Law Commission Report: Mental Capacity

Jackie Doyle-Price Excerpts

Monday 30th October 2017 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I am today announcing the publication of the Government’s interim response to the Law Commission’s report on Mental Capacity and Deprivation of Liberty, a copy of which is attached.

In England, around two million people with conditions such as dementia, learning disability or an acquired brain injury may be unable to always make decisions about their care or treatment, including where they live, because they lack mental capacity. In 2007, the Government amended the Mental Capacity Act to introduce the deprivation of liberty safeguards (DoLS), which provide a legal framework for such decisions. However, the framework has been subsequently criticised in both Houses, as well as by charities, local authorities and families. The current regime is inflexible and complex and the system is bureaucratic and unwieldly, meaning that it is unnecessarily cumbersome to ensure that vulnerable people are afforded the rights and protections to which they are entitled. The current system does not always empower people or place them at the heart of decision making about their care as set out by the Care Act 2016.

The Commission were asked to conduct a fundamental review of the deprivation of liberty safeguards provisions which are rooted in the Mental Capacity Act and integrated into healthcare practices for joined-up person-centred care. Our expressed priority at the time was that any new scheme delivers real tangible benefits for individuals and their families, and this remains the case. Any new scheme must improve the quality of care for people, improve access to safeguards and be cost-effective.

I welcome the publication of the Law Commission’s report, which we are carefully considering and thank them for their careful and considered work. We will now engage with a range of stakeholders to understand in greater detail how these changes can be implemented. We will also consider what enabling actions need to be taken to support the Mental Capacity Act ethos of greater empowerment and care centred around people, their wishes and aspirations.

This Government are committed to take action to reform mental health and to transforming care for people with conditions such as dementia, learning difficulties and autism. Action to reform the current deprivation of liberty safeguards regime is an important contribution towards achieving these aims including effectively protecting some of the most vulnerable people in our society.

The Government will provide their final response on the Law Commission report to the House in spring 2018.

Attachments can be viewed online at: http://www. parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-10-30/HCWS202/.

[HCWS202]

Social Care

Jackie Doyle-Price Excerpts

Wednesday 25th October 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I am grateful for the opportunity to respond in this debate. It gives the Government an opportunity to set out exactly where we are in this space—and the position is not as characterised by the hon. Member for Worsley and Eccles South (Barbara Keeley). The hon. Lady was characteristically challenging, and I hope to answer some of the questions she raised. I have some sympathy with some of her messages, and I hope through my remarks to reassure her on some points.

No speech on this issue should start without paying tribute to everyone who works in social care—from the care assistants, managers of care businesses, occupational therapists, social workers, nurses and trusted assessors to the many officials in local authorities who organise care packages and adaptations for people’s homes. [Interruption.] As the hon. Member for Oldham West and Royton (Jim McMahon) has just said, the number of people is increasing.

[Jim McMahon]

Decreasing.

[Jackie Doyle-Price]

They all have the best of motivations in providing care, and we should celebrate the work they do to support those who find themselves in vulnerable situations across our society. I would like all of us to recognise the excellent work they do.

The quality and provision of care has been hitting the headlines even more than ever recently. It is therefore reassuring and humbling to see the care and support sector respond with such resilience, commitment and compassion. I was delighted to see that the Care Quality Commission has rated 80% of social care settings as good or outstanding.

[Rebecca Pow (Taunton Deane) (Con)]

I thank the Minister for raising that issue, because we should not be so negative about this area. The latest report from the Care Quality Commission said that four out of five institutions offer good or outstanding service. In my constituency, I recently visited Abbeyfield to celebrate its 30th anniversary. Its staff are well paid and they love their jobs, and the people there were very happy. Somerset Care has some excellent institutions, and Cream Care was recently rated outstanding for its services. I took the Secretary of State for Health to visit it relatively recently. Our old people in Somerset need to know that that is the kind of care they can have, and this Government are facilitating it.

[Jackie Doyle-Price]

My hon. Friend highlights just some of the many examples up and down the country, but we should not be complacent about the 20% of settings that require improvement, and there will be lots of work we can do to raise the standard in them. That includes, not least, the work we are doing in collaboration with the voluntary sector and the Local Government Association to spread examples of good practice and quality. We will obviously continue to do that.

We should also celebrate the other good work going on around the country. In just one year in Sutton, for example, even though the number of beds for care homes supported by GPs in the clinical commissioning group increased by 14%, there was an overall reduction in care home residents attending. That is because the CCG has stepped up to the challenge and has better co-ordination of care, enhanced training of care staff and better health care support for older people in care homes. That shows that, with collaboration, we can get better care standards. Social care therefore continues to be a key priority for the Government.

[Jack Dromey]

The Minister is right to say that there are none so noble as those who care. However, may I press her on a specific issue? The care sector is facing a disaster as a consequence of having to pick up a £400 million bill because of the confusion in the ranks of Government, and likewise in HMRC, with regard to the entitlement to the minimum wage of those who sleep in. Can she say today that that burden, which was not the creation of the care sector, will not fall on local government and that instead the necessary funds will be met by central Government?

[Jackie Doyle-Price]

The hon. Gentleman raises an extremely important point that I am actively thinking about. He is absolutely right in the sense that providers have been following guidance that has changed. It is clear from our perspective that employers are obliged to meet their obligations under minimum wage legislation, but I am very clear on the challenge that that is giving to the sector, and we will work with it to develop a solution.

Turning to the substance of the motion, we announced in the Queen’s Speech that we will work to address the challenges of social care for our ageing population and bring forward proposals for consultation to build widespread support for future provision.

[Judith Cummins (Bradford South) (Lab)]

At least 60% of those receiving social care in the home and 70% of those in care homes are people living with dementia. The underfunding of social care has meant that the burden falls disproportionately on those people. Does the Minister agree that whatever the system of social care provided, it is unacceptable that those living with dementia, and their families, should be disproportionately affected?

[Jackie Doyle-Price]

I invite the House to reflect on what the hon. Lady has said, because that is exactly the issue that we really need to tackle. One in 10 people face very significant costs that they have to meet from their own resources, with only 14,000 ultimately protected. She is right to point out that the vast majority of those people are suffering with dementia and Alzheimer’s. We have now reached a time when it is critical that we have a consensus on the future funding of social care so that we can address the injustice that she has very ably highlighted.

[Sir Desmond Swayne (New Forest West) (Con)]

Am I right in thinking that under current statute law, a cap of £72,500 will apply from the financial year 2021-22, and that if that settlement is to be altered, it will require primary legislation in this Parliament?

[Jackie Doyle-Price]

My right hon. Friend is indeed correct.[Official Report, 3 November 2017, Vol. 630, c. 3MC.]

The ageing population presents one of our nation’s most profound challenges. It raises critical questions as to how, as a society, we enable all adults to live well into later life, and how we deliver sustainable public services that support them to do so.

[Mr Harper]

In a spirit of cross-party consensus, may I add my support to the issue raised by the hon. Member for Stretford and Urmston (Kate Green) by urging that when we bring forward our consultation we cover the nearly 50% of social care spending that is spent on adults with disabilities? I share the view that we must make sure that they are properly supported and able to live full lives, including, where they are able, moving into work. That sometimes gets lost in the debate when we completely focus on people towards the ends of their lives. We must deal with everybody. The hon. Lady made a really important point.

[Jackie Doyle-Price]

I could not agree more. I share my right hon. Friend’s support for the hon. Lady’s comments. There are still many opportunities to get working-age adults with disabilities into work. We have set ourselves a target of getting 1 million more people with disabilities into work, and we are very committed to doing that.

In response to the point made by the hon. Member for Worsley and Eccles South in her opening remarks, yes, much of the debate has focused on how we care for the elderly, but, as she and the whole House will be aware, support for working-age adults is becoming an increasingly big proportion of local authority spending in this area, and it is very important that we focus on it. Alongside the preparations we are making for consultation in the new year, we have a parallel work stream looking specifically at working-age adults, because some of the solutions will be similar and some will be different.

[Barbara Keeley]

It is very important that we have got to this point today, because very many organisations and individuals have been worried for months about that. In the Queen’s Speech and in letters the Minister has sent to me, the talk has been of a consultation on social care for older people. The wording needs to change if that is to encompass, as it should, working-age people with disabilities or learning disabilities. Let us stop focusing just on older people. If she would stop doing that in letters and we could have clarity on this, it would be helpful. I also wonder why there has to be a separate work stream.

[Jackie Doyle-Price]

There needs to be a separate work stream because it is connected to the desire to get more people into work, but the two programmes are working in parallel. As I said, today is a great opportunity to get that on the record. Certainly, it has been very much a focus of my conversations with voluntary groups in the sector.

[Mr Harper]

Picking up the point about the work being separate but parallel, in thinking about how we are going to fund the care, it is really important to make sure that we do not inadvertently put in place any barriers to work, whereby somebody would find that moving into work would increase the cost of their care to the extent that working was of no consequence. That would not be an issue of funding care for older people, where there are some different challenges. A separate but parallel structure may well be the right one to go for.

[Jackie Doyle-Price]

Again, I agree with everything that my right hon. Friend says.

To reassure the hon. Member for Worsley and Eccles South, we will have plenty of opportunity to discuss all these issues in the new year. We want to progress this by building a real consensus, because it is a strategic challenge facing us all. Not only are we all living longer, but working-age adults with disabilities are living longer. That is a matter for celebration, and we must do everything we can to make sure that we can meet all our obligations to them.

[Kate Green]

I am glad that we are spending time on this subject. The Minister will recognise, I am sure, that for working-age adults, relatively modest amounts of care may enable them to participate more fully in the workplace and in wider civil society. Will the separate but parallel work stream acknowledge that? I fear that there will be pressure just to look at the most severe and critical-level need, meaning that many people who could work with a small amount of help will be shut out of doing so.

[Jackie Doyle-Price]

I could not put it better myself. Necessarily, the system will always focus more on those with the most need, but, as the hon. Lady says, we can get a lot more return from putting in good value for money measures that will support people to live independently and to be able to work. I am very keen to explore those areas.

[Tracy Brabin (Batley and Spen) (Lab/Co-op)]

rose—

[Jackie Doyle-Price]

I will take one more intervention, but I really do need to make progress.

[Tracy Brabin]

I thank the Minister for giving way. Can she give me some advice for my constituent—a mother with a daughter who is quite disabled with epilepsy? When the mother was retiring, she realised that she would lose her carer’s allowance as she went on to the state pension. When she rang HMRC and the Department to inquire, they said, “By your age, they are normally shoved into a home.” Can the Minister give me some advice on how I could support my constituent?

[Jackie Doyle-Price]

I am not very impressed by the tale that the hon. Lady describes, but I would like to look into it more directly and get back to her.

