Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 1st March 2022 Commons Chamber

[Mr Steve Baker (Wycombe) (Con)]

10. What his timescale is for awarding the £50 million funding for targeted motor neurone disease research through specific scientific programmes proposed by MND charities.

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

Researchers can apply right now to the National Institute for Health Research and UK Research and Innovation to access the £50 million of funding. The timescale for spending the money depends on the research applications received. The £50 million over five years is a minimum commitment, and we hope to spend much more than that on research in this vital area. We are working with the motor neurone community to help it effectively access the committed funding and to boost MND research even further.

[Mr Baker]

The Minister has made a positive announcement in the course of the last few months, and this is an important repetition, but there seems to be a slight miscommunication going on because organisations are telling me that they are not sure where the co-ordination is coming from. May I invite her to meet me and the coalition of patients and researchers to try to nail down exactly what is happening, in a spirit of good faith?

[Gillian Keegan]

I would be happy to meet my hon. Friend. I have also met some of the campaigners and researchers in this area, and the head of our research arm, so that we are clear. The support we are providing to the community includes a new £4 million MND partnership. That will bring the research community together so that they can pool resources and expertise to leverage that funding further, and ensure that they put forward strategic applications.

[Christine Jardine (Edinburgh West) (LD)]

11. If his Department will make an assessment of the long-term impacts of use of (a) benzodiazepines and (b) other opioids on children being treated for acute forms of epilepsy.

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

Benzodiazepines are an important medicine in the treatment of severe cases of certain types of epileptic conditions in children. The Medicines and Healthcare products Regulatory Agency continues to monitor the safety of treatment with benzodiazepines. Opioids are not authorised to treat children for acute forms of epilepsy.

[Christine Jardine]

Benzodiazepines are not appropriate for all children, and the Secretary of State has been instrumental in approving medicinal cannabis for use by children with epilepsy. I recently visited a medicinal cannabis farm in the borders of Scotland, which is poised to make an important contribution to the pharmaceutical industry in this country. Given the economic benefits, and the moral imperative of helping those children who can only benefit from medicinal cannabis, will the Minister say what steps the Government will take to make it available on NHS prescriptions?

[Gillian Keegan]

The National Institute for Health Research welcomes funding applications for research into any aspect of human health, including epilepsy, and we would welcome those pharmaceutical companies coming forward to partake in trials. The NIHR and the NHS will support a programme of two randomised control trials into epilepsy, which will compare medicines containing cannabidiol, and CBD plus tetrahydrocannabinol and a placebo. This is a pioneering area of research, and I am aware that NHS England and NIHR are working closely to get those trials started as soon as possible.

[Karl Turner (Kingston upon Hull East) (Lab)]

12. What steps his Department is taking to tackle regional health inequalities including waiting times for NHS treatment.

--- Later in debate ---

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

NHS England and NHS Improvement have been field testing waiting time standards across 35 different local pilot initiatives. Through that clinically led review, we hope to understand the merits of introducing them. NHS England and NHS Improvement published the outcome of a consultation on those standards on 22 February, just over a week ago. We will work with them now on the next steps for the proposed measures.

[Sarah Champion]

I am very interested in what the Minister says, and I would be really interested to see the review, but in Rotherham the waiting time for children’s neurodevelopmental assessments is 200 weeks. That is almost four years of a young life. Consultant led NHS services are required to report waiting times against the 18 and 52 week standard, but neurodevelopmental assessments having no such requirements means that the political will is not there to challenge. Will the Minister please look into putting the resources necessary into children’s mental health so that no child, wherever they are, goes without that support?

[Gillian Keegan]

I thank the hon. Lady for her question. She raises an incredibly important point. As a Government, we are determined to tackle long autism diagnosis waiting times. We are investing £2.5 million as part of the NHS long-term plan to test and implement the most effective ways to reduce autism diagnosis waiting times for children and young people across England. That is vital, because we know that the earlier children get the support, the better the outcomes are for them. We are absolutely determined to work on this, but the diagnosis pathways are sometimes quite complex.

[Caroline Nokes (Romsey and Southampton North) (Con)]

16. What plans his Department has to take steps to permanently implement the telemedicine service for early medical abortion.

--- Later in debate ---

[Mr Toby Perkins (Chesterfield) (Lab)]

17. What assessment he has made of the adequacy of child mental health in-patient provision in Derbyshire.

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

We want to ensure that more children and young people can access appropriate support in their community, and that those who require in-patient cases are treated as close to home as possible. The East Midlands Provider Collaborative is responsible for commissioning tasks for tier 4 in-patient children and adolescent mental health services, including for Derbyshire. It has implemented strategies to ensure the most efficient use of in-patient beds, including a review of the types of beds required by east midlands patients.

[Mr Perkins]

My constituent Stephen Jones wants what the Minister wants, but when his daughter required in-patient child mental health facilities she was forced to go to Stoke to receive them. He had a 70-mile journey every time he wanted to see her, which was obviously very expensive and also just impossible to do. It meant that his daughter’s mental health got worse, because she felt that she had been abandoned by her own family, putting the whole family under pressure. In addition, if people do not receive universal credit, they get no support with the financial impact. Will the Minister tell us more about how we can ensure that children’s mental health is not exacerbated by the inability to access services locally?

[Gillian Keegan]

The hon. Gentleman raises a very important point. Clearly, these are distressing enough times without having that commute and those travel arrangements on top of that, but sometimes the services are highly specialised. We are trying to get the right blend between access to highly specialised in-patient services and making sure that we increase community efforts. We have been working very hard to ensure that there are more community efforts, but we have also invested £10 million more in capital for more beds to make sure people can get treatment closer to home.

[Fleur Anderson (Putney) (Lab)]

18. What assessment the Government have made of the adequacy of support for young carers.

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

We have introduced significant changes to support for young carers, with statutory entitlements to young carers’ assessments from April 2015. Local authorities are held to account for such assessments and support through the social care inspection framework. Further, as we set out in our adult social care White Paper, we will amend the school census at the earliest opportunity to include young carers, allowing us to establish a wealth of evidence on this cohort.

[Fleur Anderson]

I welcome more information being found out about young carers, because this is a hidden health crisis. A constituent came to see me. She is a young person now and has been a young carer for many years. The impact on her educational attainment, physical health and mental health has been devastating. There are 800,000 young carers in the UK, with 800 of them in Wandsworth where support services have been slashed. Does the Minister recognise the impact of that unpaid child labour and does she have a plan to tackle it?

[Gillian Keegan]

Very much so. Young people should be protected from inappropriate and excessive caring responsibility, and adult and children’s services need to work together better. We recognise, though, the lack of hard data and evidence on outcomes for young carers. That is where we are and that is why we have made the commitment, with the Department for Education, to amend the school census. We intend to introduce that as early as 2022-23 and each year thereafter. The data will be collected at primary school and secondary school, so we will be able to look at all kinds of outcomes for this particular cohort and take actions.

[Mr Philip Hollobone (Kettering) (Con)]

19. If he will ensure that the NHS new hospital programme team complete approval processes by summer 2022 to allow the preparation of the full business case for the redevelopment of Kettering General Hospital by the local NHS trust.

