Whorlton Hall

Debate between Caroline Dinenage and Sarah Wollaston

Thursday 23rd May 2019 Commons Chamber

[Caroline Dinenage]

That is what we are looking towards, which is why the Government are putting so much more money—£4.5 billion of the extra investment in the NHS—into the sorts of community services that we need to make exactly that a reality. There are cases where people do end up in an in-patient setting, often because services have failed and their situation has almost reached crisis point. The transforming care and building the right support system that I spoke about earlier is all about ensuring that we get people out of those settings as quickly as possible and into the right kind of support in the community.

[Dr Sarah Wollaston (Totnes) (Change UK)]

Too many people are ending up in terrible institutional care hundreds of miles from home for the want of much more appropriate community care, including social care. The Minister has spoken about not wanting to delay the publication of reports, but she will know that the delay to the social care Green Paper has been unaccountably prolonged. Will she bring forward the social care Green Paper, because this issue lies at the root of inappropriate admissions?

[Caroline Dinenage]

The hon. Lady knows that I listen very carefully to what she says. I completely share her frustration about the delays to the social care Green Paper, but I do not think that we should ever be held back from making progress on all the things that are wrong in society that we care very deeply about because we are awaiting the publication of such documents. We will therefore be pushing forward with all the work on a lot of the issues that I have spoken about today as a matter of great urgency.

Local Government and Social Care Funding

Debate between Caroline Dinenage and Sarah Wollaston

Wednesday 24th April 2019 Commons Chamber

[Caroline Dinenage]

I think the honest answer to that question is that there will be a bit of both. The Green Paper is a big document which covers a range of issues. It will be possible for some developments to take place immediately, but others will take longer.

[Dr Wollaston]

The Minister’s reply suggests that the Green Paper already exists. There is a great deal of frustration about the delay. The Green Paper was supposed to follow hard on the heels of the 10-year plan, because the two were closely linked. The Secretary of State gave a pledge from the Dispatch Box that it would be published before Christmas. Will the Minister at least set out the reasons for the delay, and give some indication of when we might expect it? It is such a crucial document.

[Caroline Dinenage]

As the hon. Lady will know, a version of the Green Paper already exists, but that does not mean that we are resting on our laurels while we are waiting for an opportunity to publish it. We are continuing to improve it and evolve it so that when we do publish it—as soon as possible—it will be in the best possible shape.

My hon. Friend the Member for Chelmsford also spoke about dementia, and about the importance of investing in dementia care and research. We lead the world in this regard, but we know that there is more to be done if we are to achieve our aspiration of being the best place in the world in which to live with dementia by 2020.

The hon. Member for North Tyneside (Mary Glindon) spoke about some of the difficulties for councils that had been addressed by “working smarter”. She also said that she thought it unfortunate that councils had had to raise council tax in order to have the money that they need. I point out to her gently that the average annual increase in council tax bills from 1997 to 2010 was 5.8% and since 2010 it has been only 2.2%—half what it was under the previous Labour Government.

The hon. Member for Lewisham, Deptford (Vicky Foxcroft) spoke about youth violence and the importance of schools, social services, voluntary sector organisations and public health bodies working together through a community-led approach to deal with it. She was absolutely right.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) spoke about the challenges facing rural communities and the higher costs of delivering things such as domiciliary care. She also spoke about the importance of innovation, quality of care and being outcome-focused. She spoke glowingly about the National Centre for Rural Health and Care.

I always listen very carefully to what the right hon. Member for North Norfolk (Norman Lamb) has to say because he has done this job. He spoke about the importance of investing in prevention and said that social care must help people stay independent for longer. He admitted that this job is not quite as easy as it looks and that when he was fulfilling it, there were difficult funding decisions that had to be made. It will be no surprise to him that that continues to be the case and that nothing has changed since he left the role. It is important that he recognises that the challenges continue.

The hon. Member for Chesterfield (Toby Perkins) said that innovative choices have had to be made, that there are better services that cost less in his constituency and that the local authority has had to invest in order to save money. He did make a couple of errors, unfortunately. He mentioned that Labour councils are producing lower council tax, but everybody knows that it is actually Conservative councils that deliver better value for money, with a combination of delivering great quality services while keeping council tax lower than either Labour or the Liberal Democrats.

