Draft Down Syndrome Act Guidance: National Call for Evidence

Gillian Keegan Excerpts

Tuesday 19th July 2022 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

Today, I am delighted to announce the launch of a national call for evidence to inform the development of the draft Down Syndrome Act Guidance.

There are around 47,000 people with Down’s syndrome in the UK and we know that people with Down’s syndrome often face significant challenges and can struggle to access appropriate services and support.

I am grateful to the right hon. Dr Liam Fox MP for bringing forward the private Member’s Bill which is now the Down Syndrome Act. This important legislation aims to improve access to services and life outcomes for people with Down’s syndrome. It does this by requiring that relevant authorities when providing certain health, social care, education and housing services take account of guidance issued by the Government—the guidance. The guidance will set out the steps it would be appropriate to take to meet the specific needs of people with Down’s syndrome.

Since the Act received Royal Assent on 28 April 2022, we have been engaging with stakeholders and developing the national call for evidence which will inform the guidance.

This call for evidence is an important stage in the process leading to the publication of the guidance in 2023. It will allow us to collect invaluable information over the next few months, which will then be used to inform and support the production of draft guidance. The draft guidance will in turn be published for full public consultation before final guidance is published next year.

Through the call for evidence, we want to hear about the specific support needs of people with Down’s syndrome and examples of best practice in service delivery from across the country. We want to hear views on other areas that guidance could cover such as employment support and potential linkages with other genetic conditions that we committed to explore during the Act’s passage through Parliament.

We want to hear from all relevant stakeholders including people with Down’s syndrome, their families and carers, organisations that represent them, and professionals such as those working in health, social care, education and housing.

The process must be as accessible as possible and therefore the call for evidence will run for the maximum duration of 16 weeks. Alongside the online questionnaire and an easy read version, we will work with voluntary sector organisations to undertake workshops and focus groups to input into the call for evidence. We want to make sure we gain the views of everyone, including children and young people with Down’s syndrome, their families and carers.

Following this national call for evidence, we will continue to engage with people with Down’s syndrome and other stakeholders to develop the guidance. The draft guidance will also be subject, in due course, to a full public consultation.

The guidance represents a real opportunity to improve the way that services are arranged and delivered but it is essential that it is based on the views and expertise of those it will affect. I therefore strongly encourage everyone to complete the call for evidence and share widely.

I am determined that people with Down’s syndrome should have the opportunity to be fully included in our society and to have access to the services and support that enable that, throughout their lifetime.

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Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 19th July 2022 Commons Chamber

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

11. What steps he is taking to help reduce waiting lists for people transferring to a care setting.

[The Minister for Care and Mental Health (Gillian Keegan)]

I assure the hon. Lady and everybody in the House that this is a key focus for the Department as we know that delayed hospital discharges put pressure on the health and care systems and, most importantly, impact our patients. To address delays, we have established a national hospital discharge taskforce, which is running a 100-day discharge challenge, and integrated care systems can now become discharge front-runners to share good practice and ambitious ideas.

[Rushanara Ali]

I thank the Minister for her answer, but Miriam Deakin of NHS Providers has said:

“There is huge pressure on beds…and a lack of social care capacity means that hospital patients can’t be discharged as soon as they could be to recover closer to home”.

The Royal College of Emergency Medicine has estimated that 57% who longer meet the criteria are stuck in hospital. That is putting huge pressure on hospitals such as the Royal London in my constituency, which is doing amazing work. However, it cannot get the job done if the Government do not step up and back local authorities with the resources they need to provide care for those who can be discharged. That is what is needed. Is it not time that the Minister, with the new Health Secretary, got to grips with this problem, which has built up over a decade because of the decimation of social care? That is what is needed. There is a fix; the Government need to get on with it.

[Gillian Keegan]

Between March 2020 and March 2022, we made nearly £3.3 billion available to support discharge, recognising the pressures faced by the health and social care sectors, as they manage the demands of covid-19. Under section 75 of the National Health Service Act 2006, funding can be pooled across health and social care to ensure the effective use of available resources. That allows funds such as the better care fund to be used to support discharges, and I know that many integrated care systems are focused on doing that and pooling more resources.

[Mr Speaker]

We come to shadow Minister Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

I do appreciate that it has only been two weeks, but the Secretary of State will be familiar with the use of root cause analysis to solve problems; however, yesterday he spoke for almost eight minutes on ambulance delays with scant reference to social care. Had he been badly briefed?

[Gillian Keegan]

The Secretary of State did mention social care, and of course, very recently, on 1 July, we established the integrated care systems. They are specifically focused on making sure that local authorities work with their local health services to really focus on the patient and improve outcomes for the patient. We recognise that these systems all have to work together around the patient.

[Karin Smyth]

We understand what the proposals are, but the Secretary of State said earlier that he welcomed solutions. We have heard today from the Association of Directors of Adult Social Services. Seven in 10 say that care providers have closed, handed back contracts or ceased trading. We have all seen this in our constituencies. It is mainly due to the now imminent workforce crisis. Will the Minister ensure that the Secretary of State heeds those warnings and responds adequately to the workforce crisis?

[Gillian Keegan]

This is absolutely key, which is why we are implementing a comprehensive reform programme of adult social care. In September 2021, we committed to investing an additional £5.4 billion over three years, and in December we published “People at the Heart of Care”, which set out our 10-year vision for reforming adult social care and our priorities for investment. This absolutely has to be done—it is a key part of the system—but we have to put the foundations in place. Our 10-year plan will put those foundations in place.

[Kirsten Oswald (East Renfrewshire) (SNP)]

12. If he will make an estimate with Cabinet colleagues of the amount of unusable PPE procured by the Government since the outbreak of covid-19.

People with a Learning Disability and Autistic People: Sixth Annual Report

Gillian Keegan Excerpts

Thursday 14th July 2022 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

Since becoming the Minister for Care and Mental Health in September 2021, I have had the privilege of engaging and meeting with many people with a learning disability, autistic people and their families, carers and many dedicated health and social care staff. It deeply saddens me to hear some of the stories they have shared of experiences of poor health and care service provision and the premature loss of a loved one. That is why today I would like to acknowledge the publication of the sixth annual report of the “Learning from lives and deaths—People with a learning disability and autistic people” (LeDeR) programme compiled by the King’s College University and its partners (University of Central Lancashire and Kingston and St George’s Universities). A copy of the sixth annual LeDeR report will be deposited in the Libraries of both Houses.

The annual LeDeR report remains a crucial source of evidence that enables us to build up a detailed picture of the key improvements needed, both locally and at a national level, to tackle existing health disparities faced by people with a learning disability. It is an important step that as of January 2022, LeDeR reporting will be inclusive of the deaths of autistic people. This new information will be included in next year’s report.

It is encouraging that the sixth LeDeR report found that the life expectancy of a person with a learning disability has improved by one year for both males and females in 2021. The report also highlighted the phenomenal work of learning disability liaison nurses whose role in acute hospitals settings has been

“valued as a bridge between the principles and the provision of good care”.

