Reforms to NHS Dentistry

Darren Henry Excerpts

Thursday 27th April 2023 Commons Chamber

[Darren Henry (Broxtowe) (Con)]

Like many colleagues, I have received a large volume of communications from constituents in Broxtowe regarding the ongoing problems with securing an NHS dentist appointment. Polling conducted by YouGov on behalf of the British Dental Association has shown that one in four adults in England have already delayed or avoided much-needed care due to cost. I am aware that improving access to NHS dentistry is one of the Government’s key priorities for our health service. It is evident that waiting times have been affected by the infection control measures required during the pandemic. Despite these pressures, dental services in many parts of England have been slowly recovering, which is good to see. However, much more must be done to reduce waiting times and ensure that appointments are available. As my hon. Friend the Member for Winchester (Steve Brine) said, we need more gums on seats.

The BBC recently contacted every NHS dental practice in England and found that 91% were not able to accept new adult patients and 80% were not able to accept new child patients. This is not acceptable. Oral health inequality is rising, and we must act now to ensure that we focus on retaining current dentists, recruiting new ones and ensuring that adequate funding is in place.

My constituent Sacha told me about the difficulty she has had. Not being able to book a dentist appointment has caused her great stress and anxiety. She will potentially lose her teeth if a dentist is not found. Sacha has gum disease and is supposed to see a dentist four times a year. She faces great pain and does not have the option of visiting a private dentist. I have heard many cases like hers, and a private dentist is often not an option. People should not have to turn to private dentists. Sacha is currently waiting for a response from NHS England.

Another constituent, Joan from Toton, recently shared her difficulties with me. She rang multiple practices in her area but was told there are no NHS dentists available. Joan is 70 this year and should not be unable to get basic dental care. It is essential that we fix this problem by ensuring that new NHS dentists are entering the workforce and that we retain the ones we currently have.

The Government have rightly been holding talks since 2021-22 with the British Dental Association and other stakeholders on reforming dental contracts. Through these talks, a number of steps have been and are being taken, including improving financial incentives for dental practices, supporting new practices to take on patients and supporting people with dental costs, but more must be done.

The Department of Health and Social Care has stated that it will publish a plan for dentistry in the coming months. I welcome that announcement and look forward to receiving the plan. In the meantime, I implore the Minister to do all he can for those, such as Sacha and Joan, who face not being able to access dental treatment.

Social Care: Nottinghamshire

Darren Henry Excerpts

Monday 21st February 2022 Commons Chamber

[Ben Bradley (Mansfield) (Con)]

It is great to have the opportunity to raise the issue of social care in the Chamber, and I am grateful for the time from the Minister and from colleagues to engage with this really important issue. I would also like to thank the Government for finally taking the issue of social care reform seriously and coming forward with plans, which are long overdue.

Social care is absolutely key, not just in itself, but to the success of our wider health services. NHS backlogs could be prevented or reduced by investment in care, with hospital admissions prevented or timely discharges achieved by better integration between the two. For example, an emergency care package could be put in place in a timely way rather than having someone need an ambulance to accident and emergency. It is important therefore to ensure that the funds described as being “for social care”, from the national insurance increase, do make their way to care provision—to local authorities and providers—to improve support and capacity. I know that the Government have prioritised tackling hospital backlogs with the first year or so of that money, but care has backlogs too—in Nottinghamshire we have gone from a waiting list of zero to one of 400 over the course of the covid pandemic. As I have described, care services play a key part in tackling those backlogs in the health service. As ever, we often focus on hospitals, but I have always felt that primary care, community-based services and, of course, social care are by far and away the best and most cost-effective ways to tackle these issues and improve our wider health service provision.

That said, this White Paper and talk of improved integration between the two services is very welcome. I have already described how this is key to reducing pressure on hospitals, but the same applies for our ambulance services and GPs too, if people are able to be cared for effectively without calling on acute or emergency services. As the White Paper says, the current system can be complex and disjointed. The focus on community-based provision and improving healthy life expectancy is a good one, and I welcome the fact that it explicitly talks about support for working-age adults with disabilities, who are so often forgotten. The debate about social care in the public domain and in the media always seems to focus on elderly people, and of course that aspect is vital and really important to us all, but half of the provision of social care is actually for disabled, working-age adults with increasingly long-term and complex support needs, which are also increasingly expensive and unsustainable. That area certainly needs more focus, so I welcome the fact that it is included—

[Darren Henry (Broxtowe) (Con)]

An integrated approach is needed for social care. Nottinghamshire’s social care needs are not the same as those of any other county, so does my hon. Friend agree that a communities-based approach is needed, as is precisely laid out in the social care White Paper?

[Ben Bradley]

My hon. Friend knows the challenges in Nottinghamshire social care as well as anybody—I am sure they come across his desk in Broxtowe all the time—and he is right that this work has to be locally led. I welcome the opportunity in the White Paper to build from the community upwards through our integrated care strategy and to work together with health partners around the county. In the long term, locally led and community-based provision will help us to tackle the challenges we face.

This debate is on social care in Notts. As the Minister knows, among those in this place I am unique in being responsible for the direct delivery of social care services in my county and in my Mansfield constituency, so this is a unique opportunity for me to raise the key issues that affect those services with her and with the Government—from the coalface, so to speak. That is part of why I have argued that my dual role can benefit my constituents and the Government. I hope that proves to be true.