--- Later in debate ---

[Kim Leadbeater (Batley and Spen) (Lab)]

On the issue of children’s mental health, does the Minister agree that children with ADHD and autism have found the last two years even more stressful than usual? A cross-departmental approach is long overdue to ensure that their needs are adequately met.

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

The hon. Lady is absolutely right, which is why we are working cross-departmentally to bring forward a mental health strategy. It is also why we have put in place mental health recovery funding specifically for the recovery from the pandemic, which has had a terrible effect on children’s mental health.

[Ronnie Cowan (Inverclyde) (SNP)]

The Secretary of State is on record saying:

“Making medicinal cannabis available on prescription will benefit the lives of ill patients currently suffering in silence. There is nothing harder than seeing your loved ones in pain”.

Since he said that, there have been three prescriptions for medical cannabis on the NHS. They are important, because they set a legal and medical precedent that it can happen, and it can happen now. Currently, however, if I can afford it, I can buy it, but if I cannot, I cannot. When will he address that anomaly?

Social Care: Nottinghamshire

Gillian Keegan Excerpts

Monday 21st February 2022 Commons Chamber

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

I thank my hon. Friend the Member for Mansfield (Ben Bradley) for securing this debate. I also thank him personally for his sterling work during the pandemic as Leader of Nottinghamshire County Council. He brings a unique insight to this debate as a result of being both a Member in this place and someone who works on the frontline dealing with the issues that I also have to wrestle with. I listen to him and very much appreciate all that he has to say.

I commend, too, the powerful contributions from my hon. Friends the Members for Broxtowe (Darren Henry) and for Gedling (Tom Randall). As they said, the adult social care sector faces challenges in recruiting and retaining care staff. We recognise that, and we have put in place a range of measures, as I am sure my hon. Friend the Member for Mansfield would recognise, to support local authorities and care providers in addressing those workforce pressures, including making available a total of £462.5 million in workforce recruitment and retention funds, and the latest phase of our national recruitment campaign, promoting the rewarding and stimulating roles in the adult social care sector. I am sure many hon. Members have seen the adverts now on TV.

The new workforce recruitment and retention funds can be invested in a number of measures to support staff and to boost staff retention within social care. They include, but are not limited to, occupational health, wellbeing measures and incentive and retention payments, and there is a lot of flexibility within that fund, which I am sure is appreciated. On 15 February 2022, we added care workers, care assistants and home carers to the health and care visa and the shortage occupations list for a 12-month period, which will make it quicker, cheaper and easier for social care employers to recruit eligible workers from overseas.

The Government are also providing a sustainable local government settlement, which is designed to ensure key pressures in the system are met, including the national living wage and national minimum wage. An increase in the rate of the national living wage will mean that many of the lowest-paid care workers will benefit from a 6.6% pay rise effective from 1 April 2022. We continue to monitor workforce capacity and the impact of our interventions through the Department’s capacity tracker, workforce data and local intelligence, as well as monitoring the impact on unmet need and NHS discharge—and, of course, hearing from many hon. Members about what is happening on the ground locally.

Turning to our workforce strategy, in our “People at the Heart of Care” White Paper we committed to at least £500 million to develop and support the workforce over the next three years. That is an important part of our wider investment to reform the social care system. The commitment includes developing a knowledge and skills framework, developing career pathways and linked investment to support progression within roles and across the wider sector for care workers and registered managers. That will help to ensure that staff feel recognised, rewarded and equipped with the right skills and knowledge, and that their health and wellbeing are supported.

Moving to the fair cost of care, we are committing £1.4 billion over the next three years to support local authorities in moving towards paying providers a fair cost of care. That will enable local authorities to ensure that local care markets can respond to the changes that reform will bring, and to address under-investment and poor workforce practices.

On funding, our focus has been on ensuring that the social care sector has the resources it needs to respond to covid-19. Throughout the pandemic, we have made available over £2.9 billion in funding for adult social care. Additionally, we provided £60 million for local authorities to support the adult social care response to covid-19 in January 2022 alone; since May 2020, we have provided over £50 million of specific funding to Nottinghamshire to support the adult social care sector in its response to covid-19. The most recent infection control and testing fund provided almost £400,000 of funding to Nottinghamshire to enable vaccination of social care staff.

My hon. Friend mentioned hospital discharge. To support safe and timely hospital discharge, we have made nearly £3.3 billion available via the NHS since March 2020. That includes an additional £478 million to continue hospital discharge programmes until March 2022.

I was delighted that my hon. Friend recognised the importance of housing in preventing social care needs from deteriorating and the link between housing and health. In our “People at the Heart of Care” White Paper we announced that we will launch a new investment in housing of at least £300 million over the next three years to connect housing with health and care and to drive the stock of new supported housing for adults of all ages. We have committed to continuing to incentivise the supply of supported housing through the care and support specialised housing—or CASSH—fund, with £213 million available over the next three years, which works out as £71 million a year.

Our integration White Paper is the next vital step in our journey of joining up health and social care at a local place-based level. Our proposals will help the system to recover from the pandemic. I know that Nottinghamshire has seen the introduction of End of Life Together—a collaboration of local hospices, community trusts, primary care providers and acute trusts that came together to deliver palliative care and end-of-life services. That was much needed in the local area and I am sure it has provided a lot of support to families at their time of need.

We have also focused on training and opportunities for the workforce across the system, and that will allow staff to get on with doing their jobs without organisational silos standing in the way. Both my hon. Friend and I very much hope that the integrated care systems will really help to deliver much better services locally.

I thank my hon. Friend and all hon. Members for their contributions on this important topic today. I know that they are deeply committed to supporting the social care system and making sure that people get the support they need. I hope the actions I have set out today reassure them that the Government are working tirelessly to make that happen, and I look forward to continuing to work with them to make it happen in Nottinghamshire. Finally, I take this opportunity to thank all those on the frontline providing care: people who go the extra mile, day in and day out, to make a vital difference to people’s lives. I say thank you on behalf of all of us.

Question put and agreed to.

Mental Health Strategy

Gillian Keegan Excerpts

Thursday 10th February 2022 Written Statements

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

This week, the UK has marked Children’s Mental Health Week with the theme of “growing together.” I am grateful for the brilliant work of our vibrant voluntary and community sector, who are encouraging children and young people to take action to look after their mental health and learn how they can support others.

Across the country, we are talking more about our mental health and wellbeing than ever before. Thanks to the trailblazing courage of campaigners in the public eye, and thousands of quiet conversations in homes, schools and workplaces, more and more people now feel comfortable opening up about their mental health.

Over 4 million people have used our Every Mind Matters resources to make a tailored mind plan to help them take active steps to look after their wellbeing. Initiatives like “Thriving at Work” have driven improvements to workplace wellbeing. The NHS is offering care and support to more people with mental illnesses than ever before, backed by record levels of investment, workforce expansion and the advancing mental health equalities strategy. And we are reforming the Mental Health Act to improve care for people who are acutely unwell and to address ethnic disparities in detention rates.

Since March 2020, the wide-ranging effects of the pandemic and the impacts on mental health have fostered a strong spirit of innovation in the NHS and collaboration across Government. The Government published a cross-Government covid-19 mental health and wellbeing recovery action plan for 2021-22 in March 2021, backed by an additional £500 million. As part of this additional investment, we are accelerating the roll-out of mental health support teams in schools and colleges so that an estimated 3 million children and young people (around 35% of pupils in England) will be covered by these teams by 2023.