This signals some improvement in the right direction, but there is much more to be done, such as reducing the number of avoidable and excess deaths of people with a learning disability.

I must acknowledge the unique circumstances that the pandemic presented in 2021; for the second year in a row covid-19 remains the leading cause of death for people with a learning disability. The LeDeR report highlights that during 2021 the rate of excess deaths from covid-19 was more than two times higher for people with a learning disability compared to the general population.

The report shows that people with a learning disability who were unvaccinated were nine times more likely to die of covid-19 than another cause compared to those who were vaccinated. These findings highlight the importance of the vaccination programme and the sustained focus on its roll out and uptake. NHS England have continued to engage on the delivery of reasonable adjustments in the vaccination programme and are offering a further booster in autumn 2022 for adults who are in a clinical risk group following the success of last year’s autumn booster programme.

We have made it clear throughout the pandemic that blanket application of “do not attempt cardiopulmonary resuscitation” (DNACPR) decisions is never appropriate. Concerningly, the report highlights an increase in the proportion of deaths in which the reviewer was unable to determine whether the process for making a DNACPR decision had been correctly followed. Whether the process for DNACPR decisions were correctly followed and completed properly were unknown for around a third of people whose deaths were reviewed in 2021 due to insufficient data. We will continue to monitor this closely and measure the impacts of steps already taken and planned to address inappropriate DNACPR decisions and recording of decisions, including the new requirement which came into force on 1 April 2022, requiring GPs to record conversations about end-of-life care and DNACPRs as part of annual health checks.

There have been recurring themes in previous years’ reports that have prompted action, and some are present once again in this year’s report. Amongst these, the most prominent were the need for greater learning disability and autism awareness training, and the significant under reporting of deaths and increased health disparities among people from an ethnic minority.

I am pleased that we are taking action to address these issues. As of June 2021, NHS England have begun carrying out focused reviews for every death of a person from an ethnic minority that is reported to LeDeR.

The Government have introduced a new requirement in the Health and Care Act 2022 requiring Care Quality Commission registered service providers to ensure their employees receive learning disability and autism training appropriate to their role. Significant progress has been made on the Oliver McGowan mandatory training programme to support this new requirement, with over 8,000 people participating in the trials in 2021. A final evaluation report was published in June 2022 which will inform next steps. This action will help to ensure health and social care staff have the skills and knowledge to provide safe, compassionate, and informed care.

NHS England has published its action from learning report alongside the sixth LeDeR report, setting out a range of work taking place to improve the safety and quality of care to reduce early deaths and health disparities. We will continue to work with all our partners to ensure we are tackling the issues raised with urgency.

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People with a Learning Disability and Autistic People: Support Action Plan

Gillian Keegan Excerpts

Thursday 14th July 2022 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

Today I am delighted to announce the publication of the “Building the right support” action plan. This action plan aims to reduce reliance on in-patient care in mental health hospitals for people with a learning disability and autistic people of all ages by building the right support in the community.

People with a learning disability and autistic people should live in their own home and have the right support in place to live an ordinary life. This includes access to education, employment and other opportunities which help people to fulfil their aspirations. We know these aspirations are not currently being met.

The action plan brings together the commitments that have been made by different partners to realise this aim.

We want this action plan to support the NHS long-term plan commitment to achieve a 50% net reduction in the number of people with a learning disability and autistic people being cared for in an in-patient unit by the end of March 2024. There may be times when admission to a mental health hospital is necessary and has a therapeutic benefit. Where this is the case, we are clear that this care should be of high quality, the least restrictive possible and for the shortest time possible. It should also be close to home so that a connection can be maintained with family, friends, and their local community.

Too often we have heard that the care of people with a learning disability and autistic people in specialist mental health in-patient care has fallen far short of the standards we would expect. Instances of abuse or poor care, as seen in appalling cases such as Winterbourne View, Whorlton Hall and Cawston Park, are unacceptable. I am determined that, working with our partners, we do everything we can stop this from happening again. I am pleased the NHS is taking action to avoid admitting people with a learning disability and autistic people to hospital settings rated inadequate by the CQC unless, in exceptional circumstances, it is in the best interests of the individual and their family and is being done with their involvement.

In the manifesto, we committed to improving how people with a learning disability and autistic people are treated in law and to making it easier for them to be discharged from hospital. Our proposed reforms to the Mental Health Act will support this by ensuring people with a learning disability and autistic people can only be detained where there is a clear mental health need and by creating new duties on commissioners to ensure that there are sufficient community-based services in their local area to support people with a learning disability and autistic people.

Delivering “Building the right support” is a joint endeavour—no one organisation can make this happen on their own. The “Building the right support” delivery board, which I chair, brings together organisations with the levers to make change happen. The board will have oversight of the implementation of this plan.

The action plan includes:

work to ensure that people with a learning disability and autistic people receive high quality

care and support, and are safe;

a commitment to make it easier to leave hospital when people are ready;

what is being done to enable people to live an ordinary life in the community, for example

with the right housing and support;

specific activities to enable a good start to life, including early diagnosis and positive :

experiences of education;

reforms across Government to make wider improvements, such as the Mental Health Act and adult social care reforms; and,

work and changes to deliver increased integration and join-up across systems.

We also recognise that the way that funding flows through and across the health and social care system can impact on the provision of support and people’s overall experiences of care. To support this, we commissioned an independent consultancy organisation to undertake a rapid review of funding flows. I am pleased that we have been able to publish the report alongside the plan today and I will work with the delivery board to take forward action in response to the findings.

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Care Costs Cap

Gillian Keegan Excerpts

Thursday 7th July 2022 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

The Government are implementing a comprehensive reform programme of adult social care with £5.4 billion investment over three years, building on measures in the Health and Care Act. This includes £3.6 billion to reform the social care charging system and enable all local authorities to move towards paying providers a fair cost of care.

Today the Department of Health and Social Care has published updated operational guidance on implementing the cap on care costs, alongside the Government response to the consultation on this draft guidance. This guidance seeks to support all local authorities in their preparations for implementing our reforms from October 2023.

These changes will end the lottery of unpredictable care costs through the introduction of a £86,000 cap on personal care costs, as well as a more generous means test, raising the upper capital limit from £23,350 to £100,000, and the lower capital limit from £14,250 to £20,000.

The Government’s consultation on the statutory guidance to implement charging reform ran from 4 March until 31 March 2022 and sought views on how a cap on care costs would operate in practice. The consultation received 161 responses, indicating broad support of the policy principles and the aims of our reforms. The feedback suggested that sections of the guidance needed further development to ensure they are clear and workable. We have therefore worked with local authorities and the wider adult social care sector to clarify and expand the guidance in line with this feedback.

The guidance updates the existing care and support statutory guidance (CASS) and covers the following areas:

Cap on care costs (including detail on: daily living costs; what counts towards the cap; the metering process; requesting that the local authority meets self-funders’ needs and cross-border issues);

Independent personal budgets (including detail on: the principles of establishing an independent personal budget; verification of the purchase of care; dispute resolution; and moving from an independent personal budget to a personal budget);

Care accounts (including detail on: what should be included in a care account; care account statements; retention of care accounts; and portability of care accounts).

