made by the employer. The draft regulations enable the tribunal to consider a complaint that is otherwise out of time, if it considers it just and equitable in the circumstances.
Justin Madders
I know that the Government want to reduce the number of tribunal applications made. Does not the hon. Lady feel that there is a risk that, if employers are putting in applications not in possession of the full facts, more litigation would actually be encouraged rather than less?
Caroline Dinenage
The Government will keep that under review. It is important that we keep this as consistent as possible with the time limits for general employment cases, but if there do appear to be any issues along those lines, they can be reviewed.
The draft regulations also set out the remedies that the tribunal may or must award if the complaint is upheld. The employer may be ordered to pay compensation or the tribunal may recommend that the employer take other specified steps or make a provision on the amount of the compensation that may be awarded.
The application to an employment tribunal under the draft regulations is subject to the early conciliation regime, which provides an opportunity to resolve the claim via ACAS. We often find that, when people are able to resolve their differences via ACAS, it helps to alleviate the problem of someone who has had tribunal experience to the detriment of their future employment. It should also help to ensure that only cases that cannot be resolved through other methods actually reach the final step of an employment tribunal.
The draft regulations enable an employment tribunal to order compensation to be paid where there has been an actual breach of the prohibition on discrimination. The power to award damages is discretionary. Ultimately it is for the court to decide whether damages should be awarded, and we expect the court to take into account all the relevant factors when deciding whether that is appropriate, and to act fairly.
The hon. Gentleman is right to ask why the measures focus specifically on NHS employers. That was the original reason behind the legislation. The freedom to speak up is important, though, and we shall keep the regulations under review and assess their impact on the NHS before we assess the possible impact on other employers, such as social care providers.
Justin Madders
It was not just the fact that it is applied only to NHS employers, but that it is applied only to some NHS employers. I gave examples of various organisations within the NHS that are not covered by the regulations.
Caroline Dinenage
I totally understand what the hon. Gentleman is saying—for example, GPs are not covered if they have independent contractor status, because the powers for the regulations in the 1996 Act are limited to NHS public bodies. As I said, though, we will keep all of that under review and come back to it if necessary.
We talked about future-proofing. As I said, we will review it over time. It is important that there are existing protections for employers as well; this is not just about employees. Under the draft regulations, the normal route for individuals would be via a normal employment tribunal. The fees have recently been abolished, and I do not think there are any plans to revisit that decision. The Government will keep the matter under review to assess the impact, before making any further decisions.
The hon. Gentleman mentioned the definition of a “worker”, which for the purposes of these regulations would carry the extended meaning under the Employment Rights Act. That is already a broad definition, and we will need to consider carefully whether there is a case for extending it. The test for discrimination includes the concept of appearance to the employer. That is actually in the primary legislation—the Employment Rights Act—and the regulations reflect that. We will again keep under review how that legislation is working.
If there are any questions I have not answered, I shall be happy to write to the hon. Gentleman. I commend the draft regulations to the Committee.
Question put and agreed to.
Autism
Caroline Dinenage Excerpts(6 years, 7 months ago)
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The Minister for Care (Caroline Dinenage)
I will start by heaping praise on my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) for securing this important debate and her incredible work over many years to raise the awareness of autism both within and outside this place. It is thanks to her ground-breaking private Member’s Bill on autism that we now have an adult autism strategy. Next year, it will be 10 years since her Bill became the Autism Act 2009, transforming services for autistic adults and having a huge impact on public awareness of autism. That is entirely down to her.
Caroline Dinenage
I am not going to give way too much because I have a lot to get through, but I will definitely give way to my right hon. Friend.
Dame Cheryl Gillan
I thank the Minister and other Members who have acknowledged that I have had a part to play in this. She is sitting next to my hon. and learned Friend the Member for South Swindon (Robert Buckland); he and Members of all parties have contributed to this work. I assure the Minister that no one MP can do this on her own. My tribute is to all those people who have done the hard work and the heavy lifting.
Caroline Dinenage
My right hon. Friend is as honourable and modest as ever. I also want to thank all the other Members who have worked long and hard on this over a number of years, and those who have contributed so beautifully today. This high-quality debate has included strong personal stories and great examples of fantastic constituency work.
I thank the Backbench Business Committee for enabling this debate to happen during World Autism Awareness Week. It has given us the opportunity to draw much-needed attention to the challenges that autistic people, and their families and carers, face on a daily basis. Members who have spoken are absolutely right to say that we need to understand more about autism across all sectors of society and in all parts of government. I share their determination to address this important issue.
Since the introduction of the autism strategy in 2010, it has done much to improve the lives of those living with autism, but we know that there is still much to be done. As hon. Members may be aware, we have recently put in place revised governance arrangements to continue taking forward the strategy. On Monday I had the pleasure of chairing the first annual accountability meeting, where I heard from key stakeholders, self-advocates and partners about the challenges facing autistic adults across England and how we can keep making progress in realising the ambitious autism strategy.
Caroline Dinenage
May I make a little bit of progress? I will take questions if I manage to get through this wad of paper.
In reference to a point made by the hon. Members for Huddersfield (Mr Sheerman) and for Cardiff West (Kevin Brennan), there were representatives at that meeting from all the other Government Departments, including the Department for Transport, the Department for Work and Pensions, the Department for Education and the Home Office. The hon. Gentlemen were absolutely right to point out that this subject reaches all Government Departments. It was clear that the complexity of autism and the multifaceted nature of the needs of those on the spectrum pose particularly challenging questions. Frequently this results in regional disparities that are far too wide in autism diagnosis waiting times and in the services someone can access once they have a diagnosis. Some areas are doing well, but others are not, and we need to ensure that good practice is identified and shared across all areas.
Many Members have highlighted particular challenges that autistic children face in school. My hon. Friend the Member for Henley (John Howell) explained exactly why it is important that autistic children are well supported in their education if we are to raise their attainment and improve their life chances. The Government congratulate the all-party group on autism on its report about education in England, which was published in November. It is really important that support for young people with autism is targeted where it will be most effective. The recommendations of that report are being considered by the Department for Education and will be key to its plans. As my hon. Friend said, all teachers are now trained to help children with conditions such as autism as part of their teacher training. Since 2011, we have funded the Autism Education Trust to provide autism awareness training for more than 150,000 education staff—not just headteachers, teachers and teaching assistants, but support staff such as receptionists and dinner ladies, thereby encouraging a whole-school approach to supporting children.
Exclusions were mentioned by a number of Members, including my hon. Friend the Member for Henley, my right hon. Friend the Member for Harlow (Robert Halfon), my hon. Friend the Member for Cleethorpes (Martin Vickers) and the hon. Members for Cardiff West and for Bedford (Mohammad Yasin). We are funding work via the Autism Education Trust to provide advice to parents and professionals on trying to cut down the number of exclusions. We have introduced the biggest reforms to special educational needs and disability support in a generation; introduced education, health and care plans that are tailored to a child’s needs; and given councils £223 million extra funding to help them to introduce these significant reforms.
Diagnosis was mentioned by many hon. Members. Adults and children should not have to face long waiting times for autism diagnosis. We will continue to work with partners to try to address these long waiting times. This is also a key part of the task and finish group that is being led by NHS England. We have included autism indicators in the mental health services dataset, with data beginning to be collected from 1 April this year. This is a real step forward. We need such robust, comparable data to be regularly collected and monitored so that we can be certain of the true extent of the problems not just on waiting times for diagnosis, but on post-diagnostic outcomes. In the Think Autism strategy, we are clear that there should be a pathway to diagnosis, care and support in every local area so that we improve recognition, speed up the process of diagnosis, and meet individuals’ advice and support needs.
