Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 27th November 2018 Commons Chamber

[Marsha De Cordova (Battersea) (Lab)]

5. What assessment he has made of the ability of people with learning disabilities to access GPs.

[The Minister for Care (Caroline Dinenage)]

People with learning disabilities still face significant health inequalities. Data from 2017 shows that about half of patients with a learning disability received an annual GP health check, and our target is 75% by 2020. We will shortly consult on plans to introduce mandatory learning disability and autism training for all health and care staff.

[Marsha De Cordova]

There are shocking health inequalities between people with learning disabilities and the general population, and that is recognised by GPs: 60% say that they have received less than a day’s training in how to meet the needs of patients with learning disabilities and autism, while 98% say that they would appreciate more training. The Government are clearly failing people with learning disabilities. Will they commit themselves to ensuring that every new GP who is trained in England is also given training in how to meet the needs of people with learning disabilities and autism?

[Caroline Dinenage]

Yes. That is already part of the training framework. As I have said, however, we are consulting from early next year on plans to make training on learning disabilities and autism mandatory for all health and care staff, not just medical professionals.

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

Let me start by thanking my right hon. Friend the Secretary of State for his support last Thursday on 22q Awareness Day; 22q11 deletion syndrome is second only to Down’s syndrome in its prevalence as a genetic condition, but perhaps surprisingly, there is a remarkably low level of awareness among GPs of this condition, which can lead to avoidable mental health issues in children. Will the Minister meet me to discuss options to increase awareness in the first instance, but also to improve early diagnosis and treatment?

[Caroline Dinenage]

I congratulate my hon. Friend on all the excellent work that he is doing to draw attention to this condition, and I should be happy to meet him.

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

6. What assessment he has made of recent trends in the level of health inequalities across England.

--- Later in debate ---

[Sir Hugo Swire (East Devon) (Con)]

10. What his policy is on the future of community hospitals.

[The Minister for Care (Caroline Dinenage)]

Community healthcare plays a vital role in helping people stay independent and healthy. Last week, the Prime Minister set out a major new investment in primary and community healthcare worth £3.5 billion a year by 2023-24.

[Sir Hugo Swire]

I am extremely grateful that my right hon. Friend the Secretary of State came down to East Devon on his first visit outside London. He was able to visit the health and wellbeing hub that we have created in Budleigh Salterton, learn about the beds that we have kept in Sidmouth and Exmouth, and see Ottery St Mary Hospital. Will the Minister instruct all her officials to work collectively with us and the local community in Ottery St Mary to ensure that the hospital has a great future and fits in with the rest of local healthcare provision?

[Caroline Dinenage]

First, I congratulate my right hon. Friend on his elegant Movember facial decoration. I very much recommend that he keeps it.

My right hon. Friend the Secretary of State was delighted to visit the East Devon constituency recently, where he was impressed by the work at some of the existing community hospitals and care hubs and discussed with Royal Devon and Exeter NHS Foundation Trust how it will work on a sustainable future for the constituency’s community hospital in Ottery St Mary.

[Helen Goodman (Bishop Auckland) (Lab)]

Since the Department says that it likes community hospitals, why are services and wards closing at the Richardson in Barnard Castle?

[Caroline Dinenage]

We know that patients prefer to be treated in their local area, which is much better for preventing hospital admission and getting people out of hospital for longer. However, such clinical decisions must be taken at a local level in consultation with local people.

[Dr Sarah Wollaston (Totnes) (Con)]

Dartmouth has lost its much-loved community hospital. Unfortunately, that loss has been compounded by the closure of River View nursing home, which had been due to house some replacement facilities. The total loss of community beds in isolated coastal communities such as Dartmouth is causing a collapse of trust in such programmes. Will the Minister meet me to discuss the situation in Dartmouth and the loss of nursing home and community beds?

[Caroline Dinenage]

I will of course meet my hon. Friend. She is right that we need to keep such valuable local resources right in the community, where they are most needed and where they keep people out of acute hospital services and surrounded by their friends and family.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

The usage of Caithness General Hospital in Wick in my constituency is way below what it was originally designed for, causing my constituents great anxiety if they have to travel over 200 miles to Inverness and back. Mr Speaker, you will tell me that such matters are devolved, so will the Government share best practice on community hospitals with the Scottish Government and NHS Highland?

[Mr Speaker]

What a wily fellow to get the question in order. Well done, man.

[Caroline Dinenage]

I am happy to work with our colleagues in Scotland to push forward best practice in helping to support community facilities and to ensure that they are investing in facilities at the heart of people’s local areas, which is where they are needed.

[Mr Edward Vaizey (Wantage) (Con)]

Wantage Community Hospital was built and opened by the local community in 1927, but it has been closed for two years. Moves are afoot to improve both our local health centre and health facilities in Didcot, but all that must be joined up and the community needs an answer. Will the Minister use her power to convene a meeting of local stakeholders and her officials to find a way through the maze and a future for our hospital?

[Caroline Dinenage]

I am always happy to speak to my right hon. Friend about such things. I understand that the intention is now to move to a more place-based approach to health and care planning in his local area, but all such changes are subject to consultation.

[Alison McGovern (Wirral South) (Lab)]

I will be honest, I am confused. We have heard the Minister say several times that community approaches are important, but our walk-in centre in Eastham is yet again being threatened with closure. Which is it—do this Tory Government want crowded A&Es or proper walk-in centres that will prevent people from unnecessarily ending up at A&E?

[Caroline Dinenage]

I do not think I can make it any clearer: this Government are committed to providing community services right where people need them, and we are putting our money where our mouth is. Last week, the Prime Minister announced a major new investment in primary and community healthcare of £3.5 billion.

[Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)]

11. What the timetable is for the NHS to meet its target of seeing 95 per cent. of A&E patients within four hours.

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The learning disabilities mortality review—the LeDeR—investigated 1,000 early deaths of people with learning disabilities in hospital settings, but today major concerns have been raised by the parents of Oliver McGowan about the way in which some deaths have been investigated. The Secretary of State knows that 40 autistic people and people with learning disabilities died in assessment and treatment units, and he has called for a year-long review of the use of seclusion in ATUs. But that is not urgent action. Will he commit to stopping the use of ATUs immediately and to looking urgently at how early deaths are being investigated, particularly that of Oliver McGowan?

[The Minister for Care (Caroline Dinenage)]

I have met Oliver McGowan’s mum, Paula, on a number of occasions, so I am more than aware of this case. I have spoken to her about the deeply distressing report she has had on Oliver’s death. The NHS is looking into this case and will continue to work with Bristol University to further develop and improve guidance and local review teams.

[Johnny Mercer (Plymouth, Moor View) (Con)]

T4. The Secretary of State and I spent the night together at Derriford Hospital down in Plymouth, so he will be aware of the unique challenges facing that hospital, which has not had an infrastructure expansion since the 1970s. We have a bid in at the moment. Can we hear whether we have done well before Christmas?

--- Later in debate ---

[James Cartlidge (South Suffolk) (Con)]

Next year marks 10 years since the passing of the Autism Act. What more can the Government do to support people who suffer from autism?

[Caroline Dinenage]

To mark the fact that it will be 10 years since the Autism Act was passed, we will start a formal review of that piece of legislation and the autism strategy, to ensure that they remain fit for purpose and heading in the right direction.[Official Report, 29 November 2018, Vol. 650, c. 4MC.]

