Oral Answers to Questions

Kevin Foster Excerpts

Tuesday 23rd January 2024 Commons Chamber

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

As the hon. Lady will know, we are investing more in mental health services for young people in particular and, indeed, for those with eating disorders. We are seeing more young people more quickly than ever before, but if the hon. Lady wishes to raise a local issue with me, I shall be happy to meet her and discuss it.

[Kevin Foster (Torbay) (Con)]

The opening of a new block of operating theatres next month marks the latest investment in Torbay Hospital, but it is, of course, a prelude to the major rebuilding work. When does the Secretary of State plan to deliver the next update on the progress of that project?

[Hon. Members]

Hear, hear!

Hospice Funding: Devon

Kevin Foster Excerpts

Wednesday 17th January 2024 Commons Chamber

[Simon Jupp]

I thank the hon. Gentleman for his point. One of the points he raised with me earlier, when he told me he was going to intervene on me, was about fundraising, and that has been really difficult since covid for all sorts of reasons.

Across the rest of my part of Devon, Hospiscare runs hospices at High View Gardens in Exmouth and Searle House in Exeter, and it has run has fantastic clinical nurse specialist teams in Budleigh Salterton, Exmouth and further afield in neighbouring constituencies. Hospiscare is the biggest of the local charities, and it supports 2,500 people each year. However, these charities need dedicated teams and a lot of funding to support many thousands of patients.

Funding matters even more because we know that Devon’s population is ageing and growing. In Devon, there are proportionately more older people than the national average. More than 25% of the total population in the Devon County Council area is aged over 65, compared with less than one in five of the total England population, and 14% of these people are 85 and over. By 2040, Devon’s population aged between 65 and 84 is predicted to increase to 225,000, which is a 27% rise, and the 85-plus population will nearly double to 56,000. Hospices across our county are therefore playing an increasingly key role.

[Kevin Foster (Torbay) (Con)]

My hon. Friend is right to highlight the future challenges for hospices. Would he agree that plans such as those coming forward for Rowcroft Hospice in my own constituency to very much integrate and provide both nursing and sheltered accommodation, alongside the hospice services they will continue to provide, show a way to generate additional income, while not conflicting with their core purpose?

[Simon Jupp]

I completely agree with my hon. Friend. These services are dynamic and they are working, and the people of Torbay are well served.

I was reminded of the increasing importance of hospices by Dr Timothy Dudgeon, a constituent of mine from Ottery St Mary. He first approached me two years ago, and we met at one of my regular surgeries in Exmouth shortly afterwards. His plea was simple: Hospiscare, one of the charities I have mentioned, needs fairer funding from the NHS in Devon to cope with growing demand. I fully agree with him, but here we are two years later because the NHS simply is not listening.

I have raised the matter through meetings, letters and everything else to the NHS Devon integrated care board, and I am taking my call to the Floor of this House because I want the chair of the ICB, Dr Sarah Wollaston, formerly of this place, to realise that I am not letting this unfair deal for Devon’s hospices go without challenge. The issue here is obvious to all, and the solution is simply common sense, which is something we ought to try a little more often.

Hospices across our country and county are facing a perfect storm: income from fundraising is falling while costs and demand for their services are rising. Hospiscare in Devon has told me that it is facing a £2.5 million deficit in the next financial year. Meanwhile, Sidmouth Hospice at Home has told me that its average case load has risen by over 50% in the last year alone. Amid this perfect storm, I have been calling on the NHS Devon ICB to increase its funding for all of our hospices.

ICBs are responsible for determining the level of funding for palliative and end-of-life care in their area. This is devolution, and I support it. The Government do not decide how funding is spent; local organisations should know their area best and where to send their money. However, I question the situation in Devon. If the ICB needs more money to achieve fairer hospice funding, I would bang down the door of any Minister to help them, if asked, but they have not asked, and we have faced a wall of silence.

That was, intriguingly, until a couple of hours ago, when I received a letter from the NHS Devon ICB. It is intriguing timing, do we not think, given that it did not reply to previous letters I sent last year? Now it has finally responded to one of my letters from November. The NHS Devon ICB says that it is

“working on plans to move towards more equitable NHS funding”,

starting in the next financial year. I am sure colleagues here will be pressing for more details about that.

The wall of silence we have all faced in Devon is why I have launched a campaign and a petition on my website to put pressure on the ICB to increase funding to our local hospices, which residents across my constituency of East Devon and beyond are supporting. I first raised this with NHS Devon ICB two years ago after I met with Dr Timothy Dudgeon. I really hope the Minister can support my message to the ICB and its chair Dr Sarah Wollaston. Our message is crystal clear: there needs to be a fairer deal. Hospiscare is funded for 18% of its costs from NHS Devon ICB compared with the national average of 37% from ICBs across England. Sidmouth Hospice at Home receives no funding from the NHS in Devon at all, and that puts it in a small minority in the country receiving no money from a local NHS body. That simply cannot be right.

Hospice Services: South Devon

Kevin Foster Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster (Torbay) (Con)]

I beg to move,

That this House has considered support for hospice services in south Devon.

It is a genuine pleasure to serve under your chairmanship, Mr Sharma. It is probably worth saying in my introduction why I brought forward this debate. At its root is a subject we often do not want to talk about: the end of life, and death. It can be uncomfortable; there may be people listening to this debate who are facing a difficult illness, whose prognosis is uncertain, or for whom discussion of hospice services brings up memories of the loss of a loved one. This is never a subject we can discuss without doing this, and this effect includes me.

My mother, Linda, passed away in St Luke’s Hospice in Plymouth back in January 2014. This week would have seen my parents mark their golden wedding anniversary. My step-daughter, Anne, was also supported by both a hospice and NHS palliative care services prior to her death. These experiences are why I want to be sure hospice services will be there when they are needed, at what will be the most difficult time in anyone’s life, ensuring that not only the patient is supported, but their whole family is, too.

Debate on hospice services in south Devon must start with mention of the services provided by Rowcroft Hospice in Torquay. Established on 4 May 1982 and located in 23 acres of beautiful gardens, it delivers specialist palliative care, free of charge, to more than 2,500 adult patients each year, across 300 square miles of Torbay and south Devon. It does this 24/7, 365 days a year, with a clinical and professional staff supported by a small army of volunteers who give their time simply with the aim of helping others in need. The hospice is also innovative in its approach to supporting our whole community, having recently launched a new project to support homeless communities across south Devon. Funded by the Masonic Charitable Foundation, the project is a collaborative initiative working in partnership with other charities and organisations that support homeless people in the region, with the goal of improving access to end of life care and palliative care for them.

