Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 10th June 2014 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

Everyone will be protected against catastrophic costs by the insurance the cap provides from April 2016, in line with the Dilnot commission’s recommendations. We are working through the detail of how it will operate in partnership with stakeholders. We will publish draft regulations and guidance for consultation towards the end of the year.

[Andrew Bridgen]

I thank the Minister for that statement. I have constituents who are very concerned about how they will continue to fund ongoing care costs in the interim period, when the proceeds of an asset or house sale have dissipated. What reassurance can my hon. Friend give my constituents?

[Norman Lamb]

I thank my hon. Friend for that question. Another reform that we are introducing is universal access to a deferred payment agreement for everyone who would otherwise be forced to sell their home to pay for care—something of which we should be very proud. That will be introduced in April 2015 and it will mean that no one has to sell their home during their lifetime to pay for their care.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

For the avoidance of doubt, will the Minister list the care costs that will not be included?

[Norman Lamb]

The amount that will count towards the clock running to reach the cap will be based on what the local authority determines will be the cost of meeting a person’s eligible care needs. That is exactly the model that Andrew Dilnot recommended, and we are implementing it as he recommended.

[Keith Vaz (Leicester East) (Lab)]

Last Thursday, the first ever care home diabetes audit was published. It showed a significant lack of support for the 37,000 people with diabetes who live in care homes. Will the Minister confirm that when a person in a care home has diabetes, there will be no lack of funding to help them?

[Norman Lamb]

I pay tribute to the right hon. Gentleman for his tireless campaigning on diabetes. He has played an essential role in ensuring that it is brought to public attention. It is critical that people who require care for diabetes get access to the care they need, whether they are living in a care home or in their own home.

[Mr John Baron (Basildon and Billericay) (Con)]

4. What assessment he has made of the role of the comprehensive delivery dashboard in holding clinical commissioning groups accountable for their one-year cancer survival rates.

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[Grahame M. Morris (Easington) (Lab)]

7. What discussions he has had with NHS England on the future of the cancer drugs fund.

[The Minister of State, Department of Health (Norman Lamb)]

We have committed to continuing the cancer drugs fund until the end of March 2016. We will consider carefully with NHS England how, in the longer term, we can support patients in accessing cancer drugs that could benefit them, at a cost that represents value to the NHS.

[Grahame M. Morris]

I thank the Minister for that answer, but is it not true that last year the cancer drugs fund was again underspent—funds that could be used to pay for advanced radio therapy? Every MP has received a letter from the England rugby legend Lawrence Dallaglio asking for a meeting to highlight this problem. Why is the Secretary of State refusing to meet Mr Dallaglio, along with top cancer clinicians in Cancer Research UK?

[Norman Lamb]

First, if only it was underspent. More than 50,000 patients have now benefited from the fund, which is fully spent. More than £1 billion will have been committed in the full period of the fund. I have confirmation from the Secretary of State that he has already met Lawrence Dallaglio. I hope that will reassure the hon. Gentleman.

[Jason McCartney (Colne Valley) (Con)]

8. What steps his Department is taking to improve access to and standards of dental care.

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[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

13. If he will bring forward proposals to widen the range of services and treatments available in community hospitals in rural areas.

[The Minister of State, Department of Health (Norman Lamb)]

Responsibility for the commissioning of local NHS services lies with clinical commissioning groups. Community hospitals have an important role in achieving more integrated care across health and social care services in rural areas by providing better out-of-hospital care, particularly for frail older people and those with long-term conditions.

[Sir Alan Beith]

A new community hospital is to be built in Berwick, which is 50 miles from major hospitals. Will it be free to offer a wider range of services, along the lines envisaged by the NHS chief executive in his recent comments?

[Norman Lamb]

I know that my right hon. Friend has been campaigning for that hospital. I welcomed the comments of the chief executive of NHS England, who has argued for a much more flexible and adaptable NHS, and for ensuring that GPs locally, working with community services, can offer the maximum range of health services to the local community as close to them as possible.

[Sir Edward Garnier (Harborough) (Con)]

Two and a half years ago, my right hon. Friend the Member for Chelmsford (Mr Burns), then Minister of State, opened the St Luke’s hospital day care unit in Market Harborough, which serves a large rural area in my constituency. During those two and a half years it has been open for only 131 days, which is a huge waste of public money. I wrote to the Secretary of State yesterday. He will not have had a chance to read my letter yet, but will my hon. Friend and his colleagues look into the matter, and ensure that we do not waste public money on opening hospitals that do not provide a service?

[Norman Lamb]

My hon. and learned Friend has raised an extremely important point. It is essential that the maximum possible use be made of investment. I know that the Secretary of State will look into this issue when he has received the letter, but we must ensure that all such facilities are properly used.

[Sir Edward Leigh (Gainsborough) (Con)]

14. What steps he plans to take to improve the provision of health services in the east midlands.

[The Minister of State, Department of Health (Norman Lamb)]

Decisions about local services should be made as close to patients as possible, by those who are best placed to work with patients and the public to understand their needs. Clinical commissioning groups commission the majority of health services, working with health and care professionals to design services for local populations.

[Sir Edward Leigh]

In large rural areas like Lincolnshire, the air ambulance can make the difference between life and death, particularly for car crashes where roads are blocked. What plans does the Minister have to strengthen the services of the East Midlands air ambulance service?

[Norman Lamb]

I will be very happy to discuss the issue with my hon. Friend, if he would like to do so. I pay tribute to the extraordinary work the air ambulance services undertake across our country. I have witnessed that in my own community and I would be very happy to talk further about what more can be done to strengthen the work they do.