[Hannah Bardell (Livingston) (SNP)]

My constituents Kirsteen and Wilma Ord have had their lives blighted by the Primodos hormone pregnancy drug. The review that the Government undertook was a whitewash, and now the further review, led by Baroness Cumberlege, will focus only on people in England. She has said that she will consult groups in Scotland, but drug regulation is reserved. What will the Minister do to promise that my constituents will not be let down again?

Wales-England Cross-border Healthcare

Caroline Dinenage Excerpts

Monday 12th November 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

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

Whilst delivery of healthcare across the border between England and Wales is collaborative and high-quality, the Government are aware of the problems that a significant number of patients living along the Welsh-English border have faced for a number of years in accessing healthcare in accordance with their rights under the NHS constitution. We are pleased that a new statement of values and principles, co-produced by NHS England, the Welsh Government and the local system is now ready for publication.

The new statement will replace the existing cross-border protocol, which was established in 2005, revised in 2013 and agreed between the Department of Health and Social Care and the Welsh Government with input from the system. This protocol outlined the process for residents living along the Welsh-English border in accessing healthcare and which bodies were legally and financially responsible for these patients. Soon after the publication it was realised that the protocol did not comply with English law in that it did not safeguard the constitutional rights of English residents living along the border and registered with Welsh GPs—those residents were unable to exercise their rights to English standards in terms of waiting times for treatment and choice of secondary care provider. Since then, extensive work has been conducted on both sides of the border to ensure this is possible.

NHS England and the Welsh Government, working with clinical commissioning groups (CCGs) and local health boards (LHBs), have developed the new statement to replace the existing protocol and to address the issues that have arisen from it. The new statement allows patients to exercise their rights under the NHS constitution by being referred to a provider under contract with NHS England or electing to receive treatment in Wales, waiving those rights and accepting Welsh standards.

The Government are pleased that the process for producing the new statement has been collaborative across the border and has involved affected stakeholders to ensure it is acceptable and appropriate. We note the diligence by which constituency MPs, especially my right hon. Friend the Member for Forest of Dean (Mr Harper), have sought a solution and also commend the work by Action4ourCare to reach a way forward. We hope this statement of values and principles provides a long-term resolution.

[HCWS1076]

Assessment and Treatment Units: Vulnerable People

Caroline Dinenage Excerpts

Tuesday 6th November 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the long-term seclusion and deaths of autistic people and people with learning disabilities in assessment and treatment units.

[The Minister for Care (Caroline Dinenage)]

I want to address the care that the NHS and social care system gives to some of the most vulnerable in our society. The millions of people who work in the NHS and social care do so every day with compassion and commitment to care for us all, but sometimes the system gets in the way, and when we see that, it is our task and our duty to change it. That is the case with the care given to people with some of the most significant and complex needs, such as those with learning disabilities and autism who are in-patients in assessment and treatment units and other mental health in-patient settings across the country. The care received by some of the people with the most significant needs quite simply is unacceptable.

With respect to in-patient care in assessment and treatment units and other in-patient settings, I absolutely share Members’ concerns about reported deaths, and I want to restate my Department’s commitment to reducing the number of preventable deaths among people with a learning disability. NHS England is ensuring that relevant investigatory processes have been followed in respect of each and every one of the cases it has responsibility for, and it is seeking assurance from all relevant clinical commissioning groups that they too have ensured appropriate investigation. As it stands, there is no indication that any of the deaths were untoward or that due process was not followed in every single case, but we are double-checking each and every one.

The hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned seclusion. Like everyone in the House, I have been incredibly moved by reports of the care for Bethany and by the dignity of her dad, Jeremy, who has described the daily battle he has fought to get her the best possible care. It is completely unacceptable for seclusion to be used in this way. Restrictive practices must only ever be used as a last resort, and we must strive to totally eliminate them. With that in mind, the Secretary of State has instituted a serious incident review in Bethany’s case, and we will act to ensure that she gets the best possible care for her.

However, this is not just about individual cases; it is about the system. Three years ago, the Government committed to reducing the number of people with learning disabilities or autism detained in mental health hospitals by at least a third. The latest information we have shows that the number is down by around 20%, but that is not nearly enough. Today, 2,315 people with a learning disability and/or autism in England are held in mental health hospitals. I want to see that number drastically reduced, and in the first instance I want us to meet the target of reduction by a third. I want to see everyone who can be cared for with their family living as normal a life as possible.

The Secretary of State has instituted a wide-ranging review into the inappropriate use of prolonged seclusion and long-term segregation as restrictive practices. He has asked the Care Quality Commission to initiate that review immediately, and it will be undertaken in two stages. Furthermore, he has asked the NHS to address this issue in the long-term plan that it is writing for the future of the NHS, and I know that NHS leadership shares our passion to get this right. We will also address the role of local authorities in the social care Green Paper, and both of those will be published before Christmas.

[Several hon. Members rose—]

[Barbara Keeley]

I want to put on record my disappointment that the Secretary of State tried to shoehorn an issue of this severity into an NHS policy announcement yesterday, and my thanks to you, Mr Speaker, for allowing this urgent question.

The treatment of people with autism and learning disabilities in assessment and treatment units is nothing short of a national scandal. Six years ago, these units were described by the then chief executive of NHS England and the chief executive of the Care Quality Commission as a model of care that has

“no place in the 21st century”.

Seven years after the Winterbourne View scandal, the Government have not rid the country of these units or substantially cut their use. Indeed, as the Minister said, there are still 2,315 people in assessment and treatment units, including 230 children, and the number of under-18s has been increasing.

A Sky News investigation last week revealed that, since 2015, at least 40 people with a learning disability or autism have died while in assessment and treatment units, and nine of those who died were aged 35 or under. Some of the country’s most vulnerable people are being exposed to physical abuse in institutions that the chief inspector of mental health services described as being

“in danger of developing the same characteristics that Winterbourne View did.”

Can the Minister tell us why the NHS is still sanctioning the use of settings that expose thousands of vulnerable people to abuse, at a cost of half a billion pounds, despite the Government pledging to close them?

The transforming care programme has manifestly failed. What are the Government going to do to ensure funding is available for cash-strapped local councils to pay for community placements with care support for autistic people and people with a learning disability? The Times has revealed that the private companies running these units are making millions of pounds out of detaining vulnerable people in unsafe facilities, in one case funnelling £25 million into a secret bank account in Belize. Can the Minister tell us what the Government are doing to immediately stop private companies that have a vested interest in keeping people with learning disabilities in these Bedlam-like conditions from doing that?

On Saturday, as the Minister has outlined, the Secretary of State ordered the Care Quality Commission to undertake a thematic review of assessment and treatment units, and he has ordered a serious incident review in the case of one young autistic woman, Bethany. Reviews are not urgent action, there are very many Bethanys trapped in seclusion, and 40 people have died in these units. Will the Minister tell us the timetable for the completion and publication of the CQC review and what urgent action can be taken to free all the young people and adults trapped in these appalling conditions?

[Caroline Dinenage]

Hon. Members will be very aware of and concerned about the report published this week by University College London. As the hon. Lady said, the report, which was commissioned by the NHS, draws attention to how people with learning disabilities die on average 15 to 20 years sooner than the general population, often for reasons that are not an inevitable consequence of any underlying medical condition. I was reassured that this report shows that programmes and opportunities that Government are putting in place to improve outcomes for people with learning disabilities and autism are addressing some of the concerns. However, I share very strongly her views and the views of this report that there is still much further to go and that now is the time to take action.

