Transforming Care Programme

Cheryl Gillan Excerpts

Thursday 5th July 2018 Commons Chamber

[Norman Lamb]

The hon. Gentleman makes a really important point, and I totally agree. I said at the start that this is not a great demand for a whole load more money. However, some up-front investment is needed, not only in establishing the facilities in the community, but in training people in the community, and I will come back to that in a little while.

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

I add my voice to others in the Chamber in saying that I am very grateful to the right hon. Gentleman for securing the debate, and I hope to catch the Chair’s eye to make a contribution on autism. Does the right hon. Gentleman agree that when it comes to financing and co-ordination, a lot can be learnt from the National Audit Office report from 2017 that looked specifically at progress in the transforming care programme? Does he also agree that it is quite worrying that the NAO said that it was concerned about the programme’s overall progress and whether it would achieve value for money? One of the problems that it pointed out was that some of the local partnerships were

“struggling to put in place appropriate accommodation quickly enough”,

which had led to delays in people coming out of hospital and perhaps not the correct co-ordination to provide the services that are so desperately required by this vulnerable group of people.

[Norman Lamb]

I thank the right hon. Lady for her intervention, although it was a bit freaky, because I was about to come on to the National Audit Office report. She is absolutely right in identifying the criticism that it made of progress on this programme.

Let me deal with the numbers involved. As I said, the commitment was to close between 35% and 50% of in-patient learning disability and autism beds and to provide alternative arrangements in the community by March next year. The document, “Building the Right Support”, mentioned getting 2,600 beds down to between 1,300 and 1,700 beds, which is a very significant drop. Hitting the minimum drop that the Government committed to of 35% would involve the closure of 922 beds. Of that total, 531 still need to be closed in what is now a very short space of time.

The latest data, from the end of May, shows that there are still 2,400 people in institutions, 41% of whom are over 50 km away from home. I ask hon. Members to think about what that means. Many of those families are not wealthy, and some people are themselves disabled. If their loved one—their child—is put in an institution a long way from home, it can sometimes be impossible to maintain contact. Just imagine—all of us—what that must mean to people to lose touch with their vulnerable child. It is not acceptable, but it persists today, and according to that latest data from the end of May, the length of stay is still over five years. There has been very little change in the length of stay. Perhaps most troubling of all from that latest data is that the number of children in in-patient beds has more than doubled. For goodness’ sake, this programme is about moving away from institutional care, yet between March 2015 and May 2018, we have doubled the number of children in institutions. This is intolerable and in a little while, I will come back to why that is not necessary if things are done properly.

I find myself in a horrible position of expressing anxiety about closing the rest of those beds by March next year, but it is important for the Minister to note that there is a real fear on the part of families and the organisations that represent them about a big risk in a head-long dash to close beds by the deadline in cases where many people have complex needs. Some people in units that have been earmarked either for closure or reductions in beds, apparently defined as “impacted sites” in the system, will not be going home but will have to be shunted somewhere else in the country. Of course, a move for someone who has very complex needs can be massively destabilising. If this is done in a hurry to meet a target because there has been a failure of the programme to date to prepare community resources, it will be a disaster for the individuals involved. For those able to live in the community who are still in institutional care, there is a massive concern that not enough has been done to develop community services or train the workforce. We have to avoid the risk of discharging people only to readmit them weeks or months later.

I mention the really shocking case of a young lad called Eden. He has been failed throughout his life, from childhood into adulthood. He has been in hospital for more than 10 years. His mother, Deb, is desperate. She constantly fights against the system, which does not listen to her. He is in a hospital in Norfolk, and they live in London. She has long journeys—a 10-hour round trip or something of that sort—to visit him. She is not wealthy. Eventually—I visited Eden in that hospital—she got him home to a facility near their home in west London, but because arrangements had not been made properly by the local authority to have the proper support services in place, within weeks he was back in that institution again. That individual has been horribly failed by the NHS—by the system—and it is wholly unacceptable.