I have previously described my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) as a force of nature, and today we saw another example of that. She spoke about regional centres of excellence—a fabulous idea—and said that there is nothing wrong with people with autism; they are just different. I had the pleasure of meeting her different and fabulous son James for an evening in Edinburgh last summer. I would hate to be on the receiving end as somebody she encountered in a shop giving her fine young gentleman a hard time.
Mr Sheerman
Will the Minister give way before she concludes, as she said she would?
Caroline Dinenage
If you will give me a little extra time to complete my remarks, Madam Deputy Speaker, yes.
Mr Sheerman
I am grateful to the Minister, who is making an excellent speech. I just wanted to get her to say something about the report we launched yesterday—I know she could not make the event—about people selling harmful interventions to individuals on the autism spectrum. Does she believe that that is a problem?
Caroline Dinenage
The hon. Gentleman is absolutely right to raise this; I know that he has done so at Health questions in the past. The Department of Health and Social Care does not in any way condone any of the so-called cures or remedial substances that are being proffered. We do not think that any of them are any good whatsoever.
Last year, NICE’s indicator advisory committee recommended including autism diagnosis in a menu of GP indicators. A review of the quality and outcomes framework is being undertaken by NHS England, and it will conclude later this spring. NHS England has confirmed that the GP autism register will be considered in the context of this work.
We know that there are sometimes issues with the health gap. The hon. Member for Dulwich and West Norwood (Helen Hayes) raised the case of her constituent, Matthew, which shows how horrible things can be when they do go wrong. I will be very happy to meet her to ensure that Matthew’s experience is not in vain.
Many Members raised issues around employment. We know that having a job is not just about earning a living, as it also contributes to people’s wellbeing, gives them a sense of belonging and purpose, and builds self-confidence and self-esteem. Through the Disability Confident scheme, the Department for Work and Pensions is engaging with employers and helping to promote the skills, talents, abilities and value of people with autism. Additionally, Access to Work has a hidden impairment support team that gives advice and guidance to help employers to support employees with conditions such as autism, to offer eligible people an assessment to find out their needs at work, and to help to develop a support plan.
My right hon. Friend the Member for Harlow, the brilliant Chair of the Education Committee, who is passionate about apprenticeships, made a brilliant point about the need for more focus on ensuring that children do not drop off the edge when they leave school. We will certainly take that forward. In December, the DWP published “Improving Lives: The Future of Work, Health and Disability”, which set out how it will deliver on its ambitious plan to help 1 million more people with a range of disabilities into work.
On the civil service becoming an autism-friendly employer, we have committed to support the autism exchange programme, and the civil service is working with Ambitious about Autism to provide work placement opportunities for young people.
On access to democracy, under Representation of the People Acts, polling stations must be as accessible as possible to disabled voters. We recognise that there might be specific challenges, and we will explore with the Electoral Commission what further adjustments can be made.
A few Members talked about the criminal justice system. The Ministry of Justice is working with the Home Office and the Crown Prosecution Service to develop a guide to help officers to identify people with autism. That is now included as part of all police training. NHS England has also issued a revised liaison and diversion specification, which includes autism. To date, eight prisons and young offenders institutions, including Feltham, where the programme started, are part of the criminal justice accreditation scheme, and another 35 are currently looking at the process.
I am really disappointed to hear examples from Members across the House of bad experiences with jobcentre staff, PIP, work capability assessments and so on. All healthcare professionals conducting work capability assessments and other things receive extensive training regarding autism spectrum disorder as part of their new entrant training. All work coaches in jobcentres receive the same training, but I will pass those comments on to the Department for Work and Pensions.
The hon. Member for Bristol West (Thangam Debbonaire) is clearly a true champion for autism in her local area, and I give her massive credit for what she does. She mentioned loneliness. I will be working closely with the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), in developing the cross-Government strategy on loneliness, which is supported by the Prime Minister.
We have heard wonderful examples of great community projects offering fantastic support in different Members’ local areas, and I should give a shout-out to the incredible Marvels and Meltdowns in my constituency—a blatant plug.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) mentioned poor mental health. Obviously that is not an inevitable consequence of autism, but if someone has autism and a mental health problem, it is essential that they can get the appropriate help and support.
The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) highlighted worrying figures about suicide. We are committed to tackling suicide in every community and for everyone who is at risk, and we updated the national suicide prevention strategy last year to strengthen delivery on key areas.
I want to join the hon. Member for Dewsbury (Paula Sherriff) in paying tribute to the National Autistic Society and its Too Much Information campaign, Autism Alliance, Autistica and various other charities throughout the country that do fantastic work to raise awareness and offer support.
We all want to live in a world and in a country where autism is never a barrier to the opportunity afforded to others. World Autism Awareness Week enables us to continue keeping this issue high on the agenda and in the minds of policy makers, professionals and members of the public alike, which is where it should be.
Question put and agreed to.
Resolved,
That this House notes that World Autism Awareness Week 2018 runs from 26 March to 2 April; believes that there is a lack of understanding of the needs of autistic people and their families; and calls on the Government to improve the support provided to autistic children in school and to autistic adults in or seeking employment, to reduce waiting times for autism diagnosis, and to promote a public awareness campaign so people can make the changes necessary for the UK to become autism-friendly.
Patient Safety
Caroline Dinenage Excerpts(6 years, 7 months ago)
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The Minister for Care (Caroline Dinenage)
I wish to start by congratulating my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing this really important debate on patient safety. All patients have a right to expect care that is compassionate, effective and safe. The courageous testimonies of individuals such as Julie Bailey, who exposed the scandalous failings at Mid Staffordshire NHS Foundation Trust, and Sara Ryan, who campaigned fearlessly following the death of her son, Connor Sparrowhawk, while in the so-called care of Southern Health, show that safer care starts with listening to patients and their families.
It is important that we recognise that there are many victims when care fails—the families and the loved ones, of course, but also the healthcare professionals who carry the burden of their mistakes. The great majority of NHS patients receive effective and successful care. However, according to international studies, levels of healthcare harm range from 1% for the most “negligent” adverse events, to 8% to 9% for preventable adverse events. We are clear that any level of harm over 0% is unacceptable, and we believe that the route to a safer NHS is through transparency, learning and action. What is most frustrating is when harm persists, despite our having the knowledge and wherewithal to prevent it. There are approximately nine “never events” in the NHS every week—avoidable harms such as wrong-site surgery or foreign objects left after an operation.
Thirty years ago, the aviation industry stood at a similar crossroads. Since then, there has been a massive reduction in fatal accidents every decade, despite a huge increase in the number of passengers. According to the Civil Aviation Authority, there is an average of one fatality for every 287 million passengers carried by UK operators. Compare that with the 150 avoidable deaths every week across the NHS. That rate would potentially equate to the loss of 52 airliners per year.
How has the airline industry transformed its safety record so successfully? The key has been a “just culture” that recognises honest human error, but continues to hold people to account for criminal acts or wilful negligence. Creating a safe space that protects the evidence provided by pilots and air traffic controllers when there is an investigation is a cornerstone of the approach. It helps to create a culture in which people can be open about their errors and a system of learning from one’s mistakes, rather than blaming individuals.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Member for Sleaford and North Hykeham (Dr Johnson) on securing this debate on an important matter. NHS staff are greatly restricted by their work and the long hours they do. We all know that and pay tribute to them. Sometimes, however, we have to look at better ways of keeping records and at innovations to streamline things to make sure that the real focus of NHS staff is on the work that they do. Has the Minister looked at streamlining and innovations to take away the red tape that restricts the caring job that NHS staff do?
Caroline Dinenage
The hon. Gentleman is absolutely right. The more we can innovate and put in place the technology that helps to streamline day-to-day processes, the more that will help NHS staff, who do such a marvellous job, to do their job even more effectively and efficiently.