The Government have already invested an additional £2 billion to put social care on a more stable footing and alleviate short-term pressures across the health and care system. However, further long-term reform is required to ensure that we have a sustainable system for the future—one equipped to meet the challenges of the increasing numbers of people with care needs. To address these questions, the Government will work with partners—including those who use services, those who work to provide care, and all other agencies—to bring forward proposals for public consultation. The consultation will cover a wide range of options to encourage a very wide debate. It will set out options to improve the social care system and put it on a more secure financial footing, supporting people, families and communities to prepare for old age, and it will address issues related to the quality of care and variation in practice. It will include proposals on options for caps on overall care costs and means-tested floors. It is, however, a consultation, and the Government wish to approach the future of social care in the spirit of consensus. Our consultation is designed to encourage a grown-up conversation in order that society can rise to this challenge.

[Kevin Hollinrake]

The Minister refers to a number of options that the Government will consider. Will they also consider the suggestion contained in that Select Committee report of a system of social insurance, which would be sustainable and simple and would deal with some of the points raised about adults of working age with learning disabilities? The scheme would cover all those things and provide protection for people who are on low incomes. It seems to work very effectively in Germany, where it garnered cross-party support when it was introduced.

[Jackie Doyle-Price]

I agree that we want to learn from examples in other countries. As I have said, the spirit of the consultation will be to allow a well-informed debate, as a result of which consensus can be established. In view of that, we will consider a wide variety of options, covering not just funding but lifestyle solutions and other issues.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[Jackie Doyle-Price]

I must make some progress, because I have taken many interventions. I do apologise.

Adult social care funding is made up of Government grant, council tax and business rates. The better care fund, which was announced in 2013, has further helped to join up health and care services so that people can manage their own health and wellbeing and live independently in their communities for as long as possible. The 2015 spending review introduced an adult social care precept that enabled councils to raise council tax specifically to support social care services. By 2019-20, that could raise up to £1.8 billion extra for councils each year. As a further boost to social care, the Chancellor announced in the Budget earlier this year that local authorities in England will receive an additional £2 billion for social care over the next three years. This year, £1 billion has been provided to ensure that councils can fund more care packages immediately. The additional money means that local authorities in England will receive an estimated increase of £9.25 billion in the dedicated money available for social care over the next three years. Statistics produced today show that spending on adult social care increased in real terms last year by 1.5% thanks, in part, to the precept.

[Barbara Keeley]

This is an important point. Our motion mentions the need to close the funding gap, which is not £1 billion but £1.9 billion. So £900 million is still not covered, and that is what councils are struggling with. The Minister makes the point about extra funding being raised from local taxation. Does she accept that there is still a funding gap, which means that people cannot be paid the national living wage? We are going to struggle all the way through winter unless the Government accept the existence of that gap and work to close it.

[Jackie Doyle-Price]

I do not accept that. Let us recognise that this has been hard in the past. We have made money available in recent years, but we know that local authorities have faced challenges. As one local authority put it to me, however, austerity has been the mother of invention, and I congratulate local authorities on the efforts that they have made. [Interruption.] That came from a local authority leader, and I agree that local authorities have shown considerable initiative by implementing savings. As for the national minimum wage, it is enforceable, so I do not accept the hon. Lady’s point at all.

[Barbara Keeley]

Does the Minister accept that the Government are providing less funding for social care than they were in 2010? She can check that with NHS Digital. The funding is less in real terms. It does not matter that it has increased this year because of the social care levy; it is less. Given the complexity of the issue and the growing demographic challenge, it is clear why we have this gap.

--- Later in debate ---

[Jackie Doyle-Price]

I think it matters a great deal that we have made £9.25 billion available.

[Mr Harper]

Will the Minister give way on the funding issue?

[Jackie Doyle-Price]

I need to make progress. I apologise to my right hon. Friend.

On delayed transfers of care, the Government are clear that no one should stay in a hospital bed for longer than is necessary. Doing so removes people’s dignity and reduces their quality of life. It leads to poorer health and care outcomes, and it is more expensive for the taxpayer. I will set out in more detail the work we are doing to reduce delayed transfers of care. That is critical, because a well-functioning social care system enables the NHS to provide the best possible service.

We are clear that we must make much faster and more significant progress well in advance of winter to help to free up hospital beds for the sickest patients and reduce pressures on overcrowded A&E departments. Last year, there were 2.25 million delayed discharges, up 24.5% from the 1.81 million in the previous year. Just over a third of those delays were attributable to social care. The proportion of delays attributable to social care increased over the last year by four percentage points to 37% in August 2017.

We have put in place an agile and supportive improvement infrastructure, and I have been very clear about priorities. First, in this year’s mandate to NHS England we set out a clear expectation that delayed transfers of care should equate to no more than 3.5% of all hospital beds by September. Those in the system have worked extremely hard to agree spending plans and put in place actions to make use of the additional funding, and they deserve real congratulation for their efforts. Since February, there have been significant improvements in the health and care system where local government and the NHS have worked together to tackle the challenge of delayed transfers of care, with a record decrease in month-on-month delayed discharges in April 2017.

[Liz Kendall (Leicester West) (Lab)]

Will the Minister give way?

[Jackie Doyle-Price]

I must make progress. Secondly, we put in place a comprehensive sector-led support offer. In early July, NHS England, NHS Improvement, the Local Government Association and the Association of Directors of Adult Social Services published a definitive national offer to support the NHS and local government to reduce delays. This package supports all organisations to make improvements and includes the integration of better care fund planning requirements to clarify how this and other aspects of the better care fund planning process will operate.

[Liz Kendall]

Will the Minister give way?

[Jackie Doyle-Price]

I have limited time, and I really must get this improvement on the record.

The package also includes joint NHS England, NHS Improvement, LGA and ADASS guidance on implementing trusted assessors; the introduction of greater transparency through the publication of a dashboard showing how local areas in England are performing against metrics; and plans for local government to deliver an equal share to the NHS of the expectation to free up 2,500 hospital beds. The package sets out clear expectations for each local area, reflecting the fact that reducing such delays in transfers of care must be a shared endeavour across the NHS and social care. Those expectations are stretching, but they are vital for people’s welfare, particularly over the winter period.

Thirdly, we have asked the chief executive of the Care Quality Commission to undertake 20 reviews of the most challenged areas to consider how well they are working at the health and social care boundary. Twelve of the reviews are under way and a further eight will be announced in November, based on the performance dashboard and informed by returns from July. Those reviews commenced in the summer, and the majority of them are due to be completed by the end of November. They are identifying issues and driving rapid improvement.

Fourthly, we have provided guidance on best practice, including how to put in place “trusted assessor” arrangements, which can allow more efficient discharge from hospital by avoiding duplicative patient assessments by different organisations. All areas have now submitted their better care fund plans, which include their trajectories for reducing delays.

Finally, in October we asked NHS England to extend the GP and pharmacy influenza vaccination service to include all paid careworkers in the nursing and residential care sector. They will be able to access the service via local GPs and pharmacies free of charge.

I know that the hon. Member for Worsley and Eccles South is concerned about the provisions for those that fail to improve, and I want to tackle head-on the suggestion that there will be fines. We are not talking about fines at all. The money that has been earmarked will continue to be retained by local authorities.

[Liz Kendall]

Leicestershire County Council fears that it could have £22 million removed from its budget because of fines for delayed discharges, when the Government have cut its funds. The Conservative deputy leader, Byron Rhodes, says:

“I can’t think of anything more stupid.”

The Conservative leader, Nick Rushton, says:

“How long can we put up with the Secretary of State?”

That is the reality of the policy. What is the Minister going to do about it?

[Jackie Doyle-Price]

I reject the suggestion that there will be any kind of fine. The £22 million that the hon. Lady talks about will be retained for spending within Leicestershire. That funding has been allocated for a specific purpose, and where local authorities are not showing the improvement that we expect, we will work collaboratively with them and advise them how best to use that money.

Let me put on record exactly what we are going to do. There is significant variation in performance across local areas. We know that 41 health and wellbeing boards are collectively responsible for 56.4% of adult social care delayed transfers of care. That cannot be right, when other local authority areas have none. In particular, Newcastle has no adult social care delayed transfers of care, and if it can do that, other areas can as well, provided we have good partnerships and good leadership. I trust that I have demonstrated the extent to which the Government are supportive of the best performing systems where local government and the NHS are working together to tackle this challenge. However, we are clear that we must make much faster and more significant progress in advance of winter to help to free up hospital beds for the sickest patients and to reduce pressures on our A&E departments.

It is right that there should be consequences for those who fail to improve. Earlier this month, we wrote to all local authority areas informing them that if their performance did not improve, the Government may direct the spending of the poorest performers—it is not a fine—and we reserve the right to review allocations. It is important to note that the allocations will remain with local government to be spent on adult social care. It is not a fine; this is about making sure that public money delivers the intended outcomes.

[Barbara Keeley]

Is the Minister saying that revising an allocation is not a fine? When an allocation is revised—presumably downwards, not upwards—that is a fine.

[Jackie Doyle-Price]

I am sorry, but that is not the case. The money will be retained by local government, but we will direct the spending to achieve the outcome the money is intended to deliver. That is exactly what we should do as a Government, and it is how we ensure value for money.

The health and care system has committed staff and managers up and down the country who are working every single day to deliver the best outcomes for people.

[Karin Smyth]

Will the Minister give way?

[Jackie Doyle-Price]

I have already taken too much time.

The measures I have set out have given our hard-working workforce and their leaders clarity about how the Government expect the NHS and local government to work together to achieve the joint ambition of reducing delayed transfers of care, which will be instrumental in delivering high-quality care.

To summarise, we accept that there are significant challenges in the health and care systems, which is why we are increasing funding in real terms over the lifetime of this Parliament, but this is not just about money. It is about sharing innovation and best practice; it is about integration and defining new models of care; it involves thinking about a long-term sustainable solution to the care system; and, most importantly of all, it is about supporting the 1.5 million people who work in the care system, as well as the millions of people who selflessly look after families and friends with little or no reward. We are committed to all of these.