A debate on hospice services in south Devon should also include a mention of the vital support provided by Children’s Hospice South West, one of the largest children’s hospice organisations in the UK, which provides vital support to children with life-limiting diseases across the whole of the south-west peninsula. The charity, which Eddie Farwell and his late wife founded in 1991, offers care and support to around 600 children from their three hospices located in north Devon, north Somerset and Cornwall. They are currently supporting 29 children from Torquay postcodes, and a further 63 from the EX and PL postcodes, which cover south Devon.

[Anthony Mangnall (Totnes) (Con)]

I thank my hon. Friend not only for calling this debate but for his wise speech on an important subject that is often not talked about out in the public. I commend him for his reference to Rowcroft Hospice and the services that are provided across the south-west. He may intend to do so, but I encourage him to ensure that a collaborative approach is also supported by Government funding, and that we can bring Ministers down to see what is going on in the south-west and how our services are actually leading the charge in the UK in terms of high-quality hospice care and supporting those most in need.

[Kevin Foster]

I always welcome an intervention from my hon. Friend, who is absolutely right that we are seeing leading work. He will be unsurprised to hear that later in my speech I will refer to some of that and invite the Minister to see for herself what is being done.

Hospice services provide vital support to those with life-limiting conditions, but they do face challenges themselves. In terms of their income, a Hospice UK survey in March 2023 revealed that 96% of hospices were budgeting for a deficit. While some of this confirms planning based on the likelihood of receiving bequests from wills, which for obvious reasons cannot be specifically predicted, it reflects the way hospices must continually look for support to maintain their services. There is also strong regional variation in the percentage of statutory funding; to be clear, this is a balance between NHS funding, contract funding and the fundraising income they receive. The variation in the percentage of support provided through statutory funding is significant: for example, in London this accounts for an average of 43% of funding, whereas in the south-west it accounts for just 24%—the lowest overall percentage rate, which it shares with south central and Wales.

The range of statutory funding percentages for individual hospices is worth noting, with 23 getting over 50%, while 85 get less than 32% of their funds from statutory sources. I accept that fundraising abilities vary depending on the community and the type of services, as well as the type of services being contracted, but these figures are very stark in their difference.

[Peter Gibson (Darlington) (Con)]

I congratulate my hon. Friend on securing this important debate. As the co-chair of the all-party parliamentary group on hospice and end of life care, the opportunity to highlight the wonderful work that our hospices do is really incredible; we should all take the opportunity to do that.

My hon. Friend mentioned the challenges about funding from statutory sources. I wonder whether he agrees with me that, now that we have the statutory obligation to commission palliative care in the Health and Social Care Act 2012, our integrated care boards need to step up to the plate and properly commission these services universally across the country, ending the postcode lottery.

[Kevin Foster]

I thank my hon. Friend for his intervention and for the work that he does as the chair of the APPG. I could not have put it better myself; he is absolutely right that there can be postcode lottery. Also, the variations are quite significant; I accept that some areas may have different types of services and some may have a greater ability to fundraise, but we should certainly seek a level of consistency across the country, to ensure that people have access to that service when they need it.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. Hospice care is important for us all, but I want to note Horizon House in Belfast, which is a children’s in-patient unit. It is the only service of its kind in Northern Ireland. There are 10 cots and beds available in Horizon House, but it does not have funding for clinical care. Does the hon. Member recognise, as I do, that it is not just about the clinical funding that comes in, but the voluntary and charitable work that volunteers do to make it happen?

[Kevin Foster]

I must say that that is slightly far away from south Devon, but the hon. Member for Strangford (Jim Shannon) always manages to find a relevant point in his interventions. The nub of his point is rightly received, although he will, of course, recognise that there is devolution of healthcare responsibilities to Northern Ireland, which makes that slightly different from the responsibilities of the Minister who is here today.

Like other public services, businesses and community organisations, hospices have faced increase costs. For example, Rowcroft Hospice outlined to me that the cost pressures that they face include a 30% increase in total staff costs and a 52% increase in utilities bills, and yet NHS funding—what they receive for contracts—has only increased by 8% in five years.

Alongside these pressures, demand is growing. We should never talk about what I am about to say as if it were a problem: more people are living longer, in good health, well into their 70s, 80s and even 90s. That is the biggest and most positive achievement of modern science, healthcare and public health measures implemented since 1948. It is not a problem, which is how we sometimes talk about it. Many conditions that once cut lives short can now be cured or no longer circulate, yet there remain conditions that are likely to affect us later in life that will require palliative care. According to major study published by BMC Medicine in 2017, if age and sex-specific proportions relating to palliative care remain the same as in 2014, the number of people requiring palliative care will grow by 25% from just over 375,000 to just over 469,000 by 2040, but if the upward trend observed between 2006 and 2014 continues, it will increase by 41.2%, with the biggest drivers being conditions such as dementia and cancer. In south Devon, those estimates would see the demands on Rowcroft Hospice grow from 2,500 patients per year now to over 3,500 by 2040. The pressures outlined above apply not only to those working with adults, but also to children’s hospices where funding from local integrated care boards can be patchy—it actually fell on average between 2021-22 and 2022-23.

I note that the Department for Health and Social Care and NHS England have provided vital centrally distributed ring-fenced grants to children’s hospices since 2007. As the Minister will be aware, NHS England initially indicated to hospices that 2023-24 would be the final year of that grant, but I am pleased to note that, after a campaign by the group Together for Short Lives, it has been confirmed that NHS England will be renewing £25 million of funding for children’s hospices in 2024-25. That is excellent news, but I note that it has not yet been confirmed how children’s hospices will receive that funding or how much each of them will receive. I am sure the Minister does not need reminding of the potential impact on vital services if such funding is not available in future. Initial indications from hospices are that they will see a range of services reduced.

It is easy to outline problems in any debate, but there are also great opportunities to provide solutions, the greatest of which could help transform our view of the role of hospice care in south Devon. The Ella’s Gardens project is a transformative vision of what high-quality palliative, nursing and residential care should look like in the middle of this century. At its centre is the construction of a new in-patient unit and the remodelling of the existing hospice building to provide the very best specialist palliative care for generations to come. The proposal is to enhance hospice care for patients and their families by increasing the number of single beds from the current two to 14 to further support the local population and help to meet future demand for specialist palliative care, giving hospice patients and their families even greater independence and choice during those vital moments together. It also aims to enhance the level of care to ensure that patients’ physical, emotional, social, psychological and spiritual needs are being met, while enabling family and friends to stay overnight to be near loved ones.