The consequences of the failure to get people out of institutions include, as I said, the loss of contact with family. Care behind closed doors often involves unacceptable practices, hidden from view. I mentioned Fauzia earlier, who was admitted to St Andrew’s hospital in Northampton—she was a child of 15 at the time. Her family asked me to go and visit her. It is an unusual thing for a Minister to do, but I decided to go at the invitation not of the institution, but of the family. I went to see her and she was living in what I would describe as “a cell”. This is a 15-year-old girl. She suffered from the constant use of force—restraint—and she was being put into seclusion in another room that was completely bare, with concrete walls. She had a tiny exercise yard. This girl was in there for over two years. It was really shocking—a total abuse of her human rights. She had no life at all, yet from the day that she was discharged, when we finally got a review undertaken, there has been no more restraint. She went to a brilliant place called Alderwood, also in Northamptonshire. The people who work there have never had to use restraint against her, because they have been trained, crucially—the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) will know about this—in how autism affects the individual, which so often does not happen in big institutions.

I visited Fauzia at Alderwood. She has a very happy life. She is outdoors much of the time, happy and contented—still very complex, but not in the horribly alien environment that she was in in St Andrew’s. St Andrew’s is receiving a fortune in Government money—taxpayers’ money—in many cases to treat people using the wrong model of care, trapping them in this institution. It has invested in a very substantial new unit. It may be smart—I am told that it is—but why are we making this investment in new in-patient facilities when children should not be going into hospital, unless there is an absolutely exceptional circumstance?

I also visited Josh, who I mentioned earlier. He had been in a hospital in Birmingham that had cared for him well, but he was far away from home. He has now made a substantial improvement and is developing brilliantly. He has a life again, and he is happy with his family. It is inspiring to see what people are doing to support individuals in those community settings.

What have the Government done to assess the progress of this programme? The Department of Health commissioned an independent review of transforming care partnerships, allocated £1 million to it and put it out to tender, but I am told that it has now been pulled and will not go ahead. Why? I understand that it might be because NHS England is also, bizarrely, commissioning an independent review, but we have only had provisional results from that. When will we know more? Those provisional results are disturbing. They show that, in quarter 3 of 2017-18, only 35 of the 48 transforming care partnerships had intensive support services to look after adults 24/7 in their own homes across the whole area of the partnership. Those services are required by the Government’s document, and they are critical to ensuring that people can be safe at home, yet only 35 out of 48 partnerships have them in place.

Only 23—less than half—of the partnerships had intensive support services for children and young people, so it is little wonder that we have seen a doubling of the number of children going into institutions. Only 19 had adult community forensics services across the whole area, and only 14 had children and young people’s community forensics services across the area. There is no detail at all yet about what the services that are in place actually consist of. All we have is a tick-box exercise to show whether there is a service in place. As the hon. Member for Ipswich (Sandy Martin) rightly identified, there is so much missing from community support that would enable people to be safely discharged and return home.

The National Audit Office report, to which the right hon. Member for Chesham and Amersham referred, made a pretty damning assessment in 2017. It questioned the credibility of the transforming care partnership plans and highlighted the fact that care and treatment reviews were not taking place as promised. Those reviews are supposed to be carried out for every individual in in-patient care every six months, yet, as of May this year, only 54% had had one in the past six months, and 390 patients—16% of the total—had not had one for more than a year. Why not? If the programme is being properly implemented, with proper national leadership, surely those reviews should happen in every case, every six months.

The NAO made the case that money was not transferring quickly enough from hospitals to the community and that there was still no effective mechanism to guarantee that that would happen. It identified an absence of workforce plans for community provision and found that most transforming care partnerships did not intend to produce such plans until 2019. Well, how the hell are they going to meet the target of this dramatic reduction in beds by March 2019 if they do not produce workforce plans until that time? That is completely the wrong way round.