[Several hon. Members rose—]

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good and full debate. I wish to thank the 25 Back-Bench colleagues who have contributed to it, including my hon. Friends the Members for Leicester West (Liz Kendall), for Leigh (Jo Platt), for Colne Valley (Thelma Walker), for Sheffield, Brightside and Hillsborough (Gill Furniss), for Bedford (Mohammad Yasin), for Batley and Spen (Tracy Brabin), for Warrington South (Faisal Rashid), for Bury North (James Frith), for Crewe and Nantwich (Laura Smith), for Weaver Vale (Mike Amesbury) and for Birmingham, Edgbaston (Preet Kaur Gill) and the hon. Members for Totnes (Dr Wollaston), for Erewash (Maggie Throup), for Halesowen and Rowley Regis (James Morris), for St Ives (Derek Thomas), for South West Bedfordshire (Andrew Selous), for Yeovil (Mr Fysh), for Faversham and Mid Kent (Helen Whately), for Rochester and Strood (Kelly Tolhurst), for Bexhill and Battle (Huw Merriman), for Chelmsford (Vicky Ford), for Redditch (Rachel Maclean), for Thirsk and Malton (Kevin Hollinrake), for Aldridge-Brownhills (Wendy Morton) and for Edinburgh West (Christine Jardine).

Clearly, on both sides of the House, there is a shared concern over the Government’s inaction on addressing the growing crisis in social care. It has been illuminating to hear the thinking of the Social Care Minister in her opening speech. I am astounded that a Minister of the Crown thinks that austerity is the mother of invention.

[Jackie Doyle-Price]

rose—

[Andrew Gwynne]

Let me finish. I will let the hon. Lady in if she wants to apologise.

It is a play on words of the old English proverb that necessity is the mother of invention. Let me tell the Minister that she might be quoting a councillor, but she did not deny that it was her view, too. There is nothing necessary about austerity. It is a political choice, and it is a choice that is driving up inequality and unfairness.

[Jackie Doyle-Price]

I need to remind the hon. Gentleman that the only money that we can spend is that we collect from taxpayers. I pay tribute to the innovation shown by local authority leaders who deliver better outcomes with less money. That is good value for money and should be celebrated by Opposition Members, too.

[Andrew Gwynne]

I pay tribute to councillors who are making very difficult decisions under very tightly constrained financial situations. I remind the hon. Lady that, yes, we can only spend money that we have, but it is a question of priority about how we spend it. That is why we set out in the election exactly how we would use the money in a better, smarter, fairer and more equal way.

As Members of Parliament, we have a duty to our constituents to defend the services on which many rely and the services that are there to protect us all should we find ourselves in need of support—care homes for the elderly, child protection and support for parents with disabled children. It is the duty of all Members to protect the principle on which our welfare state was founded. All people deserve a life of dignity. As shadow Secretary of State for Communities and Local Government, I speak to council leaders, to councillors, to council staff and to organisations delivering public services, and they are all telling me the same thing. They are not only unable to cope financially; they have lost confidence in this Government. The country needs fresh ideas and leadership. Instead, it is suffering from the weakest and most divided Government in memory. One thing is clear: this Government are facing a looming crisis of trust in local government. Many within the local government sector, including the Tory chair of the LGA, had hoped that the Prime Minister would use her Tory conference speech to announce new measures to help to alleviate the pressures on adult social care. But I, like many, think they were left wanting for leadership.

Our ageing and growing population means that there is more demand for social care. An increasing number of people will need support with their mental health, a physical disability or learning and social needs. Skills for Care has predicted that we will need an additional 220,000 to 470,000 workers by 2025 due to population growth and ageing, but local government will be unable to meet this demand under current and projected budgets.

We do not have to wait until 2025 to witness a crisis. Across the country right now, our health and social care system is straining at the seams. Last year, councils spent over £366 million more than they had predicted on their social care budgets. That is double the overspend reported in 2015-16, and it is not sustainable. The only response that we receive from this Government is the long-awaited consultation, which a Minister first promised would be published in the new year. Now it is suggested that it might even be delayed until next summer.

When will our communities see action to help the one in eight elderly people who will not receive the care they need, such as help getting dressed, going to the toilet and washing themselves—basic dignity for those most in need? When will we see an end to the closure of children’s centres that are providing support to families in need? Right now, one children’s centre closes every week. When will people no longer have to live in fear in their own homes? Cuts to care hours mean that a fall in the home could leave somebody trapped on the floor, unable to get up for several hours. If Ministers had discussed these issues with the sector, they would know about them. They would know that the sector is warning that social care faces a perfect storm of staffing shortages, rising demand and a lack of funding made worse by this Government’s policy on transfer of care.

I recently asked the Minister whether his Department had conducted an assessment to ensure that local authorities had the financial and staffing capacity to comply with their statutory social care duties. I was told that these were decisions for local authorities, not for the Government. Well, I have done the work for the Minister. The number of social care workers has fallen each quarter for five years to its lowest level since 1999. It has decreased almost 8% in the last year alone. Councils face a £2.3 billion annual social care funding gap by 2020. With this black hole in the Budget, I am unable to understand the justification for fining cash-strapped councils for failing to meet transfer targets. The Minister denied that it is a fine. But if it looks like a duck, waddles like a duck and quacks like a duck, it is a duck; and this is a fine.

The Government are at odds with the whole sector. As the LGA has also argued, I am unable to see how this will not make the financial pressures affecting social care even worse. Ministers have failed to understand the depth of the problem with delayed transfer. Too many patients are stuck in hospital who could be better cared for elsewhere, but ensuring that patients can be cared for in the right settings requires investment in not only social care, but intermediate care, reablement services, and sheltered and supported housing. Added to that, we know that there are issues about pay too.

I urge the House to recognise that this problem does not fall on party lines: these cuts hurt all our communities, whichever side of the House we sit on. The Evening Standard reported this week on a new poll. Three quarters of Conservative councillors said that long-term funding for children’s social care was a major concern. Over half said the Government’s cuts had made it difficult to deliver legally required services. So this is a crisis in not just adult social care but children’s services.

History will not look kindly on a Government who promised so little and delivered even less. That is why I urge Members on both sides of the House to vote to support Labour’s motion. Abstention is a cop-out—join us in the Lobby.

Mental Health: Pharmacists

Jackie Doyle-Price Excerpts

Wednesday 25th October 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank the hon. Member for North Durham (Mr Jones) for bringing this debate before the House tonight. I am especially gratified to see so many hon. Members in attendance. This illustrates the very real concern that we have for suicide as an issue, and I welcome their participation here. I know that the hon. Gentleman has been deeply concerned by this incident, and my thoughts also go out to Alison’s family, friends and colleagues. This must be an extremely difficult episode for them. He has described a young woman of great talent and potential, and with timely support she could still have been with us today. I am truly sorry that we have had to hold this debate at all, but in doing so we must learn the appropriate lessons from this case.

Every death by suicide is a tragedy. As the Minister responsible for mental health, I hear from families bereaved by suicide about the devastating impact it has on them. That is why I am determined to drive forward the action we are taking at national level and within local communities to reduce suicides. I am encouraged that suicide numbers have fallen in recent years but they still remain too high. I am aware that the north-east of England has the highest suicide rate in England, and that Durham has one of the highest suicide rates in the region. Really, however, this debate is about Alison Stamps. I am aware that she was a pharmacist, and the hon. Gentleman has raised the issue of suicide risk among pharmacists. He has also put on record his concerns about Boots as an employer. Alison clearly had support in the workplace, but her colleagues did not know how best to help her, and that is not satisfactory.

The hon. Gentleman might be aware that the Office for National Statistics has published research on the suicide risk in occupational groups. While the research did not find a high risk in pharmacists specifically, there is a heightened risk of suicide among health professionals generally. I understand that Alison’s family raised concerns with the coroner about the awareness of mental health issues in the workplace and the ability of employers to support people who experience problems. This is an important concern and one that the Government are addressing.

First, we are looking at the issue of mental health first aid. In Alison’s case, this could have helped. Although general awareness has been raised, we recognise that there is further to go. That is why we have recently announced that we are investing £15 million to deliver an ambitious national mental health campaign to ensure that at least 1 million people receive mental health awareness training. That will be starting next year. Through innovative national programmes to engage the public and continuing to raise the importance of mental health in the same way that we do with physical health, we will increase awareness and knowledge, as well as challenging stigma.

The real concern that the hon. Gentleman has raised about the support—or rather, lack of it—provided to Alison by her employer is firmly at the top of the list in terms of what the Government are doing to address this issue. We recently commissioned Lord Dennis Stevenson and Paul Farmer to conduct a review of how people are supported in the workplace in relation to their mental health and wellbeing. I can advise the House that the outcome will be published shortly, and we will expect employers to step up to the plate as a result of what is in the review.

Pharmacists carry out important and precise work in dispensing medication, and the hon. Gentleman is right to point out that they are exposed to the very tools that can be used to take their own lives if they are minded to do so. I am aware that organisations such as the Pharmacist Support charity, which was set up by the Royal Pharmaceutical Society, do a tremendous amount to support pharmacists on a wide range of issues. That organisation also publishes information and resources about mental health support.

The hon. Gentleman has asked what more can be done, but from the Government’s perspective, the buck stops with the employers. It is they who must ensure that there is sufficient mental health support for their workers. There is much happening in this space, but change will not happen overnight. I am acutely aware that this has come too late for Alison Stamps and her family and is of little consolation, but I hope that improving mental health awareness and creating more mentally friendly and healthy workplaces will increase the likelihood that people will feel able to talk about their mental health problems at work and be assured they will get the understanding and support they need.

I am pleased to say that the profile of suicide prevention has never been so high, which is testament to the progress we are collectively making in tackling the stigma surrounding suicide and mental health problems more widely. I pay tribute to the hon. Gentleman for that. He has done much to raise awareness in this place of the impact of mental ill health. The Prime Minister has spoken about her commitment to tackling the burning injustices of people who experience mental ill health, and many well-known figures have helped to bring this vital issue into the national conversation. I am grateful to the hon. Member for Blaydon (Liz Twist) for mentioning the fantastic work of the Samaritans—what would we do without them? I am pleased to say that I met Ruth Sutherland just this week. The Samaritans is a key partner as we tackle the whole issue of suicide prevention.

Turning to Government action and the suicide prevention strategy, we are making a big step forward and responding to the calls of stakeholders. We need to ensure that locally managed suicide prevention plans are targeted, and we will provide support where plans are insufficient. We have done that because a previous suicide attempt is the strongest indicator of future risk of suicide, so local areas need to keep that intelligence and act upon it. We welcomed last year’s Health Committee inquiry into suicide prevention, which made a wide range of recommendations to reduce suicides. The Government published their response in July to set out how we are progressing many of those recommendations. We also welcomed the recommendation in the five year forward view for mental health to reduce suicides by 10% by 2020-21. The commitment is supported by an additional £25 million between 2018-19 and 2020-21, and we are working with NHS England and other stakeholders to identify the priorities for this funding in local areas.

Local areas are where real change will be delivered, and I am pleased to report that 98% of local areas have a suicide prevention plan in place or in development. I am also pleased that Durham County Council, which serves the constituency of the hon. Member for North Durham, is part of that 98%. Our aim is to reach 100% by the end of the year, but we need a qualitative assessment of the quality of the plans. We do not want this to be a box-ticking exercise, so we will work with local areas to ensure that their plans are high quality and to identify areas for improvement.