Rowcroft’s vision is also to build greater financial resilience by reducing the reliance on current income streams such as retail and fundraising. A core part of that is the creation of a 60-bed, purpose-built specialist dementia and complex care nursing home, designed on the leading model of dementia care—I hope I pronounce this correctly—called the Hogeweyk, with six households of 10 residents. Alongside that is a 40-bed assisted living complex, with a proposal that would enable Rowcroft to meet the wider care needs of the local community, as well as providing an invaluable income stream to support the hospice’s ambitions.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the hon. Member for securing the debate. I wish him condolences for his mother and stepdaughter. He talks about physical space. Seaton Hospice at Home currently works out of the Seaton and District Hospital League of Friends, and relies on that physical space. I know that at Rowcroft, four out of five patients are treated at home. Does he agree with me that palliative care nurses, after working with patients, need somewhere to come back together and operate as a team?

[Kevin Foster]

The hon. Gentleman makes an important point in highlighting hospice at home. The service is growing because many people do not want to be in a hospice or a hospital, and if given the choice, they would rather pass away at home surrounded by their loved ones. My stepdaughter was supported to do that. It is quite an experience when it happens, but it was what she wanted.

The hon. Gentleman is right to say that there is a need for those groups to have the type of facilities they require and be supported in that. I accept that, given the sheer area that some hospices cover for that service, they may have to have some form of remote working arrangement for most of the day, but certainly, I see how Rowcroft provides that facility and it works well. There is that balance of the hospice for those who need it and are at that stage in their treatment and care, and the hospice at home to try to give people the choice they deserve at the end of their lives.

The plans have been developed in a way that allows residents to live in a caring, nurturing and vibrant home that supports as much independence, mobility and inclusion as possible. The Ella’s Gardens vision is not just one for patients and families, but one of being a hospice that is part of the community. Rowcroft’s large gardens are open to the public and are a popular community facility. There is never a sense of hiding away or being something that people only talk about when affected by it. The plans therefore include community facilities, a village hall and a day nursery. That creates opportunities for recreational activities and intergenerational connections, effectively making it a facility for the whole community with a unique side to it, and not just a hospice that people only attend if they need to be with a loved one.

Unsurprisingly, the plans have been widely acclaimed across our bay and have already received planning permission from Torbay Council. They could be under way in just over 18 months, providing support to our wider healthcare services, from a formal commission agreement with the integrated care service. The Minister will be pleased to hear that this is not a direct pitch for Government capital funding, although obviously if there were funding available, it would certainly help. That said, I would be delighted to welcome the Minister to Torquay so she can see at first hand the transformation the project will bring, not just to hospice and palliative care but to the future for that kind of care. A future that is about being not just part of the health and care system but at the heart of our community’s life, as well as being there when needed at a time when a loved one is passing away. I hope the Government will see it as a model for the future and one they want to get behind.

Given what I have already outlined, I would appreciate hearing the Minister’s responses to some specific points. As a matter of urgency, will she confirm how much of the £25 million children’s hospice grant each children’s hospice will receive in 2024-25, when they will receive it and how?

What assessment have Ministers made of the impact of integrated care board funding on children’s hospice care, and the risks of withdrawing the ringfenced grant? These services will work across regions; to ensure a more planned approach, will the Government direct ICBs to work with their neighbours on planning and funding children’s hospice and palliative care services?

More widely in the hospice sector, the variation in statutory funding between regions and hospices is stark. What thoughts have the Government had on ensuring a more consistent approach? Some hospice costs, including NHS pay rates, are decided by the Government. Would the Minister consider implementing a funding formula that would allow cost increases that are out of the hospice’s control to be reflected in local service contracts? Given the increase in costs this year, could the Government supply a simple fixed amount per hospice that forecasts a deficit? How do the Government see the future needs of palliative care being met? I am not requesting that hospices be publicly funded; the charity model offers many advantages and flexibilities. However, hospices must have predictability when planning for the future.

There is much more that I could say about the opportunities, challenges and pressures on hospices in South Devon, but I should draw my remarks to a close to allow the Minister adequate time to respond and perhaps take interventions. For families across South Devon, Rowcroft Hospice is a service that is not just valued, but treasured. It is a place where memories are made, conversations had that bring peace after a dispute that now seems petty, family events are held, news is shared and smiles may be raised, even as the end nears. In short, a hospice is a place where life is added to days, when days can no longer be added to life. We need to ensure that Rowcroft continues to be such a place for decades to come.

[Mr Virendra Sharma (in the Chair)]

Before I ask the Minister to respond, I point out that there might soon be votes in the Chamber. There will be multiple votes in the next debate.

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank my hon. Friend the Member for Torbay (Kevin Foster) for securing this debate about hospice care in South Devon. Like many of us, he has personal experience of the wonderful work of hospices. He spoke of his mother Linda and his step-daughter. I remember my grandmother being cared for in a hospice that was also in the south-west, just outside Yeovil. It made such a huge difference to the end of her life, not only for her but for family members like me. I remember going to visit her there. Whether the care is given in the hospice or at home, hospices are so important to our constituents.

Even though the debate was short, we had contributions from other Members, including my hon. Friend the Member for Totnes (Anthony Mangnall). He asked that Ministers come to the south-west to see hospice care for ourselves. Perhaps slightly ironically, today I was meant to be visiting a hospital in Devon, but instead I am responding to this debate. I will reschedule the visit, and will see what more I can do in the area at the same time. We also heard from my hon. Friend the Member for Darlington (Peter Gibson), who is chair of the all-party parliamentary group on hospice and end-of-life care. He does important work lobbying on behalf of the sector in that role. He spoke of the importance of ICBs effectively commissioning end-of-life and palliative care services.

It was wonderful to hear from the hon. Member for Strangford (Jim Shannon); it would not be a Westminster Hall debate without a contribution from him. He spoke of the importance of the work of fundraisers and volunteers in hospices. That clearly applies in Northern Ireland, but it is also important in England. The hon. Member for Tiverton and Honiton (Richard Foord) referred to hospice care at home, and made the point that although the traditional hospice model involves people being cared for in a hospice building, a significant and increasing proportion of what hospices do involves caring for people in their home.