As hon. Members will know, the LeDeR report—the learning disabilities mortality review—is looking into the deaths of all people with a learning disability. It published its second annual report in May and in their response in September the Government accepted all the recommendations and included detailed actions for implementing them. NHS England has also committed that the long-term plan for the NHS will include learning disability and autism as one of the four clinical priorities. The long-term plan will also set out the future of the transforming care programme, which the hon. Lady raised.

Government policy on restrictive practices, including seclusion, is to reduce their use. Where such interventions have to be used, they must be a last resort and the intervention should always be represented as the least restrictive option to meet immediate needs. Incidents of restrictive intervention are recorded in the mental health services dataset and this data is published. The Mental Health Act code of practice highlights the particularly adverse impact of seclusion on children and young people. It advises careful assessment and periodic reviews.

I want to turn to the Care Quality Commission review into the inappropriate use of prolonged seclusion and long-term segregation. The first stage of the review will focus on settings that relate most closely to Bethany’s circumstances, focusing on people of all ages receiving care on NHS and independent sector wards for people with learning disabilities and/or autism and on child and adolescent mental health wards. That will start immediately and this stage will report in May next year. It is very important that service users, their families and people with lived experience are able to contribute to that. The second stage will report in the winter and will examine other settings in which segregation and prolonged seclusion are used. That stage will include NHS and independent sector mental health rehabilitation wards and low secure mental health wards for people of all ages, as well as residential care homes designated for the care of people with learning difficulties and/or autism. As I have said, individuals who have been subject to segregation and/or long-term seclusion and their families and carers will be invited to provide evidence, including through interviews. The Care Quality Commission will make recommendations at the end of both stages, which will seek to eliminate system-wide inappropriate use of prolonged seclusion and long-term segregation, and ensure that vulnerable adults and children supported by health and social care are accorded the best possible care.

I should point out that not all the numbers that the hon. Lady spoke about are in separately identified assessment and treatment units. The data reports there being 2,315 in-patients with a learning disability and/or autism in mental health in-patient settings as of September, but some 360 of them were in in-patient settings described as for people with acute learning disabilities

It is important that commissioners should be able to access very high-quality, value-for-money care in their local area, whichever organisation provides it. We recognise the concern that people have expressed about what happens in the transforming care process, but I see it very much as a process and not as an event that will continue. The NHS has transferred more than £50 million to ensure that the right care is put in place in respect of community support, so that people are better cared for when they are out in the community.

[Dr Sarah Wollaston (Totnes) (Con)]

Does the Minister accept that, fundamentally, far too many people are ending up in terrible conditions in secure settings because of the inadequacy of social care? Will she commit to include in the Green Paper, which is to be brought forward before Christmas, the Green Paper for young adults as well as for older people? Will she absolutely commit to that coming forward before Christmas?

[Caroline Dinenage]

My hon. Friend is absolutely right to recognise that the cases in which people end up in a long-term residential setting often reveal a failure of joint working—of the wraparound services that people need to keep them in the community. We are looking at working-age adults as part of the social care Green Paper, and it will be published before Christmas.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

The Minister will know that I chair the autism commission, which has been looking at health and fake medicine—some serious reports. Will she expand her vision? There is obviously something seriously wrong in the justice system and the fact that police are not trained to recognise and understand someone on the autism spectrum. We need Health and Justice to look into the issue thoroughly, because something is going wrong. We need to train people, and to train them now.

[Caroline Dinenage]

The hon. Gentleman makes a good point: training is fundamental. We have already accepted the LeDeR review’s recommendation that all health and social care staff should have mandatory training on how to care for people with learning disabilities and autism. I would very much like to see that sort of training spread more widely out into society.

[Mr Philip Hollobone (Kettering) (Con)]

Why has the number of children detained in assessment and treatment units more than doubled in the past three years, from 110 to 230?

[Caroline Dinenage]

That is a really good question. We are looking carefully at how we can support children much better so that they do not go into these sorts of units at all. As I say, it is about the wraparound services that can identify much earlier somebody who might be at a crisis point, and making sure that the care and support is put in place to prevent people from having to be admitted to units of this kind.

[Norman Lamb (North Norfolk) (LD)]

Does the Minister agree that the Care Quality Commission needs to look into the endemic use of force in these institutions, as well as at the use of exclusion? Does she agree that unless and until we find a mechanism to transfer money from spending in these institutions to support in the community, we will never solve this problem?

[Caroline Dinenage]

The right hon. Gentleman has done so much work on this issue and cares about it intensely. NHS England has transferred more than £50 million, up front, so that clinical commissioning groups that are planning to close beds can start to provide the community provision that is crucial to keeping people well in the community and out of residential settings.

[Norman Lamb]

And use of force?

[Caroline Dinenage]

We are absolutely clear that force should not be used at all.

[Andrew Bowie (West Aberdeenshire and Kincardine) (Con)]

Learning disabilities and autism are no respecters of “devolved” or “reserved”, so will the Minister join me in calling for NHS Scotland and NHS England to work more closely together, pooling resources and expertise, so that all patients needing in-patient care across the United Kingdom can receive the best possible care?

[Caroline Dinenage]

Yes. I think this speaks to the whole theme of people working together, communicating, collaborating, and putting the care that is needed in place for people when they need it. The ability to work across borders is fundamental to that.

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

It was over seven years ago that we came to this House to reflect on the incredibly disturbing “Panorama” footage of what happened at Winterbourne View. We have had countless statements in this House. I obtained an urgent question about this two years ago. We have seen data about the deaths that have occurred, and the fact that the numbers have not reduced. I would echo the question asked by the hon. Member for Kettering (Mr Hollobone). The number of children in these units has doubled in the period in which the Government told us they would reduce the number by 50%. It is, frankly, a dereliction of duty, and Ministers should be apologising to the people outside this House, in this country, who are detained in those assessment and treatment units.

Can the Minister tell us categorically, and actually answer the question—why has the number of children in these units doubled, and what exactly are she and her Government going to do to ensure that she meets their target of reducing it by 50% by next March?

--- Later in debate ---

[Caroline Dinenage]

I do not see this as a dereliction of duty. I think of the fact that the Secretary of State has triggered a serious incident review into Bethany’s case, that more broadly there is this thematic review, and that we are building the right support by means of the ongoing transforming care process. There is a meeting today, which I have not been able to attend because I had to be here, between all stakeholders in this area, but also with the Department for Education and the Department of Health and Social Care, so that we can work together to ensure that children, above all, are protected.

[Anna Soubry (Broxtowe) (Con)]

I welcomed the Secretary of State’s words yesterday, when he made it very clear that he understands that the situation now needs urgent action. My constituent’s daughter died at the age of 25, having been sectioned, living in a padded cell; her weight rose to 26 stone when she was apparently being cared for. Does my hon. Friend agree that it is not just about money and how we can better spend it; it is about the involvement of families, and a profound cultural change as well?

[Caroline Dinenage]

Yes. I completely agree with my right hon. Friend. I think that the setting she describes that her constituent was in has now been shut, but the point is well made, and actually it is not just about keeping people safe; it is about treating them with dignity and respect, and providing care that is compassionate.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

Several months ago, the Minister met my constituent Isabelle Garnett, whose son Matthew became seriously unwell as a consequence of the treatment he received at St Andrew’s Hospital in Northampton, where Bethany is also receiving such appalling treatment. Matthew’s parents were so worried about his health in St Andrew’s that they thought he would die there. He suffered a broken arm, bruises and other injuries and lost a catastrophic amount of weight.