We remain committed to delivering the five year forward view for mental health and the Prime Minister’s mental health reforms. That work is supported by an additional £1 billion of funding up to 2020-21 to ensure that an additional 1 million people can access mental health services. We certainly do not want people like Alison Stamps to feel that they have nowhere to go. Much of that investment will directly impact suicide prevention, such as the £400 million we have invested in developing mental health crisis services in the community and the £250 million to implement liaison mental health teams in emergency departments to support people who present at general hospitals with mental health problems.

[Lady Hermon (North Down) (Ind)]

I am grateful to the Minister for giving way. In Northern Ireland, where health is devolved, we have not had an Assembly for 10 months and we do not have a Health Minister. May I urge the Minister to ensure that there is a suicide prevention strategy? She says that there is a national strategy. I love the word “national” because Northern Ireland is part of the United Kingdom, so will the Minister ensure that the permanent secretary for the Health Department in Northern Ireland is aware of the progress being made in the rest of the United Kingdom? I am encouraged by what she has said this evening.

[Jackie Doyle-Price]

The hon. Lady makes a fair point, and I will ensure that that is taken up with officials in Northern Ireland, because it is important that the situation is tackled locally.

Members may also be aware that we launched the “Beyond Places of Safety” programme this month to provide £15 million of support for local community-based projects to ensure that there are more appropriate places of safety for people experiencing a mental health crisis and to avoid police custody or unnecessary hospital admissions. That builds on the £15 million we invested in the first phase of the programme.

The forthcoming children and young people Green Paper will set out a range of measures to improve access to services and support for young people. We will provide mental health first aid training to all state secondary schools by 2019, and we will expand that training to state primary schools. I hope hon. Members will agree that the Government’s continued investment and drive to improve mental health services will bring real change for people.

The death of Alison Stamps has been particularly tragic. Her case is a clear lesson that employers need to be alive to the mental health needs of their staff, and I make it clear that that is what we expect. There is political consensus that we must address issues such as suicide prevention, so now is the time for us all to take action to make change a reality for people and communities. We must be ambassadors in ensuring that employers step up to the plate.

As I have set out, this Government are committed to tackling the burning injustices experienced by people with mental health problems so that more people will feel able to speak out about their problems and feel confident that they will get support from those around them, including their employer. I was struck when the hon. Member for North Durham said that people are scared to speak out in case they end up being taken down a disciplinary process or losing their job. That is not acceptable, and employers need to ensure that employees realise that support will be forthcoming.

We have made huge strides on delivering parity of esteem between mental health and physical health, and on ensuring that more people have timely access to services when they need them, but there is still much more to do. We must not be complacent in pursuing those goals. We will be tireless in that pursuit, and I can tell from their interest that other hon. Members will be tireless, too. We must ensure that other families do not have to experience the grief and pain that Alison’s family are feeling now.

Question put and agreed to.

Surgical Mesh Implants

Jackie Doyle-Price Excerpts

Wednesday 18th October 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Owen. I thank the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this debate and shining a light on a condition that is very distressing for far too many women. Clearly this is not where we would like to be.

Obviously, many hon. Members would like an immediate ban on mesh products. From my perspective, the issue is not with the product but with clinical practice. That is what is going wrong. That is where we need to be much clearer, ensuring that women are treated properly by their clinicians, given proper advice and risk assessments, and given the opportunity to report any complications and the ability to complain and challenge. The Government also need to ensure that all clinicians have the most up-to-date and appropriate advice.

The focus of this debate is the women who are suffering. The most important thing we can do—my priority—is to ensure that they get the support, care and treatment they need to alleviate a debilitating condition.

With regard to the evidence, we expect to produce the NICE guidelines before the end of 2017. We will bring them forward as soon as possible. I am sure that hon. Members will want to review those guidelines, to see whether they are satisfied that they have moved forward.

The advice I have received from the MHRA is that mesh is still the best product for treating stress incontinence, but the evidence regarding prolapse is more mixed. I can give that advice to hon. Members today, but we await the NICE guidelines before the end of the year.

The women are the most important aspect of this debate. We should be focusing on them. We must make sure that they are fully supported to make informed decisions about the surgery, and I have heard from many hon. Members that in many cases they were not. This is a risky process and, as my hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, said, many women have benefited from this surgery but there is a risk to it, and those risks were not properly communicated to allow women to make an informed choice. That is not acceptable and we must make sure that does not happen in the future.

To do all of that, we are working with patients, NHS England and the MHRA, to come together with the mesh oversight group. The most recent report was published in July and its recommendations are being implemented. The updated guidelines will be published before the end of 2017. It is important that regulators ensure that advice and guidance keep up with developments in clinical technology and practice. We will constantly review evidence as it comes in to keep advice and guidance up to date.

A number of hon. Members mentioned that there have been no clinical trials for these devices, and I agree that we need to continue to draw on emerging evidence. There have been a number of research studies which have directly informed the guidelines issued by the regulators and led them to reach their conclusions, on which I have just advised the House.

It is still important that we listen to the concerns of women, and I encourage all hon. Members who speak to their constituents suffering with the consequences, to make sure that they report those complaints through the MHRA yellow card scheme, so that we can build a body of evidence about where things have gone wrong.

[Alec Shelbrooke]

Will the Minister make a specific inquiry to the MHRA about the evidence of bacterial infection on the product, which flies in the face of its advice that the product must have sterility in order to be implanted? There seems to be a contradiction in the MHRA’s advice as to how it should be licensing products.

[Jackie Doyle-Price]

I hesitate to give a full answer, but the advice I have received is that over the years these products have been reviewed and there are clinical standards for the size of the mesh. I will write to my hon. Friend in more detail, because I am not an expert in that.

The hon. Member for Kingston upon Hull West and Hessle calls for a public inquiry. I think it is more important that we get the treatment that is needed, but I encourage everybody to report their cases through the yellow card scheme.

I am horrified to hear from my hon. Friend the Member for Totnes that many women did not know they were having the device fitted in the first place. That general issue indicates some arrogance of the medical profession towards women. The stories I have heard from colleagues, about how their constituents have been treated by their GPs when they have gone for treatment, are indicative of that. Women tend to suffer in silence. Quite often that means they are not the best at championing themselves. That is clearly unacceptable. This issue has been considered by the mesh oversight group, and it has been clear that improvements are needed to ensure informed consent.

[Dr Wollaston]

Will the Minister assure the House that she will investigate clinical governance in the private sector as well as in the NHS, because many women tell me that this issue has affected them in the private sector?

[Jackie Doyle-Price]

I give my hon. Friend that assurance. To be frank, the same standards of consent and regulation apply in the private sector as in the public sector. A number of colleagues mentioned issues in the private sector, but there is no excuse; it is equally regulated by the Care Quality Commission and the General Medical Council, so the same standards apply.

[Jo Stevens]

On that point about the loophole between the NHS and the private sector, and the relationship and liability of private surgeons operating at private hospitals, will the Minister see whether that loophole should be closed?

[Jackie Doyle-Price]

I am not sure that there is a loophole. Surgeons are required to demonstrate their clinical competence as part of their regular revalidation, whether they work in the private or the public sector. Concerned patients may contact the GMC, just as they would do in an NHS trust. In addition, surgeons will be inspected by the CQC and their procedure examined to ensure that it meets standards. I cannot see that there would be any difference, but if the hon. Lady would like to bring to me a specific example, I would be delighted to look into it for her.

Clinicians working in private hospitals are under the same ethical obligations to ensure that treatment is based on consent, that complications are addressed and that information is shared with regulators as appropriate. Private hospitals are subject to CQC registration and must abide by those fundamental standards.

I am very short of time, but I suspect that we will come back to this matter, particularly after the NICE guidelines are published later this year. The most important thing we can do is make sure that the women have access to the support that they need, and that GPs know what to look for in order to give them that support, and I am always open to hearing representations from colleagues on this issue.

Safeguarding Adults with Learning Disabilities

Jackie Doyle-Price Excerpts

Tuesday 17th October 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I join everyone else in paying tribute to the dignified and passionate way in which the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) outlined her case. It is truly heartbreaking. Lee’s mother is watching today. She put her trust in the institutions of the state to care for her son, and we failed her. It should never have happened, and for that I am truly, truly sorry. I give the hon. Lady and Bev my commitment that I will take lessons from this. I hope the hon. Lady will act as my conscience in ensuring that I do so. The issues highlighted across the Chamber today need to be acted upon, to ensure that we do our best by all our constituents.

I was struck by the way that the hon. Lady talked more generally about people with learning disabilities. It is, frankly, the reason we all get involved in politics—we get involved in politics when we see the state failing and to make sure we do the best for everyone in society and for the people we can see being failed. I do not think that any group is failed more than people with learning disabilities. They have potential and the ability to live independently, but all too often they have been parked. My hon. Friends the Members for Henley (John Howell) and for North Swindon (Justin Tomlinson) outlined examples of where, with some support, people with learning disabilities can lead very productive lives, but it requires support and investment. Sadly, that is not always forthcoming, and without it, they are very vulnerable, as this tragic case all too clearly illustrates. We owe it to them and to ourselves, in order to make the best of society, to do all we can to help people with learning disabilities to live independent lives.

We need to do more to tackle the whole issue of prejudice. The hon. Member for Newcastle upon Tyne North said she has been very persistent in trying to secure this debate, but perhaps it is fitting that the debate is happening in the middle of National Hate Crime Awareness Week. That is the perfect backdrop against which to address her case. It is fair to say that we are still early in the day when it comes to hate crime prosecution. There is slowness in reporting all hate crime, and suddenly people have become more aware.

People with learning disabilities are generally victims of quite widely held prejudice. It is not just the fact that they are targeted because of their disability; the agencies that should support them do not necessarily give them the support they need because of their disability. We have seen across the board, in so many examples of abuse, that particular social groups who are not the best at representing themselves do not always get a fair deal at the hands of the organisations that support them. We should look at that under the umbrella of hate crime, but it is slightly different; it is about prejudice more generally that we can all help to tackle. It is a very real inequality that we are tackling.

Central to our job as Members of Parliament is supporting people who have been victims of maladministration and who are not getting enough support from the state. In many cases, that is people with learning disabilities. I have always found that some of the most rewarding work I do as a Member of Parliament is in supporting people with learning disabilities. It is also the most inspiring, and it is great to see the enthusiasm that my hon. Friend the Member for North Swindon referred to.

Unfortunately the Minister for Disabled People, Health and Work, my hon. Friend the Member for Portsmouth North (Penny Mordaunt), is no longer in her place, but the fact that she was here is testimony to her support for this work. We are very keen that people with learning disabilities receive more attention. I give the hon. Member for Newcastle upon Tyne North that commitment, and we will continue to engage with her as this work develops.