The Minister will not be surprised to hear that workforce capacity is far and away the biggest challenge that we face in Nottinghamshire. We have seen a further 5% decline in staffing levels in a sector that was already understaffed. I am grateful that a crisis was averted by the revocation of the mandatory vaccination plans, because they would have seen thousands more leave the sector in Notts. That change of policy was absolutely the right decision.

We estimate that the turnover of staff in home care is around 26%, which is a massive and ridiculous proportion. That reflects the fact that there is significant competition for pay; that people can earn more in other sectors locally; that we are struggling to recruit; and that staff who have been through the ringer in recent years in incredibly tough circumstances are increasingly deciding to retire early or take a break because of the pressures.

We are doing a lot locally to try to combat the amount of turnover, including through new apprenticeships and big recruitment campaigns with market providers, and by incentivising collaboration between providers and offering incentives for them to invest in staff wellbeing or training, but more is needed. We need a national workforce strategy and recovery plan with sustainable funding that recognises the disparities in pay and conditions in the sector, and that needs to be part of the “fair price for care” reforms, which is not currently the case.

We need to understand what more can be done to increase the stature and status of care workers and the care profession. The workforce plan needs to include clear and defined pathways into health services, so that people see social care as an entry pathway to wider health and NHS careers, where the range and scale of opportunities for different jobs and long-term careers is massive. Care is often perceived to be a low-skilled, low-paid job with little scope for progress or promotion, but that is absolutely mad when we consider the fact that the skills and qualifications are directly transferable into one of the world’s biggest employers, the NHS, which covers every health role under the sun.

The pathways should be obvious and we need to make them obvious and overtly available to care workers and young people in schools and colleges. I hope we can plan some of this work locally, perhaps through the devolution of skills funding in the coming years. We are already working on some of that with West Nottinghamshire College and Nottingham Trent University, which are trying to build the pathways from school directly into the health services in my Mansfield constituency. A national pathway for integrated health and care careers would be fantastic.

The shortage in home care has meant that an additional 10 people a day are waiting to be discharged from my local hospital and much higher proportions of people end up being discharged to care homes when they could and should have gone to their own home. That is not good for long-term outcomes or those people’s wellbeing and also means that our reablement services—those that support people to get back on their feet and be independent in their own home—are overwhelmed. These are observations from Notts, but the trend is regional and national, not just ours. In fact, we have fared better than many other areas.

I thank the incredibly hard-working and dedicated staff in Nottinghamshire’s social care services for everything they have done to manage incredibly difficult circumstances. I include among them our council’s service director, Melanie Brooks, who directly delivered care packages and was on call over Christmas to try to mitigate the pressure. A huge thank you to her and her teams.

We have a lack of housing stock for care provision, and investment in things such as supported accommodation has slowed down, obstructed by covid, construction and supply chain issues and other factors. It often seems like the link between health and housing is not made clear, and it does not seem to feature much in some of the recent proposed legislation, but good housing can reduce social care needs, prevent hospital admissions and support people to remain active and sociable in their own homes and communities.

Homes England funding could be devolved to support local areas to meet their needs. Housing needs to be a key part of care reform. In our two-tier area we are working hard on collaboration among councils and providers to ensure that housing and health services talk to each other, but that is an option rather than something that is automatically built into the system. That needs to change. Similarly, if we have accountable local leaders—the Government have made clear through the Department for Levelling Up, Housing and Communities their intention to devolve significant powers—could we not have more local control over how powers are managed and delivered? That would help us to integrate our local services. Children’s services are also key to this. I question whether all this needs to be linked to the children’s care work that seems to be in the pipeline, through the Josh MacAlister review and the special educational needs and disability review that is happening in the Department for Education. Children’s care services and adult care services are linked, quite clearly, and they need to be integrated just as health and care do. I know that this is complex as it spans multiple departments, but it is also sensible and it needs to happen.

Our local integrated care systems will seek to draw all these things together to offer the best start in life and the right preventive interventions, just as Nottinghamshire County Council is doing with a significant investment in the transformation of our children’s services. More proactive and preventive services will be announced in our budget on Thursday. That is something of which I am incredibly proud and it will, I think, change lives. If local plans across the country seek to integrate adult care services and children’s care services then, clearly, national ones must do so, too.

Financially, Nottinghamshire has some capacity to use adult social care precepts this year, but continued rises in council tax without major reform are also unsustainable, especially when we consider that some London boroughs pay half the council tax that many people do elsewhere, including in my own constituency. That is not fair, but, as an authority, it means that we do have some funds to draw on this year. Our social care budget for 2022-23 will rise by around £12 million compared with last year. That extra funding is very welcome, but, again, we need to understand that that is not sustainable in the current system. Fairer funding for local government needs to be a priority to make sure that we have that level playing field across the country.

There will be a significant challenge in terms of resources and staffing capacity as we try to tackle both the day-to-day care issues that I have touched on—pressures of services and staffing—as well as delivering the significant reform that we are being asked to deliver. Although it is welcome and right, it will present its own challenges and pressures. The Government must ensure that sufficient capacity exists if they want us to do both at the same time.