But I know there is much more to do. That is why I am announcing my intention to develop a new long-term, cross-Government mental health strategy in the coming year.

The Government will launch a public discussion paper this spring to inform the development of the strategy. This will set us up for a wide-ranging and ambitious conversation about potential ways to improve the nation’s mental health and wellbeing over the coming decade, both within and beyond Government and the NHS. We will be engaging widely, especially with people with experience of mental ill-health, to develop the strategy and build consensus. I will be calling on all parts of society—including teachers, businesses, voluntary organisations, and health and social care leaders—to set out their proposals for how we can shift the dial on mental health.

Alongside this, preventing suicides is a key priority for this Government. I am acutely aware that suicide prevention requires specific, co-ordinated action and national focus, and I am committed to working with the sector over the coming year to review our 2012 suicide prevention strategy for England. I am today announcing around an additional £1.5 million to top up our existing £4 million grant fund, which will help support the suicide prevention voluntary and community sector to meet the needs of people at risk of suicide or in crisis.

[HCWS609]

Down Syndrome Bill

Gillian Keegan Excerpts

3rd reading
Friday 4th February 2022 Commons Chamber

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

I start by congratulating my right hon. Friend the Member for North Somerset (Dr Fox). It has been a pleasure to work with him, the Bill Committee and all the other teams. He has done outstanding work in introducing the Bill and navigating it through its Commons stages. I personally have learned a lot from him.

This is truly a groundbreaking Bill that will make a real difference to the lives of people with Down syndrome across the country. It highlights the hugely important role of private Member’s Bills and what can be achieved when MPs from across all parties work together. I extend my personal thanks to the Bill’s sponsors, all Members who have been instrumental in getting us this far and everybody who has spoken today and brought to life why this matters. It has been wonderful to hear the stories of Mark, Rhys and his mum Alice—the Shakin’ Stevens fan—and Asher and the beginning of his journey. Hopefully this Bill will help Asher’s parents to avoid some of the struggles that other families have been through. It is so positive to see such unanimous support for this Bill, which has been a joy throughout its passage.

I thank all the members of the all-party parliamentary group on Down syndrome, of which the hon. Members for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and for Enfield North (Feryal Clark) are the chair and vice-chair. They have campaigned for equal access and service provision for people with Down syndrome, and they have supported the Bill’s passage.

I especially thank the people with Down syndrome, many of whom are in the Public Gallery with their families, and the representative organisations that have campaigned tirelessly on improved support for the 47,000 people across the UK with Down syndrome. I also thank my constituents who have written to me and the many families I have met at the Apuldram centre and at Aldingbourne in my Chichester constituency. It has been great to share their journeys and hear their stories.

I feel really fortunate to be the responsible Minister when this Bill is before Parliament. I support the Bill wholeheartedly. It will be instrumental in improving the lives of people with Down syndrome by tackling inequalities in access to services. It is not right that such disparities exist, and I have seen at first hand in my own family the challenges that people with Down syndrome can face in accessing the support they need.

On Second Reading and in Committee, I spoke about my family’s experience. Although my nephew Joseph is thriving, and his school, St John’s School in Chigwell, is helping him to thrive, there is no doubt that there have been challenges along the way. I have watched my sister-in-law, Sara—I know she is watching me now—and my brother Marcus battle for the support that Joseph needs.

I want everyone to get the right support at the right time and in a way that works for them. That is why this Bill, for the first time, will require the Government to publish guidance on how authorities should meet the specific needs of people with Down syndrome.

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

I congratulate my right hon. Friend the Member for North Somerset (Dr Fox) on introducing this Bill, which has huge support across the House. Does the Minister agree that, when the Bill passes, it will be an example for the communities that suffer from other genetic and chromosomal disorders and learning disabilities? They might not be as common or as well known as Down syndrome, but they are no less impactful on those families.

[Gillian Keegan]

My hon. Friend makes a very good point, which has been raised by my hon. Friend the Member for Stourbridge (Suzanne Webb) and my right hon. Friend the Member for Scarborough and Whitby (Sir Robert Goodwill), who have previously mentioned specific genetic conditions. We will definitely consider overlaps and linkages between these conditions and Down syndrome through the consultation on the development of the guidance. Even though, as has been stressed many times, this Bill is specifically drafted to increase its chances of being passed, many groups will benefit from the work to develop this guidance.

I also thank my right hon. Friend the Member for North Somerset for the two amendments he tabled in Committee to ensure that the guidance is laid before Parliament on publication and to amend the Bill’s long title. I was pleased to accept both amendments on behalf of the Government. Laying the guidance in Parliament, as my very experienced right hon. Friend explained, will ensure it has the proper scrutiny.

I also thank my right hon. Friend, other hon. Members and stakeholders for providing invaluable feedback, on Second Reading and in Committee, on ensuring the implementation of the guidance in practice. Of course, the guidance must be acted upon for us to see real change for people with Down syndrome. That is why we have committed to having a named lead on integrated care boards who will be responsible for the implementation of the guidance in practice. The named lead will ensure that the right services are in place at local level and that people with Down syndrome are able to access those services. That will be a much-needed voice. We are determined that the guidance will be implemented fully and as intended at local level. This will lead to tangible improvements in the lives of people with Down syndrome, and I am personally very committed to that.

At the heart of the Bill is guidance for the relevant authorities—local authorities, and education and health authorities. I am clear that to ensure that the guidance is fit for purpose, we will consult widely and in an open and inclusive way. We will seek views from people with Down syndrome and their families, from the voluntary sector and from others who support people with Down syndrome to ensure that it reflects their needs and experience. We will work with stakeholders to ensure that the guidance remains fit for purpose. This is a real opportunity, and we do not intend to miss any aspect of it.

Once the guidance is published, the Government will keep it under regular review and update it periodically. As I said, we also recognise that people with genetic or chromosomal conditions other than Down syndrome may experience similar problems to people with Down syndrome, so we will definitely look at that and consider how the guidance can help some of those groups more broadly during the process.

I know from the debates during the passage of the Bill that employment is a really important consideration, on which we have not done well enough to date. We will continue to explore any steps required to make sure that people with Down syndrome who want to work can find work that is right for them. Fundamentally, we must make sure that people with Down syndrome maintain good health and receive the right education to support their transition into work. The Bill is an important and meaningful way of achieving that aim. It will provide those lasting foundations for people with Down syndrome to be successful.

Additionally, we are delivering a wide range of employment initiatives, such as dedicated disability employment advisers at our Jobcentre Plus sites. All these schemes, including the Access to Work fund and so on, will help to ensure that people with a learning disability have better opportunities in the workplace. Again, that is something that I am personally committed to.

[Lia Nici]

I thank my hon. Friend for the plans that are being put in place, but are there plans to ensure that people who work in the Department for Work and Pensions have the relevant training to understand the specific needs of people with Down syndrome and to help get them into work?