I agree with the hon. Lady that people with learning disabilities are among the most vulnerable in our society, and it is the responsibility of all of us to protect them from risk. I will not pretend that we have got this perfect—there is a hell of a lot more to do. There has been significant progress in identifying and managing risk, but it is not consistent, and there are too many occasions when it just does not happen.

The hon. Lady articulated clear views on a specific case of hate crime. She will appreciate that that falls outside my bailiwick, but I will make a few observations, in so far as I can without treading on other Departments’ toes. As she said, the judge concluded that hate was not a factor in the motivation behind the crime. That is a matter for the courts, and it is for them to interpret, but I come back to the issue of prejudice. That case throws up a number of issues that we all need to be more vigilant about. We know that people with learning disabilities are very vulnerable to bad people, and bad people will find vulnerable people to prey on. I am aware that young women with learning disabilities are often preyed upon sexually, which is a real hidden issue that we need to think about. There is also the whole issue of modern slavery. People with learning disabilities are often subject to that. In this case, Lee was obviously being exploited financially by the people who murdered him.

[Barbara Keeley]

I did not manage to raise the very important point that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) raised about the fact that Lee Irving was labelled as difficult to help and classed as an adult who could choose a lifestyle, with such tragic results. That has echoes of other forms of abuse because, as my hon. Friend so clearly pointed out to us, his intellectual skills and reasoning were at 0.2% of those of adults of his age. Why were agencies saying that he could choose that awful lifestyle, which ended up having such a tragic result?

[Jackie Doyle-Price]

I totally agree with the hon. Lady. As she says, we have seen that in other cases of abuse. We can look at Rotherham and how the agencies behaved there. It is almost as if there is a view that, “He’s a bad ’un; he doesn’t deserve protection.” That is absolutely not the case. We need to be thinking about the person in a very person-centred way. It was very clear that Lee had a learning disability and did not have the capacity to act as an adult, yet he was treated as one. That is one of the real lessons of this case.

With specific regard to the requests of the family, the whole area of transition is certainly of concern to me. We see this issue in relation not just to learning disabilities, but to mental health. In both cases, families are often completely unable to influence support or care for their loved one; they are utterly powerless because they are in the control of institutions. We need to be learning the very clear lessons there.

We need to raise awareness of hate crime against people with disabilities. Too often, we look at hate crime through the prisms of race and gender. To be honest, we look at hate crime through those prisms because it is the victim of a hate crime who will raise it as such and, frankly, people with disabilities are in less of a position to do so. That said, things are getting better. As I said, it is early days for the offence and prosecution of hate crime, but I am told that in the past year the police have recorded an additional 5,558 disability hate crimes; the number is up by 53%. That suggests that people are more inclined to report it and that the police are more inclined to identify hate crime due to disability, but we continue to monitor the situation and see what else needs to be done to protect the vulnerable.

[Catherine McKinnell]

I appreciate the response that the Minister has given, but the increase in reporting of hate crime is very concerning. There are potentially two issues here. One is that people are more motivated or able to report hate crime, but it may be that there is a significant increase in hate crime as well. It is incumbent on the Government to find a way of monitoring that, so that we can understand whether this is a growing problem or whether there is just more success in terms of the reporting of the crime. We should not confuse the two.

[Jackie Doyle-Price]

That is a fair point. Data is everything, and as time progresses, we will build up more meaningful data, but certainly if crimes are being reported, they are more likely to be prosecuted. Even if the behaviour has been hidden, or if it is on the rise, at least prosecution can happen, but we need to tackle the behaviour first and foremost, to be frank. Prevention is always better than cure.

Under the hate crime action plan launched in July 2016, we committed to providing funding to community-led projects aimed at tackling hate crime. In the first year of the scheme, we funded nine projects across England and Wales covering all types of hate crime. We funded a project in Carlisle involving Mencap. It was to develop an education resource to raise awareness of disability hate crime and how to report it. The great thing about that was that it was created by people with learning disabilities for people with learning disabilities, so it was enabling and empowering the victims. I am advised that three of the projects for the second year of the programme will focus on tackling disability hate crime, but clearly there is more to do.

On 21 August 2017, the Crown Prosecution Service published revised public statements and legal guidance for all strands of hate crime, as well as a support guide for disabled victims and witnesses. One of the most telling things about the speech by the hon. Member for Newcastle upon Tyne North was that it was in the interaction with the criminal justice system that perhaps the most decisive intervention to support Lee could have occurred. Again, we can do more. The Solicitor General is well aware of this matter and, I am sure, is already having discussions with the legal agencies about how we can spread good practice and perhaps look at guidance.

Safeguarding was obviously the real failing in this case. Clearly, we need a system that protects those at risk and acts on issues effectively; that did not happen in this case. As we have heard, once someone becomes an adult, it is very important that it has regard to their feelings and wishes, but the whole issue of mental capacity needs to be determined. In the Care Act 2014, there is a clear legal framework for safeguarding, which gives clear instruction on the responsibilities of local authorities and the rights of adults, but it is also important to involve their families and loved ones as and when necessary. Again, that is a very troubling aspect of this case.

We need to do better. We need to make clear what is expected of the various agencies under the Care Act. We are pursuing Making Safeguarding Personal, which is a sector-led improvement programme that aims to reinforce the placing of the individual at the centre of safeguarding. We are also working with the Association of Directors of Adult Social Services to improve that.

To come back to the issue of the criminal justice system, that was a missed opportunity to give Lee support. During the past two years, we have been working very hard to expand liaison and diversion services. It has been a good news story: more than 71,000 vulnerable adults have been taken out of the criminal justice system and instead put on an integrated health and justice pathway, helping them into health services and away from custody where appropriate. I can assure the hon. Lady that that is still a key part of how we will approach this issue. In fact, I met the team doing that work just last week.

To address the specific recommendations made by the family, the transition from children’s to adults’ services is clearly key. That is where things go wrong; we need to ensure that it is joined up. I always say that if we have a weak link in a chain, we can usually get over that, but if we have a succession of them, that is when things go terribly wrong. As the hon. Lady outlined, there were probably half a dozen in this case.

We are determined that young people with learning disabilities will be properly prepared for adulthood. We are looking at four specific areas: employment, good health, independent living and community inclusion. From the way the hon. Lady articulated Lee’s circumstances, I do not think he could have been judged to be meeting all four of those criteria by any stretch of the imagination, so we must ensure that the support network is in place to help to steer individuals through that, for as long as it takes. It can take a number of years, but the end goal is a good one if we are prepared to make that investment. If people are not ready, they must have support to prevent them from being exploited by those who would exploit people who are vulnerable.

Many people think that the Mental Capacity Act 2005 is very complex legislation, and clearly in this case not everyone knew their obligations under it. There was not a clear understanding of how far the family should have been involved when Lee’s mental capacity was clearly not that of an adult. We want to do a lot more work on educating people in this space. In 2015 we established, with the Ministry of Justice, the National Mental Capacity Forum, specifically to develop those messages and good practice across the sector.

We also have to look at deprivation of liberty safeguards. The Law Commission has recently published its report on mental capacity and deprivation of liberty, and I welcome the observations of the hon. Member for Newcastle upon Tyne North in the light of this case. Like all Law Commission reports, it is a very well-thought-out piece of work. It has had lots of investigation and engagement with stakeholders. We need to make sure that the law is proportionate in respecting people’s liberties, but can also be used to protect the vulnerable. That is clearly the test that we will apply.

We have heard that Lee struggled to navigate the system and that agencies did not work well to support him. Another important tool that will perhaps avoid cases like Lee’s in future is having a named social worker who owns the individual and their needs, and makes sure that those have been satisfied. I think that would make a big difference. We have the named social worker pilot scheme so that more people can have that personalised care and support. They can hold every agency responsible under care plans and be really person-centred, recognising that this is an individual with his own personality, needs and circumstances. That is a very important piece of work. It is our response to the 2015 consultation, “No voice unheard, no right ignored”, which sought views on strengthening the rights of people with learning disabilities, autism and mental health conditions, to enable them to live more independently.

The hon. Lady raised the case of Southern Health and Connor Sparrowhawk. I think we agree that sunlight is the best disinfectant, so all NHS trusts are now required to publish estimates of how many deaths they could have avoided had they been better. That includes the deaths of people with a learning disability. From June next year, trusts must also publish evidence of learning improvements that happen as a result of those data. We expect that the leaders of trusts should show some real accountability and leadership in how they deal with their duties under that requirement.

I want to give the hon. Lady plenty of time to speak at the end, because this is clearly a very important subject for her, but I will quickly add that one of the most important things we need to get right in supporting those with learning disabilities is to invest in good quality supported housing. That is central to encouraging independent living and to having the infrastructure in place to protect them from any potential exploitation.

The hon. Lady also raised the issue of costs and challenges. It is to be celebrated that people with learning disabilities are living longer—for a long time they were dying prematurely. That is a massive improvement in justice, but it does bring with it cash challenges, and obviously we are facing cash challenges across the sector. I wish that was easy to fix. It is not, but it is at the top of my in-tray, as I am sure both she and the hon. Member for Worsley and Eccles South (Barbara Keeley) will understand, and we are very keen to address it. On the specific issue of sleep-ins, which I know Mencap is very worried about, we are actively involved in discussions about how we can support the sector to deal with that.

To conclude, what happened to Lee was not the result of a single cause. There were a number of failings, as the hon. Member for Newcastle upon Tyne North articulately set out. I think there are real challenges: how the criminal justice system understands people with a learning disability, how all the agencies can work more effectively together and how we can provide support for people with a learning disability, so that we not only support, but protect them. We are taking action at a national level to address those. The permanent secretary at the Department of Health is about to convene a cross-departmental roundtable to look at how we can deal with this across Government.

I can give the hon. Lady my assurance that people with learning disabilities are a key priority of mine, and I look forward to making sure that we do not have to have a debate like this in future.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 10th October 2017 Commons Chamber

[Paul Masterton (East Renfrewshire) (Con)]

4. What discussions he has had with the Medicines and Healthcare Products Regulatory Agency on transvaginal mesh implants.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

My colleague, Lord O’Shaughnessy, met the MHRA on 27 September to discuss this very important issue. The Department will have further discussions with NHS England on the support given to patients who have suffered due to this procedure and has asked the regulator to work with the clinical community to assess the associated risks and whether alternative treatments offer better outcomes for patients.