We have also amended the guidance in response to feedback on the implementation of one specific aspect of our reforms, the extension of section 18(3) of the Care Act 2014.

As announced in building back better, from October 2023 we will extend the right for self-funding individuals to have their eligible care needs met by their local authority, such that they can access care at, generally lower, local authority rates. This is aimed at improving fairness and accessibility, as well as supporting the operation of the cap, which is based on how much local authorities pay for care. We will do this by extending the application of section 18(3) of the Care Act 2014.

The consultation sought views on how best to ensure smooth implementation of this change. Respondents pointed towards a need to mitigate the initial impacts of section 18(3) and a common theme in responses from local authorities was concern about the workability of full implementation from October 2023. They were also concerned about the potential impact on those awaiting care and support, should a large number of people with existing care arrangements already in place approach their local authority to arrange their care at this point in time.

The guidance published today therefore clarifies our intention to stage the extension of section 18(3) over 18 months, so that people entering residential care from October 2023 are initially eligible. Additionally, anybody already living in residential care will be eligible from April 2025 at the latest, and earlier if the market can sustain full rollout. This will be kept under regular review. Section 18(3) already applies to individuals who are receiving care outside of a residential care setting.

Section 18(3) does not affect an individual’s ability to use the cap on care costs; all care users will be able to meter towards the cap on care costs from October 2023. Rather, section 18(3) helps individuals ensure that they pay no more than the metering rate when meeting their eligible needs; the metering rate is based on the fees commissioned by local authorities, and these cannot always be secured by individuals arranging their own care. This means that individuals using section 18(3) from October 2023 onwards need not pay more than £86,000 on getting the personal care they need; their local authority will arrange their care and they will meter towards the cap based on the amount they spend. Everyone who funds their own care will be able to ask their local authority to meet their needs from April 2025 at the latest. People with assets of less than £100,000 do not need to use section 18(3); they will be able to ask their local authority to meet their needs from October 2023, as a result of the extended and more generous means test.

This staged approach to introduction will allow individuals funding their own care to benefit from local authorities’ expertise in commissioning as quickly as possible, while allowing local authorities and social care providers to plan for this change and avoid unnecessary disruption to service provision.

Today’s publication is a further milestone on the Government’s journey to reform adult social care, creating a system that is fit for the future and of which we can all be proud.

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Bereavement Charities

Gillian Keegan Excerpts

Tuesday 5th July 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

Thank you very much, Mr Davies. It is also my first time —and a real pleasure—to serve under your chairmanship. I congratulate my hon. Friend the Member for North Devon (Selaine Saxby) on securing this important debate and using her voice to support a local charity and its role in helping people all the way through the pandemic. I also congratulate her on her role in getting broadband to so many of her constituents at such a vital time. I am sure they were very grateful.

It is vital that bereavement support is available and accessible to those who need it, when they need it. People who have been bereaved navigate their grief in different ways, as we have just heard in the moving testimony from the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), about the sad death of her father. I, too, would like to pass on my condolences at his untimely death. She threw herself into exercise, and some people can manage their grief in that way, with the support of loved ones—family and friends. Our role as Government is to signpost the options for support to help people through this journey, however they need that. Probably all of us have suffered a bereavement, and I understand how overwhelming the emotions associated with grief can be. From conversations with bereaved people, bereavement support organisations and my policy officials, I know that there is still more to do to overcome the stigma of grief.

As part of its “Time to grieve” campaign, Independent Age recently came to the Department of Health and Social Care to deliver to me an open letter about the importance of emotional support services. I was pleased to meet the representatives from Independent Age, as well as a number of bereaved people who had made the journey to the Department, in Victoria Street, to join them. It was deeply moving to hear their harrowing stories of loss and grief. They included people who had been, very sadly, bereaved by covid-19. I heard how much all the restrictions had impacted their ability to go through the difficult but normal mourning and grieving processes. I gained so much from that experience and the conversations that I had, and I would like to thank those people. I know that it was not easy for them to come. It took a great deal of time, and it took a great deal of strength to share their stories.

I know that many people still feel unable to speak up about their grief. We must encourage people to have conversations, whether that be with personal support networks or specialist bereavement support organisations, about their feelings and experiences. There is no quick fix for grief. But as a society, we can collectively tackle the stigma and make it easier for people to share their feelings and to seek the support that they need.

At the start of the covid-19 pandemic, the Government recognised the unparalleled circumstances and the need for additional bereavement support due to the increase in deaths. And as the pandemic progressed, we recognised that the restrictions on social contact that were in place to limit the spread of the virus disrupted the grieving process for many. That made it much more difficult to say goodbye and led to some people experiencing more complicated grief.

In 2020-21, as part of a wider package of mental health support, we provided more than £10 million of funding for mental health charities, including several bereavement support organisations. One organisation to benefit from that funding was the National Bereavement Partnership, which my hon. Friend the Member for North Devon has referred to in this afternoon’s debate. I know that the National Bereavement Partnership was able to achieve some invaluable outcomes with the funding. It bolstered its capacity to provide support for those suffering mental ill health and anxiety following a bereavement; and it was able to provide support through its helpline, a befriending programme, a signposting service and therapeutic interventions. I am truly grateful for all its hard work during this tough period.

Other organisations funded by the Government during this time were able to achieve some fantastic outcomes, such as increased signposting, online resources and training events, and increased capacity to run helplines and webchats. They were also able to advise people of something that perhaps not everyone knows: people can now self-refer for NHS talking therapies. If people go on to the NHS website and search for talking therapies, they can self-refer to get that support if required.

The wider fiscal and economic context meant that we were not able to extend the additional grant funding to bereavement support organisations beyond March 2021; it was for a specific period. Outside the extraordinary circumstances of the pandemic, bereavement support services are commissioned locally, based on the needs of the local population. We know, though, that in the past it was not always clear whether clinical commissioning groups or local authorities were responsible for providing or commissioning bereavement support. As a result, it could sometimes fall through the cracks. However, the establishment of integrated care systems, as of last Friday, in places across the country will help to improve collaboration among commissioners, local authorities and other partners. The integrated care system for Devon is now established, and I am sure that my hon. Friend the Member for North Devon will be meeting its representatives very shortly. She will be pleased to hear that we have added palliative care services to the list of services that an integrated care board must commission to ensure a consistent national approach and support commissioners in prioritising palliative and end-of-life care. To support that, NHS England will introduce new statutory guidance as well as technical guidance and tools, which will include bereavement support as part of a wider package of palliative and end-of-life care services.