Taking a step back from the situation in south Devon, thousands of people across the country are receiving palliative and end-of-life care at the moment. We have an ageing population, and many people live with complex health conditions. Around 600,000 people die every year in the UK, so it is a demographic fact that the number of people who will need palliative and end-of-life care is likely to increase in the years ahead. That care is so important; care during the hardest times makes an unquantifiable difference. As my hon. Friend the Member for Torbay said, it is not necessarily about extra days of life, but adding life to the days. It can make what seems to be unbearable somehow bearable, and it makes a difference not only for the individual being cared for, but for all those around them.

The majority of palliative and end-of-life care is provided by NHS staff and services, but hospices are an important part of our end-of-life and palliative care system; they support over 300,000 people with life-limiting conditions each year, in addition to providing bereavement support. As hon. Members have said, hospices are independent, charitable organisations that generally receive funding not only from statutory sources but, substantially, from communities and charitable donations. That range of funding, and the important role that hospices play in communities, are real strengths. As a Minister with hospices in my portfolio, I strongly support that, and want hospices to continue to play that important role, which gives them such strong local support.

In south Devon, the services reflect the national picture: there are significant NHS palliative and end-of-life services, including a specialist NHS team, community nursing care and a Marie Curie night care service. There is also Rowcroft hospice, which my hon. Friend the Member for Torbay mentioned. Given that my portfolio includes the oversight of dementia care, I was interested to hear about the hospice’s ambitions to develop its services further into dementia care; that sounds like a truly exciting proposal. Department of Health and Social Care officials are due to visit Rowcroft in the coming weeks to find out more, so I look forward to hearing from them. My hon. Friend also invited me down to see it for myself.

My hon. Friend mentioned the role of integrated care boards, which are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local population. In the Health and Care Act 2022, palliative care services were added to the list of services that an ICB must commission to ensure a more consistent national approach, and to support commissioners in prioritising palliative and end-of-life care. Back in July 2022, NHS England published statutory guidance on palliative and end-of-life care to support commissioners with that duty. The guidance refers to the need to ensure sufficient provision of specialist palliative care services and hospice beds, and to ensure future financial sustainability.

On financial sustainability, I acknowledge that, as my hon. Friend mentioned, hospices contend with significant financial pressures, including rising energy costs. Charities, including hospices, have already benefited from the energy bills discount scheme. Furthermore, hospices may be entitled to a reduction in VAT from 20% to 5%, and to exclusion from the main rate of the climate change levy on the energy that they use for non-business purposes, should they meet the scheme criteria.

On the question about the funding for pay uplifts for staff on “Agenda for Change” contracts, as my hon. Friend will know, his hospices are independent, charitable organisations that employ their staff themselves. They have the freedom to set salary rates and other terms and conditions at a level that reflects the skills and experience of their staff. Given the difficult economic context, the Government are providing additional funding on this occasion to support one-off payments to eligible staff employed by non-NHS organisations, where those organisations employ their staff on dynamically linked “Agenda for Change” contracts. Details for hospices that believe themselves to be eligible for that scheme are outlined in guidance published this week by NHS England. I encourage hospices in the south-west—and in fact around the country—to consider whether they are eligible, and to apply for the scheme if they are.

[Kevin Foster]

Will the Minister give may?

[Helen Whately]

I am happy to, although I am also watching the clock.

[Kevin Foster]

I will keep it fairly brief. I welcome some of the comments made. It is worth remembering that while the hospices are independent, paying a nurse or qualified medical personnel less than the NHS would is clearly not going to work. Rowcroft is one of the best sponsors of skilled worker visas, but of course, as the Minister will know, it is obliged to pay the equivalent of the NHS rate if it recruits internationally via that route.

[Helen Whately]

I cannot say, as I stand here, whether Rowcroft would be eligible for the support that I mentioned, but I would encourage it and others to look at whether that route would help it to address the point raised by my hon. Friend.

My hon. Friend spoke about hospice care for children and young people. NHS England recognises the importance of quality palliative and end-of-life care for children and young people; it has already confirmed that the £25 million children’s hospice grant is being renewed for 2024-25. I can assure him that NHS England will communicate details of that funding allocation in the coming weeks; that is far as I can go on that point. I cannot comment on the future of the children’s hospice grant beyond that financial year, but I can pick up briefly on my hon. Friend’s broader question about the future of palliative care. We recognise that demand for it is expected to grow. I reiterate the point about ICBs’ responsibility to plan to meet the needs for the local population’s palliative and end-of-life care.

At the national level, our NHS long-term workforce plan sets out how we will ensure that we have the necessary healthcare workforce for the future. For the first time ever, it looks 15 years ahead. It also recognises that we will need an increasing number of staff in community settings, providing people with care out of hospital and helping people with long-term conditions to live more healthily and independently. The plan recognises that people want to live in their own homes for as long as possible, and we know that many people would much rather die in their home as well.

To sum up, as I watch the clock, I fully agree with my hon. Friend on the important role of hospices in our community in palliative and end-of-life care. I can assure him and other hon. Members that I will continue to work closely with NHS England to ensure that ICBs deliver on their responsibility to commission palliative and end-of-life care in every area of the country. I thank my hon. Friend for his invitation to see the hospice care in his constituency for myself. As I will be rescheduling my Devon visit, I will do my very best to see if I can come his way.

Question put and agreed to

Hospice Services: Support

Kevin Foster Excerpts

Wednesday 14th June 2023 Westminster Hall

[Kevin Foster (Torbay) (Con)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I congratulate my hon. Friend the Member for Eastleigh (Paul Holmes) on securing this debate.

Like many Members in this debate, I have seen at first hand what it means to be supported by hospice services. Back in January 2014, my mother Linda was entering the final stages of her battle with bowel cancer when she was cared for by St Luke’s Hospice Plymouth. The staff there helped create some very special memories, which made her passing easier for all of us, especially my mum. Similarly, the support for my family from the local hospice and palliative care teams in Tameside two years ago as my stepdaughter Anne approached the end was significant to us all.