[Paul Masterton]

Thousands of women across the country, including my constituent Elaine Holmes, the co-founder of the Scottish Mesh Survivors group, have to live with the catastrophic consequences of transvaginal mesh implants. With health regulators across the globe now waking up to the scandal and issuing alerts or deregistering mesh devices, will Ministers join me in urging the MHRA immediately to reclassify this damaging procedure as high risk?

[Jackie Doyle-Price]

I thank my hon. Friend for his work in this area. I fully sympathise with anyone who has suffered complications as a result of these devices, but we do not currently have enough evidence to warrant our asking the MHRA to reclassify these procedures, and this is a view shared by other regulators across the world. I can advise him, however, that the National Institute for Health and Care Excellence strongly recommends that mesh implants not be routinely offered for the first surgical intervention on prolapse. That guidance is being updated—publication is due at the start of the new year—and will include an overarching document that looks in depth at the devices and the conditions surrounding the need for them, as well as the treatment of complications, to support better health outcomes.

[Karin Smyth (Bristol South) (Lab)]

A constituent came to my surgery to explain how this has impacted on her life. It is truly harrowing. I understand that NHS England has set up 17 regional teams to look into this. I want to be able to assure my constituent that the voice of women and how this is impacting them on will be considered. I would be grateful if the Minister could respond so that we might understand what the future holds.

[Jackie Doyle-Price]

I am absolutely aware that many women experience substantial side effects and complications following this procedure. Equally, however, many women also experience considerable relief from symptoms. We need a good review of the evidence to make sure that we adopt this procedure only when it fully suits women and that women understand the risks associated with the procedure. But I fully sympathise with the hon. Lady’s constituent.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is deeply worrying, though, that this procedure was introduced with so little evidence to support it. I think we all have to agree it has led to unacceptable complication rates for certain products. Will the Minister heed the words of Professor Heneghan and hold a public inquiry into the numbers of women adversely affected and why the safety of so many women was disregarded?

[Jackie Doyle-Price]

I say again that many women have received relief from their symptoms following this procedure, but we need more evidence before we can properly review it, so it is important that we allow NICE to undertake its work so that we can take a clear view. Any procedure comes with risk—no surgery is without it—but obviously the more evidence we can gather, the better we can advise women of those risks.

[Rebecca Pow (Taunton Deane) (Con)]

5. What plans he has for the implementation of the NHS’s five year forward view for mental health.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

We are making good progress on the implementation of the five year forward view for mental health. We have published a workforce plan and invested more money than ever before, and we are providing care to 120,000 more people this year compared with 2013.

[Rebecca Pow]

The charity Mind recently produced a report called “Feel better outside, feel better inside”, which advocated the benefits of eco-therapy—using activities such as gardening, farming and exercise. The National Garden Scheme has also produced a publication on this. Is the treatment being utilised within the NHS?

[Jackie Doyle-Price]

I thank my hon. Friend for her work in this area. Yes, I can give her that assurance. It is welcome that local authorities and clinical commissioning groups are considering innovative approaches concentrating on wellbeing, as well as acute services, and eco-therapy is part of that agenda.

[Anna Soubry]

I am sure that you, Mr Speaker, and the rest of the House will send their condolences to the family and friends of Rebecca Nevin, a constituent of mine who died aged 32 after many years of poor mental health and an addiction to alcohol. Her father, Stephen, like many parents of adult sufferers of poor mental health, felt largely excluded by health professionals. Does my hon. Friend agree that we need health systems and workers who maintain patient confidentiality while recognising and acting on the genuine concerns of parents of adults?

[Jackie Doyle-Price]

I am sure that we are all very sorry to hear of the death of my right hon. Friend’s constituent, and we send our condolences to her family. It is extremely difficult to balance patients’ right to confidentiality with the needs and requests of their families, and we will study any recommendations that emerge from the coroner’s investigation.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I heard what the Secretary of State said about funding earlier, and what the Minister said a moment before. However, I sent freedom of information requests to every CCG in the country, and found for the second successive year that more than half of them are not increasing the proportion of their budgets that they spend on mental health. That flies in the face of a commitment made by the Secretary of State at the Dispatch Box, and it flies in the face of the spirit of the Five Year Forward View for Mental Health. On World Mental Health Day, will the Minister, along with the Secretary of State, commit herself to ensuring that we ring-fence the money that they say is available for mental health?

[Jackie Doyle-Price]

On World Mental Health Day, I can confirm that we are spending £574 million more on mental health this year. It remains our principle that decisions should be made locally by CCGs, but we have very clear expectations of them, and they will be held to account via inspections.

[Norman Lamb (North Norfolk) (LD)]

The ‘Five Year Forward View’ suggested that the Government accepted the case for comprehensive maximum waiting time standards in mental health to match those in physical health. Given that children throughout the country are routinely waiting for months to start their treatment, may I ask what progress the Government are making with the introduction of a maximum waiting time standard for children’s mental health?

[Jackie Doyle-Price]

The right hon. Gentleman has raised an excellent point. Our Green Paper on children and young people’s mental health will address exactly those issues. We have made clear that we will tackle mental health through early intervention, and early intervention for children and young people is central to that.

[Thelma Walker (Colne Valley) (Lab)]

6. What recent assessment he has made of trends in staffing levels in the NHS.

--- Later in debate ---

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

7. What steps his Department is taking to improve end-of-life care.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

By 2020 we want significantly to improve patient choice in end-of-life care. The Government’s end-of-life care commitment sets out exactly what everyone should expect. In September we published a report on the good progress that we have made over the first year.

[Catherine McKinnell]

The End of Life Care Coalition has said that it remains deeply concerned about the enduring gap in resources for community-based health and social care services. Meanwhile, Together for Short Lives continues to highlight the unacceptable postcode lottery faced by 40,000 children with life-limiting conditions. What is the Minister doing to ensure that all clinical commissioning groups and sustainability and transformation partnerships will meet the Government’s requirements in full for both children and adults by 2020?

[Jackie Doyle-Price]

I thank the hon. Lady for her question, and I know that she, through her role on the all-party parliamentary group for children who need palliative care, will continue to hold me to account on these commitments. We did look at the work undertaken by Together for Short Lives to improve end-of-life care for children, which does require special attention—she is quite right to raise that. NHS England recently co-hosted a policy summit with Together for Short Lives, and I will be meeting it next week to discuss that further. We are also engaging local sustainability and transformation partnerships to support planning for end-of-life care, and helping all trusts to develop and improve their services. This work is ongoing, but it remains a key priority.

[Will Quince (Colchester) (Con)]

When it comes to baby loss, the end of life can often be sudden and unexpected. In this Baby Loss Awareness Week, will the Minister join me in welcoming the launch of the national bereavement care pathway, and pay tribute to Sands, baby loss organisations and charities, the APPG and the former Care Quality Minister, Ben Gummer, who did so much to make it happen?

[Jackie Doyle-Price]

I am of course happy to join my hon. Friend in congratulating those organisations and thank him for all the work that he has done. The 11 pilots launched only last month are very much down to his work and that of hon. Members across the House, who have done so much over the past year to raise awareness of the issue.

[Tony Lloyd (Rochdale) (Lab)]

Many people would prefer to die at home, but that is actually very difficult to achieve, not only because of the lack of support for Macmillan nurses, for example, but because, frankly, of the reluctance of the authorities to effect a speedy transition to a home base. What can the Government now do to ensure that dying at home is a real option?

[Jackie Doyle-Price]

The hon. Gentleman is quite right: many people would elect to die at home, if the opportunity were available. We need to ensure provision to allow people to do that, if that is their choice, because we should be supporting people to honour their choices at the end of their lives, and it enables us to treat more people in hospitals and hospices.

[Maggie Throup (Erewash) (Con)]

Hospices, such as Treetops Hospice Care in my constituency, provide outstanding end-of-life care. Although these services benefit from generous charitable donations that enable them to operate on a day-to-day basis, what more can the Government do to help support hospices when capital investment is needed to improve the current setting of new build?

[Jackie Doyle-Price]

One of the strengths of our hospice movement is that it relies heavily on charitable donations, which shows that people are generous and that they want to support good, locally focused care. However, CCGs should look at where they can support hospices with their care costs, and we will certainly consider including that in the end-of-life care programme.

--- Later in debate ---

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

15. What estimate he has made of the number of people living with unmet social care needs.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

By passing the Care Act 2014, this Government established a national eligibility threshold that defines the care needs that local authorities are required to meet. This eliminates the postcode lottery of eligibility across England. Social care continues to be a key priority for this Government. That is why local authorities in England will receive an additional £2 billion for social care over the next three years. In the longer term, we are committed to establishing adult social care on a fair and more sustainable basis.

[Preet Kaur Gill]

Age UK estimates that nearly 1.2 million older people have unmet care needs. After the Government dropped their disastrous dementia tax policy during the general election, all they can offer people is yet another consultation. In the words of the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, is it not time the Government just got “on with it”?

[Jackie Doyle-Price]

I do not recognise Age UK’s assessment of unmet need. As I said, the requirements are enshrined in statute and local authorities should be held to that. In response to the hon. Lady’s final point, let me say that we are getting on with it, but we need a real cultural change in how we tackle these issues. There is a long-term issue to address in the fact that we are all living longer. This is not just going to need a sticking plaster; we will need to take the public with us. So this is not just another consultation; it is a vehicle for making sure that we as a society tackle this issue once and for all.

[Derek Thomas (St Ives) (Con)]

The Royal Cornwall Hospitals NHS Trust was put into special measures last week, but delayed discharge caused by unmet social care needs contributes to the pressure in the trust. I welcome the £12 million that was awarded to the council this April to address that, but what more can the Minister do to help to relieve the pressure? Will he meet me and my Cornish colleagues to discuss the healthcare challenges faced in Cornwall and on Scilly?

[Jackie Doyle-Price]

My right hon. Friend the Secretary of State has visited twice in the past year, and the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne) is more than willing to meet my hon. Friend next week, with other colleagues.

[Robert Neill (Bromley and Chislehurst) (Con)]

16. What assessment he has made of the level of co-operation between clinical commissioning groups and local authorities.

--- Later in debate ---

[David Linden (Glasgow East) (SNP)]

T3. The palliative care we provide to terminally ill children is an incredibly serious topic. I want to refer to the point made by the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and to press the Minister on giving children’s care parity of funding with adult care. Will she follow the example of the Scottish Government and provide parity of funding?

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

As I previously advised the House, I am in conversation with Together for Short Lives to look at how we improve palliative care for children. This clearly raises a different set of circumstances and sensitivities, and it is essential that we do our best for these children.

[Huw Merriman (Bexhill and Battle) (Con)]

Do Ministers have any plans to review the “do not resuscitate” guidance for hospitals? I have a constituent who has such an order placed on him, despite the fact that he has left hospital and is in a care home, it cannot be rescinded and his family have not consented.