I was interested to hear about the many achievements of Michaela Willis and how many people she has personally helped. It was sad to hear her powerful testimony that the National Bereavement Partnership has had an abundance of calls from those who have lost loved ones, including by suicide, and from people contemplating suicide as a result of personal loss. The NHS long-term plan has ensured that every local area has services for suicide bereavement support. By the end of the year, these services will proactively communicate with bereaved families within days of a sad death to offer their support. The Government can provide better support in other ways. For example, we know that fewer people from minority ethnic groups access bereavement support services, so we are working with the National Institute for Health and Care Research to commission research into the barriers that prevent minority ethnic groups from using these services. That bid is backed by at least £350,000, and we expect the findings of the research in 2024.

My hon. Friend the Member for North Devon said that many people may experience complex grief. We recognise that, and we are working with the National Institute for Health and Care Research on other areas relating to bereavement support, including prolonged grief disorder, on which further research could be commissioned. We will continue to work closely with the bereavement support sector on the matter. In June 2021, in response to the pandemic and the societal impact of the huge numbers of individuals and families suffering a bereavement, the UK Commission on Bereavement was established. Its remit is to explore issues and make recommendations to Government on how to support bereaved people better. Alongside launching calls for written and oral evidence from bereaved members of the public, the commission is informed by a lived experience advisory forum and is working with stakeholders in the sector via a steering group. I have met with the commission and I await the publication of its report in September. Knowing the extent to which its report is informed by the voices of the bereaved, I look forward to reading the findings and recommendations. I have made a commitment that the Government will formally respond to the commission’s report.

I have been actively engaging with a range of bereavement support stakeholders. Their main concern is the lack of join-up across Departments on areas that impact bereaved people. We have listened and acted to address that. I directed my officials to set up a cross-Government working group to discuss cross-cutting issues that relate to bereavement support, and I am pleased to say the working group first met earlier this year, with representatives from 10 Departments. The working group continues to meet on a regular basis and has met with the UK Commission on Bereavement to discuss its initial findings.

The pandemic has been the largest public health challenge in the past 100 years. Its legacy is clear: thousands of bereaved families are grieving the loss of a loved one. So bereavement will form a central component of the public inquiry into the Government’s handling of covid-19. As a Government, we are working with the bereavement sector to ensure that support is available for those who need it. We must break down the factors that create barriers to bereavement support, such as ethnicity. Our research with the NIHR will help us do that. I thank all those who have lost friends, families and loved ones and have shared their deeply personal experiences with me, either directly or through the UK Commission on Bereavement. To all bereavement support organisations, I want to say thank you. The services they provide are vital for their communities. I encourage bereavement support organisations to reach out to their local integrated care system to understand the support on offer and how they can help deliver bereavement services.

Finally, to my hon. Friend the Member for North Devon, I am truly sorry to hear about the loss of her grandmother—my condolences to her and her family. I, too, lost my grandmother, who was nearly as old at 96. I still have her as my screensaver on my phone. It cheers me up every time I switch my phone on. It is still very sad and a loss that is keenly felt. I thank my hon. Friend for her strength in bringing forward this important debate and championing her local charity. I hope that the information I have provided will be instructive, so that she can carry on those discussions with the integrated care system in Devon.

Battersea Funfair Disaster: Child Trauma Support Services

Gillian Keegan Excerpts

Tuesday 21st June 2022 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

I congratulate the hon. Member for Battersea (Marsha De Cordova) on securing the debate. I must admit that I was not aware of the tragic events that unfolded 50 years ago, on 30 May 1972, and I am sure that others were not, either, so it is fantastic that she secured the debate to remind us all. However, I discussed it with my husband when I got home last night. At the time, he was a 10-year-old boy growing up in London. He was very much aware of what happened and he vividly remembers it. What should have been a happy day in Battersea Park, on the bank of the River Thames, resulted in five children losing their lives and a further 13 being injured, and it shocked many more. I very much hope that the survivors’ campaign for a permanent memorial in Battersea Park is ultimately successful, so that that terrible event is never forgotten—maybe that is the plaque the hon. Lady referred to, or maybe there is something else that they are still campaigning for.

Undoubtedly, many affected by the Battersea funfair disaster will have suffered from what we now call post-traumatic stress disorder, but let us not forget that PTSD was not even added to the International Classification of Diseases until the ’80s, and guidance from the National Institute for Health and Care Excellence was not published until 2005. Events have taught us that people affected by any traumatic incident must be able to access timely mental health support when and if needed, but I am not sure there was the same understanding all those years ago.

Luckily, PTSD can be successfully treated even when it develops many years after a traumatic event. The treatment depends on the severity of symptoms and how soon they occur after the traumatic event. The hon. Lady reports that survivors of the tragedy remain concerned that mental health support for children who have suffered trauma has not changed much since 1972. I too would be very concerned if that was the case, but I must respectfully disagree with that assessment.

If a child has witnessed or experienced a traumatic event, it is quite natural for them to be stressed, upset or frightened. That should not usually last beyond four weeks, but if it does, it may indicate post-traumatic stress disorder and it is then important to seek help via their GP. There are now some really effective treatments, including cognitive behavioural therapy, for children and young people who are experiencing the effects of trauma.

To respond to the hon. Lady’s specific question, NHS England and NHS Improvement have issued guidance on responding to the needs of people affected by incidents and emergencies, which stresses that plans for incidents and emergencies must provide psychosocial and mental health care for people affected, since early intervention for people at risk of developing mental health problems may reduce their severity and chronicity and, ultimately, related costs.

In general, psychological support can be accessed four to six weeks after the event for those who are exhibiting signs of needing professional help, as per NICE guidelines. Those who require urgent support may be referred to services sooner than that, and it is important to ensure that messaging about support services is appropriate. Not all people need psychological support, and many recover over the course of time without specific interventions, but it is still important that such people continue to look after their health and wellbeing after a traumatic incident. That includes getting enough rest, eating well, returning to their routine and staying connected with others.

[Marsha De Cordova]

I just want to ask about the support that is available via NHS England and ensuring that it is available, as the Minister says, within a four to six week period. Can she assure me that that is actually happening? Is there any evidence base to ensure that children who experience trauma or post-traumatic stress disorder are getting that support in a timely fashion?

[Gillian Keegan]

Yes, and of course we always try to ensure that, as the targets we put in are worked throughout the system, those targets are met. That is why we measure those things. Maybe it would be helpful to the hon. Lady if I gave some recent examples. In the wake of the Manchester Arena terrorist attack, which sadly affected many children and young people, the Greater Manchester Resilience Hub was set up to provide a central point for mental health advice for those directly affected, including children and emergency responders. The hub worked with other agencies to develop packages of care.

In response to the tragic fire at Grenfell Tower, more than £10 million has been spent on treating the mental health of those affected. In the year after the fire, 2,674 adults and 463 children were screened for symptoms of post-traumatic stress disorder, and the St Charles Centre for Health and Wellbeing was opened up so that those affected could be treated in dedicated therapy suites. I hope the hon. Lady will recognise that we have seen a dramatic change in both attitudes towards mental health since the days of the Battersea disaster, and the NHS services available to support people with their mental health.