[Heidi Alexander (Lewisham East) (Lab)]

15. What recent assessment he has made of the adequacy of child and adolescent mental health services.

[The Minister of State, Department of Health (Norman Lamb)]

We know that there is a varied picture of services across the country, where decisions on spend and allocation of resources are made by local commissioners. NHS England is preparing to publish a report based on its recent analysis of tier 4 child and adolescent mental health services, along with a service improvement plan. We expect these to be published in the coming weeks.

[Heidi Alexander]

A recent survey conducted by the Royal College of Psychiatrists found that over a quarter of trainee psychiatrists have had to send a child or young person more than 200 miles away from their family in order to access an appropriate bed. What is the Minister going to do about this totally unacceptable situation?

[Norman Lamb]

I agree, and that is why NHS England undertook the work to analyse exactly what the position is across the country. In fact it is very varied. There are some regions where it is fine, and others where it is not acceptable. I think we would all agree that it is completely unacceptable for children to be sent sometimes hundreds of miles away from home. When it publishes its report, it—[Interruption.] If the right hon. Member for Leigh (Andy Burnham) would just listen, when it publishes its report, it will be publishing an action plan of the steps it will take very soon to meet any shortfalls in provision.

[Dr Phillip Lee (Bracknell) (Con)]

Although I supported the Health and Social Care Bill at every stage, I have always harboured some concerns about the ability of GPs to commission mental health services. Mental health is a fast-growing problem and a challenge to the NHS for the future. What assurances can the Minister give me that GPs will receive the appropriate specialist guidance, if required?

[Norman Lamb]

I thank my hon. Friend for that question, and it is a legitimate one. A lot of work is being undertaken by NHS England and the national clinical director Geraldine Strathdee, a highly regarded individual, to strengthen the quality of commissioning of mental health services. It falls short in many areas at the moment and it is essential that it is improved.

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

Ministers say that they are committed to parity of esteem between mental and physical health, yet we have already learned from an NHS England report that three quarters of children with anxiety or a diagnosable depression are not receiving the treatment they need. This is plainly unacceptable. It would not happen to children presenting with a broken arm or asthma, so can the Minister please tell the House when he will translate his rhetoric into reality?

[Norman Lamb]

Absolutely, and we are doing it. One of the problems we are having to confront is that when the Labour Government introduced the 18-week waiting standard, unbelievably they left out mental health. When mental health is left out from a standard of that sort, that determines where the money goes, and ever since then mental health has lost out. We are committed to changing that.

[Mr John Baron (Basildon and Billericay) (Con)]

T1. If he will make a statement on his departmental responsibilities.

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[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

T6. The new specialist emergency hospital is nearly 60 miles from Berwick. Given the serious delays in ambulance attendance in recent cases in Northumbria, how can we be sure that serious cases will get paramedic attendance and delivery to the hospital within the critical hour?

[The Minister of State, Department of Health (Norman Lamb)]

My right hon. Friend is right to raise concern. The North East ambulance service has traditionally been a good performer, but any deterioration that has been identified needs to be addressed very speedily. I urge him to monitor this closely, and if he wants to talk about it further with me, I will be happy to do so.

[Mr Andy Slaughter (Hammersmith) (Lab)]

T10. Last October the Secretary of State said that Hammersmith accident and emergency would be closed when it was safe to do so. Imperial proposes to close it on 10 September, when on its own admission there is insufficient capacity at St Mary’s and it is not safe to do so. Will he keep his promise and ensure that Hammersmith A and E does not close, especially when there is not sufficient capacity in the system?

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[Sir Andrew Stunell (Hazel Grove) (LD)]

Stockport Mind reports that it takes on average 12 months to receive the first appointment for cognitive behavioural therapy after diagnosis. What action can be taken to improve that standard in Greater Manchester?

[Norman Lamb]

I mentioned earlier that when the last Labour Government introduced the 18-week waiting time standard they left out mental health. That is at the heart of the problem. We are committed to changing that and to introducing access standards in mental health, and we plan to start next year.

[Kerry McCarthy (Bristol East) (Lab)]

The Stitch project in Bristol has contacted me with concerns about the number of overdoses by people on prescription medication and suggested that allowing medication to be dispensed in instalments would be a better way of handling those vulnerable patients. I was disappointed in the response that I got from the Department, and I urge the Minister to think again on this issue.

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[Bill Esterson (Sefton Central) (Lab)]

The Minister said that he was dealing with the chronic shortage of staff who help vulnerable children and young people, who cannot get access to mental health services. Will he tell us when there will be enough staff delivering those services to that important group?

[Norman Lamb]

I mentioned that NHS England will very soon publish a report following its analysis of existing facilities across the country, so the hon. Gentleman will get the answer in the next few weeks.

[Duncan Hames (Chippenham) (LD)]

When will the public health Minister publish the regulations for the plain packaging of tobacco products, on which she proposes to consult?

Health

Norman Lamb Excerpts

Monday 9th June 2014 Commons Chamber

[Gordon Birtwistle]

I am delighted to hear that, and I would like Wiltshire to become a standard that everyone else copies. I would hope that my constituency and the rest of Lancashire copies that. There are great companies—I know a few good companies that really care about the customer. These elderly people are customers: if Tesco treated people like some of those carers, they would shop somewhere else. Unfortunately, elderly people cannot go anywhere else, because a contract has been organised, and they have to use it. I urge the Minister to consider those suggestions and look at ways of improving the service that we deliver to our old people. I would be very happy if he did so, and I am sure that he would be too.

[The Minister of State, Department of Health (Norman Lamb)]

I completely agree with what my hon. Friend is trying to achieve. I hope that he is reassured that the Government have effectively introduced compulsory minimum training for all care assistants for the first time. I think he will welcome that.