The hon. Members for Burnley (Julie Cooper), for Bradford West (Naz Shah), for Warrington South (Faisal Rashid), for York Central (Rachael Maskell) and for Peterborough (Fiona Onasanya) all made passionate speeches, mainly about the impact of austerity on areas of deprivation.

The hon. Member for Redcar (Anna Turley) spoke about an innovative employment hub that has grown from the loss of the steelworks in her constituency. She spoke about the Care Academy in Cleveland, which is doing great work equipping more people for roles in adult social care. She mentioned how the challenges of caring for an ageing population are being addressed at a local level. I say to her that that is something that will have to be addressed not just at a Government level, but at a local level and a voluntary level. We all have to work together to face these challenges, which are being faced the world over.

The hon. Member for Totnes (Dr Wollaston) spoke about how important it is to have cross-party and collaborative work on this issue. We all face difficult choices. For too long, adult social care has been used as a political football. Even today, the Opposition spokeswoman talked about the dementia tax once again. That is very unhelpful language that does not help us come to a meaningful consensus or to work together.

Oral Answers to Questions

Debate between Caroline Dinenage and Sarah Wollaston

Tuesday 19th February 2019 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

T3. Key parts of our NHS workforce are registered and regulated by the Health and Care Professions Council. Does the Minister share their concern about the steep rise in professional fees that they face—in particular, the loss of the 50% discount that applied to graduates within two years of qualifying—and will she look again at whether anything can be done to assist this key group of our workforce?

[The Minister for Care (Caroline Dinenage)]

My hon. Friend is absolutely right about the need to support and enhance the protections for allied health professionals. One of the recent planned HCPC increases was to raise its annual fees by £16, but it would still remain one of the lowest of any of the UK-wide health and care regulators. It is also important to remember that regulation fees are tax deductible.

Mental Capacity (Amendment) Bill [Lords]

Debate between Caroline Dinenage and Sarah Wollaston

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Caroline Dinenage]

I am afraid that I cannot take any more interventions at this stage.

Our Bill allows the person themselves to request an IMCA from the responsible body if they have the capacity to do so, and it explicitly states that an appropriate person can request an IMCA or that the responsible body should appoint an IMCA if it believes that the appropriate person having the support of an IMCA would be in the cared-for person’s best interest.

I agree that the appropriate person has a challenging role with vital duties to ensure that the person exercises their rights, and we want to work with others in the sector to establish how best to support them in this role. There is existing provision in the Bill to address the concerns raised by amendment 51. In some areas, the amendment adds uncertainty and over-complication.

This Bill is about protecting vulnerable people and replacing a one-size-fits-all system.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank my hon. Friend for giving way and for listening to many of the concerns that have been expressed about the Bill, as shown in the Government amendments. How are we going to deal with the extraordinary backlog of cases, which has left over 125,000 people without protection? The safeguards she has set out will stop this being a rushed process, but will she say something about the backlog?

[Caroline Dinenage]

The backlog of 125,000 people without the safeguards they need, with their families lacking reassurance and with the people who care for them lacking legal protection, is an enormous concern. That is why, during the long period in which we will set out the code of practice, we will be supporting local authorities to go through those backlogs. From day one, when the system is implemented, any new applications and those still in the backlog will be processed using the new system.

With grateful thanks for your patience, Mr Deputy Speaker, I will now sit down. This new system puts individuals at its very heart, and it removes the one-size-fits-all, box-ticking exercise we have unfortunately come to live with under the current system.

Oral Answers to Questions

Debate between Caroline Dinenage and Sarah Wollaston

Tuesday 27th November 2018 Commons Chamber

[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.

Assessment and Treatment Units: Vulnerable People

Debate between Caroline Dinenage and Sarah Wollaston

Tuesday 6th November 2018 Commons Chamber

[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.

Learning Disabilities Mortality Review

Debate between Caroline Dinenage and Sarah Wollaston

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

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

[Dr Sarah Wollaston (Totnes) (Con)]

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

[Caroline Dinenage]

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