Matthew is now, thankfully, thriving in a community setting, at significantly less cost than the £12,000 a week that the NHS was spending on completely inappropriate care at St Andrew’s. St Andrew’s is not a fit for purpose location for young people with autism and learning disability. Despite the testimony of Isabelle and many parents like her, why have hospitals like St Andrew’s been allowed to expand, while there has been no expansion of the type of entirely appropriate community provision that is needed?

[Caroline Dinenage]

The hon. Lady brought Matthew’s mum to meet me and I was very disturbed by the photographs she showed me of how poorly he looked when he was in the St Andrew’s setting, and how much happier and so much better he looks now that he is in the right kind of community provision. It speaks volumes about exactly what we are trying to achieve—to get people out of such settings into the right kind of community provision. That is what this is about, but people can only be moved out of settings like St Andrew’s—which is a place that does require improvement—about which the Care Quality Commission is concerned, when the right provision is available in the community. That is why we are putting the money through NHS England into local provision.

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

I welcome the Secretary of State’s recent request to the CQC for an immediate review; it is very timely. Can the Minister assure the House, however, that the Government and the NHS are prepared to hear the uncomfortable truth, and change to find the right and compassionate care for those with autism and those with learning difficulties?

[Caroline Dinenage]

I thank my hon. Friend for that question, which gets to the root of the issue. It is not enough to ask people what they think and set up commissions and reviews; we have to listen to what people are saying but then we have to act. The thematic review the CQC is starting straight away is reporting back in two phases. That is important as it means that, as soon as the first phase comes back, we can start action straight away.

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

Can the Minister say what resources will be made available to local councils to enable people with learning disabilities and autism to move out of the units as a matter of urgency and into community placements?

[Caroline Dinenage]

NHS England transferred over £50 million up front to CCGs that are closing beds over the course of the financial year, so that they can invest in community alternatives. In addition, between 2015 and March 2019 it will invest another £50 million in transforming funding to put in place things such as the much needed crisis prevention teams, which are focused on supporting children in the community.

[Kevin Foster (Torbay) (Con)]

The number of people with learning disabilities and autism in secure mental health hospitals is unacceptable and I welcome the commitment to reduce it. Can the Minister confirm exactly how she will monitor that and keep the House updated on progress?

[Caroline Dinenage]

That is the thrust of the whole transforming care and building the right support programme. We know that in some cases during the course of the programme people who have left residential units and gone into the community have gone back in to the units again. We have to keep a very close eye on the figures and ensure that the right package of support and care is provided so that once people leave a secure unit and go into the community, they are able to stay there.

[Several hon. Members rose—]

Health and Social Care Provider Update

Caroline Dinenage Excerpts

Tuesday 6th November 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

Yesterday, in line with duties set out in the Care Act 2014 the Care Quality Commission notified 84 local authorities that they were issuing a stage 6 notification for the homecare provider, Allied Healthcare.

I would like to update the House on why the Care Quality Commission has taken this action now, and steps being taken to assure people with care and support needs being met by Allied Healthcare that they should not suffer a gap in their care service—even if their care is funded privately.

A stage 6 notification is intended to be an early warning to local authorities that CQC consider that the business failure of a provider in their area is likely and this could lead to services ceasing for people who receive care from that provider.

The Care Quality Commission has not taken this decision lightly. They have continued to monitor the financial sustainability of Allied Healthcare since it secured a company voluntary arrangement in May. It has been speaking with Allied Heathcare’s senior management team on a regular basis to seek assurances about the company’s performance and the sustainability of its future finances. The company has not been able to provide the necessary assurances beyond 30 November 2018 and the Care Quality Commission has taken this prudent action in order to give local authorities the time to prepare their contingency plans to ensure continuity of care, in the event that it is required.

Allied Healthcare can take action to reassure the Care Quality Commission of its financial position beyond 30 November 2018, in which case the Care Quality Commission would revise its position accordingly. The Care Quality Commission is clear that there is no current service disruption. Allied Healthcare remain responsible for these services and their staff.

The law was changed in 2014 giving the Care Quality Commission a new responsibility to monitor the financial sustainability of the largest and most difficult to replace care providers across the country. It means the CQC can notify local authorities of the likelihood of service disruption caused by service failure earlier so that they have more time to prepare their plans to protect individuals.

Local authorities have a statutory duty under their section 48(2) of the Care Act to meet the needs of individuals temporarily if their care provider is no longer able to carry on. Business failure is a normal part of a functioning market and local authorities have appropriate plans in place to minimise disruption of services. The Care Quality Commission has provided local authorities with time to begin their preparations. This will include working with Allied Healthcare to ensure the local authority is given an up to date list of all people the company is providing care for, whether this is state or privately funded. Local authorities will be reviewing contingency plans and speaking to other providers to ensure continuity of care.

The Care Quality Commission and my Department are closely monitoring the situation. They are also working closely with the Local Government Association, the Association of Directors of Adult Social Services and NHS England to ensure that local authorities are supported in their contingency planning to ensure individuals’ care and support needs continue to be met.

[HCWS1071]

Hospice Funding and the NHS Pay Award

Caroline Dinenage Excerpts

Wednesday 31st October 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

As ever, it is a great pleasure to serve under your chairmanship, Mr Davies. I add my voice to those congratulating the hon. Member for Heywood and Middleton (Liz McInnes) on securing a debate on this important matter, and congratulate every Member who has been involved, either through a speech or an intervention. As MPs, we are all aware of the crucial role that hospices play in supporting and caring for our communities at a time of great need. I understand the concerns that have been raised, and have listened carefully to the strong arguments that have been made.

Hospices across England are delivering excellent end of life care and contributing to their local communities, as they have for many years. The Care Quality Commission’s “State of Care” report, published on 10 October, is testament to that. That report showed that hospices have continued to provide high-quality care at the end of people’s lives, even improving on their performance last year, which saw them rated as the highest performing secondary care servicer, with 27% of hospices—more than a quarter—rated as outstanding. I know that Springhill Hospice in the constituency of the hon. Member for Heywood and Middleton was rated as good overall in the CQC’s most recent assessment, but was rated as outstanding in the delivery of care and effective services, and people spoke highly of the kindness and caring attitude of staff. That is why the hon. Lady is right to raise this debate. I add my thanks to all those working and volunteering in the hon. Lady’s hospice, and in hospices up and down the country, for the quality of care that they offer.

We all know that palliative care can take many forms, whether at home, in a hospice, or in a hospital. There is never a more important time to make sure people get the right level of care. My hon. Friend the Member for St Ives (Derek Thomas) spoke about the immeasurable support that was given to his mum by his local hospice, and he rightly mentioned the crucial role of local commissioners in ensuring that hospices can do their amazing work, which I will speak more about in a moment. My mum was responsible for fundraising to build the Naomi House children’s hospice that my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) mentioned earlier.

[Sir Desmond Swayne]

Will the Minister address the question that was raised about local deals, and will she acknowledge the bid that I made?

[Caroline Dinenage]

Sadly, I cannot comment on individual cases. I am not aware of any individual deals being done with the Government, but of course, this could be a local arrangement. For 2019-20 and the remaining two years of the deal, funding will follow the usual route. It goes through CCGs, so I imagine that the instance that the hon. Lady mentioned is due to that, but I am keen to hear more.