[Dame Cheryl Gillan]

I happen to agree with the right hon. Gentleman. Does he expect the Minister to be able to tell us what has happened to the extra £2 billion of investment that the Government have made in social care services since March last year? It seems to me that something is not quite right about the co-ordination in this area, because the money is going in but the outcomes are not coming out at the other end.

[Norman Lamb]

I agree, and I suspect that the social care system as a whole is under considerable strain. The Government have chosen to produce a Green Paper only on the older people element of social care. They are not looking at the position of younger adults with disability. The right hon. Lady is absolutely right to say that we are not seeing the outcomes that we absolutely need to see.

Importantly, the NAO focused on the proportion of people with learning disabilities who are in paid employment. We need to take a holistic view. This is not just about whether someone is in a hospital bed or in the community. We need to empower people, as far as possible, to live the kind of lives that the rest of us take for granted. The report highlights the fact that only 5.8% of people with a learning disability are in paid employment. However, some local authorities have up to 20% employment rates in that area, which shows what is possible. [Interruption.] Madam Deputy Speaker, I am moving towards the end of my speech. I heard a cough, and I note the point that you are trying to make.

Before I finish, however, I want to highlight the fact that there are good things going on. I want to ask the Minister a number of questions. Some areas of the country do this really well. They include Salford, Hertfordshire, Ealing and Bristol, and there is a brilliant community service in my own county of Norfolk, which is run by an immensely inspiring woman called Melanie Bruce. She previously worked in institutions, but now takes the view that very few children ever need to go into hospital and that, if they do need to do so, it should be for only a very short time. The community service is called Starfish, and I have written to Simon Stevens saying that that model should be applied everywhere. In the past year, among the group of people in the Starfish programme, there has not been a single admission to hospital. That shows what is possible, rather than the doubling of the numbers that we are seeing elsewhere. I also want to mention Shared Lives Plus, a scheme in which someone with a learning disability or with mental ill health goes to live in a family. The families are paid for the support that they give, but the scheme treats the person as a human being and an equal citizen, rather than putting them in an institution. That is what is so important.

I will end by asking the Minister some questions. What will happen after March 2019? Will she commit to an improved successor programme that learns lessons from the last seven years and actually fulfils the promise of the transforming care programme, with a focus on implementation and inspiring effective national leadership? Will she confirm that those other programmes in NHS England, which are vital for people with learning disability, will continue and that the same national focus will be maintained or indeed enhanced? What assurances can she give that this programme of work will continue as an absolute priority beyond March next year?

Given the slow progress to date on closing beds and the stated plan to close 922 beds by March, what evidence does the Minister have that new community support is available to support the safe discharge of those people? Can she guarantee that there will be a close focus on every single case, to avoid the risk of neglect? Will the Government establish a new workforce development fund to ensure that there are enough staff with the skills to deliver the right care in the community?

What actions will the Minister take to guarantee the pooling of money and the shift of resource from hospitals to the community? Will she address the conflict of interest of clinicians making decisions when they are employed by organisations that earn their money from keeping beds occupied? How will the Government ensure that all in-patients receive a care and treatment review every six months, instead of the failure of delivery that we have at the moment? What steps are the Government taking to improve data on in-patient numbers so that we can bring to an end the two unreconciled data sets that we still have, years on from when the NAO complained about this in the first place?

How will the Minister ensure that progress is robustly and independently monitored and scrutinised? When will the independent evaluation be published in full? How do the Government intend to learn from the areas of really good practice to deliver an approach based on early intervention and crisis prevention? Will she ensure that, from here on, children will be central to the Government’s programme? If we can prevent children from going into institutions in the first place, we can change their lives completely. We can rescue them from a life in an institution.

Finally, will the Minister discuss with the Prime Minister the case for a cross-departmental ministerial taskforce to drive progress and show that all parts of Government are doing their bit to meet people’s full range of needs, given the importance not only of where they are but of employment, housing, education and the criminal justice system? This is a story of the awful neglect of people’s human rights, and of people in this country here and now being treated as second-class citizens. This really does have to end, and we owe it to the families sitting in the Public Gallery today and their loved ones to do far better by them in the future.