[Gillian Keegan]

I regularly meet the Minister for Disabled People and the Minister for Employment—the three of us are often together—to talk about how we can optimise opportunities for many people across our society, but particularly those with learning disabilities. The numbers are not good enough, and we know that we have more work to do. As I said in Committee, I will return to the issue of employment in developing the Down syndrome statutory guidance. We know that good work helps people to live happier, healthier and more independent lives.

On scope, as healthcare, education and housing are devolved matters, the Bill and guidance will cover England only. However, I know that there is real commitment to improving outcomes for people with Down syndrome across the whole of the United Kingdom, and I look forward to working with my counterparts in the devolved Administrations as we develop the guidance so that we can ensure that there is consistency of approach and inclusion for people with Down syndrome across the whole of the UK.

It has been a pleasure to work with my right hon. Friend the Member for North Somerset in supporting the Bill on behalf of everybody with Down syndrome and their families, including my own. Its passage so far represents the very best of the parliamentary process, with MPs working together cross-party for a common purpose. I very much look forward to the Bill’s successful passage through the Lords, which Lord Kamall will oversee. He will have heard the pleas from many Members about timing, to try to coincide with World Down Syndrome Day on 21 March. I commend the Bill to the House.

Down Syndrome Bill

Gillian Keegan Excerpts

Committee stage
Wednesday 26th January 2022 Public Bill Committees

[Karin Smyth (Bristol South) (Lab)]

I congratulate my neighbour, the right hon. Member for North Somerset, on his work and on bringing together so many colleagues across the House. Everyone has worked enormously hard on this Bill. I thank the Minister for her co-operation. We should have more poachers turn game keepers—they are all terribly welcome.

As Members have said, the families of the 40,000 people with Down syndrome are all watching and listening to the debate carefully. As my hon. Friend the Member for Nottingham North (Alex Norris) previously said, we take every opportunity to remove all the barriers and to tackle stigma and the poverty of ambition that hold back progress in this area. The Bill is the perfect opportunity to do that, particularly around housing, mental health provision and education—all key areas that can really improve and empower those with Down syndrome across the country.

I welcome the Bill and the amendments. As the Minister said in the last debate, the Government recognise that the legal duties and frameworks are already in place. The duty under the Care Act 2014 is to assess people based on need and not diagnostic categories. It is vital that every person’s needs are met to ensure that they can fulfil their potential in their lives. This Bill is about people, not a condition; as it is implemented, we need to recognise that every individual will have their own specific needs. Social care is facing unprecedented strain, so new responsibilities must come with an assessment of investment.

I welcome the Department’s commitment that new guidance will be formed in consultation with partners, and a new burdens assessment will be undertaken ahead of that guidance. As you know, Ms Elliott, having chaired some of the sittings, I spent six weeks in Committee on the Health and Care Bill throughout the autumn. The provisions about having a named accountable person on the integrated care system and the guidance are very important and welcome developments. If the Government could learn from this Bill and take that approach more widely to the current legislation and other legislation, that would be not only good practice but very welcome for Members of Parliament and our constituents.

Our constituents expect us to see guidance and perhaps be part of scrutinising it, raising objections and problems and improving it—that is the role of a Member of Parliament—before that guidance is developed by organisations that are not accountable in the same way and imposed on our constituents. Bringing that circle back, so that Parliament has a greater role in the guidance, is really a very important step, and I hope that that starts to permeate not only the Department of Health and Social Care but other Departments and, indeed, current legislation.

I very much commend the right hon. Member for North Somerset for introducing amendments 1 and 2. They will be landmark—really important. I commend the Minister for working with the right hon. Gentleman to agree to them, and I thank everybody involved in the Bill. I agree with the right hon. Gentleman: this is an example of how Parliament and the proper role of Members of Parliament can be made real. That is only for the good of our constituents.

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

It is an absolute pleasure to serve under your chairmanship, Ms Elliott; I think it is the first time. I am delighted that the Bill has received the same endorsement today from across parties as it did on Second Reading. What can I say? My right hon. Friend the Member for North Somerset has really set an example to all of us. I guess that is the voice of experience—30 years in various roles around this place, which have enabled him to optimise and maximise the situation and to get all colleagues rowing in the same direction. It is very important for a Member to do that if they are to get their private Member’s Bill into legislation; as we know, that is not typical.

Some 47,000 people in the UK have Down syndrome. It cannot be right that people with Down syndrome and their families should have to fight for access to appropriate services. I have seen this personally, as my right hon. Friend mentioned, with my nephew Joseph Gibson. Although Joseph is now happy and thriving—he is 15 now —it has not always been easy for my brother Marcus and sister-in-law Sara to secure the support that they need and that meets his needs.

That is what we want to change through clause 1, which provides that relevant authorities will be issued with guidance that they will implement locally. The guidance will enable those authorities to understand the needs of people with Down syndrome and how best to meet them. Of course, we will consult widely on the development of the guidance.

Once the guidance is published, the Government will keep it under regular review and update it periodically to ensure that it remains fit for purpose. It is very important that, when going through the clauses of the Bill, we put the right things in place, and that we do that with wide consultation. I thank my right hon. Friend for tabling the amendment to require the Government to lay the guidance before Parliament upon publication, because people here have a lot of experience and a lot to give. I am pleased to support amendment 1, which will bring this important guidance to the attention of Parliament once it has been published.

[Dr Fox]

As well as the issue of other conditions, employment and employment law were raised a great deal by the public, although we did not address those issues in the Bill because of the complexity that they would bring. Will the guidance given by the Secretary of State include employment issues, so that those issues can be addressed without requiring further legislation?

[Gillian Keegan]

First, I will deal with rare genetic disorders other than Down syndrome. We recognise that people with genetic conditions other than Down syndrome may experience problems similar to those of people with Down syndrome, so we will consider the overlaps and linkages between such conditions and Down syndrome through consultation on the development of the guidance. I will go on to address employment.

I commit that the Secretary of State will ensure through statutory guidance that the integrated care boards will have a named lead for overseeing the implementation of the guidance issued under the Bill. That named lead will ensure that Down syndrome statutory guidance is implemented and considered throughout the commissioning decisions of an integrated care board. That will play an important role in ensuring that there is accountability for improvements at the local level and that the intentions behind the Bill are fully raised across Government.

[Sir Robert Goodwill]

Does the Minister accept that while many Down syndrome sufferers can get into the workplace and make a real contribution, there are others who are very profoundly affected—who cannot communicate and have great behavioural problems? I know that from experience with my wife’s family. These are not the Down syndrome sufferers who we see in the media; these are people who often have to be kept in a controlled environment with 24-hour care.

[Gillian Keegan]

Down syndrome is a condition that has a very wide spectrum of abilities, as many conditions do—and as we all do, as people. Of course, the right support has to be provided for a whole range of different capabilities. We were talking about a particular case, and how important it is to get early access to speech therapy and to hearing aids so that people can develop language. It is very important to be able to maximise life chances.

Employment will differ for different people. The Government offer a range of programmes to support people with disabilities—learning or physical—to get into and stay in employment. All those programmes can also help people with Down syndrome. This includes the work and health programme and intensive personalised employment support programme, which offer personalised help and support for people with learning disabilities to get into work. The Bill creates the foundations to ensure that people with Down syndrome stay well, receive the right education, secure the appropriate living arrangements—the hon. Member for Bristol South mentioned the importance of the right support around housing—and receive support to transition into employment.