[Gordon Birtwistle]

I do welcome it, and I am delighted to have heard that. I just hope that we make it a major condition of all Government and local authority contracts that all companies deliver that service to our elderly people. We will all become elderly—I am catching up very quickly—so who knows how soon it will be before someone comes to my house to say, “Gordon, it’s bedtime. It’s 8 o’clock—it’s toilet time.” That’s the worst thing I think I have ever heard—someone coming in and saying that it is toilet time. An old man said to me: “I do not want to go to the toilet, but I am told that it is time to go to the toilet.” It is just not acceptable to do that to an elderly man. I am delighted to hear what the Minister said, and I hope that we ensure that it continues in future so that we really respect and care for the people who have put us where we are today.

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[Dr Sarah Wollaston (Totnes) (Con)]

May I start by paying tribute to my predecessor, Anthony Steen, for his tireless work in bringing in a modern slavery Bill?

Today, however, is for talking about health, which is a great passion for me in this place and outside it. The NHS touches people’s lives 1 million times every 36 hours, which is a staggering figure. I believe that the NHS is worth every penny of the nearly £110 billion that we spent on it in the last financial year. I am very proud that this Government have protected the health budget, but that does not of course mean that there are not enormous financial pressures. We are now in the fifth year of effectively near-flat funding, and the issues set out by the hon. Member for Ilford South (Mike Gapes) are part of those pressures. We know that whichever Government were in power, there would have been serious challenges.

If the NHS is to be sustainable, we need to listen to the new chief executive of NHS England, Simon Stevens, who has called on all staff members to think like a patient and act like a taxpayer—we must do that to get every ounce of value out of our NHS—and to address issues of patient safety and of how we keep people out of hospital in the first place and get on with implementing the measures. The nature of the challenge has been set out in exhaustive detail; now we need to get on with the measures that have been put in place to help to prevent hospital admissions, to treat people at the right time in the right place, and to integrate health and social care. I want us to look carefully at the better care fund and the plans for getting best value out of it, and at the issues of patient safety that were mentioned earlier.

Given the absence of much legislation in the Gracious Speech, there is one regret that I want to point out: the absence of the Law Commission’s draft Bill on the regulation of health and social care. I hope that in summing up this debate, the Minister will give some reassurance that he can use secondary legislation to bring forward at least some of the measures in that draft Bill. It covers issues that touch 1 million people across 32 professions that are covered by nine regulatory bodies. Unless we clarify the language so that there is a common language in respect of patient safety across all those regulators, it will be difficult to implement some of the core messages from Francis and to act quickly in response to emerging threats to protect the public.

Every year for three years, the Health Committee has called on the Government to allow the General Medical Council to appeal panel decisions that clearly have not protected the public. Likewise, the Nursing and Midwifery Council would like powers to reopen cases in which it has been judged there is “no case to answer” if serious new evidence emerges. Alongside that, the General Pharmaceutical Council would like to implement transparency and to be able to take enforcement action. Those are all simple measures that I hope the Minister will mention in summing up. I also want the unacceptable level of delays to be addressed.

[Norman Lamb]

I want to give a quick confirmation that we will do what we can through secondary legislation to do what the hon. Lady requests.

[Dr Wollaston]

I am very pleased to hear that.

There will not be an absence of debates on health in this place. Two Bills will probably come here from the Lords in this Session: the Medical Innovation Bill and the Assisted Dying Bill. I will briefly put some of my concerns about the Medical Innovation Bill on the record while there is time for it to be amended. I have no doubt that it was introduced with the best of intentions to bring forward innovative treatments. However, I fear that it will have the reverse effect: it could undermine research and open the door to the exploitation of people when they are at their most vulnerable.

Currently, clinical negligence law provides redress for patients who have been harmed as a result of treatments that would not be supported by anybody of medical opinion. There is insufficient evidence that doctors are not introducing new treatments or are put off from doing so because of the fear of litigation. The NHS Litigation Authority has made it clear that doctors are protected from medical litigation in that respect. However, the briefing note for the Saatchi Bill talks about a doctor being able to use a novel treatment if he is “instinctively impressed” by it. In other words, doctors will be able to use an anecdotal base for treatments, rather than a clear evidence base. There are dangers in going down that route.

There have been some amendments to the Bill. Lord Saatchi has accepted that a doctor should have to consult colleagues and their medical team, but not that they should consider a body of opinion or consult ethics committees. I fear that we could be turning the clock back. We should rightly be proud of the advances that we are making in the field of medical research. We should rightly be proud of the push towards greater transparency, particularly in respect of open data and drug trials. However, I fear that if we allow people to access innovative treatments that have no evidence base, we will open the door to the purveyors of snake oil, rather than those who want to allow patients to enter controlled trials to establish a clear medical evidence base.

We should not underestimate the extent to which the purveyors of snake oil are out there. I put on the record my congratulations to Westminster city council and its trading standards department on fighting two successful prosecutions under the Cancer Act 1939 against two individuals, Errol Denton and Stephen Ferguson, for peddling so-called nutritional microscopy to people who were at their most vulnerable—cancer patients and patients with HIV—and telling them that it was an alternative to evidence-based treatments.

We must therefore be careful in how we move forward with such legislation. We should take more notice of the concerns of the Medical Research Council, the Wellcome Trust and the Academy of Medical Royal Colleges, who feel not only that the Bill is unnecessary, but that it could turn the clock back on evidence-based medicine. I hope that the Government will look at the concerns that have been expressed about the Bill in its current form.