[Jackie Doyle-Price]

My hon. Friend is right to raise this issue. Certainly, in CQC inspections in the past, the whole issue of “do not resuscitate” orders has been an area of concern. This is something we will very much look at as part of the end of life policy, but I would like to hear more about the case my hon. Friend mentioned, if he would like to write to me.

[Clive Lewis (Norwich South) (Lab)]

T5. Accountable care systems are a systemic change to the way the NHS will be managed and a significant step towards an Americanised care system, so will the Minister explain why NHS England is having a fundamental reorganisation take place under the radar without a national consultation?

Infected Blood: Government Response

Jackie Doyle-Price Excerpts

Monday 9th October 2017 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

In 2016 the Government decided to improve the way we support people who have suffered as a result of the infected blood tragedy of the 1970s and 1980s. At this time the Government committed an additional £125 million of support to those affected, more than doubling the Department of Health’s annual spending on the scheme over the spending review period to April 2021.

Following the 2016 consultation we announced new annual payments for people with chronic hepatitis C (stage 1 infection) and a new one-off payment for bereaved partners and spouses; a new process for those with stage 1 infection to apply for the higher payment amount; and increased annual payments from 2018-19.

In March 2017 we launched a second consultation, looking at the new voluntary process by which those infected by stage 1 Hepatitis C can apply for higher annual payments (the Special Category Mechanism). The Special Category Mechanism aims to benefit beneficiaries with hepatitis C stage 1 who consider their infection, or its treatment, to have a substantial and long-term impact on their ability to carry out routine daily activities.

The consultation was open to all beneficiaries and other interested parties across the UK to comment on our proposals. The consultation closed on 17 April 2017.

The Government have listened carefully to the consultation responses, analysed pre and post-consultation evidence from other sources, and reviewed consultation proposals in line with respondents’ views and evidence. Following this, the consultation response sets out the Government’s plans for reform, which are summarised below:

Introduction of planned uplifts in annual payments from 2018-19. All beneficiaries will receive an increase in annual payments from 2018-19.

A new Special Category Mechanism (SCM) for those with hepatitis C infection at stage 1 in November 2017.

The introduction of a single programme of discretionary support for all—infected and bereaved.

An increase in the overall level of funding for discretionary support from 2018-19.

All annual payments will include the winter fuel payment.

Addition of type 2 or 3 cryoglobulinemia accompanied by membranoproliferative glomerulonephritis, MPGN), to the current hepatitis C stage 2 conditions.

A letter will be sent to the beneficiaries of the English scheme to make them aware of these changes, and advise them on how to access the consultation response, a link to which is also provided as part of this statement. When the SCM process opens beneficiaries with hepatitis C at stage 1 will receive a letter telling them how to apply.

For the first time, all beneficiaries of any of the current five schemes will be receiving support from a single scheme. As previously announced the NHS Business Services Authority (NHSBSA) will become the new single scheme administrator in England, with effect from 1 November 2017. While this transition takes place, annual and discretionary payments and services will continue to be made by the current schemes to ensure a smooth transition to the new scheme with minimum impact on the beneficiaries.

The Government strongly believe that all those who are affected by this tragedy should be supported by a fair and transparent scheme that focuses on their welfare and long-term independence. With this additional funding and scheme reform, the support provided to those affected by the infected blood tragedy will be greater and fairer than ever before.

A copy of the full consultation and the related equality analysis can be found on gov.uk using the following link: https://www.gov.uk/government/consultations/ infected-blood-support-special-category-mechanism.

[HCWS142]

Autism Diagnosis

Jackie Doyle-Price Excerpts

Wednesday 13th September 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship this morning, Mr Howarth. Thank you for giving so many Members the opportunity to speak, because the debate has been extremely valuable. I congratulate the hon. Member for Enfield, Southgate (Bambos Charalambous) on securing it. The discussion was highly informed and showed how important Members consider the issue to be. That is to be celebrated, given the 2009 starting point that my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) mentioned.

There have been significant advances in the treatment of people with autism, notwithstanding the serious issues raised today. I will not pretend that things are as they should be, because clearly they are not. Our ambition is for people to receive a timely autism diagnosis, but the cases that hon. Members have raised today make it clear that the standards that families deserve, and that they have a right to expect, are not being met. All Members who said that we need to do more are right. I give the House an assurance that I am determined about our need to do better.

I look forward to cross-party work with the all-party parliamentary group, and to the review of where we have reached since the Autism Act 2009. I welcome the input of all Members, because only by understanding the real-life experiences can we make everything work better. In Government we tend to work through such things as targets and processes, which ignore the fact that we are dealing with real people. When we are dealing with people who have conditions such as autism, the processes can leave them behind. It is down to all of us to be the conscience and to ensure that all our public services work better in this field. We do have a sense of urgency on this.

I want to deal with some of the common points that have been raised. Many Members wished to know when the autism data will be published. Our intention is that the data will start to be collected from next April, with a view to publication in 2019. That is hugely important, because it will enable us to see which local areas are doing the job and which are not. There is nothing like transparency to hold people to account and to ensure that we get the consistency and delivery of service so that nobody is left behind.

The Care Quality Commission and Ofsted are currently undertaking a five-year rolling programme of inspections, looking at how things are being implemented in local areas, how health services are working and how education authorities are dealing with education, health and care plans, which were mentioned in earlier contributions. We all know, and have witnessed, that so much is dependent on local leadership. If we can highlight good practice and where things are going well, as well as where things are not, we will be able to generate the pressure to increase performance across the board.

My right hon. Friend the Member for Chesham and Amersham mentioned mortality rates for people with autism. I know that the Minister for Disabled People, Health and Work, my hon. Friend the Member for Portsmouth North (Penny Mordaunt), shares my concern that people with autism and learning disabilities tend to get left behind when it comes to employment and access to health, which has an impact on mortality rates. She and I are very much prioritising that. I look forward to engaging with the all-party parliamentary group on those issues too, because we will have much to learn from its expertise.

The hon. Member for Worsley and Eccles South (Barbara Keeley) specifically asked whether we would commit to including autism in the primary care register. We have said that we expect GPs to do that and that we want to spread that good practice. We will be working with NHS Digital to do exactly that. Again, I am open to any suggestions in that space.

With regard to access to further services following a diagnosis, that is very much the space of local commissioners, but the inspections by the Care Quality Commission will enable us to hold local commissioners to account on exactly that.

[Alex Cunningham]

The Minister knows how frustrated parents are by the delay in getting an official diagnosis, but it is the knock-on effect on other assessments, such as education support plans, that really adds to their burden. Will she give any advice to local authorities and CCGs to look beyond the official diagnosis, to make some of those other things happen?

[Jackie Doyle-Price]

We very much send the message that parents of children with autism are entitled to good services and that is what they should expect. We need to spread that good practice and collect those data, in order to highlight exactly where it is not happening. When we look at the work that the Care Quality Commission has done to highlight good practice, we should be able to get some messages. We are looking for transparency to drive performance and to have those conversations. The NHS mandate for 2017-18 sets a priority for the NHS to reduce health inequalities for autistic people, so that is very much part of NHS England’s conversations with local CCGs.

[Siobhain McDonagh]

On that point, will the Minister refer to the issue of South West London and St George’s Mental Health NHS Trust and the five CCGs in south- west London?

--- Later in debate ---

[Jackie Doyle-Price]

I was just coming on to that. I have to say that I was very concerned by the issues that the hon. Lady raised. It occurs to me that there is a real risk that what they are suggesting could be seen as discriminatory. Certainly what she suggested should not be undertaken without real consultation with the local community and illumination of the issues concerned. She mentioned that she was going to write to me about that, so I look forward to considering it with a bit more reflection and then coming back with a response.

[Mrs Gillan]

While the Minister is discussing correspondence, she may not have the answer to what, for me, is a crucial question—the detail of the self-assessment framework that is sent to the top-tier councils. She will remember me mentioning that we know that one local authority has a 125-week waiting time. I appreciate that she will not have the detail here, but will she undertake to write to me in the next week and let me know when she will publish that detail, so that we can all access the information?

[Jackie Doyle-Price]

There is a good argument for being very open about this generally. The self-assessment framework obviously requires local authorities to mark their own homework, and even then we are not seeing the increase in performance that we would like to see. One of my main messages is that we can all learn from good practice elsewhere, and bad practice can also be a learning experience. The more sunlight we can bring to what is happening, the better. I am happy to write to my right hon. Friend on that.

That brings me to the results of the most recent self-assessment exercise, which show that only 22% of local authorities are meeting the recommendation of a maximum three months between referral and first appointment for an assessment. That is obviously not good enough. On the plus side, a further 23% said that they anticipated meeting recommended waiting times by March this year and that they would be able to sustain that, but that is still only half. Although the direction of travel is positive, there is a lot more work to do.

[Norman Lamb]

The Minister may be coming on to this, but will the Government consider introducing a national maximum waiting time standard for diagnosis, rather than for first appointment, so that every child knows that they will get that within a specified time?

[Jackie Doyle-Price]

I fully appreciate the right hon. Gentleman’s point. I am slightly uncomfortable about this, because often it can take a considerable amount of time for a proper assessment between first appointment and diagnosis, but perhaps we need to look at other measures. Generally, the more data we have in this area, the better we can measure performance. Clearly we need to ensure that we have sufficient specialists who are able to undertake these assessments and diagnoses. Sometimes that can be a challenge, so we need to ensure that local commissioners have access to those specialists.

[Jonathan Reynolds]

Many of us are flexible about how we will get to the system we want to see, and capacity is definitely an issue when it comes to specialists. On the point just made by the former Minister, the right hon. Member for North Norfolk (Norman Lamb), the problem is that at an initial assessment people are told, “You don’t need to go and have the official diagnosis yet. Try to persevere in mainstream school. See how the child develops.” The problem, as other Members have said, is that in the early stages of life, each month of development is so important, and we get to a point where, frankly, even if a diagnosis is given, so much has already been lost. That is the purpose of a national maximum diagnosis waiting time.

[Jackie Doyle-Price]

I hear the hon. Gentleman’s point, but the wraparound support and care will do more than any finite target time. I am happy to look at that.

We are running short of time and I really need to give the hon. Member for Enfield, Southgate time to respond. We have had a very constructive discussion today, and I look forward to engaging with all hon. Members on these issues.

[Mr George Howarth (in the Chair)]

Before the hon. Gentleman responds, may I thank all Members who contributed today, and particularly those on the Front Benches? It was very difficult to get everybody in, but we managed it in the end—certainly all those who had applied to speak. I call Bambos Charalambous to respond.