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

Once again, I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate, but I regret that more of our colleagues are not in the Chamber for what I consider to be a very important debate.

I hope that the right hon. Gentleman and the House will forgive me if I come at this purely from the angle of autism, but, having the privilege of chairing the all-party group on autism, I tend to refer to it on every occasion, as many of my colleagues know. I have just come from a lunchtime event in the other place with the Baroness Browning, Angela Browning, who entered the House in the same year as I did and who was the original inspiration behind the Autism Act 2009, a private Member’s Bill that I took through the House. She was entertaining a group of people from an organisation called Fixers. I appreciate that we are not allowed prompts in the Chamber, but its report, “Feel Happy on the Spectrum: Young Autistic People Speak Out”, has already left an impression on me. Two very impressive young people, Jenny and Gabriel, talked us through their experiences.

As the right hon. Gentleman talked about employment, I had a look at the recommendations in the report, and of course they include something we would all like to see: more education on autism in the workplace. It contains testimony that I thought would be interesting to read into the record from a young person who has obviously found an employer who is understanding and welcoming of their autism. They wrote:

“Civil Service fast-stream is really good for people with autism. They go out of their way to accommodate your autism in their entrance exams with things like extra time and they don’t discriminate if you disclose”.

That is a positive note on which to start my remarks in a debate that is partly a reflection of the very sad and disturbing stories that came out of Winterbourne View care home. The transforming care programme was developed in response to that atrocious scandal. No one could have failed to be moved by the shocking abuse of adults with learning disabilities and autism in that private hospital, which was supposed to be an assessment and treatment unit—it most certainly was not a treatment unit; it was a maltreatment unit. Following that, the Government committed to moving about 3,000 adults with learning disabilities and autism out of in-patient settings and into community-based support by next April.

Although we have seen a small reduction in the number of people in in-patient settings, about 2,500 people are still in hospital, as the right hon. Gentleman said. Some 10% of those patients are under 18—that number has more than doubled since 2015; 61% have been in hospital for over two years and some, sadly, for over 10 years; and 46% have not had a care treatment review in the past six months, as mandated. As he also told us, and as I also understand from an excellent organisation called Dimensions, which provides personalised social care services to people with learning disabilities and autism, more than 22% of people are placed more than 100 km from home. So although there has been a reduction in the number of people living in hospital and some real success in moving people into community support, too many people are still being admitted or readmitted to hospital, and there remain obstacles to moving some of the original cohort considered under the programme into real homes.

The success of the programme relies on the right support being available in the community to prevent people from being admitted in the first place or to help them move out of hospital. The number of autistic people recorded in in-patient units has increased by over a third in the three years since data collection began in March 2015. That is a phenomenal increase. According to the latest figures, almost 48% of people covered by the transforming care programme are in fact autistic. While some of this increase may be put down to better identification of autism, it still displays a concerning over-reliance on hospitals rather than homes. Put simply, if transforming care does not work for autistic people, I am afraid that it will not work. If the programme is to continue, all mental health staff will require better training on and understanding of autism and the right community support will have to be made available.

It is crucial that we hear from the Minister what plans there are beyond March 2019 to ensure that any progress made is not lost and that there is a focus on areas where better progress needs to be made, specifically in supporting autistic people.

[Jim Shannon (Strangford) (DUP)]

I am sorry I was not here earlier, but I was in a one-hour Westminster Hall debate. I commend the right hon. Lady for the hard work she does on autism across the United Kingdom. As she will know, Northern Ireland has an autism strategy that leads the United Kingdom. It is similar to the programme in Wales, but we are leading the way. Will she kindly suggest to the Minister that the Government look at the plan in Northern Ireland, along with the one in Wales, as a good way of proceeding?

[Dame Cheryl Gillan]

Yes, it is very important that we look at what arrangements the devolved countries make for people with autism. Certainly a few years ago, Wales was well in advance with its plans for autism, which I found most commendable, but I think it now needs to revisit and update its plans, because none of these plans must be left to one side; they need to be constantly reviewed and updated.