Finally, Lord Falconer’s Assisted Dying Bill would enable competent adults who were terminally ill to have assistance to end their lives, but it would require the involvement of a medical practitioner. Although the Bill comes under the responsibility of the Ministry of Justice, it would have profound implications for end-of-life care and medical practice. It would fundamentally change the relationship between doctors and patients. There is a risk that the right to die would slide into a duty to die. I have seen how often patients who are towards the end of their lives fear being a burden on their families, and they often go through periods of profound depression. I do not feel that this Bill is the way forward.

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[The Minister of State, Department of Health (Norman Lamb)]

I thank all right hon. and hon. Members who have contributed to today’s debate. It has been a wide-ranging debate stretching well beyond the NHS, as the shadow Minister said. I think that we all enjoyed the alternative Queen’s Speech from the hon. Member for Blyth Valley (Mr Campbell). His Front-Bench colleagues looked horrified, but it was the authentic voice of Labour.

[Mr Ronnie Campbell]

There were some good policies in there.

[Norman Lamb]

Well, let us just make sure that Opposition Front Benchers listen to the hon. Gentleman.

We can be justifiably proud, it seems to me, of the action we have taken in health and care over the course of this Parliament. The hon. Member for Scunthorpe (Nic Dakin) made a speech that faded away from agreement, but at the very start he made the point that we should all pay tribute to a really remarkable work force in the NHS—1.3 million people doing incredible work. We want to free those people up as much as possible to do the very best they can.

[Andy Burnham]

Would not the best way to pay tribute to those thousands of staff in the NHS be to honour the 1% pay increase that the Chancellor promised them?

[Norman Lamb]

That is equivalent to about 6,000 nurses a year. The right hon. Gentleman has to demonstrate how that would be paid for. The fact is that there is an average wage increase of 3% as a result of annual pay increments under Agenda for Change. We have ensured that at least everyone will get a 1% increase. If he is arguing for something different, he has to say where the money would come from to pay for it and how he would cope with 6,000 fewer nurses, which would be the result of his action.

For the first time, it is this Government who have made decisive moves to join up the care and health system and focus more on preventing ill health. Contrary to the shadow Secretary of State’s claims, the better care fund has been widely welcomed, and it has initiated action across the country to join up a very fragmented system. We have sent out the signal that we encourage innovation and change, driven by clinicians from the bottom up, not from the top down. Brilliant pioneers across the country are ending this fragmented system that has interrupted patient care for so long and failed patients. Those pioneers are combating loneliness, which my hon. Friend the Member for Burnley (Gordon Birtwistle) spoke passionately about. It is so far removed from the caricature offered by the shadow Secretary of State and the tired old refrain about privatisation. It was, after all, a Labour Government who mortgaged the future of the NHS to the tune of billions of pounds with their private finance initiative programme, giving massive windfall profits to private consortiums—a scandal of historic proportions. Yet Labour Members continue to argue that the Government are privatising—an argument that is based on thin air, not substance.

[Tom Blenkinsop]

Will the Minister tell the House at what point the provisions of the Competition Act 1998 were introduced into the Bill that became the Health and Social Care Act 2012? I think it was this Government who did that. In the Public Bill Committee, I commented on the fact that they were exposing the NHS and undermining the category B status of the European competition regulations by putting the Competition Act at the very heart of the Bill.

[Norman Lamb]

I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.

This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.

This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.

[Geraint Davies]

Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people. He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?

[Norman Lamb]

The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.

In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.

Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.

The Government remain committed to legislating on professional regulation when parliamentary time allows.

[Mr Jamie Reed (Copeland) (Lab)]

Will the Minister give way?

[Norman Lamb]

Let me complete this point.

This is a complex area and we should not rush to legislate. We will keep making progress to respond to the scandal of Mid Staffordshire for the remainder of this Parliament. We are working closely with the regulators to ensure that key provisions, such as a faster fitness to practise test for nurses and midwives and English-language checks for all health care professionals, are in place during this Parliament.

The shadow Secretary of State quoted selected statistics on access to a GP, yet 86% of patients are satisfied with their GP practice. The Government have introduced a £50 million challenge fund, which will support more than 1,000 practices to develop innovative and flexible services. That will include Skype and e-mail consultations, as well as extended hours, and will benefit more than 7 million people.

The right hon. Member for Cynon Valley (Ann Clwyd) again spoke extraordinarily passionately, giving a voice to those who feel they have no voice in our system. We should all express our gratitude to her for her continued campaigning on this critical issue, which demonstrates that we still have a long way to go if we are to ensure that we have a system of which we can all be genuinely proud. Like the right hon. Lady, I hope that one day the flood of letters on poor care will stop. We are doing what we can through the actions we are taking and we are grateful to her for the enormously valuable work she did on the complaints system. I hope the Labour Administration in Wales will do the same, especially after she eloquently highlighted the problems there in a recent BBC documentary.

[Barbara Keeley]

Will the Minister give way?

[Norman Lamb]

I have given way quite a lot; I need to make some progress.

The right hon. Member for Newcastle upon Tyne East (Mr Brown) asked about allocations. It is right that the allocation of funding is no longer a political football but in the hands of experts. NHS England is seeking to make progress on reducing inequalities.

The hon. Member for Blyth Valley talked about charging in the NHS. Access to NHS services is based on clinical need, not on an individual’s ability to pay. That is fundamental to the NHS, and for as long as this coalition Government are in power the NHS will remain free.

We heard from Members on both sides of the House —my hon. Friend the Member for Bracknell (Dr Lee) and the hon. Member for Westminster North (Ms Buck)—that health care needs to change so that care is provided more locally. The better care fund establishes a £3.8 billion pooled fund, to help people to stay healthy and independent.