I feel proud that we can already see in our society that people with Down syndrome can secure meaningful employment. That is really important to their life, structure and self-esteem—as it is to all of us here today. We will continue to explore any steps required to make sure that people with Down syndrome can find work, where it is right for them and where that is part of their life’s journey. I expect to return to this issue in the development of the statutory guidance.

I would like to give a few examples, because all of us have met many people and seen the range of capabilities. Dilesh, who my team have spoken with, lives in Barnet with his family. He said he felt total inclusion at school, which was fundamental in providing him with the skills to secure a supported internship as a Project Search ambassador. Dilesh continued this role on a temporary basis and is working closely with his local jobcentre to find another job he enjoys. His mum believes the jobcentre has gone above and beyond to support him to reach his full potential.

We can also see big strides in representation that inspires people with Down syndrome to seek employment that truly matters to them. George Webster joined the BBC at 21 as the broadcaster’s first ever children’s presenter with Down syndrome. Ellie Goldstein, who has been a model since she was 15, has recently been in big campaigns for Gucci and Vogue while also studying performing arts.

On a world stage, George and Ellie are making big strides for representation and inspiring children, young people—not just with Down syndrome but with learning disabilities in general—and adults everywhere. Of course, we must also mention Tommy Jessop, who was very much part of a fantastic show that we have all enjoyed, and of this Bill as well. There are many role models now, and it is fantastic that they are being celebrated and seen much more in roles on our TV screens and in the media.

[Dr Cameron]

The Minister is making some extremely important points. Would she agree with me that it is very important that as many hon. Members as possible also engage in the disability confidence scheme in the workplace, to help employ and offer work-experience placements to people with disabilities in their constituency offices? Is it not also important that Members consider supporting the Speaker’s disability internship programme, which has been very successful in this House?

[Gillian Keegan]

As one of the Ministers who is a disability champion, I completely agree. It is only when one tries to take a view from the perspective of someone who has some kind of disability that it becomes possible to understand how difficult it is to do many daily things. Whether it is people with physical or learning disabilities, the more that we understand their perspective the more we can accommodate them. That, of course, makes a massive difference for somebody who has more to deal with on a daily basis than perhaps we do. It is important that we all take up the training that we are offered.

I thank my right hon. Friend for tabling amendment 3, which updates the long title of the Bill. I agree with those proposals. As outlined, this guidance only applies to England, as healthcare, education and housing are all devolved matters. I know there is also firm commitment from my counterparts to improve the outcomes for people with Down syndrome in Scotland, Wales and Northern Ireland, including through legislation. I look forward to working collaboratively with the devolved Administrations on this matter.

Regarding the schedule, it is important to have clarity within the Bill about who the relevant authorities are, and what functions the guidance will apply to. The list of authorities and their functions has been drawn from existing legislation, such as the Care Act 2014, the Children and Families Act 2014 and the Housing Act 2004. For that reason, the Government support the schedule.

This Bill is hugely significant. It will improve the lives of people with Down syndrome, improve their prospects and improve their families’ lives. I am proud to support it on behalf of the Government as it progresses through Parliament. I thank all the hon. Members for their support. To be in this privileged position, and to be able to use that privilege to make a massive difference to people, is probably what brought most of us here. I thank everybody for their support of the Bill.

[Dr Fox]

One question that was often asked before Second Reading, and continues to be asked, is: “Why Down syndrome?” Many have written to all members of the Committee, I imagine, saying, “Why pick a particular condition? Why not simply have it lumped in with learning difficulties?” The point is that those with Down syndrome and their families know that it is much more than “just” another learning difficulty.

There is the addition of complex health conditions—very complex, in many cases. The changes in demographics, which we discussed on Second Reading—for the first time, many of those with Down syndrome will outlive their parents—bring an element of the importance of care into the equation. Rather than singling out a single grouping, we have shown the increasingly complex needs that a range of different conditions will require, as medical science improves and we have greater life expectancy, which is something we should celebrate, as a society.

The point has been made, as it was on Second Reading, that this Bill is not about a condition, but about people—people who have a particular condition, their families, and the people who care for them. We are talking about individuals who, I believe, have for too long been more vulnerable than they need to be, and were overlooked by a series of pieces of legislation, which did not adequately take into account the combination of needs that they uniquely have.

We all come to this Bill from our personal experiences. As I said in the Chamber, my personal experience is through growing up next door to someone with Down syndrome, from working with people with Down syndrome and, as a doctor, coming into contact with a lot of them. I would like to say a couple of things about what this Bill is not. First, it is not a UK Bill; we purposely took that decision very early on. We could have made it a United Kingdom piece of legislation, and effectively confronted the Welsh, Scottish and Northern Ireland Governments, saying, “You must give us the legislative consent.” That would not have been in the interest of people with Down syndrome. It would have made it a constitutional Bill, with the arguments becoming about constitutional propriety and not about those who are actually involved.

I hope that, with the House of Commons taking this decision, we will see legislation from the devolved parts of the UK giving equal rights to those who live under those devolved systems. It should not matter where someone lives in the United Kingdom; they should have access to the same quality services, the same representation, and the same parliamentary remedies as anybody else. That is why the Bill was designed as it has been.

Skin Conditions and Mental Health

Gillian Keegan Excerpts

Tuesday 25th January 2022 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Gray.

I add my thanks to my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) for securing the debate. The subject is clearly important to many people in the House and to many people across the country who have skin conditions and are concerned about their mental health. I also thank my right hon. Friend for championing this cause for so many years. I am relatively new to my role, but I look forward to working with him. I thank him for sharing his story, which I am sure will have given a great deal of comfort, as well as having resonance in this debate. It is real that people suffer bullying. I was very interested to hear about Changing Faces, the visible signs and the pledge, and I am happy to hear more from the hon. Member for Swansea East (Carolyn Harris).

Skin conditions, such as acne, psoriasis—we heard the personal story about psoriasis of the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar)—the rosacea we heard about from my right hon. Friend the Member for Gainsborough and eczema can be complex and affect people of all ages. Many young people are affected by acne and one in 50 of us will develop psoriasis. Eczema is also very common, affecting one in five children, including me when I was younger. It can also start later in life.

Some of those conditions can be relatively minor, as in my case, and will clear up over time, but others are much more serious, causing pain and scarring and being for the long term, perhaps lifelong. Clearly, that can and will have a negative impact on a person’s life, often causing stigma, discrimination and bullying. It can seriously affect their self-confidence, self-esteem and overall mental health. I understand that. I assure the Chamber that the Government are committed to supporting people with all dermatological conditions.

I note the report on “Mental Health and Skin Disease” by the all-party parliamentary group. I will be happy to attend the group on occasion. I acknowledge that the need for specialist mental health support for people suffering with often debilitating long-term skin conditions was raised as a particular issue, as has been discussed. As my right hon. Friend the Member for Gainsborough stated, the mental health issues faced by people living with skin conditions can be severe, in particular when people are not getting the treatment they need—or waiting for more than a year, as he outlined. Obviously, the longer someone waits, the worse the condition often gets. I reassure my right hon. Friend that mental health and ensuring that people get the treatment that they need will continue to be a priority for the Government.