As my hon. Friend the Member for Sleaford and North Hykeham rightly said, to err is human. I am told that every year, 30,000 motorists put diesel fuel into their petrol cars—that is around 15 every hour. Those people are not intentionally destructive or feckless, they are human. Of course, I am not making an analogy with medical mistakes, which can be significantly more damaging and life-changing than the need to get a new engine, but in the same sort of way we need to move away from a blame culture in health—away from investigations that single out one individual rather than seeing their actions in the context of a complex overarching system.
Rachael Maskell
Robert Francis’s report included 290 recommendations to address these issues, not the least the duty of candour. However, people are still fearful to report—why is that?
Caroline Dinenage
I think it is for a variety of reasons. The hon. Lady is absolutely right to raise that issue; if she bears with me, I shall come to it a little later.
A first step in our new direction, based on an aviation model, is the Healthcare Safety Investigation Branch, which became fully operational in April last year and will independently investigate some of the most serious patient safety incidents every year. It is the first investigatory body of its kind in the world and demonstrates our commitment to learning and innovation. As part of the Government’s drive to make the NHS the safest place in the world to give birth, HSIB will standardise investigations of cases of unexplained severe brain injury, intrapartum stillbirths, early neonatal deaths and maternal deaths in England.
As an MP who represents a constituency in the area served by Southern Health, I am particularly aware that tragedy can spiral when an organisation loses sight of systematic problems in its provision of care. Our Learning from Deaths programme is a direct response to such events. Trusts are now expected to have proper arrangements for learning from the deaths of patients and are subject to new reporting arrangements, including evidence of learning and improvements. I should add that we are one of the first countries in the world to measure deaths in this way. Through Learning from Deaths, NHS England is supporting improved engagement across the NHS with bereaved families and carers.
As my hon. Friend the Member for Sleaford and North Hykeham rightly says, healthcare professionals need to feel safe to speak out about problems in the workplace. To support that, we have introduced an independent national officer for whistleblowing, and new regulations to prevent discrimination against whistleblowers who move jobs. Recent commentary in the media and among professionals has highlighted a possible brake on openness and transparency arising from high profile convictions of healthcare professionals for gross negligence manslaughter, which is exactly the same example as the one that she cited. That is why the Secretary of State for Health and Social Care announced in February that he was asking Professor Sir Norman Williams, former President of the Royal College of Surgeons, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.
Absorbing the review’s recommendations into our healthcare system will be crucial to ensure that our healthcare professionals feel valued and secure, and that includes the GMC. The deadline for submitting evidence is April, and I encourage patients, families and professionals to contribute.
It is essential that infants have the best possible start in life, and the safety of mothers and their babies is a fundamental starting point for safer care. In November 2017, the Secretary of State announced his intention to bring forward the ambition to halve the rate of maternal deaths, neonatal deaths, birth-related brain injuries and stillbirths by 2025—a full five years ahead of our previous target. Pre-term birth is a major health inequality with mothers, and the Secretary of State has set an ambitious target to reduce the national rate of pre-term births from 8% to 6%.
Continuity of care is a key factor in a healthy pregnancy. Evidence shows that women who continue to receive care from the same midwives are 19% less likely to miscarry, and 16% less likely to lose their baby. That is why, yesterday, the Secretary of State announced important steps towards ensuring that the majority of women receive care from the same small team of midwives throughout their pregnancy, labour and birth by 2021. That announcement includes 650 new training places for midwives in 2019, which represents a 25% increase in the number of midwives in the UK.
We can never be complacent. Zero harm might sound impossible to achieve, but it should always be our aim. By learning lessons when things go wrong, listening to patients and their families, and working across the whole system to create a genuine culture of improvement, this Government are making a significant and lasting contribution to patient safety.
Question put and agreed to.
Oral Answers to Questions
Caroline Dinenage Excerpts(6 years, 8 months ago)
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Mr Mark Francois (Rayleigh and Wickford) (Con)
The Minister for Care (Caroline Dinenage)
Since 2016, the Government have invested £750,000 to fund the provision of sports and activity prostheses for children and young people on the NHS. We have also invested a further £750,000 in a new National Institute for Health Research child prostheses research collaboration to drive improvements in technology. I can confirm that that funding will continue, and we will announce more details shortly.
Mr Francois
I thank the Minister for that reply. The centre at Headley Court provides world-class support for our servicemen who unfortunately lost limbs in Iraq or Afghanistan. It does incredible work. What lessons have we learned from Headley Court that we are able to transfer into the NHS?
Caroline Dinenage
My hon. Friend speaks about this with great knowledge. He was an outstanding Defence Minister and understands this subject better than almost anybody. He will be pleased to learn that, following the incredible progress that we have seen with adult prostheses through places such as Headley Court, we are now seeing the same technology in the development of children’s sports and activity prostheses, using the same manufacturers. The research collaboration will also enable us to invest in future studies, including in the development of some exciting technologies, such as myoelectrical bionic upper-limb prostheses for children.
Richard Graham (Gloucester) (Con)
The Minister for Care (Caroline Dinenage)
Over the last three years, about 65% of social care service users have been extremely or very satisfied with their care and support in England, and 81% of adult social care providers are rated good or outstanding.
Dan Carden
Since 2010, Government funding for Liverpool City Council has been cut by 64%, or £444 million in real terms and, given that 90% of properties are in bands A to C, our ability to raise money locally through council tax is at the bottom end of the UK average. We need integrated health and social care, but a departmental name change will not do it; we need the money locally. When will we see proper reform and proper funding to plug the gap in our most deprived areas?
Caroline Dinenage
The hon. Gentleman is right to say that the integration of health and social care is vital, and I think that the renaming of the Department is a symbol of how seriously the Government take our commitment to it. I am keen to talk to him about funding, given that the figures for Liverpool show that it is raising £7.4 million from the social care precept and has received approximately £21 million in grant from the Government.
Mr Mark Harper (Forest of Dean) (Con)
I agree that the social care system needs more funds. In recent Budgets, the Chancellor of the Exchequer has found those funds and put them into the system. May I urge my hon. Friend, as she looks at the Government’s proposals in the Green Paper, to ensure that the Dilnot proposals are included? Those proposals, for which we have already legislated, will give us the best chance of a sustainable system in the current Parliament.
Caroline Dinenage
The Secretary of State was with Andrew Dilnot yesterday, and we are looking carefully at his proposals. My right hon. Friend is right: although 81% of adult social care providers are registered as good or outstanding, it is unacceptable for levels of care to fall below the standards that we would expect, and in preparing the Green Paper, we will look closely at how we can improve the system.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
Caroline Dinenage
I do not entirely agree with what the hon. Gentleman has said. We provided an extra £2 billion in last year’s Budget to help councils to commission care services that are sustainable, high-quality and diverse. In the Green Paper, which will be published this summer, we will consider how we can future-proof the system.
Mr Philip Hollobone (Kettering) (Con)
The Government inspector for Northamptonshire County Council has recommended that, because of misgovernance over the last five years, the council should be abolished. Will my hon. Friend and her colleagues work with the new successor authorities to ensure that a successful social care system is established in the county?
Caroline Dinenage
The Secretary of State has already had conversations with councillors about this matter, but my hon. Friend is absolutely right to raise it. The Care Act 2014 placed a duty on local authorities in England to promote diverse, sustainable, high-quality care, and it is important for them to continue to do that.
Barbara Keeley (Worsley and Eccles South) (Lab)
The National Audit Office says that our care system is not “sustainably funded”, the Care Quality Commission says that one quarter of care facilities are not safe enough, and care providers cherry-pick to whom they will give care places, and even evict people with advanced dementia on cost grounds. What is the Care Minister doing to address those issues and the sharp decline in public satisfaction with the social care system?