[Jim Shannon]

I am very encouraged by what the Minister has just said. In my intervention on the hon. Member for Battersea (Marsha De Cordova) I suggested some contact with the authorities in Northern Ireland, which unfortunately have a long 30 years’ experience of trauma, especially among children. Has that happened?

[Gillian Keegan]

I have not met my counterpart in Northern Ireland but, having heard the hon. Gentleman’s intervention, I sent a WhatsApp message to request that a meeting be set up, because it is probably long overdue. We can learn a lot from each other, and I am always keen to learn from anyone I can.

Over the past 50 years, we have seen the transformation of NHS mental health services for children and young people. From the passing of the Mental Health Act 1983 and the establishment of mental health trusts to more recent developments including the Time to Change campaign, which between 2007 and 2021 helped to improve the attitudes and behaviours of some 5.4 million people towards those living with mental health problems, these are all important steps along the way towards destigmatising mental health.

The publication of the five-year forward view for mental health in 2016 made the case for transforming mental healthcare in England. The implementation of the “Transforming children and young people’s mental health provision” Green Paper from December 2017 has seen the introduction of senior mental health leads and mental health support teams in schools and colleges. We regularly talk about that programme, and I am sure it will make a massive difference to young people, particularly those affected by the pandemic. The 2019 NHS long-term plan commits to expanding and transforming mental health services in England so that an additional 345,000 children and young people will be able to access NHS-funded specialist mental health treatment by 2023-24.

We are continuing to build up those services and the staff, as in some cases demand outstrips supply. As part of this work, we have all-age 24/7 urgent mental health helplines in all areas of England so that people experiencing a mental health crisis, or those worried about someone experiencing such a crisis, can speak to a trained professional. The helplines were established during the pandemic, so they are a relatively new addition to the landscape, but I am sure they are very welcome because many people have sought these services.

We are also accelerating the coverage of mental health support teams in schools and colleges from the 287 currently in place to over 500, covering around 35% of pupils by 2023-24. There are currently 16 mental health support teams operating in or planned for south-west London, so they have already started to roll out.

Our hard-working NHS community mental health services treated over 420,000 children and young people in 2020-21, an increase of around 95,000 on the previous year, so we can see there has been a massive increase in demand for these services, which is why we are working very hard to try to build up the mental health workforce.

Although none of us wishes to see a repeat of the events in Battersea Park and the many things that have happened since, not only in mental health but in safety, I assure hon. Members that the NHS will always be there to support the survivors of such tragedies. However, it is important that we never forget. I am therefore grateful to the hon. Member for Battersea for securing this debate and for making us all aware of something that happened. This issue is important to her constituents, and this debate will ensure that we all remember the tragedy and learn from the events of that day.

Question put and agreed to.

Infant Mental Health Awareness Week

Gillian Keegan Excerpts

Thursday 16th June 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve for the first time under your chairmanship, Mrs Murray. I thank my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) and congratulate her on securing the debate. I soaked up her speech—when she used that phrase, I felt that that was what I was doing. It was insightful and educational, and all of us got the benefit of her 25 years of experience and understanding of what we need to do and how we should do it. As we know, in this place quite often we can appreciate the problems, but it is much harder to come up with the solutions. I know that her work has been vital in doing that and in helping the Government shape policy in this area.

I thank all hon. Members for their contributions and their support for this initiative. We are at the very beginning of this journey and we want to keep that collegiate approach. We have a real opportunity to shape this and, as in many of the areas that I am responsible for, it is not particularly party political. It is really about how we impact real people’s lives, and in this case babies.

It is clear to us all that the development of babies is incredible and needs lots of vital support in the first years. They are born with more brain cells than there are stars in the Milky Way galaxy. If a baby is loved and receives care, their brain flourishes, laying the foundations for good future physical and mental health. That is why the first 1,001 days have been described as critical for development. There is a real understanding of that now, and that is undisputed. It is also why I am delighted to speak about this important topic and also work on developing the new services. I welcome being able to do so during Infant Mental Health Awareness Week.

Infant mental health refers to social, emotional and cognitive development. For good infant mental health, babies need parents or carers who will consistently meet their needs, as outlined by my right hon. Friend, because that leads to secure attachment relationships. Over 60 years of research tells us that that is related to positive long-term developmental outcomes, from improved emotional development and school readiness to reduced rates of offending, as mentioned by the shadow spokesperson for the SNP, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron).

Having a baby can be a time of great joy, but also a time of challenge and change. Many new parents get the support that they need from midwifery and health visiting teams, as was mentioned by the hon. Member for Richmond Park (Sarah Olney), whose mother I thank for her service. I am sure she has helped a lot of parents and families in her time. Many new parents get support from family and friends as well. We talked about how a lot of that could not happen during covid when it was a very difficult time for many new parents. We know that having a baby can be a time of great challenge. With or without a pandemic, it is a time of great change. There are many reasons why a new parent may struggle, from social isolation, as has been mentioned, financial stress, a traumatic birth, relationship difficulties or their own experiences of early trauma. Without the right support this can impact parents and babies alike.

Perinatal mental health difficulties are common. Approximately one in five mothers and one in 10 fathers experience mental health difficulties during the 1,001 critical days. They are critical days, but also difficult days, which is why the numbers are so high, and parental mental health difficulties are associated with increased rates of mental health difficulties in children. As has been mentioned by a number of hon. Members, these difficulties can be passed on.

Parent-infant relationship difficulties are common. They can involve a parent struggling to bond with their baby, or may relate to a perinatal mental health difficulty. Although exact prevalence is difficult to establish, some estimates indicate that approximately 40% of babies have insecure attachment and 10% have a disorganised attachment style. Both are associated with an array of long-term developmental outcomes.

I recently visited Knowsley’s building attachment and bonds service, which is one of the new services being trialled and introduced. It is on the same estate where I went to school—I literally passed my old school—so the area was very familiar, and I was familiar with the problems the service was trying to deal with. I saw at first hand that relationships are everything and that early intervention is crucial. I met a mum there, with her baby. She had had several children and had problems, and she was no longer with the children. With this baby, the service had put in a lot of effort to keep mum, dad and baby together, and to make sure that they built that family. It was making a massive difference, and her other children have since come back to join her. The service was changing everything about the outcome not just for the baby, but for the other children in the family as well. These issues are why ensuring that every baby gets the best start in life is of central importance to this Government.

As all hon. Members said, this is an investment in the youngest and most vulnerable members of our society, and it is part of our ambition to level up health outcomes and opportunities across the country. Our vision is for every parent and carer to have access to high-quality universal services in their local area. That is set out in “The Best Start for Life: A Vision for the 1,001 Critical Days”, published by the early years healthy development review in March 2021. I thank my right hon. Friend the Member for South Northamptonshire for her inspirational work enabling us to support the implementation of this vision.