Mental Health Act 1983: Detention of People with Autism and other Lifelong Conditions

Darren Henry Excerpts

Thursday 20th January 2022 Commons Chamber

[Sir Robert Buckland]

I am grateful to the hon. Gentleman for his intervention. He has a long-standing interest in autism issues, in Northern Ireland in particular. He is right that if there is early intervention, more can be done to prevent a lifelong condition such as autism becoming a co-morbid mental health condition. I will explain that in a little while.

Behind the statistics are real-life stories of people whose lifelong conditions have led to the system, however well-intentioned it might be, ascribing a lower value to their quality of life. That implicit judgment, I believe, runs through everything from the continued lumping together of autism and learning disabilities with mental health conditions, which in many cases is wholly out of date and inappropriate, to the discriminatory and unjust application of “do not resuscitate” guidance to people with these conditions. Those are abuses in plain sight.

Furthermore, the profound sense that the system is, in effect, making assumptions about the life of people with learning disabilities in particular has been exacerbated by the use of DNRs during the covid pandemic. Not only do we need to stop new orders being issued inappropriately to people with learning difficulties, but existing inappropriate DNRs need to be retracted. I ask the Minister: when will the Government act on the Care Quality Commission review recommendations about better staff training and family involvement in decision making about care and treatment?

It is no longer good enough for people with learning disabilities to be discharged from hospital with a form in the bottom of their bag, effectively having signed away their rights about the end of their own life. That is what we are talking about; I cannot put it more bluntly than that.

[Darren Henry (Broxtowe) (Con)]

I thank my right hon. and learned Friend for securing this debate. We are heavily relying on hospitals to manage individuals with complex needs, which costs the NHS thousands of pounds per individual per week. If we invested more in care in the community, perhaps using the coming health and social care levy, we could prevent hurt or trauma to individuals and save money for the NHS.

[Sir Robert Buckland]

My hon. Friend is absolutely right about the waste of resources that I am afraid underlies much of this. I shall come to some of the figures, which are pretty shocking. He is right to highlight the levy that is being introduced in April. It is imperative that the £12 billion that we are told is being earmarked as part of the £36 billion to be raised from the levy is actually used on social care.

The worry we all have is that the money will be eaten up by spending on the health backlog, and that there will be no audit trail at all to make it possible to ensure that it is, in effect, ring-fenced and used in social care. I put that big challenge to Ministers. The Health Secretary knows my strong view; I was writing about it in the national media on Sunday. We have to really laser in on these issues.

The horror of Winterbourne View is still seared into my mind 11 years on, together with other instances of abuse. But in general, we are not in this position because of malice or hostility towards people with autism or a learning disability; we are here because of indifference, frankly. It is all too easy to make the assumption that because the person has been detained for their own safety, the letter of the law has been followed and the clinicians have given their opinion, that will just have to do. That really is not good enough in this day and age.

Recent news coverage of the cases of Tony Hickmott and Patient A has brought these issues into stark relief. I will briefly mention Mr Hickmott’s case, which was highlighted by the media just before Christmas. Ongoing legal proceedings mean that I must limit my remarks, but I read reports that this gentleman has been detained for more than 20 years under this system—nearly half his entire life. That is deeply distressing for his family and should be of grave concern to the rest of us.

Patient A’s case was reported in The Sunday Times just after new year, the result of some excellent investigative journalism. He has been confined for over four years so far in a secure apartment at the Priory Hospital Cheadle Royal. That apartment—I use the word advisedly—is the size of a large living room. He is monitored by CCTV. His food and medication are passed through a hatch. He is now 24 years of age. The story of his life leading up to this incarceration is heartbreaking in itself but also emblematic of failure. The interventions made exacerbated his existing anxiety, creating a descending spiral of deterioration in his health that has resulted in over-medication, more restrictions and even poorer mental and physical health. We are spending money on harming people rather than saving them.

Children and Young People with Complex Needs

Darren Henry Excerpts

Friday 10th December 2021 Commons Chamber

[Sir Charles Walker (Broxbourne) (Con)]

Sadly, some children and young people are not able to live safely with their families. The significant majority of these children have experienced trauma at a point during their developmental years, resulting in a range of behaviours, many of which cause distress to them or others. Those behaviours include self-harm and an increased vulnerability to criminal exploitation.

If a young person is unable to live safely at home, he or she may come into the care of the local authority or require hospital care. There is currently an insufficient supply of specialist care to meet the needs of such young people. As a result of the challenges posed by covid-19, health and social care professionals describe an unprecedented level of complexity and acuity of need, making an already difficult situation worse.

When a young person comes into care they will require either a children’s home, with staff skilled and experienced in meeting complex needs, or in some instances a court-directed placement into a secure unit, to keep them safe. Over the past 18 months, Hertfordshire children’s service has made three applications to the national secure bed bank. Despite repeated referrals, a secure placement was achieved for only one child. The most recent referral was made approximately six weeks ago, and on that occasion the local authority was advised that there were 50 referrals for only four available beds. That means that a secure bed was not available for 46 young people who had been assessed as requiring such accommodation to keep them safe. In each of those cases, the relevant authorities, including Hertfordshire, were required to make their own arrangements while the secure referral remained active.