I am pleased that next year we will have the opportunity to conduct a 10-year review of the Autism Act. I hope the right hon. Gentleman will contribute to the work that many Members are doing on both sides of the House in various areas, from education to employment, healthcare and even the over-representation of people with autism in the criminal justice system, so that we can put down a marker for the Government after 10 years on what progress has been made and how much further we have to go. If the hon. Member for Strangford (Jim Shannon) would be good enough to send me a link to the plans in Northern Ireland, or point me in the right direction, I am sure they will be taken into consideration as we carry out the review.

I am pleased to see the Minister in her place, as she obviously has a lead role, but I think that all relevant Departments need to play their part. I still have a feeling that we need a cross-departmental ministerial taskforce to cover the areas that I have just been highlighting, such as health, education, housing, and justice, all of which we will include in the APPG’s summary and presentation to the Government next year. Let me put down a marker for the Government. I want to know what plans the Minister has for the future of transforming care, whether she will establish that cross-departmental taskforce to lead the process, and what steps she will take to reduce the number of admissions of autistic people and improve the community services that should support them.

I work closely with many autism charities, and in particular with the National Autistic Society. Alongside Mencap and the Challenging Behaviour Foundation, it has been leading research on the experience of families who have been affected by the transforming care programme. It wanted to look into exactly how relatives came to be in mental health hospitals, and what was getting in the way of their being discharged back into the community. I commend to the Minister the report “Transforming Care: our stories”. It contains the very powerful stories of 13 families, and I think that she will find it very useful, if she or her officials have not yet been able to read it.

The report found that, despite the existence of a national programme, five areas needed real focus to make the programme successful. The first is

“Making sure the right services are available in the community”.

I think we have covered that. The second is involving and listening to individual families, and helping them to be heard through advocacy if necessary. The third is improving the quality of in-patient care. The fourth is

“Making plans for discharge and sticking to them”.

The fifth is providing specialist support from trained and understanding staff. For me, that last one is key. When we have met someone with autism, we have met just one person with autism. Everyone is different. Staff really need to understand that, and to be trained to understand people with autism.

[Sandy Martin]

Does the right hon. Lady agree that one of the most important aspects of support for the families of children and young people with autism is the availability of respite care, to enable them to cope with the very great additional duties that they have?

[Dame Cheryl Gillan]

Absolutely. I know from my constituency casework—as, I think, will every MP—that providing a safe home and a safe environment for a family member who has autism can be a very intense, demanding and challenging process, and respite care plays an important part in giving family members a breathing space.

The report includes some remarks from someone called Anna, the mother of Catherine, who is autistic and has a learning disability and obsessive-compulsive disorder.

“Anna told us, ‘she’s not getting any treatment, it’s just a holding pen because staff [in the unit] don’t have the right skills, expertise or mindset…Everything is about seclusion, never about trying to prevent incidents happening in the first place.”

That demonstrates to me that there is a lack of training, and that much more emphasis should be put on that.

The report goes on to outline recommendations made from people and organisations at every level, from individual professionals to NHS England and the Government. In particular, it suggests that a cultural shift is needed to ensure that individuals and their families are listened to in a way that can reduce the number of adversarial relationships that sometimes arise. The importance of a good understanding of both autism and learning disabilities, as a comorbidity, should be emphasised more than it is at present.

One of the parents of an autistic man with mental health problems said:

““Stephen just falls between the gaps and no one takes ultimate responsibility for his case… Where is the pressure to get Stephen back into the community?”

That is a cry for help from a father who wants to see his son go out into the community and have the quality of life that everyone deserves to be able to achieve.