[Liz McInnes]

Maybe the Minister would like to take the issue up with my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who has informed me of an agreement that has been made in Plymouth regarding a social enterprise, with the support of the trade unions. That is an interesting example that we potentially should extend to the whole country.

[Caroline Dinenage]

I can only applaud the hon. Lady’s tenacity in continuing to make that case, and we will certainly look into the matter. As I say, I have no knowledge of that individual case, but I share the desire of my right hon. Friend the Member for New Forest West to ensure that hospices such as Naomi House and Jacksplace have the funding that is necessary to do their incredible work. My mum got the whole family involved in all manner of quite humiliating fundraising exercises back in the 1990s to build Naomi House children’s hospice, and I was delighted that my role as Minister took me back to Naomi House and, indeed, Jacksplace, which caters for young adults. I went there over the summer, and Mark Smith, its director of care, was kind enough to give me a tour of the facilities. We discussed some of the issues that have been raised today, as well as others, and my team has been looking carefully at what more we can do about some of those issues.

Since I was appointed Minister for Care in January, I have met with a range of charitable stakeholders from the end of life and palliative care sector, as well as the national clinical director for end of life care, Professor Bee Wee, who is quite incredible. Having met both system representatives and representatives of charities, I have been impressed by not only their incredible passion and commitment to see Government aims for end of life care delivered, but the shared consensus on what changes are needed to drive through the improvements that we would all like to see. Hospices are an incredibly important feature of end of life care provision, but we have to see them in the wider context of our ambitions in that area. In 2016, the Government published our end of life care choice commitment, which encompasses the whole system approach to transforming end of life care, placing patients and their choices, needs and preferences at the heart of planning. The NHS gets it right when choice is meaningful, personalised, and matched by healthcare services that can respond in an effective way that places patients, families and carers at the centre of the decision-making process. I know that parts of the country are delivering excellent palliative and end of life care for both adults and children.

[Thelma Walker]

The Minister’s reference to “parts of the country” is of concern to me. Does she agree that the amount of funding, and the capacity for particular communities to raise that funding, is still a postcode lottery? In more deprived areas, accessing the knowledge, skills and ability to raise that funding is more of a challenge. How would the Minister suggest that we create more equity and parity?

[Caroline Dinenage]

The hon. Lady makes an excellent point. She is right: there are services up and down the country delivering first-class care, but there are also areas where we know we need to do more. NHS England is firmly focused on providing both the support and the challenge to achieve that, and the hon. Lady is right to mention the incredible efforts of the imaginative and resourceful volunteers who do incredible work to raise much-needed funds for those vital hospices.

A key objective in delivering our commitment to strengthening the provision of end of life services out of hospital and in the community is that people should have that level of choice, and a quality choice, up and down the country. Work is ongoing nationally to provide sustainability and transformation partnerships with tailored information to assess and enhance end of life care services in their areas. We talked earlier about commissioning; NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. Historically, hospices have struggled to demonstrate strong evidence of the services they provide and the fabulous care that we all know they offer.

The hon. Member for Burnley (Julie Cooper) mentioned currency. NHS England is working to support local use of the specialist palliative care currency, which can help local areas to plan and deliver services, including hospice services. The currency can help local services better understand the complexity of palliative care and the investment needed to deliver it properly. It is also essential that we can assess how effectively commissioners are working to improve end of life care services. My hon. Friend the Member for St Ives hit the nail on the head when he spoke about that. This year we have a new indicator in place designed to help measure how well patients needing end of life care are supported in the community. Going forward, we are planning to do more work to develop indicators that will enable NHS England to further scrutinise the effectiveness of local health economies in delivering choice in end of life care and securing the progress we all want to see.

[Julie Cooper]

Can the Minister give some idea of the timescales? The point has been made that not only are these organisations at risk of closing, but the people who need the care have not got time. Timescales that indicate the urgency with which the Government are treating the matter would be welcome.

[Caroline Dinenage]

That is a very good point. NHS England will bring forward its report on hospice care very shortly, in November.

I want to talk about staff funding. In common with much of the sector, I know hospices have faced financial challenges. I recognise the concerns of hospices that the recently announced NHS pay rise is putting them under pressure to match the uplift awarded to staff employed on the Agenda for Change contract not only to retain the incredible staff they already have, but to attract the staff they need. We have agreed that for 2018-19, non-NHS organisations that employ existing and new staff on the Agenda for Change contract will be eligible to receive additional funding. Most hospices do not employ their staff on the Agenda for Change contract because of the cost that would entail and so are ineligible.

[Sir Desmond Swayne]

Is it possible for a hospice to employ some staff on those contracts and then achieve the benefit of doing so without handing over its entire employment budget and losing control over it?

[Caroline Dinenage]

That is a very good question, which I will drop my right hon. Friend a note to answer, if he does not mind, as we need to make a few more inquiries about that.

It is important to stress that the Agenda for Change pay deal does not seek to make any distinction between the value we place on staff working in NHS and non-NHS organisations. Staff work incredibly hard to provide services, always putting patients and service users first. Funding is linked to the direct costs of implementing the Agenda for Change pay deal, which includes both pay and non-pay reforms. As the hon. Member for Heywood and Middleton mentioned, it is not just about headline pay. It is right that those organisations that employ existing and new staff on the Agenda for Change contract and must implement the entire pay deal should receive additional funding for 2018-19.

The hon. Lady is right to raise the matter, and I thank her again for doing so. I have listened carefully to the issues that have been raised, and we will look again at all of them and what we can do to better support our hospices to continue doing their vital work.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 23rd October 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

Health and social care hubs are a great example of health and care systems coming together through sustainability and transformation partnerships and integrated care systems to transform services in local areas. The NHS long-term plan will set out how we will enable and encourage better integration.

[Luke Pollard]

The Minister will know that Plymouth is leading the way in developing health and social care wellbeing hubs. She will also know that we have bid for £15 million of funding to create more hubs across the city, especially in our city centre, to bring together NHS dentistry and dental schools, sexual and mental health support, social care and new forms of general practice. Will she do all that she can to look positively on that bid, so that we can help to improve our health outcomes?

[Caroline Dinenage]

I am really pleased that the hon. Gentleman has raised this issue. Plymouth is indeed leading the way in creating hubs and showing how incredibly valuable they are in bringing together all the relevant services in one place, not only to tackle people’s current healthcare needs but to play a vital role in prevention.

[Derek Thomas (St Ives) (Con)]

Health and social care hubs provide a real opportunity to ensure that patients are cared for in the right place, and it is vital for that to be extended to those who need palliative care. Can the Minister confirm that the NHS 10-year plan will adequately address the need for equal and appropriate access to palliative care across the country?

[Caroline Dinenage]

My hon. Friend is absolutely right to mention this. Palliative care is crucial to the experience not only of patients but of their families and carers. He will be interested to know that we have a new indicator from 2018-19 to measure the proportion of people who have had three or more emergency admissions in their last 90 days of life, which will help us to assess how people can be better supported in the community, and to do that better.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

24. Social care hubs could be part of the way forward for social care, but, in response to a recent survey of care providers in my constituency, 71% said that despite the best efforts of staff the quality of care had greatly diminished because of years of chronic underfunding. Does the Minister agree that we need a systemic change in social care funding, given that the extra money provided so far is a drop in the ocean and does not address levels of need?