Caroline Dinenage
We know that the sector is under pressure because of the ageing population, but the Government have given councils access to £9.4 billion more dedicated funding over three years. The hon. Lady is right to emphasise the importance of putting power back in the hands of residents and their families, which is why we published a package of measures to ensure and protect consumer protections in the social care sector, and we will continue to look at that very closely.
Huw Merriman (Bexhill and Battle) (Con)
Nigel Mills (Amber Valley) (Con)
The Minister for Care (Caroline Dinenage)
Patient safety, and particularly infection prevention, are among the Government’s key priorities. Public Health England has carried out some initial analysis of available data. However, currently the data is incomplete and would not give a true reflection of the usage of hand gel. We are working with Public Health England to explore how we can improve that data.
Nigel Mills
I am sure the Minister will agree that it is a matter of real importance that all NHS staff wash their hands at all the required five moments of patient contact. Does she agree that it is disappointing that we have not quite got that data published yet, and will she set a date when we will be able to see that data for each trust?
Caroline Dinenage
As I have said, we will continue to look at that, but, as my hon. Friend knows, the Department has a really strong track record of tackling infection. Incidents of MRSA are down 54% on 2010. We have published a revised code of practice on hand hygiene and we are working with partners across health and social care to ensure that this remains a focus.
Stephen Pound (Ealing North) (Lab)
There has been some excellent work on extending hand gel usage throughout the NHS, and the decline in MRSA is, I think, indicative of that. However, there is a glaring prejudice, certainly in my part of the world, amongst people who think that these gels contain alcohol, and will not use them for that reason. Is it possible to instigate some form of signalling or marking to prove and to state that there is no alcohol within these hand gels, because we do not want to see people prevented from using them?
Caroline Dinenage
The hon. Gentleman makes an excellent point, and it is certainly something that we can look at more closely.
Theresa Villiers (Chipping Barnet) (Con)
Will the Minister explain the work that the Government are doing with Public Health England to raise awareness of sepsis infections, and do urgent work to tackle that potential killer?
Caroline Dinenage
This is a massive priority for the Government, and we are about to start a public information campaign. Sepsis is a killer—one that deserves to be given the utmost importance, and one that we will be seeking to tackle in every way that we can.
Anna Turley (Redcar) (Lab/Co-op)
Edward Argar (Charnwood) (Con)
The Minister for Care (Caroline Dinenage)
Dementia Awareness Week runs from 21 to 27 May, and the Department of Health and Social Care is expecting to participate fully in a range of activities that week, working with partner organisations and the voluntary sector.
Edward Argar
Alongside the work of Governments of both parties to improve dementia research, care and awareness—Dementia Awareness Week is a key part of that—the role of voluntary organisations and dedicated volunteers around the country is vital. Will the Minister join me in paying tribute to the fantastic work of specialist dementia care Admiral Nurses and in backing Leicestershire Dementia UK volunteers in their campaign, which is well on track, to raise the £50,000 needed for an Admiral Nurse for our county?
Caroline Dinenage
First, I pay tribute to my hon. Friend for the sterling work he does as co-chair of the all-party group on dementia. He is absolutely right to say that Admiral Nurses do fantastic work in many parts of the country, helping people with dementia to maintain their independence, and improve their quality of life and that of their families. I very much support all the fundraising activities going on in his local area.
Stephen McPartland (Stevenage) (Con)
Deprivation of Liberty Safeguards and Mental Capacity
Caroline Dinenage Excerpts(6 years, 8 months ago)
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The Minister for Care (Caroline Dinenage)
Subject to the written ministerial statement HCWS202 made on 30 October 2017, I am today announcing the publication of the Government’s final response to the Law Commission’s report on mental capacity and deprivation of liberty safeguards (DoLS), a copy of which is attached.
I welcome the publication of the Law Commission’s report and thank them for their careful, comprehensive and considered work. This Government are committed to take action to reform mental health, and transform care for people with learning difficulties and/or autism. Taking action to reform the current DoLS regime is an important contribution towards achieving these aims and providing greater protection for some of the most vulnerable people in our society.
We have set out in detail our provisional view of each individual proposal in our response, and we broadly agree with the liberty protection safeguards model. As the Government have commissioned a review into the Mental Health Act, proposals that relate to the interface between the Mental Health Act and Mental Capacity Act will be considered as part of that review. We also want to ensure that liberty protection safeguards fit with the conditions and future direction of the health and social care sector, so we will continue to work through the detail of the recommendations and engage further with stakeholders particularly on implementation. We will bring forward legislation to implement the model when parliamentary time allows.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-03-14/HCWS542/
[HCWS542]
Respite Care for Vulnerable Adults: Teesside
Caroline Dinenage Excerpts(6 years, 8 months ago)
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The Minister for Care (Caroline Dinenage)
I am grateful to the hon. Member for Stockton North (Alex Cunningham) for raising his concerns this evening, and indeed to his colleagues, the hon. Members for Stockton South (Dr Williams) and for Redcar (Anna Turley). They have stated the justifiable concerns of their constituents powerfully and articulately. Whenever change is afoot, people have a tendency to feel concerned, and it is absolutely right that those concerns are articulated.
Supporting the most vulnerable in our society—those with complex needs, those with autism and those with learning disabilities—is one of the most important but exacting tasks that health and social care commissioners face. It is a task that must be undertaken with a genuine desire to get the very best outcomes not only for those who need support, but for those who care for them.
It is important to remember that many of the services that we are discussing today are focused on people with autism and learning disabilities—conditions that can manifest with very different requirements. They may need care and help ranging from routine, occasional help in the home to full-time personal support, with perhaps two or more people at a time providing that personal assistance.
Our mandate to NHS England includes a clear objective to improve outcomes for people with autism or learning disabilities. That means making sure that they are fully supported in the community, that hospital admissions are reduced and that they have the opportunity to live an ordinary life. Building the right support is our plan to use concerted local action to deliver that community support and to reduce the number of in-patients by March 2019.
We know that respite services are extremely important and a significant element of community-based support. They benefit not only the individual receiving that care, but their family and carers. Members have spoken very powerfully about that tonight. The hon. Member for Stockton North rightly points out that family carers in particular play an invaluable role—a role that is often unsung and undervalued. Often, they do so not out of a sense of duty or compassion, but out of pure love, and they deserve nothing other than our unbridled respect and our thanks. He asked me about the work that we are doing to support carers. They will of course be an integral part of our thinking in the Government Green Paper on social care that will be produced later in the year. In the interim period, we have a carers’ action plan, which I care passionately about and which will set out some short-term steps that we want to introduce to support carers and their valuable work more fully.
Alex Cunningham
It is very clear that the Minister gets this, and I admire the way in which she is putting her argument across, but this is also about resource. I am very concerned about the current problem on Teesside, but in the longer term young people in their 20s are coming through the system and approaching 30. These are children who in a previous generation would never have survived, and they are going to need more and more services. More children are becoming adults who will require more provision. What are the Government doing in terms of longer-term planning?
Caroline Dinenage
The hon. Gentleman articulates a real issue with which we have to contend. That is why we have increased NHS spending every single year since 2010, so that our NHS now has about £13 billion more to spend on caring for people than it had in 2010. That goes to the heart of the issue that he has identified. We need to ensure that care, particularly respite care, is responsive to the needs of individuals. That implies both a need to assess and determine the right kind of support, and a need for flexibility to allow for personal choice, as I believe is being looked at in Teesside.
Some needs may be best met through a stay in a suitable service that provides overnight beds, with appropriately trained staff to support people’s individual care needs, but that may not be true for everybody. Those with less severe physical or learning disabilities may find that action in the community is more desirable and appropriate for them—for example a visit, leisure activity or even visiting family members with the right personal support. We do not want those opportunities to be written off for them because we have a very restrictive system, which is why it is right that commissioners have the means to seek new approaches and to be flexible in how they meet people’s needs. I understand that the intention in North Tees is exactly that, but it must be based on suitable engagement, as the hon. Gentleman said, to assess people’s individual needs.