The report also highlights a lack of accountability throughout the system, particularly when it comes to meeting the needs of autistic people. At a national level, in NHS England, leadership for autism falls into the gap between established learning disability and mental health teams. The appointment of a new strategy lead for autism in NHS England is considered to be a very positive step, but I need to be reassured that, in the future, NHS England will focus on the needs of autistic people in order to meet the Government’s requirement for a reduction in their health inequality, which is a commitment in the NHS mandate. I hope that the Minister will tell us what steps she will take to ensure that NHS England allocates appropriate resources to the needs of autistic people, and to ensure that the issues set out in “Transforming Care: our stories”—I am going to give her a copy—are addressed.

Autism charities regularly hear that autistic people struggle to find mental health support that meets their needs, and in the worst cases, if this is not available, people hit crisis and are admitted to hospital. Traditional mental health interventions might need changing, for example by using clear, non-metaphorical language or communicating with someone who does not speak. That, again, requires a good understanding of autism.

In 2016 NHS England published its mental health “Five Year Forward View” outlining how it plans to improve mental health services in England. It includes a number of proposals for new care pathways to help people access the right support and, importantly, it proposes a care pathway for autism. Work on designing this pathway is due to start this year, but I have not seen any detail on what it will include. It is vital that it covers the following for children, young people and adults on the autism spectrum: timely access to autism diagnosis, autism training for all mental health staff, and the ability to make reasonable adjustments for mental health treatments so that if autistic people need mental health support, they can get the right help from services. I hope that the Minister will also address how the autism care pathway will be developed and that it will cover diagnosis, access to tailored mental health support and autism training.

Another contributory factor to the number of autistic people in mental health hospitals is the inclusion of autism in the Mental Health Act 1983 definition of mental disorder, meaning that autistic people can be sectioned without a diagnosed mental health problem. The independent review of the Mental Health Act is very important and has been welcomed by the autism charities. They believe it is important to create a legal regime around mental health support that properly meets the needs of autistic people and their families. The status quo fails to do this, and that has resulted in autistic people being inappropriately detained under the Act and far too often subjected to damaging over-medication. The NHS digital data show that autistic people are not benefiting entirely from the NHS England transforming care programme, because the in-patient numbers are failing to meaningfully reduce and in some cases are rising. The review’s interim report has identified this definition of autism as a mental disorder as a key question to be addressed in the final report, and I strongly urge that the review must address the inequality for autistic people at the heart of the Mental Health Act. I hope the Minister addresses that in her closing remarks.

I have spoken for some time, and I hope I have added to the debate initiated by the right hon. Member for North Norfolk, although I appreciate that I have, inevitably, repeated some of the points he made. In conclusion, I go back to something I said earlier about the transforming care programme that I think summarises the situation. Put simply, if transforming care does not work for autistic people, it will not work. We want transforming care to work; we want it to succeed. It has made a start: it is not an all-good start, but it is not an all-bad start. The Minister and the Government have a golden opportunity to turn what is a visionary programme into something that can reflect the success of the care with which we look after people in our community with learning disabilities and autism. I look forward to hearing the Minister’s response.

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[Paula Sherriff]

My hon. Friend makes a very valid point. Everybody here this afternoon could not fail to be shocked and horrified by the case outlined by my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) regarding her young constituent, Matthew, and the quality of care that he received on an in-patient unit.

Some 1,311 cases were passed for review between July 2016 and November 2017, but only 103—that is 8%—have finished so far. The report cited a lack of local capacity to review cases, inadequate training for people completing mortality reviews and insufficient staff capacity to complete a mortality review. Will the Minister update the House on when the remaining cases will be finalised and what the Department is doing to ensure that these barriers are tackled? In 13% of cases reviewed, the person’s health had been adversely affected by delays in care or treatment, gaps in service provision, organisational dysfunction, neglect or abuse.

Just how many more deaths must occur before the Government tackle the unjust treatment of people with learning disabilities? Dr Ryan, Connor Sparrowhawk’s mother, was also damning in her assessment. She said that too many agencies had shown “systematic disregard” for some people with learning disabilities and she felt that certain people “simply don’t count” in the eyes of the authorities. We must do better, and we must show that every single life matters. But our fear is that, without some fundamental changes in the Government’s approach, the problem is set to get worse, not better.