[Caroline Dinenage]

The hon. Lady is right. We know that the adult social care system is under pressure, which is why we are setting out a more sustainable future in the Green Paper which will be published later this year. It is, however, important to point out that more than 83% of adult social care providers are rated good or outstanding, and that, thanks to a range of Government actions, County Durham has received an additional £37 million for adult social care in 2018-19 and was allocated £2,822,376 in the recent winter funding announcement.

--- Later in debate ---

[James Cleverly (Braintree) (Con)]

15. What steps he is taking to improve preventive care in the NHS.

[The Minister for Care (Caroline Dinenage)]

Our NHS offers a range of world-leading preventive care services, but we can go further and faster. The Secretary of State has named prevention as one of his top three priorities, signalling a renewed focus on public health, community and mental health services.

[James Cleverly]

I thank the Minister for her reply. She will know, because I have spoken about this to the Secretary of State’s team, about the pressures on my constituency, and particularly on the Church Lane GP surgery. Specifically on preventive services, wearable tech, health tech and medical tech provide an opportunity to keep people healthier for longer, and can provide early digital diagnosis that can relieve pressure on medical services. What more can be done to pursue this way of relieving pressure on the health service?

[Caroline Dinenage]

I completely agree that technology can really help in this way. I recently visited Hampshire County Council, which is using a range of gadgets including a really simple one involving a light bulb that comes on when someone gets out of bed in the night to go for a pee. That is ingenious, and it is helping to prevent avoidable falls.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My constituent Holly Alliston has contacted me about the epipens that her two-year-old son, who has a severe nut allergy, relies on. There is a national shortage of them, and the Northfield Pharmacy has been emailed by NHS England to say that the situation is critical. What is the Minister doing about this? We hear about the possibility of troops having to distribute stockpiled medicines when we leave the EU, but this is hitting us now.

[Caroline Dinenage]

The hon. Lady is absolutely right to raise this matter. We are working closely with all the manufacturers of adrenaline auto-injectors to improve the supply situation as quickly as possible.

[Vicky Ford (Chelmsford) (Con)]

One in 10 mums gets post-natal depression, and we know that early identification is key to preventing it from becoming more serious. May I urge the Minister to look at the National Childbirth Trust’s campaign to ensure that all mums—as well as all babies—get a six-week check?

[Caroline Dinenage]

We are really supportive of the Hidden Half campaign, run by the NCT—my colleague the Minister met the trust last week. We must ensure that we are supportive of new mothers’ health needs.

[Mr Jim Cunningham (Coventry South) (Lab)]

What improvements have emerged in relation to prostate cancer treatments?

[Caroline Dinenage]

I am really pleased that the hon. Gentleman has raised that. Clearly, early screening is fundamental and one of the key pillars of what we want to focus on with cancers. Prostate cancer affects so many gentlemen up and down the country, and we know that that early detection is the difference between life and death.

[Michael Fabricant (Lichfield) (Con)]

17. What steps his Department is taking to tackle antimicrobial resistance and inappropriate use of antibiotics; and if he will make a statement.

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Last week, The Times reported that a young autistic woman with severe learning disabilities and an IQ of 52 was sexually exploited for months after her care provider had a court accept a plan for her to have sexual relations with men at her home. It is unacceptable that the agency charged with the care of this young woman decided that unsupervised contact with men for sex was in her best interest, yet the Government would give all such care providers a role in assessing the mental capacity of the people for whom they care. Will the Secretary of State urgently investigate this case? Given that the case illustrates the conflict of interest that arises from involving care providers in mental capacity assessments, will he pause the Mental Capacity (Amendment) Bill to allow time to make it fit for purpose?

[The Minister for Care (Caroline Dinenage)]

The hon. Lady is absolutely right to raise this incredibly concerning case. Unfortunately, because the case is ongoing and due to be heard before the High Court very shortly, we are unable to discuss the specifics of the case, but we are incredibly concerned by what it suggests. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure that the services they commission are safe, effective and high quality. Once this case has gone through the High Court, we will look to take further action.

[Sir Edward Leigh (Gainsborough) (Con)]

T2. A constituent has just written to me saying that his diabetic care has been moved from John Coupland Hospital to Lincoln Hospital under the mistaken bureaucratic belief that bigger is better. United Lincolnshire Hospitals NHS Trust, which covers Lincoln Hospital, is struggling. It is treating only 69% of people in A&E within four hours, when the figure should be 95%. What is the Minister going to do to ensure that large rural areas get the best and the same healthcare as large cities?

--- Later in debate ---

[James Frith (Bury North) (Lab)]

Last month, the Mayor of Greater Manchester adopted the five recommendations of my report, “Living Well and Dying Well”, which seeks to include hospice care provision more formally in our NHS and social care planning. Will the Minister meet me and representatives of our hospices to see how we might best make use of these brilliant community health assets?

[Caroline Dinenage]

Yes, I am happy to meet the hon. Gentleman to discuss the matter. Hospices provide an incredible level of care right across the UK, and we cannot do enough to support them.

[Several hon. Members rose—]

Autism and Learning Disability Training: Healthcare Professionals

Caroline Dinenage Excerpts

Monday 22nd October 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a pleasure to serve under your chairmanship, Mr Austin, and that of your predecessor, Dame Cheryl, who has done more to further the cause of people with autism than any other Member of Parliament. I put on record my thanks to all hon. Members who have taken part in the debate. There have been some impressive and high-quality contributions. In particular, I thank the hon. Member for Cambridge (Daniel Zeichner) for bringing the case before us and the Petitions Committee for permitting the case to be brought. I also thank the hon. Member for Sheffield, Hallam (Jared O'Mara) for his testimony, although he is no longer here. I am sure we all agree that it was incredibly powerful, extremely important and exceptionally brave.

It is hard to hear the story of Oliver McGowan, which inspired the debate and the petition that triggered it. I am the mum of a teenage boy a bit younger than Oliver, so I find it heartbreaking to even think about what Paula and her family have been through. I have been in this role for nine months, and one of the great honours of the job is being able to speak to some incredible, awe-inspiring people, but surely the most amazing of them are the mothers who have turned the unthinkable heartbreak and anger at the loss of a child into a crusade for change.

Dr Sara Ryan, who has already been mentioned, whose son Connor Sparrowhawk drowned in a bath while under the care of Southern Health, is the most remarkable campaigner for the way that we support adults and children with learning disabilities. Another example is the incredible Paula McGowan, Oliver’s mum, who I met last month. To say that I feel humbled by her story is a massive understatement. The way that she has been fuelled by the unspeakable tragedy of Oliver’s death to fight, to battle and to campaign to ensure that other children and parents do not have the same experience is incredibly brave and courageous. She is nothing short of an inspiration, and she inspires me to strive to tackle the inequalities that people with autism and with learning disabilities face and to do my best to prevent further avoidable tragic loss of life.

The health inequalities between people with learning disabilities and autism and the general population are well understood—virtually every hon. Member present has mentioned them. In recent years, there have been ongoing efforts to address them, but the shameful case of Winterbourne View Hospital is an example of how things have not worked.

It is a sad fact that it takes an avoidable tragedy to spur the action that we want. Since then, significant programmes of activity have been devoted to tackling the inequality that has blighted the experiences of people with learning disabilities in society—inequality is not confined to health and social care. That activity is not only about reducing the number of deaths that may have been preventable, but about improving people’s genuine experiences of care, reducing the use of restrictive interventions, increasing health and wellbeing, and ensuring that people are not hospitalised when they can be better supported in the community.