Having listened to hon. Members’ comments, I understand their concern that not everyone can currently access respite services and that these services may not be flexible enough. Local commissioners are rightly looking to change respite provision. The hon. Gentleman will understand that it is not customary for a Minister to comment in detail on specific commissioning decisions or on the extent to which there was appropriate consultation, unless that is part of a formal review process. I understand that the local CCG has consulted on the proposals for 10 weeks and is now in the process of designing the service.
Alex Cunningham
Does the Minister recognise that the CCG has acknowledged that it will have to get more people into the system, so the service will be diluted? Having recognised that, what can she do about it?
Caroline Dinenage
As I have already said, it is up to CCGs to commission the local services that they feel are appropriate in their local communities. It is not for the Government to force a top-down diktat on how they need to spend their resources. I understand that local councils are, quite rightly, scrutinising the proposals right now. This is an important means of quality assurance and is informed by local people with local knowledge. I hope that the hon. Gentleman will find some reassurance in that. However, although it is right that service reconfigurations are considered locally and are not driven from the top down, any significant changes to services are subject to the Government’s four tests. The changes should demonstrate support from clinical commissioners, strengthened public and patient engagement, clarity on the clinical evidence base, and support for patient choice.
There is a clear set of expectations in relation to the provision of respite care and the role of commissioners. Alongside provisions in the National Health Service Act 2006, all CCGs must secure services to meet the needs of their population to a reasonable extent. Respite care may be routinely commissioned or made available as part of a package of NHS continuing healthcare, and is often also provided as part of social care. The Care Act 2014 requires that where an adult or carer appears to have care and support needs, the local authority must carry out an assessment and meet any need where the person has met the eligibility criteria.
Alex Cunningham
The scrutiny groups on Teesside—at least some of them—are thinking of referring the matter to the Secretary of State. What happens when it is referred, and what can the Government do then?
Caroline Dinenage
That will of course be a matter for the Secretary of State, who will deal with it in the appropriate way.
The Care Act also requires local authorities to take a preventive approach to addressing people’s needs in taking steps to intervene early to prevent or delay any worsening of an adult’s need for care and support. This would of course include the carers about whom the hon. Gentleman and his colleagues care so passionately. It is really important to allow carers to take the respite that we have spoken about.
The hon. Gentleman might be interested to know that the Autism Act 2009 requires the Government to have a regularly reviewed autism strategy and to issue guidance to local authorities, NHS bodies, and foundation trusts. In addition, the Children and Families Act 2014 introduced a new statutory framework for children with special educational needs and disabilities. This gives commissioners very clear responsibilities towards those with learning disabilities and autism, including those who may be affected by the review on Teesside.
Jim Shannon
I think that everyone in this Chamber will have a knowledge of autism. The Minister will be aware that we have an excellent autism strategy in Northern Ireland, and there is also a very good strategy in Wales. Has she had a chance to check out both those strategies in order perhaps to introduce them, in full, to England?
Caroline Dinenage
I have not, but now that the hon. Gentleman has recommended that to me, I will certainly look into it.
It is really important that commissioners have the prerogative to make a local determination of what constitutes the right services. We have set clear expectations for how health and social care meets people’s need for support and families’ and carers’ needs for respite. We can close the gap between the outcomes for those who are most vulnerable and those without complex needs, but it has to be via a combination of setting national expectations alongside a local approach to delivering the necessary services. The NHS has a responsibility to ensure that people have access to the best and safest healthcare possible. This means that it must plan ahead and look at how best to secure safe and sustainable NHS healthcare provision, and provide flexible approaches to meet the widest range of needs.
That is what we hope to see in action in Teesside. I understand that any change to local services for vulnerable people must be viewed with a degree of apprehension. However, considering the assurances given locally by commissioners, the process they have undertaken, and the overall aim of providing a more flexible set of options for respite care that moves away from a very medical model, I am hopeful that these changes will be of benefit to the people who most need these services.
Question put and agreed to.
PACE Trial: People with ME
Caroline Dinenage Excerpts(6 years, 9 months ago)
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The Minister for Care (Caroline Dinenage)
It is a great pleasure to serve under your stewardship, Mr Hollobone. I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing today’s debate. As she has articulated so beautifully, the situation is clearly very concerning. I know that she has done an enormous amount of work in this area, and has met people, both in her constituency and more widely, affected by the condition, and with expertise on the condition, to hear about its impact on individuals’ lives. As MPs, we all know people in our constituencies who are affected by the condition.
As we have heard, chronic fatigue syndrome, also known as myalgic encephalomyelitis or encephalopathy, is a debilitating and very poorly understood condition, which is estimated to affect more than 200,000 people in England. We do not understand the underlying causes of it, there is no one diagnostic test to identify it, and although patients can improve and recover, there is no cure for it. The condition, which for brevity and to avoid covering you in a thin layer of spittle, Mr Hollobone, I shall refer to in the abbreviated form CFS/ME, can stop a life in its tracks, leaving sufferers unable to carry out the most basic tasks. In the most serious cases, people can be bedbound for weeks at a time. It has a complex range of symptoms, including a very disabling, flu-like fatigue and malaise, and neurological problems. Of course, the impact on friends, families and carers can be significant as well.
It is also true that the difficulties in diagnosis mean that patients with CFS/ME often experience delays in getting the treatment and support that they need. In recognising the need for GPs to be aware of the condition, the Royal College of General Practitioners identified CFS/ME as a key area of technical knowledge that GPs should have as part of their qualifying exams, which answers a question raised by the hon. Lady.
The recommended treatments for CFS/ME, namely cognitive behavioural therapy, or CBT, and graded exercise therapy, or GET, and the evidence for them are the subject of today’s debate. Those treatments were first recommended for patients with mild or moderate CFS/ME in 2007 in the NICE guidance, in line with the best available evidence, which showed that the treatments offered benefits. The guidance sets out that there is no one form of treatment to suit every patient and that the personal needs and preferences of patients should be taken into account. Doctors should explain that no single strategy will be successful for all patients; that in common with all people receiving NHS care, CFS/ME patients have the right to refuse or withdraw from any part of their treatment; and that those with severe symptoms may require access to a wider range of support, managed by a CFS/ME specialist.
The results of the PACE trail, which examined pacing therapy, cognitive behavioural therapy, graded exercise and specialist medical care for chronic fatigue syndrome, were published four years after the NICE guidance. The trial ran from 2005 to 2011 and, contrary to what the hon. Lady said, was primarily funded by the Medical Research Council, not the DWP. Total funding was £5 million and the MRC contributed almost £3 million.
The study was undertaken by the Queen Mary University of London. It was the largest ever trial for CFS/ME, including more than 600 participants in England and Scotland. It sought to assess and compare the effectiveness of the four main treatments for CFS/ME—adaptive pacing therapy, CBT, GET and standardised specialist medical care.
The peer-reviewed trial results published in The Lancet in 2011 found, as the hon. Lady said, that 60% of patients with CFS/ME benefited from CBT and GET when provided alongside specialist medical care. CBT and GET were found to be better than pacing therapy or specialist medical care alone in improving both symptoms and disability, and a follow-up study looking at recovery after one year further supported the benefits of interventions. The trial had ethical approval from the NHS research ethics committee and had ongoing oversight from an independent trial steering committee, which included patient representatives. Trial reports were regularly provided to a data monitoring and ethics committee that had the power to halt the trial if harm was indicated. NICE considered the PACE results in 2011 and concluded that they supported its existing recommendations on both CBT and GET.