Increasingly, local authorities turn to the courts for a deprivation of liberty order in the absence of more appropriate secure placements. Such orders are sought as a last resort, even though when granted they can place local authorities in the invidious position of having knowingly to place children in environments that are not best suited or equipped to meet their complex needs. Similarly, young people who require psychiatric hospital care find such care unavailable because of a shortage of appropriate hospital beds. In Hertfordshire, a number of young people have been assessed as detainable under the Mental Health Act 1983 and are waiting for appropriate hospital beds. The number waiting for a placement often rests at around 10 children, which means that in each of their cases their needs are not being met.

Despite people’s best efforts, the whole system is creaking because it is unable to cope with the demand. Problems with recruitment and the increasing complexity of some children’s needs mean that Ofsted and the Care Quality Commission too often find themselves in the position of having to close providers down, or reduce their bed capacity. It is important to note that there is a difference between physical beds and usable beds. Many beds are not in service because, in meeting the increasingly complex needs of children in care, there is not the staff capacity safely to service all the available beds in a home.

Not only is the current situation having a detrimental impact on young people, but its impact on the public purse is significant. Delivering bespoke care to a young person, often through a commissioned provider, is very expensive, particularly because these young people, due to the risks they present, will require high staffing levels. Placements are expensive: they can cost from £4,500 a week to upwards of £30,000 a week. Often, a child who has difficulty accessing support further down the needs scale quickly ends up requiring a far most costly set of interventions and specialist care.

It is of course important to intervene early to work with young people in the community to prevent family breakdown and the escalation of needs, but the current placement situation must be addressed, so in this debate I wish to ask regulators to work with the care sector to reopen closed beds through the development of a specialist taskforce that supports providers—be they mental health providers, social care providers or specialist schools—that struggle to deliver good-quality care. Alongside such efforts, we should make a national intervention to reassure providers that their Ofsted rating will not be negatively impacted if they admit children with the most challenging of needs. Too often, specialist care providers will refuse these children because they are concerned that if a child absconds or creates a high level of service demand, that will negatively affect their Ofsted rating.

We also need a national campaign both to challenge the stereotypes about children in care and to recruit residential childcare officers. Such schemes are already in place for fostering and adoption, and we have Teach First and Think Ahead. A similar programme now needs to be introduced to attract people into child social care and, in particular, the care of children with high levels of need.

Backing up this recruitment drive, we need a programme of support to design children’s homes that can accommodate children with the most complex needs but, as I have already said, without extra specialist staff the Government programme to match fund local authorities to develop new children’s homes will face significant challenges. New homes require skilled staff if they are to be viable. Also, in wanting to build new specialist homes, we need to appeal to the better part of people’s human nature, as too many of these specialist homes, when they come up for planning approval, are opposed by local communities.

When it comes to registering specialist residential care homes and facilities, we need to find a way of expediting the Ofsted registration process, which can take upwards of three months. In an emergency, a local authority will sometimes use one of its bedroomed properties as a care setting for a vulnerable child or adolescent, with a rota of specialist social care staff in attendance. Without Ofsted registration, such facilities will be operating outside the regulatory framework.

[Darren Henry (Broxtowe) (Con)]

I hear my hon. Friend’s point about care in the community, which is essential and something we need to focus on. Children and young people with complex needs too often end up in hospital, which is not the right place for them, as they end up being affected by people in hospital with other issues. Care in the community is essential. How can we give local authorities the onus and the investment to make this happen?

[Sir Charles Walker]

I thank my hon. Friend for his intervention, and I will come on to that. We need to have the right setting delivering the right care—the care that the child needs. The child needs to be at the centre of that care.

How does a care emergency arise? That question is often put to me. Beyond the national shortage of beds, a provider can notify a local authority, with only a few hours’ notice, that it will be terminating a young person’s placement in its facility. They can say, “In just a few hours, you will have this child back. This child is now your problem again.” This practice needs to be eliminated, but eliminating it will only alleviate the need for the provision of emergency accommodation and care; it will not end it. That will be done only through the provision of more beds, in both the social care sector and the psychiatric care sector. In the psychiatric care sector, it is not just the overall quantum of beds that counts; it is also the type of bed. These will cover general adolescent units, eating disorders, low-secure units and psychiatric intensive care units.

Almost all the concerns I have highlighted and will highlight this afternoon were identified in Sir Martin Narey’s independent review of residential care and in the Government’s response of 2016. We need to implement the findings of this report and tie them into a review of the Care Standards Act 2000 and the children’s homes regulations.

If anyone watching or listening to this debate wants to learn more about what is happening in this sector, I refer them to an excellent report by the BBC correspondent Sanchia Berg that can be found on the BBC website, dated 12 November, “The court orders depriving vulnerable children of their ‘liberty’”. The report contains harrowing accounts of what is happening, and they are framed throughout by the concerns of the High Court judge Sir Alistair MacDonald, who is deeply concerned about what he is witnessing in the courts and family courts.

Let me return to Sir Martin Narey’s independent review. Beyond its implementation, we need better joined-up care between the NHS and local authorities. The continuing healthcare framework has much to recommend it in relation to children and adolescents, but it is still heavily slanted towards their physical health. A robust commitment to parity of esteem would see the framework cover clinically diagnosed mental illness, as well as the challenges caused by trauma, attachment difficulties and, increasingly, autism. Let me say, as an aside, that all Department of Health legislation should make it perfectly clear that health means mental health and physical health; we cannot have one without the other.