The existence of the learning disability mortality review programme—LeDeR—testifies to our commitment to reduce the number of preventable deaths among people with a learning disability. LeDeR is focused on learning disability, but has important lessons that relate to the care of autistic people. The programme, led by the Norah Fry centre at the University of Bristol, was introduced to ensure that local evidence-based action is taken to improve support for people with a learning disability. The result is that commissioners are focusing their attention on their local mortality rates and the reasons for them, and are highlighting the further national action that is needed. We must learn from those deaths quickly and translate that learning into effective remedial action that prevents any repetition.

In May, the University of Bristol published the second annual LeDeR report, which showed that 13 deaths had involved circumstances where an individual’s health had been adversely affected by entirely avoidable external factors. The report also found that, based on the examples that were reviewed, the median age of death is 23 years younger than the general population for men and 29 years younger for women. It makes for shocking and chilling reading. LeDeR is ongoing, so many reviews are still to come. Since then, there has been significant action to increase the number of reviews undertaken, including NHS England investing an additional £1.4 million in support of them. Hon. Members from across the House will feel, as I do, that the report is a stark message that we need to do much more to ensure that people with a learning disability receive the best quality care.

In the Government’s response to the LeDeR report, which we published on 12 September, we set out a clear action plan to make progress against each of its national recommendations. The key theme is that of facilitating better care for people with a learning disability by sharing information on their needs and by making reasonable adjustments to improve access and the responsiveness of services to meet those needs. It highlighted some actions that I am glad to say were already well under way, as well as many new actions.

[Barbara Keeley]

The Minister has used the word “action”. If we had been able to discuss the Government’s response to the LeDeR report, which came out the day before the conference recess, I would have said to her that there is very little action in it. The whole point of the cross-party feeling of the debate is that we want action. There are an awful lot of consultations in the response but, as I highlighted in my speech, we have had 10 years of reviews, starting with the report that came out 10 years ago. The Minister used the word “action”—can we not just get on with some?

[Caroline Dinenage]

We have accepted every single recommendation in the LeDeR report, and the only reason we are consulting on the recommendations about training is that we have to do that to introduce legislation and change the regulations. We need to do that properly and ensure that we take on board the experiences of people from a wide range of backgrounds so that it actually works. Training is already in the guidelines for healthcare professionals, but the hon. Lady and many other hon. Members have said that it is simply not happening. This is not about action for the sake of it or to say that we have ticked a box to make it happen, but about meaningful action that will save lives. That is why I want to get it right. I am not going to hang around; it will be done to a timescale, which I will explain more about in a moment.

An example of action is that NHS England is working with NHS Digital to add a reasonable adjustment flag to digital care records to indicate the potential adjustments that people with a learning disability may require. The flag will be available to all organisations that provide care. It will support improved communication between patients, their carers and clinicians and lead to more personalised, safer patient care and better outcomes. That capability is being developed for piloting in the NHS summary care records application this summer. We are also exploring with NHS England and NHS Digital the potential for a comparable autism flag.

We have also commissioned Oxford Brookes University to look into best practice in co-ordinating the support for people with a learning disability and a long-term condition. Hon. Members have raised the difficulties that autistic people and people with learning difficulties experience in communicating their needs to health professionals, and also highlighted the importance of hospital passports in overcoming these difficulties and ensuring that their hospital stays are safer and more comfortable. However, I know that Oliver had such a passport and it was not read, so that needs to be taken into consideration as well.

As part of our governance arrangements for the autism strategy, we have set up a task and finish group on health, care and wellbeing, which is looking at barriers to care. We will ask it to consider how we can best disseminate tools such as the hospital passport, to ensure that patients receive effective, personalised care.

Of the new actions, the one that most concerns us today is the commitment to consult on mandatory training. I believe that the steps we are taking will address the shameful inequalities that people with learning disabilities continue to experience. Everybody has the right to receive effective, compassionate and dignified care, and having a learning disability or autism should not be a bar to that.

I am absolutely committed to ensuring that all staff have the skills that they need, whether for learning disability or autism, to deliver excellent and compassionate care. We are already taking forward actions in this area, which I will set out before moving on to discuss mandatory training.

We have supported the development of the learning disability core skills education and training framework, which sets out three tiers of knowledge and skills in relation to learning disability. We are also working towards the development of an autism core skills and competency framework for health and care staff, and for staff in organisations with public-facing responsibilities.

In addition to the existing criteria for professional regulation and registration, there are also existing health and social care regulations that are designed to ensure staff have had appropriate training. However, it is clear from the tragic deaths of Oliver and the many, many like him that that is not enough; we need to go further. One of the recommendations in the LeDeR report echoes the petition in saying that there should be mandatory learning disability training for all health and care staff.

We welcome that recommendation and we have made a commitment to consult formally on it, and we will conclude the consultation by the end of March. I can also confirm that we will include autism within this consultation. My aim is not to mess around with this work, as I have already articulated; the Government’s plans will be published by the summer and regulations could be introduced by the end of 2019. A formal consultation is essential if we are going to change regulations, which is one of the routes by which we can ensure that training is absolutely mandatory.

I appreciate that several hon. Members have asked me specific questions about all sorts of logistical issues, what the content of the training should be and how it might be different for different staff groups. Of course those are all the sorts of issues that we will consult on. We need to canvass the widest possible range of opinions and we clearly are not in a position now to guess the outcome of the consultation. If it was up to me, I would want to embed this training in initial training through all the professional bodies, royal colleges and training providers, having it at all levels of health and social care, so that anybody who has any role in a health and care setting would be mandated to receive some level of this training, obviously with different levels of training for people who work in reception and for those who are medical staff.

One of the key elements of the recommendations in the LeDeR report is that people with learning disabilities should be involved in the training. We will work with people with learning disabilities and autism, and with the groups that represent them, such as Mencap, in shaping the consultation and identifying the key questions that we have to ask. I am absolutely thrilled to say that Paula McGowan has agreed to help us with this.

The petition also refers to mandatory autism training. Of course, LeDeR looks at the deaths of people with learning disability rather than autism, but when it comes to inequalities and the patient experience there are clear parallels between the experiences of both groups and in the sort of reasonable adjustments that might be made to support both groups. It would be a missed opportunity if we did not consider in our consultation the training requirements of staff to better support autistic people as well those with learning disabilities.

Our response to LeDeR and the implementation of Building the Right Support are part of wider efforts to tackle inequality for those with learning disabilities and autism. I will briefly highlight three of these efforts in particular that have great potential. First, there is quality checkers. NHS England is developing toolkits for GP services and mental health in-patient services. These will support people with a learning disability to act as quality checkers, to examine services from their perspective and to have a dialogue with providers and commissioners on what needs to improve.

Secondly, and so importantly, there is stopping the over-medication of people with a learning disability, autism, or both, which is known as STOMP. This national programme brings together multiple organisations in the health and care field, with a common purpose to stop the over-medication with psychotropic medicines of people with a learning disability, autism or both.

Finally, commissioning guidance on autism services, and an accompanying best practice toolkit for local health and care commissioners, are due to be developed shortly and are expected to be available by next spring.

As we develop the consultation on mandatory training, it is particularly helpful to hear these issues and concerns, which hon. Members and their constituents want to see being addressed. We will reflect on, and listen to, those issues and concerns in our consultation. The consultation document will be issued in the new year, giving us sufficient time to conclude the formal consultation period by the end of March, and of course I am extremely happy to discuss with any hon. Member, or any lord in the other place, any particular issue that they would like to see reflected and indeed tackled by the consultation at any time, either before or during the consultation.