We are committed to achieving parity between mental and physical health services, and to reducing mental health disparities. We know that we are not there yet, but we are committed to that. We are making good progress, however, with investment in NHS mental health services continuing to increase each year from almost £11 billion in 2015-18 to more than £14 billion in 2020-21. We are investing at least £2.3 billion of extra funding a year in expanding and transforming our mental health services by 2023-24.

Some people with dermatological conditions will be on a long-term condition pathway, due to the nature of their illness, such as cancer, including skin cancer. In these cases, the team responsible for the patient’s physical health should discuss and review the patient’s emotional and psychological status regularly and support them, through access to information and services for their mental health if needed.

Commissioners are encouraged to ensure that local pathways include assessment and ongoing support of patients’ mental and psychological wellbeing and cognitive status. They should also ensure that health practitioners have ongoing training—a number of Members mentioned that—to understand the emotional, cognitive and psychological needs of patients. We have continued to expand our flagship talking therapies programme—a number of hon. Members welcomed that. The improving access to psychological therapies—IAPT—programme for all adults with common mental health problems has been accessed by more than 1 million people in 2020 and 2021. We have expanded the programme to help people with their mental health and long-term conditions, including dermatological conditions.

A person’s mental and physical health are intrinsically linked—they are in one place, in one person. People with long-term physical health conditions, such as dermatological ones, may also need emotional and psychological support. Conversely, two thirds of people with anxiety and depression have a long-term physical health problem—the two go hand in hand. Integrating psychological therapies with physical health services can provide better support to this group of people and achieve better outcomes. That is something we discuss regularly when talking about integration and the new integrated care systems, as one of the benefits of taking that approach. It is also why we have expanded our IAPT programme to include an integrated approach for people with mental health as well as long-term conditions.

All clinical commissioning groups are expected to commission IAPT services, integrated into physical care pathways, as part of their IAPT expansion plans locally. That should bring together mental and physical health providers so they can work in a co-ordinated way to achieve the best outcomes for all people irrespective of their diagnosis. While there is some excellent practice of services offering talking therapies for people with dermatological conditions, such as those in Southampton mentioned by my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), I acknowledge that that may not be the case in every area, but IAPT services are continuing to grow and develop all over the country.

I would like to take the opportunity to remind people that IAPT services are accessible to all adults in England. I fear there is low awareness of the understanding that people can self-refer to IAPT. They do not have to wait for a GP, although that is one route, and can self-refer to IAPT. We have also launched a “Help!” campaign, accompanied by The Beatles music, which is raising awareness so people know they can access those services. They can be referred by a range of practitioners in the community or by primary care, but they can also refer themselves. They will receive a person-centred assessment that covers the person’s mental health problems and acknowledges the impact of their long-term condition. Clear pathways and processes should be in place to enable a person to progress between those services and existing pathways.

As mentioned by my hon. Friend the Member for Bracknell (James Sunderland), I acknowledge the impact of the covid pandemic and the excellent work going on in mental health services to respond to the pandemic. The past two years have been really tough. There has been a lot of innovation, as the hon. Member for Bristol South (Karin Smyth) said. We need to take that innovation and embed it in the services. There has been unprecedented demand on mental health; it was growing anyway, but the pandemic has accelerated demand. They are doing their utmost to make sure that services are there for everyone who needs them—for patients and our NHS colleagues who have been on the frontline— but services have been strained and it is harder for people to get an appointment at times. That is why, in addition to our long-term plan commitments, as part of the Government’s commitment to build back better, we have published our mental health recovery action plan, backed by an additional £500 million for this financial year, to ensure we have the right support in place and that we embed that innovation to access more people.

The plan aims to respond to the impact of the pandemic on the mental health of the public, specifically targeting groups who have most been affected—young people and children, clearly, are in that group. That investment and expansion of mental health services will help to address the needs of those people with long-term conditions, as well as other people in need of support. To deliver on our commitments, we need to ensure we have the workforce available. That is important but it takes time to deliver and that impedes our progress. It is vital that we have the right skilled workforce in place; we have improved that and we will continue to improve it.

Question put and agreed to.

Resolved,

That this House has considered skin conditions and mental health.

Tourette’s syndrome

Gillian Keegan Excerpts

Tuesday 25th January 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Cummins. I thank the hon. Member for St Helens North (Conor McGinn) for securing the debate on this important issue. I have been listening and have heard his impassioned case for better support for children and young people with Tourette’s syndrome. In particular, I was touched by the story of one of his constituents, Emma McNally, and the difficulties that she and her son face in accessing the care and support that he needs. I want to extend my personal thanks to Emma, whose tireless campaigning, along with that of other parents of children with Tourette’s, has helped emphasise the importance of children with Tourette’s getting the help they need and the difficulties that they are facing getting that help, particularly in the north-west of England.

I know that for many patients and families, Tourette’s can be an extremely debilitating condition to live with. I regularly receive correspondence on this issue. I was particularly moved by the case of Jay Mangan from Sefton Central and his two children, Rebecca and Jack, both of whom have Tourette’s. Having watched the video that Mr Mangan shared, I was struck by the severity of the tic episodes that both Rebecca and Jack routinely suffer. As the hon. Member for St Helens North flagged in his speech, Tourette’s syndrome can be misunderstood. There is not much awareness of it, so videos such as Mr Mangan’s are helpful.

It is also important that Mr Mangan and families such as his get the support that they need. We know that with the right care and support, someone living with Tourette’s syndrome can lead a fulfilling life, which is why the Government are determined to ensure that all those with the condition have access to the appropriate services.

The majority of services are commissioned by clinical commissioning groups, which are best placed to understand the needs of their local area. Services are commissioned through local community paediatric services or child and adolescent mental health services. Such services will be appropriate for the majority of children and young people with Tourette’s syndrome, and the teams involved will refer them to multidisciplinary teams, including clinical psychologists where necessary, to help with the management of their conditions.

Clinicians are supported in that work through the BMJ Best Practice guidance on Tourette’s, which covers both diagnosis and management. For children who require more specialist support, there are currently three recognised specialist centres in the UK—one in Sheffield, and two in London. These centres have internationally recognised expertise in the assessment and management of Tourette’s syndrome.

Following the retirement of a consultant at Alder Hey Children’s Hospital who had developed a special interest in Tourette’s, I understand that the current level of support available in the area is different—we heard how that impacted on Emma’s son. Local CCGs have acknowledged the impact on families and are considering options to address the matter. We understand that Alder Hey Children’s Hospital has developed a proposal for a local tertiary service for Tourette’s, which is currently under review. Discussions with the nine Cheshire and Merseyside CCGs are being led by the NHS Liverpool CCG, with a meeting planned for later this month in order to scrutinise the proposed clinical model. I have asked to be personally apprised of the situation, and I want to take this opportunity to extend an invitation to the hon. Member for St Helens North to meet me and discuss the local situation further. Of course, I would also be very happy to meet the families and learn as much as I can from lived experience.