The Government are investing £302 million to improve start for life services and to create a network of family hubs in 75 local authorities in England. The funding will help bring services for families together into one place, improving their access to support, advice and services. This funding package includes £100 million for perinatal mental health and parent-infant relationship support, £50 million for breastfeeding support and £50 million for parenting support. This significant £100 million investment will improve access to mental health support for babies from conception up to the age of two, as mentioned by the hon. Member for Twickenham (Munira Wilson). It will help us build the workforce in order to fill the gap we see at the moment.

The funding will tackle entrenched inequalities in communities, as mentioned by the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), and we announced the 75 local authority areas that are eligible for a share of this funding in April. The funding will be targeted at local authorities with disproportionate poor health and educational outcomes, and I am pretty sure that Knowsley, where I am from, has been included in that group. Indeed, my right hon. Friend the Member for South Northamptonshire once stood for election in Knowsley. Since that announcement, we have been working with the eligible local authorities and a range of expert stakeholders to further develop the programme. We will share a draft programme guide, detailing how local authorities can make the most of the funding, in the coming weeks.

The investment will complement the ambitions set out in the NHS long-term plan, as referred to by the hon. Member for Twickenham. It will deliver the fastest expansion in mental health services in NHS history, with 345,000 more children and young people having access to specialist, NHS-funded mental health care. That ambition is backed by the additional £2.3 billion a year for mental health, but we have not actually spent a penny of it yet, because it is by 2023-24. That is when this amount kicks in, and it will be for years thereafter.

Obviously, the workforce is vital. It is clear that we have to invest in developing the modern, diverse and highly skilled workforce that we will need to support babies and families by trialling and evaluating innovative workforce models in five local authorities. That is what we will be doing to ensure that we have the right mix and blend. Obviously, health visitors are also a key part of that; they were mentioned by the hon. Member for Richmond Park.

With regard to 2029, we obviously know that the training of more clinical psychologists, child and adolescent psychotherapists, psychiatrists and the perinatal workforce will require additional capacity across the current education and service providers, all of which are currently operating at full capacity or are limited. We have immediate action —at the moment—to model the workforce to support the development of new roles, new ways of working, and upskilling, particularly with regard to the perinatal, primary and community workforce, including health visitors. We are working with Health Education England, NHS England and NHS Improvement to ensure that we have this workforce plan to sit alongside the new 10-year mental health plan. When we publish that, we will be putting that together, so we absolutely recognise that this is critical. The training time, as the hon. Lady will be able to vouch for, is a long time, so we have to innovate; we have to do things differently. Otherwise, it will take too long and too many people will not benefit from what we all know is required.

We have heard from families that stigma is a real barrier to their seeking support. I really identify with that; I definitely saw it growing up in Knowsley. My friend used to run the Sure Start centre there, and it was clear that she found it very difficult to access the people that she knew she needed to access, because stigma got in the way. To reduce the stigma associated with perinatal mental health difficulties and parent-infant relationships, we must have a multifaceted approach. That includes ensuring that the family hub is a welcoming place for all families; sharing key messages about perinatal mental wellbeing and good parent-infant relationships; and enabling the workforce, paid and voluntary, to feel comfortable and confident to have conversations with families about mental health, bonding and attachment. Those are difficult conversations to have.

Needless to say, there is little point in tackling stigma if not enough support is available. As has been mentioned, there is currently huge variation in the availability of early intervention and preventative support across the country. Some areas have robust and very good offers, including universal antenatal education classes, peer support services for breastfeeding and mental health, and drop-in sessions at the local family hub. In other places, support may be available only if difficulties become particularly severe. That feeds into the stigma, because only when something is going wrong do people get access to the services. That is why the universal nature of the services is vital.

There is also a discrepancy in the perinatal mental health support that is available for mothers and for fathers and co-parents. That was mentioned by the hon. Members for Twickenham and for Richmond Park. We know that more than one in three new fathers are concerned about their mental health in the perinatal period. We identified that gap in provision of support for fathers or co-parents experiencing perinatal mental health difficulties, particularly if the mother is not experiencing any difficulties—then they will not be picked up in the same way. That inequality of access has an impact on the baby’s mental health and wellbeing. A positive relationship with both carers would lead to better long-term developmental outcomes. That is recognised; it is identified as a gap, so support will be provided.

Lastly, none of this will be achieved and achievable without a knowledgeable, skilled and confident workforce. This investment is an opportunity to improve workforce capability and capacity. We understand the workforce challenges and will encourage local areas to create capacity by incorporating greater skill mix in clinically led teams, relieving the pressure on existing teams. The funding available through the Start for Life programme will enhance capacity across a range of professions and volunteers, and improve capability through training. That will build the knowledge and confidence of the workforce needed to provide mental health support. The family hub model will enable families to receive support with perinatal mental health and parent-infant relationship difficulties. That investment will build on existing provision while responding to local needs.

Before I draw my speech to a close, I want to acknowledge the important contribution of two other Government initiatives. First, there has been an additional £200 million investment in the supporting families programme. That will enable local authorities and their partners to provide help earlier, and promote better outcomes for an additional 300,000 families, including families with babies. Secondly, we have launched a consultation to develop a new 10-year plan for mental health. The consultation is open until 7 July. We are concerned to try and get more people responding to that, particularly from black and ethnic minority backgrounds. Members could help to spread the message, to ensure that we get more representations from people with those characteristics. The mental health plan includes specific questions relating to babies and their parents or carers, in recognition of the distinct needs in the first 1,001 critical days. We look forward to seeing the results of that consultation. As I have said, please spread the word.

I will end by reassuring my right hon. Friend the Member for South Northamptonshire that early intervention and prevention sit at the top of this Government’s mental health priorities. We are committed to ensuring that babies and their families get the support they need to make sure they get the very best start in life.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 14th June 2022 Commons Chamber

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

5. What steps he is taking to help ensure that training for the social care workforce meets the needs of people living with dementia.

[The Minister for Care and Mental Health (Gillian Keegan)]

It is crucial that the health and social care workforce have the necessary skills to provide high- quality care for those living with dementia. As announced in the White Paper, we will invest £500 million in training, and we will work with social care staff to co-produce a knowledge and skills framework to include the dementia training standards framework. Later this year, we will set out our plans on dementia for England for the next 10 years, which will include plans for dementia training.

[Ms Rimmer]

People with dementia deserve to be treated with dignity and respect. There are ways to enable people living with dementia to live the lives they want to lead and that is what the inquiry by the all-party parliamentary group on dementia is investigating right now. Will the Secretary of State commit to attending the APPG’s inquiry report launch in September to hear how that can be achieved? Most importantly, will he commit to taking on board its recommendations? Families of people with dementia feel they are neglected and not getting the attention they need. I urge him to attend the launch of the report.

[Gillian Keegan]

I completely agree with the hon. Lady that we, of course, must treat all those living with dementia—and all those caring for people with dementia, which is a lot of people in the country—with respect and do everything we can to support them. That is why we will, as I say, be setting out our plans for dementia in England for the next 10 years and why the Secretary of State mentioned dementia in a speech very recently. I will personally commit to attending the APPG. I am very happy to work with her on this issue to understand what more we could be doing and what more we can do to inform the 10-year plan for dementia in England.