[Barbara Keeley]

I asked the Minister earlier whether she could give an outline of the timetable after the consultation. When does she believe that we will see regulations to make this training mandatory?

--- Later in debate ---

[Caroline Dinenage]

I believe I have already answered that question. I said that I would like the Government plans to be published by the summer and the regulations to be amended by the end of the year.

[Barbara Keeley]

Can the Minister give a date, rather than a seasonal time?

[Caroline Dinenage]

I am afraid that I am not the scheduler, but that would be my aspiration as the Minister. Obviously, I do not have the timing for the Government, the Chambers and what have you, but that is definitely my aspiration.

It is absolutely vital that we do everything in our power to get this matter right. We owe it to Oliver and to the many, many young people with autism or learning disabilities whose lives have been tragically shortened. We owe it to Paula and Tom, and to the many parents and family members who have suffered unimaginable grief. We owe it to ourselves—a country should be judged on how it cares for its most vulnerable and on this, we must not be found wanting.

Social Care Funding

Caroline Dinenage Excerpts

Wednesday 17th October 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

In the very limited time that is left to me, I will begin by thanking all the Members who have contributed to the debate. Unfortunately, I shall not have time to name them all, but I want to address some of the points that they have made. I want to reaffirm our commitment to the social care system and to ensuring that it is fit to face the challenges of the future. I also want to look ahead to the Green Paper. Most of all, however, and most importantly, I want to pay tribute to the amazing hard work and dedication of the people—both those in the social care workforce and informal carers—who play such a vital role.

A number of Members, including the hon. Members for Leicester West (Liz Kendall) and for Gedling (Vernon Coaker), made points with which I agreed about the importance of cross-party working and not using this issue as a party political football, but I disagreed with the claim made by them and others that we are complacent. We are absolutely not complacent. We absolutely recognise the need to act. It is because of the Government’s prudent actions that overall funding for social care in 2019 will be 8% higher in real terms than it was in 2015. But we also know that there are short-term pressures on local government in particular. That is why we have given councils access to up to £9.64 billion more dedicated funding for social care over the three years up to 2019-20.

Today the Secretary of State reiterated his recent announcement that the Government would provide £240 million for additional adult social care capacity this year, but that is far from our only contribution to the sector. Since 2017-18, we have been able to allow councils to raise their council tax by up to 3% per year, specifically to help them to respond to the pressures facing adult social care. Those additional resources will help councils to commission care services that are sustainable and diverse, and offer sufficient high-quality care. We have seen a real difference in services across the country. We have also discussed winter resilience and allocated £145 million to NHS trusts to upgrade wards and procure beds.

As we have made clear today, the funds that we have already put into the system have stabilised the market and enabled councils to respond to the short-term pressures they are facing, but we are aware of the future challenges faced by the care system, and our Green Paper will also present proposals designed to make our social care system much more sustainable in the long term.

The motion refers to cuts amounting to £1.3 billion. That is wrong. It is entirely misleading to refer only to the revenue support grant when councils have access to council tax, business rate retention, the social care precept, and other funding to deliver their local services. It is right that more of our money that is spent locally is raised locally. In 2010, councils were 80% dependent on Government grants; by 2020, they will be largely funded by council tax and other local revenues. We have been backing councils in England with £200 billion for the delivery of local services in their communities between 2015 and 2020. This year’s settlement includes a £1.3 billion increase in the money available to councils over the next two years, which means that they will have more money to enable them to deliver for their local communities.

The motion claims that 1.4 million older people have unmet needs. By passing the Care Act 2014, the Government established a national threshold that defines the care needs that local authorities must meet—and they can exceed it if they wish. That eliminates the postcode lottery of eligibility across England.

The Secretary of State has announced that the workforce is one of his top three priorities, and he is keen for us to find ways to support staff better and make it easier for them to work in the NHS and social care. To improve engagement, we have launched an online platform, “Talk Health and Care”, to give support workers an opportunity to interact with the Government. We are also launching a recruitment campaign this autumn to raise the image and profile of the care sector. We continue to work with our delivery partner, Skills for Care, to provide a range of resources to attract, train and retain the brightest staff.

The Government are absolutely committed to a social care system that delivers high-quality care for all, and we hope that the Green Paper on care and support that we will publish later in the year will be a catalyst for debate.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put and agreed to.

Resolved,

That this House notes that eight years of Government cuts to council budgets have resulted in a social care funding crisis; further notes that 1.4 million older people have unmet social care needs; notes that Government grant funding for local services is set to be cut by a further £1.3 billion in 2019-20, further exacerbating the crisis; recognises with concern the increasing funding gap for social care; further recognises that proposals from the Government to invest £240 million will not close that gap; and calls on the Government to close the funding gap for social care this year and for the rest of the Parliament.

Cyber Resilience in Health and Care

Caroline Dinenage Excerpts

Thursday 11th October 2018 Written Statements

[The Minister for Care (Caroline Dinenage)]

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

In February 2018 the Government published “Securing cyber resilience in health and care: A progress update”, which set out the actions taken to improve the cyber-security of the health and care system before and after last year’s largest ever WannaCry global ransomware attack, as well as our plans for the future. Today we are publishing a further update on progress and development of our future plans. In particular since February we have:

increased our investment in securing local infrastructure in 2017-18 to over £60 million;

signed a Windows 10 licensing agreement with Microsoft which will allow local NHS organisations to save money, reduce potential vulnerabilities and increase cyber-resilience;

agreed £150 million of investment over the next three years;

procured a new Cyber Security Operations Centre boosting the national capability to prevent, detect and respond to cyber-attacks;

launched the data security and protection toolkit;

agreed our plans to implement the recommendations of the Chief Information Officer for Health and Care’s review of the May 2017 WannaCry attack;

supported 25 local NHS organisations to improve their cyber-resilience via the NHS Digital “Blue Teams” pilot and;

estimated the costs of the WannaCry attack.

NHS Digital is continuing to work closely with local areas to build resilience. This work forms part of the data and cyber security programme being led by the Department of Health and Social Care with its arm’s length bodies to improve the cyber-security of the health and care system.

Copies of the “Securing cyber resilience in health and care—progress update October 2018” have been placed in the Library of the House. It can also be accessed at:

https://www.gov.uk/government/publications/securing-cyber-resilience-in-health-and-care-october-2018-update.

[HCWS992]

Health and Social Care

Caroline Dinenage Excerpts

Thursday 11th October 2018 Ministerial Corrections

The following are extracts from a Westminster Hall debate on Care Homes: CCTV on 5 September 2018:

[The Minister for Care (Caroline Dinenage)]

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

[Official Report, 5 September 2018, Vol. 646, c. 98WH.]

Letter of correction from Caroline Dinenage:

An error has been identified during the speech I gave on Care Homes: CCTV.

The correct statement should have been:

[Caroline Dinenage]

We have backed that up with more than £9 billion of investment in the sector over three years, which equates to an 8% increase in funding.

[The Minister for Care (Caroline Dinenage)]

In the last three years, we have increased funding by £9.4 billion, which equates to an 8% increase.

[Official Report, 5 September 2018, Vol. 646, c. 98WH.]

Letter of correction from Caroline Dinenage:

An error has been identified during the speech I gave on Care Homes: CCTV.

The correct statement should have been:

[Caroline Dinenage]

Over three years, we are increasing funding by £9.4 billion, which equates to an 8% increase.