Why is mental health so important? There are still far too many lengthy debates between local authorities and the NHS as to whether a child is suffering from a mental illness or a behavioural difficulty. To many, this seems like dancing on the head of a pin, as the debate does not change the fact that at the heart of the discussion is a child in crisis, as referred to by my hon. Friend the Member for Broxtowe (Darren Henry). A good solution has to be more joint commissioning between health, education and care providers, thereby removing barriers to joint funding. An example of best practice can be found in my own county of Hertfordshire, where we are opening up a three-bed unit that will be jointly staffed by social care professionals and mental health professionals. Perhaps this initiative could pave the way for a national programme of hybrid mental health children’s homes, with a hybrid model of worker.

I must conclude by returning to staffing and recruitment. There really is a need for an enhanced programme of training for residential workers that recognises the unique challenges of the role and the high level of skill required to deliver an effective service. Residential work currently requires a lesser qualification than social work, yet those working in residential settings have significantly more direct contact with the most vulnerable children with the most complex needs. Better training would lead to better pay and an enhanced profile, thereby making the role a career of choice and one which is attractive to graduates.

I have made these recommendations and observations today on behalf of the excellent Hertfordshire County Council, which does a fabulous job across my county, and, of course, on behalf of the children for which it cares. Both Hertfordshire County Council and I want to support the Government’s programme to develop more beds in the secure estate, but we want an estate that is compassionate and able to provide the high levels of care and support that I know, the Minister knows and Madam Deputy Speaker knows, it wants to provide.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

I thank my hon. Friend the Member for Broxbourne (Sir Charles Walker) for securing this important debate on care for children and young people with complex needs, and thank him for highlighting good practice in his constituency and across his local authority.

The Government are committed to ensuring that all children and young people who need care—be that health or social care—receive the safe and compassionate care that we should all expect. We are taking action to support all children and young people’s mental health, and to support those with complex needs to stay well in the community. This support starts at birth.

The Chancellor recently announced £300 million for family and early years support in half of upper-tier local authorities over the next spending review period. This includes: £100 million to roll out bespoke parent-infant mental health support to nurture parent-infant relationships, and improve access to perinatal mental health support; £50 million to fund evidence-based parenting programmes; and £82 million to create a network of family hubs. In addition, the Chancellor confirmed £200 million for the supporting families programme, increasing the number of families supported by the programme from 70,000 in 2021-22 to more than 100,000 in 2024-25.

For school-age children, we continue to implement the proposals of the children and young people’s mental health Green Paper. In March, we announced £79 million to boost mental health support for children and young people in England. Part of that will accelerate the roll-out of mental health support teams in schools and colleges to cover around 3 million children and young people by 2023. In May, the Department for Education announced funding worth £9.5 million, which will allow up to 7,800 education settings in England to train a senior mental health lead from their staff in the next academic year.

We are also taking steps to support children and young people with learning disabilities and autism through our newly published national autism strategy, the first autism strategy to be extended to children and young people as well as adults. The strategy is backed by over £74 million for the first year. That includes £3.5 million to help local systems identify children and young people on waiting lists who might be at risk of crisis, and £3 million for respite and short breaks to help families and autistic children and young people with and without learning disability who have struggled during the pandemic.

The independent review of children’s social care, which commenced in March 2021, will look at the needs, experiences and outcomes for the children supported by children’s social care. We know, sadly, that there are some children and young people who will need in-patient care or a place in a secure setting. NHS England is accountable for the provision of in-patient mental health services for children and young people. In line with the NHS long-term plan, some of the commissioning tasks and relevant budget have been delegated to NHS-led provider collaboratives.

[Darren Henry]

My understanding of the point that my hon. Friend the Member for Broxbourne was making is that we should make sure that the investment goes into residential care. The Minister is talking about the money and the investment being put into in-patient care, but that should really be put into residential care. Will she please comment on that? In addition, taking that a step further, should areas with residential care and the staff equipped to deal with children with complex needs not eventually get people into supported living so that we can ultimately get them into independent living?

[Maggie Throup]

My hon. Friend makes a very good point, and I will come to that later in my speech.

The lead provider works collaboratively with other providers to ensure the appropriate level of in-patient provision in their area; it is important that we have the right mix of provision, whether it is in-patient or community support. They also ensure that the right community services are available to support children and young people when they are discharged to prevent further crises.

Wherever possible, collaboratives will aim to provide high-quality alternatives to admission. However, where stays are required, they should be short and close to home in a high-quality, safe and therapeutic service. We must of course ensure that the rights of children and young people who are placed under the Mental Health Act 1983 are respected.

We published our White Paper on reforming the Mental Health Act in January 2021, setting out proposals to make the Act work better for people. We are committed to ensuring that the reforms we want to make to the Act also benefit children and young people. We will work to ensure that the rights we plan to introduce for patients are also available to children and young people detained under the Act. Reforms to the Act will limit the scope to detain people with a learning disability or autistic people, helping to reduce unnecessary detentions. To ensure that in-patient settings are therapeutic for autistic people, we are providing £4 million to enable in-patient settings to become more autism friendly.