The Government are aware that the use of CBT and GET in treating CFS/ME has long been a controversial issue for patient groups, charities and some clinicians. That began with the publication of the NICE guidance 10 years ago and continued with the PACE trial. Since 2011, PACE trial data has been shared with many independent scientists as part of normal research collaboration, including the internationally respected research organisation Cochrane, which independently validated the findings. However, in the last 18 months, the attention on the trial has increased substantially, following a tribunal ruling in August 2016 ordering the release of the trial data to a member of the public, which the hon. Lady referred to. The data has since been examined more widely and critics, including some clinical academics, have suggested that it shows that CBT and GET are not as effective as the trial results suggested.
Nicky Morgan (Loughborough) (Con)
This is clearly a very important debate. I think both the hon. Member for Glasgow North West and the Minister would agree that it is not possible to do justice to the concerns raised by all our constituents, and the 200,000 sufferers that the Minister has identified, in half an hour. Does the Minister agree that this is a subject worthy of wider debate in the House of Commons? Constituents such as Sarah Reed, who have written to me, say that because of the belief in CBT and GET, and because academics believe in the results, many other treatments have not been pursued. Does the Minister feel angry about that?
Caroline Dinenage
I thank my right hon. Friend for her intervention. As has already been said, it is important that we listen to patients. As I will go on to explain, NICE is now looking at reviewing its guidance on this and, in the light of that, it may well be worth discussing the issue more fully.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
Does the Minister agree that believing patients is also important here? Patients with the condition are often not believed and concerns about the PACE trial have not been believed, and that has just loaded concerns on those individuals.
Caroline Dinenage
As I have already set out, sometimes it can take a really long time for this to be diagnosed. People have to keep going backwards and forwards to GPs and others with their symptoms. Many other potential conditions have to be discounted before it can be fully diagnosed, which often leaves people feeling that their symptoms are not being taken seriously or they are being dismissed. Obviously, that is massively concerning, which is why, as we have already said, it is important that patients are listened to and that clinical professionals are well-equipped to be able to recognise the symptoms and identify them.
As I said, the data has been examined more widely. Critics, including some clinical academics, have suggested that it shows CBT and GET are not as effective as the trial results suggested. In turn, the trial authors have defended their work. They have responded to criticisms in medical journals and the wider medical printed press. I know the hon. Member for Glasgow North West raised one such criticism at the oral evidence session of the Science and Technology Committee in January, concerning possible conflicts of interest of the PACE trial authors. On that point, in line with normal practice, all such conflicts were published with the trial protocol as well as the results. If she has evidence to the contrary, I would be very happy to discuss that with her afterwards.
Carol Monaghan
I thank the Minister for that. However, they were not disclosed to the PACE participants.
Caroline Dinenage
It is very important that the hon. Lady has raised that point, and I am sure it will be taken into consideration.
Helen Whately
ME sufferers in my constituency welcome that the NICE guidelines are being reviewed, but one problem is that when they find that the existing treatments do not work for them, there is a lack of alternatives. Does the Minister recognise that alternative treatments need to be looked into urgently and offered to patients?
Caroline Dinenage
I am sure that will be part of the NICE guidance. Where there is significant evidence that alternatives deserve greater investigation, I am sure NICE will look at that. I will talk about that a little more in a second.
On conflicts of interest, it is obviously important that researchers and scientists with particular expertise in one area will have worked and shared their expertise in related fields and industries, but transparency regarding conflicts of interests is vital to the integrity of the research. The NHS Health Research Authority already issues guidance on conflicting interests and I understand it will consider whether any further clarity is needed.
Clearly, the controversy around the trial is problematic for researchers, but it is most of all distressing for patients with CFS/ME, who deserve the most appropriate treatment from the NHS and to have confidence in the treatment that is being provided. That is why we welcome the NICE decision to undertake a full review of the guidance, which will examine the concerns around the PACE trial and any implications for its current recommendations. NICE develops its guidance independently to support NHS organisations and clinicians to deliver services in line with the best available evidence. It welcomes the input of stakeholders and more than 10 CFS/ME charities and organisations are already registered to support the guideline development process. All other parties who are interested can comment on the draft scope and draft guidelines at the appropriate time during the development process. Final guidance is expected in October 2020.
Paul Blomfield (Sheffield Central) (Lab)
The Minister makes the point that final guidance is expected in October 2020, but given the significant doubt over CBT and GET and their impact now, does she recognise the strong case for NICE to suspend the current guidance, which points people towards those potentially damaging treatments?
Caroline Dinenage
As an independent organisation, that will of course be a matter for NICE, taking into consideration the evidence.
I know it is a priority for the CFS/ME community that more research into identifying the underlying causes of the condition be undertaken. I would like to reassure those affected that both the MRC and the National Institute for Health Research welcome high-quality applications for research into CFS/ME, including studies to investigate its biological causes, and it will come as welcome news that the MRC is currently funding a project to examine the relationship between abnormal brain structures and symptoms of CFS/ME.
I again thank the hon. Member for Glasgow North West for raising this important issue on behalf of those affected by the condition in her own constituency and up and down the country. I hope the debate has been helpful.
Question put and agreed to.
Oral Answers to Questions
Caroline Dinenage Excerpts(6 years, 9 months ago)
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Luke Hall (Thornbury and Yate) (Con)
The Minister of State, Department of Health and Social Care (Caroline Dinenage)
The fact that the Department has been renamed the Department of Health and Social Care reflects both their interdependence and our commitment to achieve co-ordinated care tailored to individual needs. The better care fund is a national integration programme that helps the NHS and local government to deliver better, more joined-up services.
Luke Hall
I thank the Minister for that answer and welcome her to her place. The proposal to build a community health centre in Thornbury and Frenchay is an essential part of joining up health and social care in South Gloucestershire. Will the Minister join me in highlighting the importance of Thornbury health centre and in pressing South Gloucestershire clinical commissioning group to make progress with the project as quickly as possible, after years of unnecessary delays?
Caroline Dinenage
I thank my hon. Friend for raising that important issue. He is right to do so, and proposals such as those for Thornbury health centre are crucial for ensuring that health and social care are truly integrated and centred around each individual in the community. I am advised that South Gloucestershire CCG remains committed to progressing those plans as soon as possible and that the local NHS expects to be able to provide an update on plans next month.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
The Minister will be aware of the situation surrounding pain infusion treatment for patients in Hull and East Riding. Many of the 86 patients who lose that treatment will require increasing levels of social care. Consultants have even written letters to the CCG to say that if that treatment is removed, there is an increased risk of mortality for those patients. Will the Minister meet me urgently to discuss that and write to the CCG to ask it to urgently review its decision in the light of the evidence from consultants?
Caroline Dinenage
Of course blanket bans on treatments are unacceptable, and decisions on treatments should always be made locally by doctors, based on clinical assessment. I understand that those patients will be offered an alternative, more rounded service and that the CCGs have arranged for each patient to meet their consultant to discuss their treatment. Where there is evidence of rationing, we expect NHS England to ensure that CCGs are not breaching their duties.
Sir Nicholas Soames (Mid Sussex) (Con)
Does my hon. Friend agree that the integration of health and social care is so important to the future success of the NHS that everything needs to be done to speed up the programme to integrate them better? Will she join me in encouraging a speedier approach to that method in Surrey, Sussex and Kent?
Caroline Dinenage
My right hon. Friend is absolutely right. The better care fund is already having a fantastic impact in the area. We are developing metrics for assessing progress on integration by local area, particularly at the interface of health and social care. We need to proceed with this as rapidly as possible, and I am sure that with his backing, that will happen in his local area.
Derek Twigg (Halton) (Lab)
It is of course very important that we see integration of the two services, but the fact remains that there is just not enough money. Over a year ago, one of the Minister’s predecessors praised my authority in Halton for the work it was doing in this area, but Halton is now on the brink in terms of the money it has and its ability to deliver its statutory duties. There is simply not enough money, and the Government keep trying to avoid that.