Colleagues have expressed and described the challenges facing the sector, but I also want to add a note of optimism to the debate. Rowcroft Hospice in Torquay marked its 40th anniversary last year not just by looking back over those 40 years, but by firmly looking to the future, unveiling a multimillion-pound investment and development programme that includes a new 60-bed specialist nursing home centred around a village green. A village hall, restaurant and allotments would also be part of the development, as well as a children’s nursery and estate workshop. The plans are very welcome, as they will be a boost not only for Rowcroft but for Torbay’s entire health and social care sector, with the hospice facility at its centre.

I am conscious that time is limited, but I have a couple of specific points on which I want to hear the Minister’s thoughts. First, even though it is clear that the hospice movement does not wish to become a fully publicly funded healthcare service, what further options may be provided for support with some of the costs they face? Secondly, what support will be provided to hospices that are looking to expand their services and develop new integrated care offerings, as Rowcroft Hospice seeks to do?

Hospices are a unique place where life is added to days when days can no longer be added to life. They provide a service not just to in-patients, but to a whole community. I hope we can support them to continue doing so.

NHS Dentists: South-West England

Kevin Foster Excerpts

Wednesday 24th May 2023 Westminster Hall

[Kevin Foster (Torbay) (Con)]

It is a pleasure to serve under your chairmanship, Ms Elliot. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate on a vital issue for our region.

The issues with getting a new NHS dentist in the south-west are, sadly, all too well known. I have regularly been contacted by constituents who, when their current NHS dentist has retired, or in one case converted to a fully private practice, are unable to find a new practice accepting NHS patients. Last night, when I checked the NHS website for Torquay, there were no practices listed as accepting new NHS patients. Although many were listed as not having recently given an update, their position is easy to work out from the feedback I receive. As has already been set out, the issue is not limited to Torbay.

For me, there are two key areas of focus for tackling this issue: ensuring that more of the existing dental workforce and practices offer NHS services, including by accepting new patients for registration; and expanding the future dental capacity in the south-west through training and recruitment. On the first point, the key will be to ensure that contract arrangements are attractive and provide a viable proposition to those who will provide the services.

I am aware that NHS England is holding further discussions with the British Dental Association and other stakeholders for contract reforms that are planned to take place this year. The Government talk about aiming to reduce barriers to patients trying to access dentists by changing the arrangements for treatments such as root canals, improving patient communication and recruiting overseas dentists—although we should not always assume there is a pot of skilled labour available over an immigration bridge—so it would be good to hear more about the progress being made. Where it is not possible in some areas to secure new contracts with providers, will the Government consider looking at more direct provision? We simply cannot allow deserts of treatment to exist.

On expanding future capacity, the Association of Dental Groups has said that the key to easing the burden of the unmet need for dental services is simply going to be more dentists, which includes creating more training spaces. I am aware that in England the Government fund the training of around 800 dental students per year. In the past, the Government have said that places are capped to ensure that teaching, learning and assessment standards are maintained, as well as to ensure that there are enough high-quality placements for each student.

It is clear that the current level of supply is not going to meet future demand. There does, though, appear to be more capacity for training. In 2020, the cap on the number of dentistry school places in England was lifted, to accommodate the higher number of students meeting their university offers following changes to exam arrangements prompted by the covid-19 pandemic. Similarly, in 2021 the cap was adjusted again. That suggests that capacity is available.

In 2022, the Dental Schools Council called for an increase in the number of dental school places. The DSC presented three proposals agreed by the deans of UK dental schools to safeguard dental training and secure and improve the supply of future dentists by increasing dental school places. Again, that suggests that there is capacity to expand good-quality training here in the UK, ideally in the south-west.

[John Penrose (Weston-super-Mare) (Con)]

Does my hon. Friend agree that it is essential that dentistry, along with other medical disciplines, is included in the upcoming NHS staffing plan, which we all hope will involve a substantial increase in the number of people being trained at all grades of medical discipline, including dentistry?

[Kevin Foster]

Yes.

I look forward to the Minister’s response, and have two specific questions for him, in addition to those already raised. First, what progress is being made with renegotiating the contract, and what results is he expecting to see in the south-west this year from those renegotiations in terms of the increased accessibility of NHS dental services? Secondly, what plans does he have to create additional training spaces in the south-west, given that we know that where people train is where they are likely to stay and practise?

For too many in the south-west, NHS dentistry has become a service that is difficult to access and hard to register for. I hope that in his response the Minister will set out clearly the action we will see to get more dental practices to provide NHS services, and more dentists providing NHS services across the south-west region.

Oral Answers

Kevin Foster Excerpts

Tuesday 25th April 2023 Commons Chamber

[Neil O’Brien]

I am happy to work with the Scottish and Welsh Governments. We are, as I said, driving up levels of delivery, and we will be publishing a plan to take that further.

[Kevin Foster (Torbay) (Con)]

Like other colleagues, I have been approached by constituents who are struggling to find an NHS dentist because their previous dentist has either retired or converted to private practice. When the Minister presents his new dental plan, will it include a target to ensure registrations are available, as well as to increase the number of appointments?

[Neil O’Brien]

My hon. Friend is right, and I am particularly seized of the issue of access for new patients.

Urgent and Emergency Care Recovery Plan

Kevin Foster Excerpts

Monday 30th January 2023 Commons Chamber

[Kevin Foster (Torbay) (Con)]

The Secretary of State will be aware of Torbay’s demographics, particularly the growth in the number of people aged over 85. They are living a good long time but, at that age, they need some level of support from the NHS, which obviously creates demand and puts pressure on our systems. On the resources announced today, what engagement is he planning to have with local ICBs, particularly those that cover areas where the demographics mean that they are at the leading edge and driving innovation, but need support to do so?

[Steve Barclay]

My hon. Friend makes an important and nuanced point about demographic pressure, which is not evenly spread and is more concentrated in certain parts of the country than others, so the pressure on ICBs is greater in those areas. That is why the ministerial team met almost all the ICBs in a series of meetings with chairs and chief execs in the run-up to Christmas, and it is why we want to bring greater transparency, so that we can right-size solutions for emergency departments and ensure that those facilities keep pace with the increased demand.

Mental Capacity (Amendment) Bill [Lords]

Kevin Foster Excerpts

Ping Pong: House of Commons
Tuesday 2nd April 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend makes an incredibly important point. This issue has been a huge burden for local authorities: they have had to carry out multiple deprivation of liberty safeguards often for the same people and often when those people move from one setting to another. That involves a huge amount of bureaucracy and does not offer any better protection for the individuals concerned. The new service will enable local authorities to do this in a much more streamlined and efficient way. It will save them money and, at the same time, offer better protection for the individuals about whom we all care.