Princess Royal Hospital Telford

Jackie Doyle-Price Excerpts

Tuesday 12th September 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship this morning, Mr Gray. It is also a great pleasure to respond to my hon. Friend the Member for Telford (Lucy Allan). She articulated the case on behalf of her constituents with considerable passion, and I will do my best to address some of the points she made.

My hon. Friend talked about the activities of the council with regard to this ongoing issue. I have to say, as the Conservative MP for Thurrock, which has a Labour council, that it all sounded very familiar. I am afraid that perpetrating fake news is in the DNA, and Labour does not like to have lost successive elections. I am sorry that she has had to tolerate that, but I am even more sorry that her constituents have had to.

When we discuss the future of our local health services, we want to take the community with us. Naturally our constituents get worried about change; they are always worried about the possible diminution of services. The only way we take the community with us is by having real dialogue, based on real proposals and real facts. The fact of the matter is that all the council is doing is engaging in speculation, and I personally find that deeply irresponsible. It is not the job of anybody involved in local leadership to foment fear, and I really do regret those actions. Sadly, I am afraid we cannot expect any better. I am really pleased that my hon. Friend has taken advantage of the opportunity today to make the case for her constituents and to highlight those issues. The way we will take people with us on any change in the health service is by mature discussion and reflection and by advocating on our constituents’ behalf.

[Daniel Kawczynski]

I would like to reiterate the point that my hon. Friend the Member for The Wrekin (Mark Pritchard) made. We all voted for the Bill to ensure that local communities were empowered to make these decisions. It is right and proper that local people at the coalface of providing these services are empowered to make the decisions to improve them and make them future-proof. However, in our case, it really has broken down. The most important thing the Minister can do is to work with her officials to ensure that changes are made when we cannot get an agreement in a locality, because, as my hon. Friend the Member for Telford (Lucy Allan) said, this has continued for four years, causing a great deal of concern and instability for the hospital trust.

[Jackie Doyle-Price]

I thank my hon. Friend for that intervention and will make two points in response. He is absolutely right; the whole purpose of how we structure the NHS now is that communities are empowered to make decisions. That is why it is all the more irresponsible for the council to be engaged in this speculation. The reality is that no decision will be taken on the future of services until the consultation has taken place and all those responses have been analysed. The community will have its say before any change, and anyone who suggests otherwise and is engaged in speculation really should not. Could my hon. Friend remind me of the second point he made?

[Daniel Kawczynski]

The point I wanted to make was that certain communities in the United Kingdom have come together, across parties and across the whole of the county. Northumberland, where this process has worked very well, is a case in point. Unfortunately, in areas such as ours, where a council is acting deliberately provocatively and from a political perspective, that has not come to fruition. I want the Minister to ensure that her Department takes that on board when planning for future ways to improve this process.

[Jackie Doyle-Price]

It is a matter for reflection that this has been going on for four years, which generates considerable uncertainty. Clearly we should reflect on that, to ensure that the process becomes more efficient. Equally, it takes time to have those debates. I know that the particular issues under consideration here are quite difficult to grapple with. The important thing is that the local NHS is seen to be leading the debate and not allowing anyone else to fill that vacuum when there are decisions to be taken.

My hon. Friend the Member for Telford invited me to make some comments. Obviously there are limits, but perhaps I could set out the process, so that we can put in context exactly where we are now. As I mentioned, all service changes will be based on the fact that they deliver real outcomes for patients and will be taken forward in consultation with the local community. Ultimately, the most important factor is that this is what is best for the health service in the area, driven by clinical leadership. Again, it really should be the local NHS leading this debate, and not local authorities filling the vacuum.

The issues that my hon. Friend raised affect not only her and my hon. Friends the Members for The Wrekin (Mark Pritchard) and for Shrewsbury and Atcham (Daniel Kawczynski), but also service users in Wales. As she alluded to, it has now been four years, so everyone knows that change is in the air. Until the vacuum is filled, there will continue to be uncertainty. I expect the CCG to bring forward a consultation, to have an open discussion as soon as it can. I urge everyone to participate fully in the consultation and I encourage my hon. Friend the Member for Telford to lead that debate. Where there are issues that she is concerned about, she should challenge the local NHS leadership, and where there are things that she welcomes, she should highlight them.

The proposed service changes should meet four key tests: they should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. Until those four criteria can be met, no decision can be taken.

[Mark Pritchard]

On the clinical evidence points, there was a so-called independent review, which the two clinical commissioning groups—Shropshire and Telford and Wrekin—and the NHS hospital trust commissioned. KPMG undertook that review. How independent it was and how knowledgeable KPMG, headquartered here in London, is of Shropshire’s health system is questionable, but I will just ask the Minister this. On clinical evidence, does she agree with me that if the demographics show that the younger part of Shropshire county is in Telford, it would not make sense to relocate the new—two-year-old—£30 million women and children’s unit from Telford to Shrewsbury, where there is an older, or elder, population?

[Jackie Doyle-Price]

Of course everybody wants to be able to access health services as close as possible to where they live, and my hon. Friend’s points about demographics are sensible. However, it is also important that we build critical centres of excellence. Where everything is together in one place, people can get better care. Wherever these services are ultimately located, there is a strong case for the children’s unit to be by strong A&E services, but obviously that needs to be tackled as part of the debate. My hon. Friend questions whether the KPMG study was objective. These are really serious questions that he should put to the local NHS leadership when we get into open consultation. I know he is looking for comfort from me, but I am not best placed to make the decision sitting in Whitehall.

[Mark Pritchard]

I am grateful to the Minister for giving way again; she is being very generous. Does she agree, though, in terms of transparency and openness and the fact that the public purse will have paid for the KPMG report, and given the seriousness of the issues, that that report should be published in full, in its entirety, for the public to see, in particular the Shropshire Star, which has done an excellent job in holding the local authority’s feet to the fire, to use one councillor’s term, on some of its most outrageous claims about this process?

[Jackie Doyle-Price]

It surprises me that the report is not in the public domain, according to what my hon. Friend has just said, if it is informing the approach that is being taken. I tend to take the view that sunlight is the best disinfectant, and if things are not done in an open and transparent way, the conditions are created for exactly the kind of speculation and scaremongering that we have been talking about. Having said that, I reiterate that the consultation has not yet started. It is very important that when the consultation does start, the CCG makes extremely clear the basis on which it is going forward with the proposals that it chooses.

I do not need to advise my hon. Friends of exactly what we are talking about. Clearly, they know more about their local healthcare situation than I do, and it is clear that local NHS leaders have to address significant challenges in bringing forward the entirety of their proposals as they affect the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford. I understand that they are 18 miles apart. In some areas of the country, that might not seem far at all, but when we are dealing with communities that have very separate identities, they could be oceans apart. That is another reason why we need to be very clear in our dialogue with those communities about why we are bringing forward the conclusions that we are.

Clearly, at a time when there is no money, things that it would be nice to have are not possible. It would be nice to duplicate services in both locations, but frankly that is not a luxury open to us at this stage in the economy, so where there is duplication of services, where we could bring them together and make a better service as a result, we should explore that. It is up to the local clinical leadership—there is a clear task and challenge for them—to demonstrate that whatever they bring forward will deliver better outcomes for patients. When it comes to winning over public hearts and minds, the public will not get away from the fact that services are being moved away from them. Automatically, there is a diminution of service in their mind, but bringing services together can often make a better service. We can see, with patient outcomes in particular circumstances, where that has been achieved. I therefore encourage the CCG to bring forward as much evidence as possible in making its case.

Of course, we all understand that whenever the consultation takes place, after four years of quite feverish speculation on some parts, people will be nervous. I encourage all my hon. Friends to continue this debate in public and with Ministers, so that we can reassure the public that we have their best interests and those of patients at heart with whatever decision is taken. As I have said, the more transparent and open the debate is, the better. Perhaps between them, my hon. Friends can lead the CCG to have those public discussions, away from the council, away from organised intimidation at public meetings, which will not lead to the best outcomes for patients at all. I have witnessed this myself. The left is very good at organising mobs at public meetings, but the last thing we want is for local clinical leaders to bring forward proposals in the best interests of serving the community and then be intimidated, by those who shout loudest, into changing their views because they are faced by a herd.

[Daniel Kawczynski]

This is a very important point for the Minister to perhaps share with the Department for Communities and Local Government and other Ministers. Of course councils have the right to challenge processes. Even though Telford Council’s leader and all his team are completely bereft of any medical credentials, they have the right to challenge, but we need to consider whether they have the right to use taxpayers’ money for political campaigns. I think that the Minister will be interested to see some of the literature that Telford Council has sent out and perhaps share it with her colleagues at the DCLG, to see whether we can do anything more to tighten up the rules on how councils spend their council money.

[Jackie Doyle-Price]

My hon. Friend makes an excellent point. Local authorities are all a function of who leads them, and some leaders are prepared to go further than others when it comes to engaging in debate. I also observe that there is currently an inquiry by the Committee on Standards in Public Life into abuse. Perhaps it could look beyond the abuse of parliamentary candidates and consider the kind of intimidation of clinical leaders at public meetings that my hon. Friend the Member for Telford has referred to, because this is all part of the space of public debate, and it is not helping our democracy that debates are taking place in unhelpfully fevered situations. We recognise of course that emotions will run high and that people will be passionate about the issue. We live in a mature democracy; we should be able to have our debates and discussions based on mutual respect and fact, but I am afraid, from things that my hon. Friend has described, that that has perhaps been missing.

In the short time I have left, I will just say that I hope the CCG brings forward its proposals as soon as possible, because the sooner the debate gets out in the public domain, the more informed it will be.

Question put and agreed to.

Infected Blood Inquiry

Jackie Doyle-Price Excerpts

Wednesday 6th September 2017 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

Following the announcement of the Government’s intention to hold an inquiry into infected blood on 11 July, I am writing to update the House on progress.

Bishop James Jones, former Chair of the Hillsborough Independent Panel and Chair of the Gosport Independent Panel, had a telephone meeting with the all-party parliamentary group on haemophilia and contaminated blood and a number of the campaign groups on 27 July. Following this meeting, the Bishop informed the Department of Health of the request to remove the 18 August deadline for views on the format and scope of the upcoming independent inquiry. The Government also heard this view from the correspondence we have received. It is important that the inquiry is informed by the views of the people who have been affected by contaminated blood.

The Government have therefore decided to extend the deadline to 18 October 2017, to ensure that we hear as many opinions as possible. The Government have written to the beneficiaries of the payment schemes directly to inform them of this change. We are grateful to those who have already sent their views; these will be taken into consideration.

We are also aware of the requests from some stakeholders to move the sponsorship of the inquiry to another Government Department. We can confirm that this is being considered as part of the consultation and that no decision has yet been taken on sponsorship.

The Government will provide a further update to the House after the consultation closes on 18 October.

[HCWS109]