[Barbara Keeley]

It is not new money.

[Norman Lamb]

Of course it is not new money—this is a different way of working. We have never claimed that it is new money; this is to ensure that we use the money more effectively. Indeed, the hon. Lady’s Front-Bench colleagues have made the argument that by pooling the health and social care budgets, we can achieve more with the money available.

[Barbara Keeley]

Will the Minister give way?

[Norman Lamb]

No, I will not; I have given way many times. The fund is the largest financial incentive by any Government to promote integrated care, and it would be better if Opposition Members applauded the initiative rather than constantly criticising it.

At the start of this Parliament, this Government had five priorities for health and social care. We have delivered on all of them. Through the Care Act 2014, we have delivered the most profound change to the care and support system for a generation. After a decade of inaction under the previous Labour Government, we have introduced, for the first time, a cap on care costs and extended means-tested support. No one will have to sell their home during their lifetime to pay for care.

Under the leadership of Public Health England, we have created a new public health service, giving public health the priority it deserves in local government alongside other local services. As my hon. Friend the Member for Newbury (Richard Benyon) outlined, it is vital that we prevent ill health in the first place, as opposed to repairing the damage once it is done.

We are transforming health and care so that services are integrated around the needs of patients and users. We have revolutionised NHS accountability and seen a successful transition to a new health and care system. Finally, by focusing on outcomes rather than top-down diktat, we can identify what works and where we need to give additional support to help the system do more.

[Mr Jamie Reed]

I always enjoy the hon. Gentleman’s emollient Dr Jekyll, in contrast to the Secretary of State’s Mr Hyde. Will he be following the Crosby diktat and keeping his head down and his mouth shut about the Government’s record on the NHS between now and the general election, or will the Liberal Democrats be doing something rather different?

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[Norman Lamb]

I am very happy to speak for myself, and I will do so in due course. I am sure that the Secretary of State is enormously grateful to the hon. Gentleman for his description of him.

In the final session of this Parliament, the Government will continue to ensure that the new health and care system works with both integrity and purpose, delivering safe and compassionate care to patients, their families and friends.

Ordered, That the debate be now adjourned.— (Mr Gyimah.)

Debate to be resumed tomorrow.

Care Homes

Norman Lamb Excerpts

Thursday 1st May 2014 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Oban House care home and the Government’s policy for safeguarding residents in care homes.

[The Minister of State, Department of Health (Norman Lamb)]

The images that we saw on our screens last night were truly disgusting. No one deserves treatment like that. The family and loved ones of care home residents should not have to endure that. Poor care is completely unacceptable. Everyone should receive the highest standards of care delivered by well-trained and compassionate staff. We are committed to making that a reality and to preventing abuse and neglect. We are putting in place, through reform of the Care Quality Commission, a range of measures to improve the regulation of care homes, to hold to account providers that are responsible for unacceptable care, and to improve the quality of social care.

The chief inspector of social care at the CQC is putting in place new rigorous inspections carried out by specialist inspection teams. New fundamental standards of care are being introduced as requirements for registration with the CQC, which will allow the CQC to prosecute providers—and their directors—that are responsible for unacceptable care. We are introducing a new fit-and-proper-person test for directors of companies that provide care, which will allow the CQC to remove individual directors. The care certificate is on track to be introduced in March 2015 and is currently being piloted by employers. That certificate will include compulsory training. The CQC is being given the power to produce ratings of care providers that will provide a fuller picture of the quality of care than mere compliance with minimum standards.

A new statutory duty of candour on providers of care is being introduced, which will place a legal requirement on organisations to be open with patients about serious incidents. We are introducing a new offence of ill treatment and wilful neglect—one for an organisation and one for individuals. It will apply not just to those who do not have capacity, as is currently the case, but to all users of health and adult social care and all health and adult social care settings. A consultation on the new offence ended on 31 March, and we are now considering the responses. We aim to bring forward legislation at the earliest opportunity.

[Nick Smith]

I thank the Minister for his statement. The majority of residential care providers provide good, if not excellent, care. However, many of us across the country will have been sickened by the contemptible and callous treatment of elderly people in the Oban House and Old Deanery homes that we saw on “Panorama” last night. When we were shown the many calls for help from Yvonne Grant that were ignored, I, for one, railed against her so-called carers.

I acknowledge that the Care Bill will improve the safeguarding of elderly care home residents, but residents and their families need to know that their voices of concern are heard and acted upon when they feel that care is poor. The CQC needs to be up to the job. I met the CQC two days ago and felt that its engagement with residents and relatives could be much better. Can the Minister assure the House that the CQC will have the staff and expertise to carry out all the necessary inspections, including on the financial viability of care homes? Will he ensure that there is effective monitoring of care homes between inspections so that if there is high staff turnover, for example, that will be flagged up? Can he tell the House what training will be required for care homes staff? Will it be on the job and, if so, for how long?

Although it is right that care workers are held to account for their actions, senior managers should also shoulder their responsibilities. The Government failed to support my amendment to the Care Bill, which would have introduced an offence of corporate neglect. That would allow the prosecution of a care provider if the culture they set is a contributory factor in abuse or neglect. Police Operation Jasmine identified that sort of corporate neglect in south Wales. Will the Minister look again at the proposal in order to promote the care we all want for our loved ones in the place that they call home?

[Norman Lamb]

I thank the hon. Gentleman for his urgent question and his supplementary questions, which are absolutely legitimate and important. I agree that it is incredibly important that we recognise that there is a lot of great care out there, with incredibly dedicated care workers doing a very difficult job, often in difficult circumstances and without great pay. It would be awful if they were all tainted by the actions of a few.