Lords amendment 1B was tabled by Baroness Tyler of Enfield to set out the meaning of a deprivation of liberty positively, rather than by using the exclusionary approach set out by the Government. Noble lords are, of course, absolutely right to want to ensure that any definition is understood by people and practitioners. However, a positive definition of a deprivation of liberty is likely to be subject to a legal challenge as article 5 case law evolves, and it would become unfit for purpose incredibly quickly. This is a view not only shared by the Government, but highlighted beautifully in the other place by the esteemed legal experts Lord Mackay and Lord Hope.

Lords amendment 1B does not link the definition of a deprivation of liberty to article 5 of the European convention on human rights, so creating a risk of the definition set out in statute diverging from the convention. This would mean that people who fall outside Parliament’s concept of deprivation of liberty but within the article 5 definition could not have their deprivation of liberty authorised under the Mental Capacity Act 2005. For those people, only the High Court would be available to authorise such a deprivation of liberty, which, in turn, would give rise to excessive delays in accessing vital safeguards.

That is precisely the situation that this piece of legislation looks to address—there are already too many people subject to delays when accessing safeguards, and we cannot introduce a provision that would further risk this.

Given that the Government have these concerns, we cannot agree with the noble lords in their amendment 1B. However, we know that concerns in the other place are reflected by many across the sector and we have taken that on board. We have listened carefully to the views of MPs, peers and other stakeholders and decided not to insist on amendment 1. Instead, I propose that the meaning of a deprivation of liberty will still be as defined under article 5 of the convention, as it is under section 64(5) of the Mental Capacity Act, but there will not be a clarification of the meaning of a deprivation of liberty in the Bill. The Bill will work alongside the rest of the Mental Capacity Act, so it does not impact on the existing definition.

I reassure the House that the Government are still absolutely committed to providing clarification regarding the meaning of a deprivation of liberty for both people and practitioners. We will use the code of practice to lay out in very clear terms and provide details of when a deprivation of liberty is and is not occurring, and this guidance will reflect existing case law. We will set out the meaning of a deprivation of liberty in a positive framing and in a way that is clearer for people and practitioners. We will also include case studies in the code to help bring this to life. Government amendment (a) in lieu of Lords amendment 1B will prescribe that the code of practice must contain guidance on what kind of arrangements amount to a deprivation of liberty.

[Kevin Foster (Torbay) (Con)]

I thank the Minister for giving way and I am reassured by what she says. It would not be appropriate, for example, to put case studies on the front of a piece of primary legislation. Will she outline the timescale for bringing that code of practice forward?

--- Later in debate ---

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I call Kevin Foster.

[Kevin Foster]

Thank you, Mr Deputy Speaker. It is a particular pleasure to called by you to speak in the Chamber. It is also a pleasure to speak in this debate to reflect briefly on a bit of the background as to why we need this Bill. Some 125,000 people are effectively subjected to this procedure but without the appropriate legal safeguards, so I welcome the fact that both Houses are now looking to support the Bill.

I welcome the Government amendments that have been tabled in lieu of the Lords amendments, and they take on their main thrust and spirit. As I touched on in my intervention on the Minister, it will be interesting to see the timescale for bringing in the code of practice. I accept that it needs to be done properly and be consulted on and that there must be appropriate case studies, but one of the reasons for supporting this Bill is to see that come forward relatively quickly so that there is certainty. Perhaps the Minister will put a letter in the Library that sets out the timescale.

I would not expect to hear a date picked out of the air and stated on the Floor of the House—that would be unreasonable and inappropriate—but it would be useful to get a sense of the timescale, because I assume that we are talking about months, not weeks or years. It would be inappropriate to include specific examples on the face of the Bill, but it is right that the amendments look towards the creation of a clear code of practice and review, providing the opportunity for the House to consider any reviews and hold Ministers to account, because this legislation relates to our most basic right: the right to choose where we live and what we do with our time.

--- Later in debate ---

[Barbara Keeley]

In the example I gave, residents who had lived in a care home for a long period had a manager who did not keep their care plans or any documentation, and they suffered terrible abuse. Such things do go on, and I am still concerned that we are giving responsibility to people who are already overstretched and may not be doing or may be unable to do a good job.

[Kevin Foster]

I accept the point. However, the hon. Lady’s example is not just about standards being ignored, because there was a raft of, bluntly, criminal behaviour and abuse. If we were having a longer debate about care homes and the regulatory system, we could look at whether having the Care Quality Commission cover such a wide range of areas is the best way of ensuring that such things do not happen, but Mr Deputy Speaker is always keen for us to stick to the topic of the debate.

The amendments relating to Lords amendment 1B are appropriate and slightly better than the original, and the amendments relating to Lords amendment 25A make eminent sense. It makes sense to record why something has not happened, because if there are concerns about the management of a care home, there should be a duty to record why something was not done, not just to review it. The management could in theory say, “I’ve reviewed it, but I didn’t record what I’ve concluded,” or try to come up with a conclusion later.

[James Morris (Halesowen and Rowley Regis) (Con)]

On recording things, one issue that arose when we were in Committee related to fluctuating conditions. For example, if somebody were subject to a DoLS, but then medical evidence demonstrated that they could be released from it, that makes it even more important to ensure that records are kept and that there is absolute clarity around the reasons for deprivation of liberty.

[Kevin Foster]

My hon. Friend makes a strong point. We should not just assume that once a DoLS is in place it will be there for life. For some people, it may apply during a particular period of treatment or time, and things will fluctuate for some people if they recover to a point at which a DoLS is no longer appropriate because they are able to make their own decisions. As he says, the appropriate records must be kept to ensure that that is properly reviewed and borne in mind, so that a decision cannot be made that someone should be subject to this forever. There should be a rolling review, to ensure that those in charge of caring for a person and those overseeing the care are satisfied that it is still the appropriate measure, given its impact on the person’s life.

I do not wish to prolong the debate, given that there is consensus across the House, which is welcome. The Bill will be better for having these substitute amendments, inspired by the Lords amendments, and on that basis, I hope the House will endorse them.

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to follow the hon. Member for Torbay (Kevin Foster), as I do on many occasions. I agree with what he said. First, I thank the Minister for her commitment, for our comprehensive discussions and for making herself available for each and every person who wished to have input into this process, and hopefully the changes that the Government want to see will be passed.