Caroline Dinenage
We have provided £2 billion of extra funding over the next three years to help councils commission high-quality services, in addition to giving councils access to up to £9.25 billion of dedicated social care funding by 2019-20.
Andrew Selous (South West Bedfordshire) (Con)
Will the Minister look at the benefits of independent living schemes such as Priory View, pioneered by Central Bedfordshire Council, which bring reduced hospital admissions and reduced demands on social care through greater socialisation and more use of exercise classes?
Caroline Dinenage
Independent living schemes can keep people living healthier, more independent lives for much longer and provide the comradeship and camaraderie that keep people active and healthier. My hon. Friend is right to raise their importance, and the Government very much support them.
Stephen Lloyd (Eastbourne) (LD)
With reference to the integration of health and social care, the Minister may be aware that I have two outstanding respite and rehab homes in Eastbourne called Milton Grange and Firwood House. They are both under threat of closure by the county council, which says that central Government are not giving it enough money. Those homes serve a crucial purpose in supporting the local hospital. Will the Minister agree to meet me and representatives from the county council to work out a way to find the funds to keep both those vital homes open?
Caroline Dinenage
The hon. Gentleman is absolutely right to stand up for the good-quality respite in his local area. The Care Act 2014 requires local authorities to shape local markets and ensure that they give a sustainable, high-quality local offer. I would be more than happy to meet him to discuss that further.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I welcome the Minister to her place. One model of integration that has aroused considerable concern is the so-called accountable care organisation model. Many are concerned that that means greater private sector involvement, and given legitimate worries about Carillion going bust, Capita not being able to support GPs and Virgin suing the NHS, those concerns are well founded. Can the Minister rule out any private sector involvement in ACOs? Will she also delay laying the relevant regulations to establish an ACO until after the two judicial reviews and the NHS England consultation?
Caroline Dinenage
The hon. Gentleman is right to raise this. NHS England is consulting on that at the moment, and I can confirm that no regulations will be laid until that consultation has been completed.
Jonathan Ashworth
I am extremely grateful to the Minister for offering us that clarification. May I therefore ask her about funding? The integration of health and social care needs more funding, yet the NHS is going through the biggest financial squeeze in its history and social care has been cut by billions since 2010. A few moments ago, the Minister said that the funding is adequate, but if the funding is adequate across health and social care, why are delayed discharges of care up 50%, and why did NHS England say on Friday that for the rest of this year the A&E target has in effect been abandoned?
Caroline Dinenage
We recognise that there are pressures on our social care as the population ages. In the short term, we have of course made the extra £2 billion of funding available to local authorities; in the medium term, we need to make sure that best practice is observed across all local authorities and NHS trusts; and in the long term, we will be coming forward with a Green Paper on social care later this year.
Bim Afolami (Hitchin and Harpenden) (Con)
Neil Parish (Tiverton and Honiton) (Con)
The Minister of State, Department of Health and Social Care (Caroline Dinenage)
The Food Standards Agency’s national food crime unit is crucial to protecting consumers from serious criminal activity that impacts on the safety of their food and drink. I understand that the FSA is exploring options for the unit’s future funding, and a decision is expected in late spring.
Neil Parish
The FSA is answerable to the Department of Health and Social Care for food safety, but there are a lot of assurance schemes that do not really answer to anybody and which the FSA needs to be able to bring together. That is where the crime unit could do a really good job, so anything the Minister can do to get that money and get the crime unit up and running would be very good.
Caroline Dinenage
I thank the Chair of the Environment, Food and Rural Affairs Select Committee for his advice. I know that he is keen and astute on this subject. Ensuring that food businesses meet their safety responsibilities is, of course, one of the FSA’s most important roles. It is developing a new regulatory model and actively engaging with third-party assurance scheme owners to determine how information and data can be shared and more effectively used by regulators.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
May I send a brief message of congratulation to the Secretary of State for his rapid response to President Trump’s remarks about the values of the NHS?
As chair of the Westminster Commission on Autism, let me now ask the Secretary of State a serious question. We are about to produce a report on the fake medicine that is sold to families with an autistic child. When the report is published, in the next few days, will the Secretary of State act very quickly to stop this dreadful trade?
Mr Speaker
Possibly. Anyway, it was a worthy effort, and I will give the hon. Gentleman the benefit of the doubt. Let us now hear from the Minister.
Caroline Dinenage
As the hon. Gentleman was so very charming to the Secretary of State, we will of course look into the issue.
Julian Sturdy (York Outer) (Con)
Patient Transport Services: Northern Lincolnshire
Caroline Dinenage Excerpts(6 years, 10 months ago)
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The Minister of State, Department of Health and Social Care (Caroline Dinenage)
I congratulate my hon. Friend the Member for Brigg and Goole (Andrew Percy) on securing the debate. As he has so elegantly articulated, the provision of patient transport services is important to many people throughout the country.
Let me take this opportunity to give heartfelt thanks to all the staff in the health and care system. They work tirelessly in often difficult circumstances, routinely going above and beyond the call of duty to keep patients safe. Those dedicated people make our NHS truly great. No one knows that better than my hon. Friend, who spends weekends volunteering as a first responder with the Yorkshire Ambulance Service. He deserves massive thanks for everything that he does in that role, as do all first responders up and down the country.
We recognise that effective patient transport services are vitally important, not only to ensure the provision of high-quality, safe services for patients, but to ensure that patient flow through hospitals is not slowed by missed medical appointments or delayed patient discharges. We are clear that local NHS CCGs must ensure that reliable, safe and comfortable patient transport services are delivered and maintained.
Patient transport services, like almost all other health services, are locally commissioned and provided to ensure that they are well adapted to local conditions. It is for local CCGs to set appropriate expectations of service with their providers and to take swift action where they fall short. However, that is not to say that the Government have no expectations of how these services should be delivered and should function. There is well-established national guidance on who is eligible to use patient transport services which makes it very clear that patients should reach appointments in reasonable time and comfort without detriment to their medical condition. NHS England has also communicated with the CCGs about their responsibilities when commissioning patient transport services via its CCG bulletin.
Nic Dakin
I congratulate the Minister on taking up her new post, which I am sure she will do very well. She said that CCGs should take swift action when things are not working. What does swift action look like? This has been going on for some time now; how quickly should the people of northern Lincolnshire expect to have the patient transport service they deserve?
Caroline Dinenage
Of course, we have devolved this matter locally and it is up to the local CCG to take action. I know that a recovery plan is in place and the delivery of the plan is now being monitored weekly, but the hon. Gentleman is right, and, like my hon. Friend the Member for Brigg and Goole, he has kept on articulating this issue and asking these questions on behalf of his constituents, to try to find out when they will see a visible difference to the service, because it is currently not good enough.
Patient transport providers are also required to be registered and inspected by the Care Quality Commission, the independent regulator of health services. This Government have given the CQC more powers, and it is now able to rate independent healthcare transport providers in the same way as NHS ambulance services. We fully support the CQC in its work to ensure that users of patient transport services are protected, and where services are not good enough and the necessary improvements have not been made, it can take further action, including issuing fines, service restrictions, and ultimately the cancellation of a provider’s registration.
Additionally, we are very supportive of the Department for Transport-led total transport initiative, which I think was what my hon. Friend the Member for Brigg and Goole was referring to, and which is currently piloting the joint commissioning of public sector-funded transport in order to reduce the risk of services overlapping, improve efficiency, and provide a better overall service to passengers.
From the local work carried out so far, it has become clear there are a range of potential benefits for the NHS, including helping to avoid bed blocking—where patients sometimes cannot go home because non-emergency patient transport is not available—and improving access to NHS services by reducing missed appointments due to late or unavailable transport. We have asked NHS England to ensure that CCGs are all engaging in this important work.