[Dame Caroline Dinenage (Gosport) (Con)]

I am really grateful to my hon. Friend for her commitment to train social care staff in dementia. Timely and accurate diagnosis is really important to ensuring that people living with dementia get on the right care and support pathway. A lot of my constituents are still struggling to get the face-to-face appointments that are so crucial in that. What is she doing to ensure that GPs in my local area are equipped to recruit, train and be resourced to get early diagnosis in place for people?

[Gillian Keegan]

My hon. Friend is absolutely right. We had been meeting our dementia diagnosis target consistently at the national level from July 2016 until the end of March 2020, when, obviously, we all know what happened. The diagnosis rate dropped below our target for the first time in almost four years, and reflects the impact the pandemic had on memory assessment services and GP referrals into those services. In the last financial year, we allocated £17 million to specifically address dementia waiting lists and increase the number of diagnoses. That was spent in a range of ways, including on investing in workforce to increase capacity in memory assessment services and on improving access to pre and post-diagnostic support and carer support.

[Karin Smyth (Bristol South) (Lab)]

Quality care for our loved ones depends on a well-trained and motivated care force. I think we can all agree on that, and I commend the work of the all-party group. I hear the words of the Minister, but we have had a lot of warm words about a dementia strategy and the promise of a clear date. Can she be more specific about a date for publication, and can she be clearer about the workforce plan, including training for staff, given the Government’s rejection of all workforce amendments to the Health and Social Care Levy Act 2021? We cannot give confidence to people suffering with dementia and their carers without a much clearer plan that is in place very quickly.

[Gillian Keegan]

I assure the hon. Lady that there is a lot of work happening on workforce across the whole of our health and social care services, whether in mental or physical health. Health Education England is working on the matter now and will publish a framework shortly. The workforce strategy set out in our White Paper is just the beginning. We will work closely with adult social care leaders and staff, and the people who draw on that care and support, to implement it now, and to take forward and build on those policies now and in the future. There is a lot of work, and we are serious about it; the hon. Lady can look forward to seeing a lot of documents before the end of the year.

[Rosie Cooper (West Lancashire) (Lab)]

6. What assessment he has made of the effect of integrated care systems on cross-boundary NHS trusts.

--- Later in debate ---

[Jacob Young (Redcar) (Con)]

7. What steps he is taking to increase the quality of nursing in care homes.

[The Minister for Care and Mental Health (Gillian Keegan)]

Nurses play a pivotal role in social care and work hard to deliver high-quality care. Increased funding announced on 11 May for nursing in care homes will support tens of thousands of care home residents with nursing needs, including those with learning and physical disabilities, with a 11% increase in 2022-2023 and an estimated £87 million backdated for 2021-22. Our £500 million workforce reforms will provide a new fund to help nurses to meet their continued professional development objectives.

[Jacob Young]

We have just had Carers Week, in which we recognised the significant contribution of care home staff, domiciliary care workers and unpaid carers. However, I have spoken to care providers in Redcar and Cleveland, so I know that we need to do more to support them, particularly with the recruitment and retention of skilled care workers. Will the Minister come to Teesside to meet me and care providers, and discuss what can be done to support them in their efforts?

[Gillian Keegan]

My hon. Friend rightly says that our health and social care workforce are our greatest asset; we cannot thank them enough for their extraordinary commitment, working day and night to put people’s care and safety at the centre of everything they do. We accept that there is more to be done to support our adult social care workforce and encourage more people into the sector. Our “People at the Heart of Care” White Paper, backed by our £500 million investment, will develop and support the workforce over the next three years, and help to address long-term structural barriers to recruitment and retention. I would be happy to visit care providers in Teesside with my hon. Friend.

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

I beg the departmental team to look carefully at something that is close to my heart: AF or atrial fibrillation. In care homes and every nursing setting, we need people to detect the early signs of atrial fibrillation. If it is not detected, it often leads to strokes, which are one of the most expensive things for the NHS to cope with. We do not have enough AF awareness or testing. Can we get a campaign going on the issue?

[Gillian Keegan]

I am certainly happy to meet the hon. Gentleman to understand more about the issue. At the heart of it, I think, is prevention; we are trying to understand how we can prevent some of what causes greater illnesses later on for those who are in a care home or are receiving social care in their own home. That is certainly a big part of the strategy for our social care reforms.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

8. What steps he is taking to raise the quality of leadership and management across the health and social care sectors.

--- Later in debate ---

[Kerry McCarthy (Bristol East) (Lab)]

Suicide prevention organisations such as the Campaign Against Living Miserably and Papyrus are, sadly, needed more than ever, yet in the current economic climate, because they tend to rely on charitable donations, they are struggling to provide the services to meet demand. What will the Government do to make sure they survive and provide the life-saving services that are so badly needed?

[The Minister for Care and Mental Health (Gillian Keegan)]

Of course every suicide is a tragedy. We must do all we can to help to prevent suicide. In the last financial year, we provided £5.4 million to 113 voluntary, community and social enterprise organisations; we also provided £510,000 for the Samaritans helpline for people experiencing distress. That is in addition to more than £10 million we provided to voluntary and charitable mental health organisations in 2020-21.

[Jim Shannon (Strangford) (DUP)]

As IVF treatment is incredibly time sensitive, will the Secretary of State consider increasing the funding available to allow couples to make use of private facilities on the NHS, to help families have the children that they so much want?

Government Action on Suicide Prevention

Gillian Keegan Excerpts

Wednesday 8th June 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the hon. Member for Bristol East (Kerry McCarthy) for securing this debate on suicide prevention and for hosting the recent event, “Breaking the Silence”, during Mental Health Awareness Week. I have a feeling there will be many such meetings and conversations, to which I look forward. Awareness is something we often struggle with in Government, to ensure that people are aware of what we are trying to do and the consultations to hear their voices. That event was brilliant and put a spotlight on that. I also thank Bernard and Stephen, who came along. It was powerful to hear from them, as they marked the death of Joy Division singer Ian Curtis 42 years ago, as well as all the other personal experiences expressed there.

I very much agree with my shadow Minister that such personal experiences are so important. They are important in every aspect of my job, but none more so than in suicide prevention. I must admit that when I first saw that in my job title, it felt overwhelming. Every life lost to suicide is a tragedy. Everybody wishes they could go back and reverse time. It is so, so sad. We heard from the Speaker about his personal tragedies. Every single suicide is a tragedy, but every suicide is, on some level, preventable. That is what we are here for: to work towards preventing as many suicides as possible.

Sadly, like many here today, I know the pain of losing a family member—we lost my cousin Sallie, who I babysat for from a very young age. When someone takes their own life, it affects everybody. I thank Mr Pirie and Mr and Mrs Ritchie, who I have met before, for sharing their stories of Tom and Jack, and for coming up with constructive suggestions on how we can work to help other people who are in those situations, to improve our systems and to learn from those experiences. We know that the right support at the right time can provide hope and prevent a crisis, and can prevent a crisis from becoming a tragic loss of life. We look forward to continuing to work with Mr Pirie and Mr and Mrs Ritchie, and many others.