The Government have gone to some lengths to ensure that this Bill replaces and improves existing legislation surrounding the deprivation of liberty as a matter of pressing urgency. The current system is not fit for purpose—many people in this Chamber and outside it feel that—and this legislative change by the Government is what we want to see.

The Bill implements the Law Commission’s recommendations, introducing a new system for people who lack capacity and need to be confined for care and treatment, ensuring that the system protects vulnerable people, is person-centred and includes a strong role for carers and families. I have had a chat with the Minister about this, and the Bill will also ensure that supported people and their families are supported and included throughout the process. That is very positive.

The supported person will be afforded their rights throughout the process by an appropriate person. The appropriate person will normally be a family member. Carers and families will be given a stronger role, with an explicit duty to consult them and the supported person. As someone who cares, along with my mother and son and others, for my brother Keith, who was in a motorbike accident some 15 years ago, I know the importance of the carer’s role across the whole process.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Kevin Foster Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

It absolutely is my job to tell my constituents and the whole of the country the truth, and I did that yesterday in Committee and will do it again now. If the hon. Gentleman votes for the withdrawal agreement and it passes, the EHIC will remain in place, as I said yesterday. As I also said yesterday it has always been the Government’s advice that people should purchase travel insurance. None of that has changed and that is exactly what I said yesterday and it is exactly what I am saying today.

[Kevin Foster (Torbay) (Con)]

Does my hon. Friend agree that we need to be very clear that, with the EHIC, people will get treated as if they are a local; it is not the NHS on tour, so to speak, so we can still face some charges? Particular note should be taken of repatriation costs. If going abroad on something like a skiing holiday, people would be foolish not to take out full travel insurance.

[Stephen Hammond]

My hon. Friend is right. I made that point yesterday; I made it when I was speaking at the Dispatch Box on Report; and I am happy to make that commitment again today.

It must be our foremost priority to ensure that the Bill receives Royal Assent and is in place so that we can respond to different scenarios. We take this decision with regard for the people who currently rely on the EU reciprocal healthcare arrangements and, only with that in mind, we are choosing not to disagree with the Lords amendments.

--- Later in debate ---

[Kevin Foster]

It is a pleasure to be called to speak in this debate. I do not intend to detain the House long with my observations. I enjoyed the Minister’s introduction.

I welcome the Lords amendments, particularly the ones that change the thrust of the Bill to the EEA and Switzerland, but I hope that right hon. and hon. Members will bear in mind that, in the long run, the goal of having reciprocal healthcare arrangements with other nations is not a negative one in itself. I was disappointed yet again to hear from the right hon. Member for Carshalton and Wallington (Tom Brake) that this is all about opening up the NHS to the US health giants—it is not. It is about having reciprocal arrangements for visitors to other countries, including those on business and those who are travelling.

[Julie Cooper]

I made the point that, in future, there may be a place for such arrangements, but does the hon. Gentleman accept that time is so short, given the urgency of getting something in place to secure arrangements, that now is not the time for that?

[Kevin Foster]

I meant it more as a comment. I accept the Lords amendments. To be blunt, given the pressure of time and the need to get the Bill on the statute book to give people certainty about their healthcare arrangements, if these amendments achieve consensus with Opposition Front Benchers and the other place, I am more than happy to support them.

In relation to the remarks of the right hon. Member for Carshalton and Wallington, who sadly has not stayed for the rest of the debate, this is about making sure that people who go to hospital to access emergency care are not suddenly faced with a bill for the full cost as if they were completely uninsured.

We have arrangements with Australia and New Zealand that are not at the same level as we have with other EU countries, but they could potentially be developed. I do not want to see that aspiration lost, because we want our young people to have the opportunity to travel and work abroad where appropriate. In many countries, as the hon. Member for Central Ayrshire (Dr Whitford) rightly said, people who work will start earning rights under that country’s social insurance system, which would trump the Bill.

[Mr Dunne]

My hon. Friend is generous in giving way. In talking about other Commonwealth nations to which we would like to extend such arrangements, does he agree that the dominions of the Channel Islands, which do not currently have reciprocal status with the UK, should not be ignored and should be a matter of importance once the EU arrangements have been completed?

[Kevin Foster]

As always, I thank my right hon. Friend for his incisive intervention. The Channel Islands might use our currency and, in many ways, fly our flag, but people forget they have a very different constitutional status and are not part of the European Union. For some visitors, it can be a surprise that there is not a reciprocal agreement. There is a reciprocal arrangement with Gibraltar, for example, and it makes eminent sense to try to have such an arrangement between the UK and the Channel Islands, not least given the strong cultural links and the fact that many families split their time between the mainland and the islands.

Looking across the Commonwealth more widely, it might make sense to have arrangements with countries such as Canada and Jamaica in the long run, based on the fact that they have comparable systems of healthcare provision. That is perhaps where the oft-cited example of the United States starts to fall apart, because it is one of the handful of modern, developed countries that do not have a guaranteed system of universal healthcare free at the point of need rather than a system based on insurance schemes for which people may pay.

It is welcome to have ambition, and the Bill is clear about where we are going. I have no problems with the Lords amendments, which are welcome, and I am happy to support them. I am conscious that we are looking to move the debate forward, but I wanted to get those thoughts on the record.

[Dr Whitford]

Obviously, the Bill itself is quite small. It does not extend or protect continuing reciprocal healthcare rights; it is simply an enabling Bill that gives the Secretary of State powers to try to do that. It enables him to pay for overseas treatment in the EEA and Switzerland. We have heard how the Lords removed the powers to extend that worldwide and increase the scope, as well as limiting some of the Henry VIII powers.

The Bill will allow the Secretary of State and his team to negotiate healthcare agreements with the EEA and Switzerland as a group through the EU system or, failing that, to make bilateral agreements. Unfortunately, that would mean having bilateral agreements with 31 countries, which would inevitably be more complex, more bureaucratic and more expensive.

Clause 4 allows data exchange, which most Members would recognise is absolutely critical not just for collecting payments or swapping money, but for accessing medical health records if someone goes for treatment in another country. It is important that that will be handled only by an authorised person who is part of a statutory body—a public body.

I welcome the new clause in Lords amendment 11, which says that the devolved Governments must be consulted, because it is the three devolved Governments who deliver healthcare in Wales, Northern Ireland and Scotland. It is critical that they are involved in any agreements.