I am pleased that the hon. Gentleman recognises that the Care Bill can make a difference and improve standards. It allows for the introduction of a care certificate so that everyone will be required, for the first time, to have compulsory training and meet a standard of competence before undertaking unsupervised care work. Part of that will be on the job, as I think is right for such work, but it is essential that people meet that standard.

The hon. Gentleman made the essential point that relatives, loved ones and the users of services themselves need to be heard. One thing we have done in that regard through NHS Choices is introduce the ability for anyone to comment on care services in a care home or in domiciliary care and to put their comments online, so that there is no hiding place for unacceptable standards of care. People’s comments and the judgments of the CQC will be available for everyone to see through the NHS Choices website.

I hope I can reassure the hon. Gentleman in relation to his amendment to the Care Bill. I totally agree with him about the importance of being able to prosecute for corporate neglect, which we will address, but in a different way. We are introducing fundamental standards of care that every care provider, and indeed every NHS hospital, must meet in order to be registered with the CQC. Where those standards are not met and there are serious failures, and where there is culpability because of corporate neglect of the sort he describes, the providers will be prosecuted. The CQC will have the power to prosecute not only the company or trust, but individual directors. This is the first time that that has been made possible. The existing regime is flawed, because the CQC must first serve a notice before anything can be done, and if the company complies with the notice it cannot be prosecuted, which is hopeless. We are removing that so that we can move straight to prosecution, as was the intention of his amendment.

[Dr Phillip Lee (Bracknell) (Con)]

I fear that this case will not be the last. May I invite the Minister to think longer term? I have often reflected on why our society outsources the care of elderly loved ones to the state. In the longer term, with an ageing society, I wonder whether we are going to have to look after our elderly more at home. Is there any policy formation within the Department along those lines, because the last thing I would like to happen is see my relatives being treated in the way we have seen?

[Norman Lamb]

My hon. Friend makes a really important point. In ensuring that we have decent, civilised standards of care for older people, but also for people with learning disabilities and others in vulnerable positions, it cannot be any one party on its own that achieves that objective. It is a challenge for the whole of society, and we must recognise that. Government have their part to play in setting very clear standards and making it absolutely clear that where these standards are not met there are consequences. Through the integration pioneers that we have around the country, we are demonstrating that with better collaboration between statutory services and families, wider communities and neighbours, we can achieve better care for people. The state cannot do this on its own. It has a crucial role to play, but this is a challenge for the whole of society.

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

I think the whole country was appalled last night when the BBC’s “Panorama” programme exposed the neglect and abuse of vulnerable older people at the hands of their carers. When older people and their families take a decision to move into residential care, they must be assured of high standards. Poor care must be stamped out and those responsible properly held to account.

First, I want to press the Minister on the specific case at Oban House. He will be aware that concerns were first raised about the home by whistleblowers back in 2012. What action was taken to address those concerns, and were they brought to the attention of Ministers? In its latest inspection in February, the Care Quality Commission reported that the home had too few staff and that some residents waited too long for staff to answer their calls. Will the Minister set out precisely what action was taken after those failures were highlighted back in February?

The Minister will be aware that following the awful abuse exposed by “Panorama”, a number of staff have been suspended, and HC-One has said it will increase staffing levels and improve training at the care home. However, is he fully satisfied that the safety and well-being of residents at Oban House is not still at risk?

This case raises serious questions about not only the inspection of care homes but the role of local councils. Councils and local authorities, which are much closer to care homes, should have a strong role in monitoring and driving up care standards. They should be the first safety net. Was it not a major error, therefore, to remove in the Care Bill the CQC’s powers to check that local councils are commissioning care services properly?

Care home bosses who fail to ensure that their residents are treated properly must face tough consequences. I heard what the Minister said about holding those bosses to account. My hon. Friend the Member for Blaenau Gwent (Nick Smith), as he outlined, proposed an amendment to the Care Bill to introduce a new criminal offence so that negligent care home owners can be fined or sent to jail. Is it not disappointing that the Government voted against that amendment?

In the first three years of this Parliament, social care budgets have been slashed by £1.8 billion. Yesterday, the growing abuse of zero-hours contracts, particularly in the care sectors, was revealed. Does the Minister accept that we will never get the standard of care that we aspire to from a social care system that has been cut to the bone? Should the coalition not revisit its brutal cuts to social care, which make such a situation more, not less, likely to occur?

This shocking case is yet another reminder that the time has come for a radical rethink of how we care for older people. These abuses must stop. How many more “Panorama” programmes exposing appalling cases such as at Oban House must we see before proper action is taken? Today, the Government must explain how they plan to prevent older people facing further abuse and indignity.

[Norman Lamb]

I thank the hon. Lady for those questions. I completely agree that unacceptable practices, and abuse and neglect, must be stamped out. I hope she is pleased that the Government are taking action to ensure that we can prosecute care providers who have allowed unacceptable practices. When I came into my job and had to respond to the scandal at Winterbourne View, the question I asked officials was, “What has happened to the company? How has it been held to account?” I was told that the Care Quality Commission could not prosecute because it had to serve a notice first, and if the company complied with the notice, nothing could be done.

A flawed regulatory regime was established when the CQC came into being. We are changing that so that providers of care can be prosecuted if they fail to meet fundamental standards of care. [Interruption.] I am answering the question. That is precisely what we are doing. The hon. Lady mentioned the issue of corporate accountability and corporate neglect, and that is exactly what we are addressing: we are giving the CQC the power to prosecute when there is corporate neglect.

We are also going further by introducing a fit-and-proper-person test so that every director of every care company will have to demonstrate that they are a fit and proper person. That should already be the case, but this is the first time it has happened. We are also introducing proper standards of training for all staff.