In children’s social care, we are committed to doing everything we can to support local authorities in ensuring that the most vulnerable children are protected and that there are sufficient places for children in their care. The Government have given more than £6 billion in un-ringfenced funding directly to councils to support them with the impact of covid-19 spending pressures, including in children’s social services.

I take the opportunity to refer briefly to the a point made by the Secretary of State for Health and Social Care in the House a few days ago. He set out that we will be taking further measures to support and protect social care against the threat posed by the omicron variant. We will set out a package of measures at the earliest opportunity. I reassure hon. Members that the timing of the announcement will not have an impact on our ability to implement those protections on the intended date.

The Government are also taking additional steps to support local authorities to fulfil their statutory duties. The spending review 2021 announced £259 million over the spending review period to maintain capacity and expand provision in secure and open residential children’s homes. That will provide high-quality safe homes for some of our most vulnerable children and young people.

We recognise that those in the secure estate are some of the most vulnerable in our society. Children and young people in secure settings are more likely than other young people their age to have additional healthcare needs. The integrated care framework aims to support trauma-informed care, and formulation-driven evidence-based whole-system approaches to creating change for children and young people within the children and young people secure estate.

My hon. Friend the Member for Broxbourne talked about beds. In the NHS long-term plan, we committed to investing at least an additional £2.3 billion in mental health services by 2023-24. That will see 345,000 children and young people a year accessing NHS-funded specialist mental health support if they need it. On 5 March, we announced an additional £79 million of funding that will be used to expand children’s mental health services significantly in this financial year. It will also help to improve access and reduce waiting times for NHS community mental health support.

There is much to be said about how we are supporting and should further support children and young people, not least those who, because of mental illness, learning disabilities, being autistic or complex trauma, are some of the most vulnerable in our society.

Winterbourne View Hospital and the Transforming Care Programme

Darren Henry Excerpts

Thursday 10th June 2021 Westminster Hall

[Darren Henry (Broxtowe) (Con)]

It is a pleasure to serve under your chairmanship, Ms McVey. I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing this debate. I am pleased to be here to speak on such a crucial topic. First, I want to reflect on the past 10 years since the Winterbourne View scandal, and secondly, look forward and ensure that such horrific events cannot happen again.

What the BBC “Panorama” programme exposed was absolutely shocking, disgusting and heartbreaking. It revealed patients with a learning disability and/or autism being repeatedly pinned down, slapped and taunted by staff. That community was let down. Following that, the Government promised to transform care for people with a learning disability and/or autism by 2014 by supporting those in assessment and treatment units to move out of those settings and get the right support in the community. The Government still have a long way to go before they achieve what was promised. It is vital that we continue to learn from Winterbourne View. The Government have shown that they are willing to make the necessary changes by publishing the White Paper on reforming the Mental Health Act. I commend the reforms that it has set out.

I want to send my personal thanks to the Department of Health and Social Care as well as the Lord Chancellor for driving forward reform of the Mental Health Act. The Act has long been outdated, and I hope that implementing many of the recommended changes will fire the starting gun on changing the way our country views and treats mental health conditions.

There is a clear desire, set out in the White Paper, to change the culture surrounding mental health by enacting a person-centred approach to care. That is a new approach to the way in which our mental health service is run, and will begin to achieve the desired goal of bringing the Mental Health Act in line with 21st-century principles in medical care.

Having spoken to stakeholders, including Mind, the National Autistic Society, Rethink Mental Illness and the Mental Health Foundation, I want to share the conclusions that I have drawn and the lessons that must be learnt following the atrocities of Winterbourne View. Broadly speaking, they are, first, ensuring that the shift from in-patient care to care in the community is backed by a Government commitment to provide community support services. Secondly, all in-patient facilities must take into consideration the requirements of all their residents, and ensure that when individuals are ready to be released, the right care in the community is in place for them. Thirdly, to prevent situations from reaching a stage where individuals have to be placed in an in-patient facility, we must emphasise early intervention.

I applaud the long overdue decision in the White Paper to remove autism and learning disabilities from the definition of mental disorder in the Mental Health Act. For too long, autism and learning disabilities have been grounds for detention under the Act. I also welcome the commitment to build new mental health hospitals, with two schemes already approved and more to come. And we will tackle the maintenance work needed in the mental health facilities where patients are treated.

Before new projects commence, however, it is essential that we ensure that all new facilities that are built take into account the needs of those with autism and learning difficulties. Removing autism and learning disabilities from the terminology of the Mental Health Act will not mean that individuals with autism and learning disorders will not suffer from poor mental health, so they will require access to those facilities in time. Therefore, we cannot continue establishing new mental health facilities that are not constructed with all those who will access them in mind. The needs of those with autism and learning difficulties may be different from those of others who access in-patient services, and those needs must be catered for. I would welcome a new approach to the creation of in-patient facilities that means that the needs of those with autism and learning disabilities are given greater consideration.

The White Paper states that care and treatment reviews will have statutory force to help to address inappropriately long stays in in-patient units. This is a welcome development that will ensure that people with autism and learning disabilities do not become trapped in in-patient care. In total, 2,040 people who have a learning disability and autism remain detained in in-patient settings and 59% of those people who have been detained in hospital have had a length of stay of over two years. That is simply not good enough. However, there are other barriers in place, ensuring that individuals are not being released from in-patient care at the appropriate time. There is a lack of programmes and facilities for people to be released into.