To support patients across the country, it is vital that we have sufficient numbers of trained healthcare professionals, as the hon. Gentleman said. There were more doctors and consultants working in the specialism of neurology in NHS trusts and CCGs in September 2021 than there were 12 months earlier. Furthermore, Health Education England has supported a 60% expansion in the clinical psychology training intake over the past two years, which is expected to achieve a growth of 2,520 additional psychologists in the NHS workforce by 2025. Clinical psychologists are well placed to develop new services and undertake further bespoke development to respond to the needs of patients with Tourette’s syndrome.

To support the provision of services that can help children and young people with Tourette’s, we are increasing funding to child and adolescent mental health services. In March 2021, we announced an additional £79 million of funding, which will be used to significantly expand children’s mental health services. That will allow around 22,500 more children and young people to access community health services, and it will provide a faster increase in the coverage of mental health support teams in schools and colleges. The Department for Education has also announced more than £17 million to improve mental health and wellbeing in schools and colleges, including new funding to train thousands of senior mental health leads.

However, we acknowledge that support must be provided to unpaid carers of children and young people with Tourette’s, whose lives are significantly impacted on by the responsibility of providing around-the-clock care and support. We will invest up to £25 million to work with the sector to kick-start a change in the services provided, to support unpaid carers. We know what vital role they play and the sacrifices that they make for their families. We expect that the funding will identify and test a range of new and existing interventions, which could include respite breaks and peer group and wellbeing support.

The hon. Member for East Londonderry (Mr Campbell) mentioned research, which is very important. As we look forward, we recognise the value of funding and supporting research into Tourette’s. We are currently funding a number of studies, including a study on deep brain stimulation in people with Tourette’s and a digital behavioural intervention for tics in children and adolescents.

The hon. Member for St Helens North mentioned the variability in funding: some £2.1 million was spent on Tourette’s research between 2018 and 2020, but that figure depends on applications to the fund, which are not always linear. However, we very much welcome applications to that fund in order to understand Tourette’s and its underlying conditions, in addition to those studies that we are undertaking.

I close by once again thanking the hon. Member for St Helens North for securing this important debate. It is important in raising awareness, and it is important to families in the north-west, in the Merseyside area—an area that I am familiar with, as the hon. Gentleman said, because it is where I am from. It is important that families get the support they need, because the condition is difficult for some families to overcome. I thank those parents and families as well for all their work on raising the profile of this condition and the understanding that, with the right care and support, people can go on to live fulfilling and happy lives. I look forward to meeting with the hon. Gentleman and some of the campaigners to discuss this issue further, and to focus on securing the support that many families in the north-west need.

Question put and agreed to.

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

Gillian Keegan Excerpts

Thursday 20th January 2022 Commons Chamber

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

I take this opportunity to genuinely thank my right hon. and learned Friend the Member for South Swindon (Sir Robert Buckland) for securing a debate on this vitally important topic. Improving the care and treatment of autistic people is something he has championed, particularly through his commitment to reform of the Mental Health Act. I thank him for his continued work on this matter, no matter where he is sat. I give him my commitment that I share his determination for change, and I will continue to work with him. There is absolutely no place for poor-quality care for autistic people or anybody with a learning disability in our society. The system needs change.

I recently visited Norfolk to meet the families of those affected by the tragedy that occurred at Cawston Park Hospital, which was the subject of a previous Adjournment debate. I met the parents of the young people who suffered and sadly died and heard at first hand about the experience of people with autism and people with Down’s syndrome in health and care settings, and it was shocking. Such experience has too often fallen unacceptably short of the standard of care that individuals and families—those people who are the most vulnerable and often voiceless—should rightly expect. It is truly awful to hear about such appalling experiences.

We are taking action for children, young people and adults, for people who have been in-patients for longer than they should, and to prevent people from being admitted, even for a short time, when they do not need to be. I welcome this opportunity to set out the immediate and longer-term actions we are taking. They include our planned Mental Health Act reforms, which will provide the opportunity to change the legal framework and to reinforce and underpin the changes we are making now. I cannot commit today to a timetable for that, but the planning is well under way and I will keep my right hon. and learned Friend informed.

To keep people safe now, all autistic people and people with a learning disability must receive high-quality, safe care. That is our first priority. We know that some people may require support in a mental health hospital; when that is necessary, it should have a clear therapeutic benefit, be the least restrictive support possible, be close to home and be for the shortest possible time. We will not tolerate instances of abuse or poor-quality care.

To ensure that people are safe, all autistic people and people with a learning disability in an in-patient setting now receive a safe and wellbeing review. These reviews, which are led by NHS England, are a priority and the majority will be completed by the end of January. We also fully support the more robust approach that the CQC is taking in increasing the amount of shorter, unannounced inspections and closing hospitals that do not provide a high-quality standard of care.

My right hon. and learned Friend mentioned people who are in long-term segregation. There are about 100 of them and a couple of cases were mentioned in the debate. Every single one of them will receive independently chaired reviews of their care and treatment. The reviews will consider how to move towards a less restrictive or, ideally, community-based setting.

As part of a wider £31 million package to support discharge and develop community support, we have provided funding for a senior intervenors pilot. These independent experts will work to resolve blockages in the path to discharge, where there can be multidiscipline teams who basically do not agree or manage to find a solution among themselves. The senior intervenors will help to unblock things for those people in a long-term situation, and move them towards a less restrictive setting and back into the community, which is where we want people wherever possible.

My hon. Friend the Member for Broxtowe (Darren Henry) mentioned the need to build and make sure we have the right support in the community. The Government want to make sure that, wherever possible, autistic people and people with a learning disability are able to lead full lives in the community, close to their families, with the right support in place to prevent crisis.

In the NHS long-term plan we committed to reduce the number of autistic people and people with a learning disability who are in-patients in mental health hospitals by 50% by the end of March 2024. Since 2015, we have achieved a 29% reduction, which is equivalent to a reduction of around 800 in-patient beds—800 people—and means we need to close around 600 more to meet the target. I am firmly committed to achieving that.

The building the right support programme is our national policy to ensure that autistic people and people with a learning disability are supported in the community, and more than £90 million of additional funding for community services and support for discharges has been provided for 2021-22 to help to achieve that. Joint action across organisations and systems is essential to drive progress, so we are developing an action plan to outline the steps that we and all our partners will take to deliver that action with urgency, and we will publish it as soon as possible. We also know that early diagnosis is key, as the hon. Member for Strangford (Jim Shannon) mentioned, and that prevention and intervention at an early stage are vital, so we are investing £2.5 million to test and implement the most effective ways to reduce autism diagnosis waiting times for children and young people in England. Additionally, we are investing £600,000 in significantly expanding an autism early identification pilot to at least 100 schools over the next three years. Those actions and others set out in our all-age autism strategy, which was published in July, should make a big difference.

I want to touch on the subject of “do not attempt CPR” decisions, which hon. Members have mentioned. My right hon. and learned Friend the Member for South Swindon mentioned the culture; we are working to ensure that there is a culture of compassionate care for autistic people and people with a learning disability that is also of the highest quality. The Department has remained crystal clear that it is unacceptable for DNACPR decisions to be applied in a blanket fashion to any group of people.

We have also developed and trialled the Oliver McGowan mandatory training in learning disability and autism for all health and social care staff, working with Health Education England and Skills for Care. The programme is backed by a £1.4 million investment, and I think it will go a long way towards changing the culture.