[Ronnie Cowan (Inverclyde) (SNP)]

I wonder whether the Minister will address gambling-related harm. This is a complex issue—we all get that—and it will require cross-departmental co-operation to find some sort of solution. There is an imminent opportunity coming along—there is a White Paper on gambling reform due, I am told, within weeks. Will the Minister engage with the Department for Digital, Culture, Media and Sport and help it to understand the issue, so that it can strongly regulate gambling, which would help to alleviate the number of gambling-related suicides?

[Gillian Keegan]

The hon. Gentleman has my assurance that I will definitely work cross-Government, with the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) who actually sits in the office next door to me—he finds it very difficult to escape. I think that answers the questions from the hon. Member for Bristol East about whether there are ongoing conversations, which will also continue into the future.

I am happy to visit Paul’s Place. As the hon. Member for Liverpool, Walton (Dan Carden) knows, I am often back in Liverpool, visiting my parents and friends. The first visit I made in this role was actually to James’ Place, also in Liverpool, which was set up by a constituent of mine, Clare Milford Haven, who set up the charity after the tragic death of her son, James. We met in Liverpool, but she was a constituent of mine down in Chichester. Every time I go to one of these places, I learn—every time. There are so many families trying to help the next family avoid the tragedy of losing a loved one.

I also met Tim, Mike and Andy—the 3 Dads Walking. They have done a fantastic job, walking round the whole country. They came to tell me the stories of their three daughters, Sophie, Beth and Emily, who all tragically died by suicide. They told me about the number of people who came out to take part as they walked around the country. There is that saying, “Walk a mile in someone’s shoes.” They were walking a mile together, talking about their experiences. They said that many people had never spoken about their experiences before, because they still felt there was some stigma attached to it. One of the fantastic things about having these conversations is the de-stigmatisation of not only suicide, but mental health conditions in general.

One of the things I have learned as Minister for Mental Health is that anybody can have a mental health issue at any point in their lives. One, two or three things happen that they were not expecting, and anybody can be in that situation, but everybody can recover and manage their mental health. If I can achieve one thing in my role it would be for everybody to really understand that and for us to put the services in place to address it—that is what I hope to do.

I recognise that the last two years have been exceptionally difficult. They have impacted on the mental health and wellbeing of many people, and many will have experienced harmful or suicidal thoughts. The shadow Minister for Mental Health, the hon. Member for Tooting (Dr Allin-Khan), raised the concern that too many people are having to resort to A&E in a crisis. That is why mental health service providers worked across the country at pace during the pandemic to establish a 24/7 urgent mental health helplines for anybody of any age in crisis. Those services are now operational in every area of England, handling 230,000 to 250,000 calls each month. That service was not there before the pandemic; we have tried to respond and to respond quickly.

The long-term plan also committed to increasing the forms of provision for those in crisis, including safe havens and crisis cafés, providing a more suitable alternative to A&E. We know we need to do that. There are some excellent examples throughout the country, including the Evening Sanctuary at the Mosaic club in Lambeth.

[Kerry McCarthy]

In the case of my friend Ric, we learned at the inquest last week that he had phoned a mental health crisis helpline. In that conversation, he revealed that he was in the middle of a psychotic episode. When he later went to A&E at the suggestion of the helpline and spoke to a mental health nurse, he did not reveal that. In the prevention of future deaths report, the inquest recorded that there should have been real-time updating of his medical records, because the people at the hospital would not have let him leave A&E that night if they had realised that part of the problem was psychosis. I talked about taking note of what is said at inquests, and I hope that we can pick up the recommendation on real-time updating.

[Gillian Keegan]

Absolutely. I read all the prevention of future deaths reports, which come to me, and I take them very seriously. There is always so much to learn from them, and I agree with the hon. Lady. Sharing data between services sounds easy and trips off the tongue, but it is actually quite difficult to ensure that data is there in real time. That does not mean that we do not have the desire to achieve that; we absolutely do.

Talking therapies were mentioned by the hon. Member for Blaydon (Liz Twist), and we are improving access to those. I remind people that they can self-refer, rather than going through a GP. I am sure that many people are not aware of that. We are building up mental health support teams in schools. They will really help by providing our young people with first-level support in school, but we realise that we have to invest more in mental health. That is why we have £2.3 billion more to invest in mental health services in 2023-24. We need to build up the workforce, which is a challenge, because it takes a long time to train people for many of these roles. In fact, I had another meeting on this issue earlier this morning.

I want to address the use of risk assessment tools. I am running out of time, but I am happy to respond on the situation; it is important, and I definitely want to take the time to do so, particularly as Mr Pirie is in the Public Gallery. The guidelines published by the National Institute for Health and Care Excellence in 2011 make it clear that risk assessment tools should not be used to predict future suicide or repetition of self-harm, or to determine who should or should not be offered treatment, as the hon. Member for Bristol East said. We would expect health professionals to have regard to that, but it is clear that further work is needed, and discussions are under way right now to find out what further actions are necessary to achieve this.

I acknowledge the valuable role of the voluntary sector in complementing all the things we do. We have given more money—£5.4 million—to voluntary and community organisations. That money has supported 113 organisations, which do a fantastic job at helping people who are struggling. They are in lots of areas, and have often been set up by families who have lived experience. We have also provided funding to support the Hub of Hope, which was set up by a charity in Liverpool, and which is crucial in signposting people to services locally. For people who are at risk, we now have a fantastic opportunity with the call for evidence on mental health and the updated suicide prevention plan.

We have learned a lot more, and we know that there are a lot of things that we need to fix. We have mentioned debt, drugs and alcohol, and men’s sheds—I have visited those, and they are fantastic. Our LGBT expert advisory group is meeting tomorrow to discuss suicide prevention, and to see what more we need to do. I know that Members present are genuinely committed to working with me on situations that it is difficult to prevent, and we are absolutely convinced that we can do a lot better. We will work with colleagues across the Department for Education—we have mentioned the SEND review—and DCMS. It is vital that we work cross-sector, cross-Department and cross-party, because everybody has a role to play in suicide prevention. It is not just my job—if it was, it would be overwhelming. We all have a role to play.

There have been a lot of significant steps since the national suicide prevention strategy was published in 2012. Professor Louis Appleby is mentioned a lot in these circles and has put a lot of work and effort into this endeavour. Real-time surveillance is on the agenda, and the National Suicide Prevention Strategy Advisory Group will continue to work towards making things better. We have made a lot of progress, but everybody accepts that there is more to come. We have recently launched a call for evidence, and we have had about 2,500 people respond so far, but I would like a lot more to do so—particularly those from marginalised groups, or groups that find it harder to talk about these subjects. We need to hear their perspectives and get hon. Members’ help in making sure that everybody responds to the call for evidence, which is an opportunity. I am serious about this, as is the Secretary of State. I thank everybody for their contributions.