On the care home concerned, I hope it will be helpful if I write to the hon. Lady setting out the whole sequence of events and the entire timeline of the steps taken by the CQC. I commit to doing that in the next few days so that she will have the full picture.

We have made sure that the CQC is independent—we have strengthened its independence. We are introducing a far more robust inspection regime and we are addressing a problem. When the CQC was introduced by the Labour Government, the design of the inspection system was for generalist inspectors who might inspect hospitals one week and care homes the next. We are introducing specialist inspections. When inspectors go into a care home, they will talk to relatives, residents and staff, to get a much fuller picture of what is going on. Care homes will then be rated on their standards of care, so everyone will know what their local provider’s standards are.

I hope the hon. Lady will feel that real, substantial steps are being taken to address unacceptable standards of care and to ensure that people are properly held to account when bad things happen.

[Sir Tony Baldry (Banbury) (Con)]

Everyone in the House will want to ensure that anyone in residential care is treated with the compassion we would expect if our own much-loved parents were in such care. In addition to supporting the CQC’s specialist inspections, does my hon. Friend not think that we may be reaching a point where health and wellbeing boards will need to consider setting up panels of trained, independent lay visitors to visit residential care homes in their own area—unheralded and unannounced—to check whether people are getting the care and compassion that is merited and that we would all want for anyone in a care home in our constituencies?

[Norman Lamb]

I thank my right hon. Friend for that question and I very much share his view. In my own county of Norfolk, a brilliant third sector organisation is doing precisely that. It is arranging for ordinary people to go into care homes, judge the sense of kindness of compassion there and give a much richer view than statutory agencies might be able to provide. I would also point to the role of Healthwatch England, which has been established through the health reforms. Those organisations have the power in every local area to go into care homes—they cannot be blocked from going into them or any other health or care setting—to make their own judgments on where things are going wrong. Through that much greater transparency and openness, we will not only expose poor care but drive up standards.

[Mr Ben Bradshaw (Exeter) (Lab)]

Do not terrible events such as those revealed by the brilliant “Panorama” team show that the Government were wrong to reject one of the central recommendations of the Francis report, namely that care assistants should be regulated?

[Norman Lamb]

First, I share the right hon. Gentleman’s recognition of the work that “Panorama” has done. It is interesting that two examples of appalling abuse—namely this case and that at Winterbourne View—have been exposed as a result of hidden cameras. We must acknowledge that and recognise that there might be a role for the use of hidden cameras in the CQC’s work where there is potential evidence of abuse and where we need to establish that evidence in order to take effective action.



On the right hon. Gentleman’s question about registration, my concern is that the registration of nurses did not stop awful things happening at Mid Staffordshire. It is not in itself a panacea that ensures good-quality care. For me, the most important element is proper training to ensure that everyone is trained to an acceptable standard before undertaking unsupervised care work. If we can establish that standard across the country, we can drive up standards.

[Paul Burstow (Sutton and Cheam) (LD)]

Care homes should be places of light and laughter, rather than places of fear and neglect. They should be seen as part of their communities, rather than apart from their communities. Will the Minister therefore look again at the proposals in this Government’s White Paper on care and support for commissioning a piece of work delivered by the programme called My Home Life, which is all about delivering relationship-based care? Rather than care that is just about transactions, the programme is about changing the nature of the relationship between those who provide care and those who receive it.

[Norman Lamb]

I am certainly happy to have another look at the White Paper and to discuss it with my right hon. Friend, but let me just address his key point. It is absolutely right to say that when we have closed doors, awful things can happen beyond the sight of the public. Professor Martin Green, who is a very good leader of providers of care, has argued the case for care homes to become a sort of hub in their local community, opening their doors to ensure that they become a centre of excellence for that community and providing services and support for people who may live independently at home, but who would benefit from the skills in such an organisation. Openness, transparency and ensuring that the public gaze is cast upon what goes in such places is the right way forward.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Before I came into the House, I worked for the Care Standards Inspectorate for Wales, and when I had concerns about a care home with which I was working, I made unannounced inspections. Will the Minister tell us how many unannounced inspections were made at Oban House, and can he guarantee that the CQC has enough inspectors and enough capacity to carry out frequent unannounced inspections for homes about which it has any concerns?

[Norman Lamb]

We are making absolutely sure that the Care Quality Commission has the capacity and the funding to do its job properly. That question was also asked by the shadow Minister, and I apologise for not responding on that point. We absolutely want to make sure that the CQC has the capacity to do unannounced inspections, but, critically, to do much more robust inspections as well.

This is a process—we cannot introduce a different system overnight—but the new system of robust inspections is already being used in about 1% of care homes, with a view to the process being rolled out fully in October this year. The first ratings of care homes will emerge in October this year. Members of the public, when they are making crucial decisions about where a loved one will receive care, will therefore have much more information about which care providers are good and which are not up to standard. I will make sure that the hon. Lady receives the same timeline of what the Care Quality Commission did that I offered to the shadow Minister.

[Andrew Selous (South West Bedfordshire) (Con)]

Yet again, it has taken undercover reporting by the BBC and covert recording by families to shine a spotlight on these appalling abuses. Given that people with dementia, in particular, cannot tell their own story—in some recent cases, that has involved their being slapped—should not the CQC not only make unannounced visits, but seriously consider undercover work to record these terrible abuses?