This legislation is needed whether there is a deal or no deal. As came out of the points of order exchange earlier, the withdrawal agreement would extend through the transition period, but we have all seen how the last three years have melted away like snow off a dyke. The next 20 months will also disappear, so legislation is required for the long-term protection of those who already live in Europe and want to stay there, particularly those who have been there only a few years and do not have five years-worth of residency rights in the country they have chosen to settle in. After the Bill is passed, it is therefore important that the Government hope to negotiate the continuation of reciprocal healthcare.

The problem is that reciprocal healthcare is not a free-standing thing on its own; it is there simply to enable freedom of movement. People cannot exercise their freedom of movement rights if they simply cannot afford healthcare where they choose to live, work, love, settle or retire. We have had the right over the past few decades to retire and settle anywhere. People are well aware of my husband’s situation as a German citizen who lives here and has spent virtually all his adult life working in our health system. That was certainly his first concern after the Brexit vote, and I am sure it is a concern for all 5 million people who have either settled here from Europe or settled in Europe from the UK.

The problem is that, as the Government reject freedom of movement and talk merely about a mobility framework, any reciprocal arrangement is likely to be proportional to that mobility framework, as is described in the impact assessment. The Government are not offering visas of over a year for unskilled workers. They are demanding that people be high skilled, possibly that they earn more than £30,000 a year and that they are economically active and are contributors. Will pensioners still be able to retire elsewhere, since they are not necessarily contributors in a major sense and are certainly not necessarily economically active?

People highlight the difference between what the UK has to pay into the European system and what we get back from Europe. A lot of that difference is quite simply because of the number of UK pensioners who choose to retire to sunnier climes—who can blame them?—and the general lack of obsession with retiring to the drizzle and moving in the other direction. Living in Scotland, I can vouch for that. Who would choose to leave the south of France and come to live in the mist, fog and drizzle? That is why the number of European pensioners retiring to the UK is considerably smaller than the number of UK pensioners who retire to the south of Spain and the south of France. That is simple logic.

Services for People with Autism

Kevin Foster Excerpts

Thursday 21st March 2019 Commons Chamber

[Kevin Foster (Torbay) (Con)]

It is always a pleasure to follow the hon. Member for Strangford (Jim Shannon) after a rare opportunity to hear him contribute to a debate. His contributions are always well thought out, passionate and well structured on behalf of his constituents. I definitely agree with him about the need at some point to get the Northern Ireland Assembly back up and running, doing its job again and tackling the issues that need to be tackled on behalf of Northern Ireland. Just ramming business through this place in a day is not what any of us really wants to see. We want to see the politicians who were elected to serve Northern Ireland doing so.

Let me come to the main substance of the debate. I pay tribute to my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) and to my hon. Friend the Member for Bexhill and Battle (Huw Merriman) not only for securing this debate, but for the passion that they bring to this issue. Obviously, our best wishes go to my right hon. Friend, who is facing a family situation.

This is an interesting debate. When I was about 12, I sat the Mensa IQ test and got a reasonable rating.

[Paula Sherriff (Dewsbury) (Lab)]

Division!

[Kevin Foster]

Yes, thank you—and I like the shadow Minister, too!

That was interesting, because at that rating you are not that far off the autism spectrum. A lot of people forget that the dividing line is not very big. Many people around that mark will show some traits. For example, if we go to a talk on this matter and find someone very interested in politics, when we ask them what party they support, they say, “I don’t really support a party, but I love analysing election nights, with all the statistics.” I asked such a person to reel off election results in the local area—I was in Coventry at the time on the city council, and they were absolutely able to do that, because that was their special interest. They were very passionately interested in politics, but when they were asked, “Which party are you thinking of joining with all this interest?”, the answer was, “Well, I’m not really into that. I’m into the analysis of politics.” That was their special interest.

This is about having a real understanding of autism. What started changing some of my perceptions about people with autism was when I had a volunteer activist who struggled slightly socially in certain scenarios. However, when we were carrying out—of all things—a telephone canvassing session with an automated dialling system, this guy was an absolute star. The rest of us were struggling. The rest of us were finding the whole process very difficult, but he absolutely engaged with it. It was pushing his mind to run slightly faster, and he had ability enough for the whole team. He was given a script, which enabled him to engage brilliantly with people on the phone. That was where his ability came through. In fact, what would normally be seen as a disability became a huge ability. That is why, as a Member of Parliament, I became very keen to challenge perceptions—for example, as has already been touched on in this debate, when someone is seen as naughty. We need to make it clear to employers that, when it comes to people with autism, it is about how they are supported when they enter employment.

I remember doing some work on this with a team when I was deputy leader of Coventry City Council. We looked at why people had left particular jobs—in programming or in engineering. Their skillset was there, their knowledge was there and their strengths were all in that area. What we found was that they were struggling with things such as the lunch room and the office environment—places where they had to interact with people. Everyone else assumes that such interaction is quite simple, but the perceptions of how these people would deal with them were different.

I welcome the fact that support is being provided, but I would be interested to hear from the Minister how much further we can go. We are talking not just about an employer doing a favour, but about an employer sometimes bringing in an absolutely unique talent who may be able to address a job in a way that, bluntly, most of us in this Chamber would struggle with. Sometimes the way an autistic mind works can become a massive advantage in engaging in areas such as IT and tech.

That all means that we need the appropriate levels of support. I do have some concerns over the pressure on higher needs funding in Torbay. I recognise that the Government recently provided some extra funding, but there has been an issue in Torbay. I do not think that we are unique in this, as some of the other smaller coastal unitaries face an issue with the deficit. Traditionally, their funding levels are lower than other areas, which makes it harder for them to deal with such issues. They are paired up with larger—bluntly, more wealthy—counties.

We also need to be clear that this issue is not just about learning, but about having fun. I welcome the fact that support services are available in the Bay. For example, the ASRUS Group meets at the YMCA in Dartmouth Road, Paignton. It is not just about providing education support, but about providing social support to build skills.

This has been a worthwhile debate. I have enjoyed sitting through most of it and listening to the contributions. It will be interesting to hear from both Front-Bench speakers what their thoughts are on this subject. Some people who have absolutely unique talents and some of the greatest minds on this planet may be just on the autistic spectrum, or only just below it. That is where we need to change our perception. It is not about someone with a disability, but about someone who may have a unique ability that we could unlock with the right support.