Take the NHS workforce, for example. The latest figures from Health Education England show that the number of learning disability nurses working in the NHS has gone down by a third over five years. HEE data from March 2017 shows that learning disability nursing had the highest proportion of vacancies, at 16.3%, compared with all other fields of nursing. Will the Minister tell us how the Government plan to tackle this?

It is bad enough that the failures of transforming care have left too many people inappropriately in hospital settings, but the lack of trained staff when they are there makes that failure all the more stark.

[Dame Cheryl Gillan]

I am with the hon. Lady in her criticisms, and in wanting some constructive developments and improvements, but I would not want her to stay at the Dispatch Box and paint a picture that is completely negative. There are some inspirational stories about people coming out of these settings and institutions after being dealt with by a caring team, who have put a particular emphasis on communications and turned lives around. Some of the case studies published by Dimensions show that that really is one of the ways forward, and that is what we should seek. It is possible to take an aggressive individual out of an in-patient setting and give them the quality of life and meaning to life that we would all want and expect.

[Paula Sherriff]

I thank the right hon. Lady for her intervention. I absolutely agree. There are some incredible examples around the country of excellent work that is being done, but that makes it all the more important that we share that good practice so that it is disseminated more widely. Particularly on this very special day of the NHS’s 70th anniversary, I pay tribute to all those people who are involved in being innovative, and not just doing exactly what they have to and no more.

It is bad enough that the failure of transforming care has left too many people inappropriately in hospital settings, but the lack of trained staff when they are there makes that failure all the more stark. It is also a matter of great concern that the Government are not including people with learning disabilities, or working-age people with disabilities, in the social care Green Paper, but are instead having a “parallel workstream”. Once again, the care needs of people with learning disabilities seem to have been put in second place.

If this catalogue of failure were not enough, the issue around sleep-ins threatens to make it even worse. It has been woefully mishandled thus far. Having admitted that earlier guidance on pay was misleading both for providers and commissioners, Ministers are now playing for time rather than finding a solution, ignoring warnings from care providers, charities, and the Local Government Association. The consequences for people with learning disabilities and autism could be disastrous. Some 70% of learning disability providers have warned that they will no longer be viable. It could drastically reduce the number of providers available to provide community services. For people with learning disabilities, autism or challenging behaviour who are personal budget-holders in receipt of funding from local authorities to pay care staff themselves, this crisis could lead to difficulty in paying their personal back-pay bill and, in turn, having to reduce their level of support to cover costs.

Let me be clear, as a former healthcare worker and trade unionist, that the care workers affected should receive historic back pay for national minimum wage sleep-in shifts rather than paying the price for underfunding of social care. Given the state of the sector, without imminent investment we run the risk of a systemic failure that could leave thousands of people without the care that they desperately need. That is why we continue to call for the Government to reveal the full scale of financial liability and to increase funding for social care so that care providers can continue to deliver services to vulnerable people in need of care and workers can receive the pay to which they are entitled.

A Labour Government would provide care workers with paid travel time, access to training, and an option to choose regular hours. That, of course, comes in the context of proper investment, increasing social care budgets by £8 billion over the next Parliament, including an additional £1 billion for the first year to ease the Tory social care crisis. We have made our alternative crystal clear. Our policy will include all people with care needs, with the aim of ensuring that they can live independently and, most crucially, with dignity.

The question that the Minister must now answer is whether and how this Government can work towards that goal. Will there be a successor programme to transforming care? How will the shift to early intervention, prevention and community care be prioritised and properly resourced, given that what we have now is clearly not sufficient? In the end, this is a question of how we value human lives.

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[Caroline Dinenage]

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

[Dame Cheryl Gillan]

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

[Caroline Dinenage]

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

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

[Dame Cheryl Gillan]

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

--- Later in debate ---

[Caroline Dinenage]

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

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

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

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

[Dame Cheryl Gillan]

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

[Caroline Dinenage]

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

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