We want to end inappropriate detentions for autistic people and people with a learning disability, and we are introducing once-in-a-generation reforms to the Mental Health Act that will be critical to achieving that. Under our proposed reforms, we will limit the scope to detain autistic people or people with a learning disability under section 3 of the Act. We want to prevent the detention under section 3 of people who do not have a co-occurring mental health condition; they simply have a learning disability.

We want to ensure that the right services are in place, allowing individuals to receive the best possible care in the community. Our proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and ensure that every local area understands and monitors the risk of crisis at an individual level. This will transform our capability to provide those services in the community and to keep people safe in their community.

I thank all hon. Members for their contributions and thank my right hon. and learned Friend again for securing this vital debate. It is important that we continue to listen to people with lived experience and to their families, most importantly, in shaping and delivering high-quality care, both in in-patient settings, where they still exist, and in the community. Having heard some truly shocking experiences as Minister for Care and Mental Health, I am grateful that the debate has given us an opportunity to set out my personal commitment and to give a voice to those people who, for too long, have not had one.

In addition to the work that the Government are undertaking now and in the longer term, we must make sure that all autistic individuals and people with other lifelong conditions are treated with dignity and respect and are able to lead fulfilling lives in their community. I am absolutely determined to see that happen, and I look forward to working with my right hon. and learned Friend; I know that he is determined, too. There should never be an instance of people with a learning disability and autistic people being treated as anything less than equal in our society. He has my commitment that I will work with him to achieve that.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Before I put the Question, I am sure that the whole House will wish to join me in congratulating the right hon. and learned Member for South Swindon (Sir Robert Buckland) on his knighthood. [Hon. Members: “Hear, hear.”] Congratulations, Sir Robert—I see that we have quite a lot of Sir Roberts around.

Question put and agreed to.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 18th January 2022 Commons Chamber

[Mr Laurence Robertson (Tewkesbury) (Con)]

13. What steps he is taking to help expedite the process of arranging care packages for people waiting to be discharged from hospital; and if he will make a statement.

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

People should be discharged from hospital safely and with the appropriate care and support they need. As the Secretary of State outlined, we have provided £3.3 billion via the NHS to facilitate timely hospital discharges over the pandemic, including £478 million just for this winter. We recognise that providers and local authorities have experienced significant challenges in recruiting and retaining social care workers. That is why we have provided £462.5 million over winter, for this period, to support care providers to improve existing care support.

[Mr Robertson]

I thank the Minister for that response, but even given all that help, almost 30% of available acute beds in Gloucestershire are occupied by patients who are medically fit for discharge. About half of those are awaiting care packages and the other half are looking for beds in community hospitals or care homes, or awaiting home discharge. What more can the Government do to relieve the pressure on the acute hospitals in Gloucestershire and on all the medical staff?

[Gillian Keegan]

I assure my hon. Friend that this is something we take very seriously and we meet every day to discuss this issue. We are conscious of the pressures caused by omicron, and of the herculean challenges faced by health and social care providers to discharge people in a safe and timely way, particularly with outbreaks and having to manage infection prevention and control. That includes the Gloucestershire Hospitals NHS Foundation Trust, which declared a national incident on 28 December at its Gloucestershire site. But it responded brilliantly and stood down the incident nine days later. As the Secretary of State said, we have also established a national discharge taskforce, which is driving progress to bring a renewed focus on reducing discharge delays, including in Gloucestershire, and working with local government and the NHS.

[Alex Norris (Nottingham North) (Lab/Co-op)]

14. What recent assessment he has made of cancer outcomes.

--- Later in debate ---

[Dan Carden (Liverpool, Walton) (Lab)]

The Secretary of State has introduced guidance for essential care givers so that family members can visit loved ones in care homes. Is he considering going further to guarantee the right to visit residents in care homes and patients in hospitals?

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

The hon. Member makes a very good point. It is important that people get the right to visit their loved ones in care homes. That is why we have introduced guidance that says that essential care givers should get access to care homes at all points, even during outbreaks. There is a process, which the Care Quality Commission manages, for reporting those that do not comply, but if there are specific examples, I am very happy for him to write to me with details and I will follow it up.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

Adult Social Care Funding and Reform

Gillian Keegan Excerpts

Thursday 16th December 2021 Written Statements

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

As set out in our adult social care reform White Paper, “People at the Heart of Care”, on 1 December 2021, the Government are committed to a wide-ranging and ambitious reform of the adult social care system.

To make social care fairer, we are protecting people from unpredictable care costs, are supporting local authorities to move towards paying a fair cost of care to providers and ensuring that more self-funders will be able to ask their local authority to arrange their care for them to give them a choice of better-value care.

To move us towards the 10-year vision for reform set out in “People at the Heart of Care”, the Government are today publishing the “Fair Cost of Care and Market Sustainability Fund: Purpose and Conditions for 2022-23”. This sets out how the Government will provide £1.4 billion over the next three years to support local authorities to prepare markets for reform and move towards paying providers a fair cost of care. This breaks down into £162 million in 2022-23 and £600 million in both 2023-24 and 2024-25.

Some local authorities are promoting efficient and effective operation of care markets, with sustainable rates of care. However, a significant number of local authorities are paying residential and home care providers less than it costs to deliver the care received. In many areas, this has resulted in higher self-funder fees which we are addressing by further bringing into effect section 18(3) of the Care Act 2014. The market effect of this change will be that some providers will over time need to reduce reliance on subsidising state-funded care from self-funders. This £1.4 billion will enable local authorities to ensure local care markets can respond to the changes reform will bring and will also help to address under-investment and poor workforce practices.

It is important this additional funding reaches the places and parts of the social care system that need it most. The Government propose to distribute 2022-23 funding on the basis of the adult social care relative needs formula, as is used for the social care grant. Local authority level allocations for 2022-23 have been published alongside the provisional local government finance settlement.

Today my Department is publishing a policy statement that sets out:

Funding conditions for 2022-23

As a condition of receiving further grant funding in the two following years, we will expect local authorities to conduct cost of care exercises, set out their plans for driving market sustainability, including progress towards a fair cost of care, and to report to DHSC on how funding is being used. The Department will use this information to monitor progress and provide public assurance that local markets are being managed successfully.

Practical guidance and support tools

From January 2022, we will work closely with the sector to develop a practical support offer for those local authorities who may require it to meet the funding conditions. This includes guidance and templates on cost of care exercises; workshops, webinars and market shaping tools.

The funding and conditions set out in this statement today are part of the new health and care levy announced in September this year, of which £5.4 billion is being invested into adult social care over the next three years.

We will work closely with local government to determine appropriate grant conditions, national guidance and distribution mechanisms for funding allocations in 2023-24 and 2024-25.

Beyond this additional £1.4 billion, we are proposing today in the provisional local government finance settlement to make available over £1 billion of additional funding for social care in 2022- 23.

Councils are not expected to rely solely on this earmarked funding to meet the inflationary and demographic pressures facing these services; they also have access to funding from unringfenced grant, including the 2022-23 services grant, and from council tax. The funding available to councils means overall local government core spending power will increase by over 4% in real terms in 2022-23, including the investment in adult social care reform.

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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