Without the appropriate resources in place, individuals are becoming trapped in facilities that may no longer have the correct environment. I spoke about this today with one of my constituents in Broxtowe, Justin Donne, who is chairman of the board of trustees at Autistic Nottingham. He had this to share:

“What has become clear in our communities is that the suffering of autistic people being locked up is needless, as our advocacy, social and personal assistance services have successfully kept most of our service users out of that condition. Moreover, we get occasional requests from outside our geographical remit”—

that is Nottinghamshire—

“regretting that they do not have the appropriate facilities in their location. This proves that we obviously need to significantly invest more funding in organisations such as ours”—

that is Autistic Nottingham—

“who provide real, tangible help that benefits both the individual and the community, and saves money and hospital resources by investing in essential preventative services.”

The National Autistic Society’s vital community work is a testament to just how successful community support can be in helping individuals outside an in-patient facility. More must be done to address these issues and I look forward to hearing the Government’s comments on this area in particular. I would welcome a commitment to evaluate and improve the services that are currently in place across the UK to support individuals with autism and learning disabilities when leaving in-patient facilities.

The Government have committed £31 million of mental health recovery funding for a range of projects, including admission avoidance and quality of in-patient care. I would welcome a breakdown from the Minister of what specific projects will be funded.

The focus of the White Paper is on a new person-centred approach to care. Putting the individual at the centre of their own treatment enables them to make their own decisions surrounding care and results in a more tailored approach. To those with autism or learning disabilities, it is even more vital that the care is centred on their specific needs. The introduction of a statutory advanced choice document will go a long way to ensuring that that is acted upon and to enable people to express their view on the care and treatment that works best for them as in-patients, and that is before the need arises for them to go to hospital. As the White Paper states, putting these plans on a statutory footing for the first time will require them to be developed in good time in partnership with patients.

My concern about shifting the emphasis of care away from in-patient facilities to community support relates to whether properly established and funded support is in place in the community. The NHS long-term plan established a commitment for increased community support for early mental health intervention, which is echoed in the White Paper. I would welcome a detailed outline of what this expansion of community support will look like at all levels, how and when it can be expected and how it will be implemented across the UK to ensure that all areas of the UK have the same levels of support. As I have stated, we need to focus on prevention. If that is not possible due to the complex needs of the individual, how can we ensure that individuals with learning disabilities and autism in hospitals are safe and respected, that their dignity is maintained and that their human rights are not violated?

I spoke recently with another constituent of mine, Ashley Swinscoe, who does vital work in my local community supporting those with autism and/or learning disabilities within our local community. He discussed early intervention and proposed that schools needed to offer support to individuals until they were 21 years old. He said that through this stage, consistent support should be offered from childhood to adulthood. This consistency would help the individuals manage the stress caused by the changes in life. That would also reduce the risk of behavioural and mental health declines.

If individuals are not ready for supported living and require residential care, providers must also offer supported living in the future. Residential care is not long term, and providers should promise to progress individuals to become more independent, with fewer restrictions, and to move to supported living. That is a suggestion from Ashley Swinscoe from my constituency.

A Plan for the NHS and Social Care

Darren Henry Excerpts

Wednesday 19th May 2021 Commons Chamber

[Darren Henry (Broxtowe) (Con) [V]]

I start my short remarks by thanking all NHS and care workers in my Broxtowe constituency for the work that they have done over the past year. There is much to welcome in the Queen’s Speech that will begin to help all areas of the UK to recover from the devastating impact of the pandemic. I welcome the Government’s plans to deliver the health and care Bill, which will put in place better integrated care between the NHS, local government and other partners. The Minister will be aware that any comprehensive health service must focus on mental health as well as physical, so I would like to focus my remarks on that issue.

Mental health affects all corners of our society and has, for far too long, been overlooked as a priority, which is why I am proud that the Government are ensuring that mental health is at the top of the agenda. The Office for National Statistics has shown that, during the pandemic, mental health has worsened across every age group in the UK, and the number of individuals showing symptoms of depression has doubled. The announcement to boost mental health funding by at least £2.3 billion over the course of this Parliament, as well as transforming mental health services and supporting more people in our communities, is very welcome.

Recently, I wrote to the Government to offer my thoughts on the Mental Health Act White Paper. The Government announced landmark reforms to the Mental Health Act to give people greater control over their treatment, ensuring that it is fit for the 21st century and delivering on a key manifesto commitment. The White Paper details an increase in community support. I would welcome a detailed outline of what this expansion of community support will look like at all levels, when it can be expected and how it will be implemented across the country to ensure that all areas of the UK have the same levels of support in place.

I welcome these much needed changes, and I am particularly pleased to see recommendations to ensure that mental illness is the reason for detention under the Act and that neither autism nor learning disability is grounds for detention. I met a number of Broxtowe residents to consider the issues surrounding autism and mental health, and there is a clear need for further support. While speaking to constituents, I have come to understand that a lack of community resources is often the largest barrier to those with autism and learning difficulties returning to their communities after being in in-patient facilities. I would appreciate a commitment to evaluate and improve services in place across the UK to ensure that that support is available. I welcome the Bills outlined in the Queen’s Speech and I look forward to seeing the Government continue to prioritise our nation’s mental health.