Melanie Onn
I welcome the Minister to her new role and wish her the best of luck, but from what she is saying I am not entirely clear how the Government will follow up and pressure will be brought to bear on the CCGs in the delivery of the contract. I had a 97-year-old lady, whom the new chief executive of the Diana, Princess of Wales Hospital and the Northern Lincolnshire and Goole NHS Foundation Trust met. She had had to wait for eight hours in the emergency care centre for transport to go home. There needs to be a little more urgency in the Minister’s response.
Caroline Dinenage
I completely understand why the hon. Lady is articulating that; every one of these incidents is absolutely unacceptable and in many cases very distressing. The issue with devolving such clinical decisions to local areas, however, is that we have to allow the CCG to take the necessary steps to ensure the service is put back on to a better footing.
Diana Johnson
This is not just one CCG; it involves more than one. I have already mentioned the fact that Hull contracts with Thames Ambulance Service. Does the Minister really think that this business—it is a profit- making business—is fit for purpose?
Caroline Dinenage
The hon. Lady is absolutely right to raise that point. I am aware that similar problems have been identified with the same provider in other parts of Yorkshire and the east midlands. Improvements must of course be made, which is why commissioners are working to oversee and manage the necessary improvements and trying to achieve the level of performance that is required.
Turning to the particular issues affecting northern Lincolnshire, my hon. Friend the Member for Brigg and Goole and other hon. Members across the House are absolutely right to point out the problems with the services commissioned in and around their constituencies. I have read some of the cases today, including some distressing cases involving patients with conditions such as dementia and cancer experiencing long delays with their transport. Such delays are clearly a source of incredible distress for people who are already facing a very difficult time in their lives. Many of them may be very vulnerable, and we are absolutely clear that this needs to change.
North Lincolnshire CCG awarded a patient transport contract to Thames Ambulance Service in October 2016 following an open procurement process. Issues around the quality of service are acknowledged, and we are aware that people have experienced delays. That is clearly unacceptable. I assure my hon. Friend and other Members that a range of actions is being undertaken to ensure the delivery of an appropriately high-quality service. The CCG is working closely to support Thames Ambulance Service to achieve the required level of performance. It has served a contract notice to the provider based on delivery against key performance indicators, the number of patient complaints, and issues associated with data reporting.
A robust recovery plan has been put in place, and delivery against this is carefully monitored on an ongoing basis. Key actions include the recruitment of six additional staff in north Lincolnshire and the mobilisation of additional vehicles. I understand these staff have recently been trained and deployed. A patient transport co-ordinator has also been employed, working with the hospital to improve the process for patients being discharged. The CCG has also worked with the provider to improve its complaints process, and I am advised that its backlog of complaints has now been cleared.
I hope that my hon. Friend is also reassured by the level of Care Quality Commission engagement with Thames Ambulance Service. In its inspection report of April 2017, the CQC uncovered a number of areas for improvement, ultimately issuing enforcement action against the provider in respect of regulation 17, which covers good governance; regulation 13, covering safeguarding; and regulation 5, which deals with requirements relating to registered managers. The CQC continues to monitor the provider closely to ensure that the required improvements are being made. It is currently undertaking a fresh review of the service and will issue a further report when its latest inspection is complete. We expect this to be published and available online before the end of March. That will be exactly the same for the provider in the constituency of the hon. Member for Kingston upon Hull North (Diana Johnson).
Finally, I am also advised that the CCG has reviewed the application of the eligibility criteria for patient transport services across the area to ensure that they are being applied evenly. Through this process, it has determined that some patients who have historically accessed these services may no longer be considered eligible. We obviously have to take steps to ensure that the service is more consistent and that the CCG is working with the provider to ensure that affected patients are informed as soon as possible and given helpful advice on how to access alternative services if they are required. I would like to thank my hon. Friend again for bringing these matters to our attention, and I very much hope he is reassured that all appropriate actions are beginning to be taken to restore the delivery of effective patient transport services to his constituents.
Question put and agreed to.
Contaminated Blood
Caroline Dinenage Excerpts(9 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Alistair Burt
I personally think that it is. That process will be informed by what the all-party group has spoken of, and its members will speak today. I thank the hon. Gentleman for his intervention.
As I said to my hon. Friend the Member for Stratford-on-Avon, I am not sure that I fully share the conclusions of the all-party group’s report with regard to the MacFarlane Trust. There is a great deal of detail in the report. As I was not responsible for compiling it, I can be lavish in my praise of the effort that went into it. A lot of hard work was done by a lot of people connected with the offices of the hon. Member for Kingston upon Hull North and my hon. Friend the Member for Colne Valley, and I am grateful for that. On the basis of information contained in the report and other information that we have, I do not believe that the MacFarlane Trust is saveable or capable of reform. I and others have seen a copy of a letter to the Secretary of State from two former trustees that is quite damning of its leadership, and one from some 68 beneficiaries that is equally uncompromising.
It would be unfair to go into more detail now. It may be that the trust has an impossible role. However, there should be no doubt that a body set up to support beneficiaries and those who have been victims of what happened is anything other than on their side—not an arm of Government, nor seen to be, and prepared to take on the Government to argue for the funds it needs without fearing a conflict of interest. The Department of Health has contributed to the situation by structuring too cosy a relationship, possibly in its own interests, and that has to stop.
Caroline Dinenage (Gosport) (Con)
My right hon. Friend has worked very hard on this issue, as has the all-party group on haemophilia and contaminated blood. I attended a public meeting yesterday with survivors and their families, and there was a very strong feeling that they have just had enough. They have been through a series of betrayals and disappointments at the hands of those who were supposed to help them, including trusts, departments and the Government. Does my right hon. Friend agree that this is our last chance to get this right for those people who have to suffer so very much?
Alistair Burt
I thank my hon. Friend for her kind words, and I agree with her. I will come to the trust invested in us in a moment, but, given the effort that has been put in, the work being done by Members on both Front Benches and the acknowledgement that we all share this responsibility, perhaps there is a chance that we will get to where we want to be.
Mr Speaker has been very generous with time, so let me finish. Last week, on the day that we circulated information about today’s debate to the community, I received the following e-mail, which was addressed to all of us as MPs:
“Thank you for your continued persistence in this issue. I wish to continue to be informed of any developments but I am very bitter that my husband of 21 years who got Hep C as a child from being a Haemophiliac sadly lost his fight and passed away yesterday after years of suffering due to Hep C. He never had an apology for all the years of ill health, he was a fighter right up to the end but it was also a fight he should never have had to deal with. Again on behalf of my husband, my daughter and myself thank you for your continued support and I hope a speedy result is had for those who still continue to struggle with the physical and mental stress this situation has caused.”
Finally, a friend who was told as a child that he had HIV and hep C, and a life expectancy of four years if he was lucky, says:
“I find each and every day is like being on death row for a crime I didn’t commit. I long for the day that I can wake up in the morning and not have to fight the Gov’t for the right to have a better life. Imagine what it’s like to believe for years that what we have been given was an accident. The medical staff constantly told us ‘it was an unavoidable accident’ only for us to learn the truth for ourselves. Where did my human rights go at 12 years old. And WHY do I still not have any?
When you are stripped of your pride, your dignity, your finances, your job, career, your future, what do you have left? Your spirit and your fight, that’s what. Which is why we will be sitting there on Thursday and we will keep coming back until justice is done or the last one of us dies.”
As MPs, we have been privileged to be given the deepest, most personal details of these people and their loved ones. Some of us have been given family medical records, people’s deepest, darkest secrets and their hopes and fears. We have been privileged to have that. The words “devastation” and “struggle” appear far too often in the stories we deal with. We are not talking about a tiny handful of people, but about thousands who still feel wronged. As Members on both Front Benches prepare for an election, let us ensure that this Parliament as a whole remains committed to providing, finally, the best closure for those who trust us to do so.