Women’s Health Strategy

Darren Henry Excerpts

Monday 8th March 2021 Commons Chamber

[Ms Dorries]

Ever since sodium valproate was first licensed, the Medicines and Healthcare Products Regulatory Agency’s position has been clear: valproate should only be used in women of childbearing potential if no other medicine is effective or tolerated. The MHRA has kept sodium valproate under constant review. The national director for patient safety has recently set up a clinically led valproate safety implementation group to consider the range of issues relating to valproate and prescribing and to explore options to review and reduce prescribing. In terms of the redress agency, we have looked at that across the board as a result of the Cumberlege recommendations. A number of redress processes are available already, and we did not want to complicate the landscape any further. We feel that, with the MHRA and the national director for patient safety, we have a response to sodium valproate.

[Darren Henry (Broxtowe) (Con) [V]]

I absolutely applaud the statement from the Minister, especially as it comes on International Women’s Day. I speak on behalf of Broxtowe constituent Sarah Kolawole and her daughter Ariella Kolawole, who sadly passed away shortly after being born in February 2019. I welcome all the research that has been conducted to explore why negative birth outcomes and traumatic births for pregnant women of black, African and Caribbean descent are more frequent than other ethnicities. As we move forward with our NHS long-term plan, does my hon. Friend agree that we must use this call for evidence to ensure that equal outcomes are achieved for mothers of all ethnicities?

[Ms Dorries]

I thank my hon. Friend for raising such an important point. It is the very reason I established the maternal inequalities oversight forum, so that I could learn from experts and organisations such as MBRRACE —Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries—and Maternity Voices about the issues that affect black, Asian and minority ethnic women in particular and why the statistics are as they are. I thank him for raising the individual case of his constituent, and I ask him to ask her to provide us with her evidence of what her experience was. It is really important that BAME women understand that we want to hear their stories and birth experiences. BAME women are five times more likely to die in childbirth than white women. We need to know what those issues are, and it is important to get that message out to those women.[Official Report, 12 March 2021, Vol. 690, c. 6MC.]

Coronavirus

Darren Henry Excerpts

Tuesday 7th July 2020 Commons Chamber

[Matt Hancock]

Yes, this is an incredibly important issue. Our goal as a country to reach no HIV transmissions by 2030 stands unaffected by covid. It is a vital objective, and there is a huge amount of support and effort behind that goal. Access to treatment has, of course, been made more challenging. We talk about the epidemic and think about it as being the biggest since the Spanish flu, but it is not. The biggest epidemic before this one was the HIV epidemic, which we are still working to rid the world of. I have every hope that in our lifetimes we will get there. We will play our part.

[Darren Henry (Broxtowe) (Con)]

People in Broxtowe have written to me about their fears that due to lockdown their mental health has declined and vital treatment, including therapy, has been postponed. The coronavirus has made them more anxious to seek help and, like many, I am worried about the impact a lack of early intervention can have on vulnerable people. Can my right hon. Friend reassure me that mental health support will be part of the NHS “Open for business” campaign and that people who are concerned about their mental health can safely seek help?

[Matt Hancock]

Yes, mental health services absolutely are open and people who need support with mental ill health should come forward. They should go to their GP in the first instance. The good news in this area is that telemedicine is particularly effective for psychiatry. Of course, it cannot be effective for all mental illnesses, but it can for many, and it is being used very effectively by psychiatrists across the country.

Covid-19: R Rate and Lockdown Measures

Darren Henry Excerpts

Monday 8th June 2020 Commons Chamber

[Matt Hancock]

We talk to the Welsh Government all the time about making sure that the public health matters that are devolved are exercised in as co-ordinated a way as reasonably possible, and I fully respect the Welsh Government’s capability in making these sorts of assessments for Wales.

[Darren Henry (Broxtowe) (Con)]

Can my right hon. Friend assure me that steps to ease lockdown will be taken cautiously and carefully so that we can examine the effect on our R rate in different parts of the country before proceeding?

[Matt Hancock]

My hon. Friend is absolutely right to raise this question. Of course, we proceed cautiously. That is why we take steps in turn to see the effect. The good news is that the evidence thus far is that the steps we have taken have coincided with a continued reduction in the incidence of the virus. That is why it is safe to proceed on the plan that we have set out.

Covid-19 Response

Darren Henry Excerpts

Monday 18th May 2020 Commons Chamber

[Darren Henry (Broxtowe) (Con) [V]]

We are rightly tackling the global pandemic, covid-19, but there is a danger that the totally preventable diseases of measles, mumps and rubella will re-emerge if vaccinations are missed. Will my right hon. Friend reassure me and the parents in Broxtowe that it is safe and vital that scheduled vaccinations continue?

[Matt Hancock]

Yes, it is very important that the scheduled vaccination programme continues wherever possible, and we have protected it as much as possible. We must remember that, with the hope of a vaccine for coronavirus, so, too, will we have to redouble efforts to vaccinate children for MMR and for flu this autumn. Everybody will need to get a flu jab if they possibly can, and we will have more to say on that soon. It is really important that people vaccinate and that anybody who hears messages from anti-vaxxers stands up to them and says that what they say is wrong and harmful.