[Norman Lamb]

I agree with my hon. Friend. I have spoken to the chair of the CQC, David Prior, specifically about this matter. It is looking at both the use of hidden cameras in appropriate circumstances and at mystery shopping—going into care homes, finding out what is going on and getting a real picture, rather than things perhaps being hidden away from view when a named inspector turns up. All these mechanisms have to be used. We have to be prepared to do these things to ensure that people in very vulnerable situations, particularly people with dementia, are cared for with dignity.

[Barry Gardiner (Brent North) (Lab)]

The care homes sector is growing in size and in profitability. In his remarks, the Minister focused on the low wages that are paid to care workers in the sector. Often, the pay reflects the value that is put on the work that is being done. Will he look at pay and profitability in the sector, and consider the impact that it may have on bad practice?

[Norman Lamb]

The hon. Gentleman makes a fair point. The difference in the providers that pay people properly is clear. Incidentally, domiciliary care is another area where there are concerns. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) visited Wiltshire recently, which has moved away from the old style of paying people a pittance and now gives care workers a salary. When that happens, the whole culture starts to change completely.

We must ensure that there is compliance with the minimum wage, as well as advocating wages that are better than the minimum. Her Majesty’s Revenue and Customs has done a lot of work in the sector to address the abuse of the minimum wage regulations, which is far too widespread. It is completely intolerable for any care provider not to meet its statutory obligations. As the shadow Minister said, we have to ensure that when they commission care, councils cannot be complicit in an arrangement that they know will end up with people not receiving proper pay.

[Mr Speaker]

Nobody could accuse the fastidious Minister of excluding from the answers any consideration that he thinks might in any way be material. If he can combine that with reasonable economy, the House will be even more grateful to him than it is.

--- Later in debate ---

[Norman Lamb]

Thank you, Mr Speaker, for your gentle guidance. I will do my best.

The hon. Gentleman makes an incredibly important point. One cannot change the culture of an organisation overnight. The Care Quality Commission was a dysfunctional organisation, but it now has really good leadership in the form of David Behan and its chairman, David Prior. They understand the importance of changing the culture and ensuring that they are always the champion of the patient.

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

I say to the Minister and all colleagues in the House that this is not good enough. It is disgraceful. We had it before and we had similar answers. We have to stop this. There are wonderful carers out there—most carers are wonderful—but they need support, good skills training and to be paid properly. Surely we ought to have a charter in every home that says, “These are your rights. Don’t let them be infringed. They are clear.” Every good hotel and business has such a charter hanging up where everyone can see it. Can we not have that tomorrow?

[Norman Lamb]

Many care homes are signing up to exactly those standards. The more that happens, the more we should applaud and encourage it. The hon. Gentleman is right that we should all be completely intolerant of such abuse and neglect. It is a challenge for the whole of society. Whichever Government are in power need to hold the line of being absolutely intolerant of any failures of care and must demonstrate that when they happen, there are real consequences that will hold people to account.

[Tim Loughton (East Worthing and Shoreham) (Con)]

As I found out recently when trying to find a suitable home for a relative, trying to get assurances about the quality of care and not just the quality of the buildings, let alone working out how one pays for it all, is a minefield. The truth is that this abuse was uncovered not by the CQC but by the BBC. Following on from the comments of my right hon. Friend the Member for Banbury (Sir Tony Baldry), could we not have a reporting mechanism, be it through residents, their relatives or volunteer visiting friends, which would be particularly appropriate for those who lack capacity, that would trigger such an investigation by the CQC, with the use of undercover cameras and so on? Could we not have something as high profile as ChildLine that works and that people know about?

[Norman Lamb]

I thank my hon. Friend—or is he right honourable?

[Tim Loughton]

Just honourable.

[Norman Lamb]

I thank my hon. Friend for his question. Of course the work has to go way beyond just what the CQC can do. I mentioned in response to my right hon. Friend the Member for Banbury (Sir Tony Baldry) the fact that organisations focusing particularly on compassionate care now carry out inspections and make reports. I have also mentioned NHS Choices, which means that any member of the public can give their comments on the care experience of a loved one. The more people use their power to highlight unacceptable things that are happening in care homes, and indeed great things, the better.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituent Maureen Pycroft witnessed appalling standards in the home where her husband Barry was meant to be cared for, and she was horrified to learn that the same care provider went on to run other services and abuse other vulnerable people some years later. Will the Minister assure me that the CQC now has powers to ensure that when there is abuse in homes, the providers who run them will be barred from running homes in the future?

[Norman Lamb]

The hon. Lady is absolutely right, and that is why we are introducing the fit and proper person test for every director of every care or health care provider. If they have been complicit in unacceptable standards or prosecuted for unacceptable care, the CQC can require them to be removed from the board of a care provider. The new standards should help considerably.

[Andrew Percy (Brigg and Goole) (Con)]

Nobody who uses schools is unaware of Ofsted and its job. Should we not look for a similar situation with regard to the CQC, and is there not a big public information job to be done to ensure that people know better what the CQC is there for and how to access it?

[Norman Lamb]

My hon. Friend is absolutely right. The CQC needs to build a reputation so that everyone has confidence in its ability always to represent the patient’s interests. I believe that the CQC’s leadership understand that mission and are well on the way to achieving it, but it will not happen overnight.

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

I have seen wonderful examples of residential care in my constituency, but I have also had concerns raised with me about staffing levels and zero-hours contracts in other care homes. There is no one-size-fits-all solution, and transparency is key, so what are the Government doing to enhance and protect the vital role of employees who blow the whistle on poor standards of care?

[Norman Lamb]

The hon. Lady is absolutely right to recognise that there is great care out there, and we should applaud care workers who deliver fantastic care. I was at an awards dinner recently at which individual care workers were given awards for providing great care. Celebrating great care is incredibly important in changing the culture of the sector.

The Government took steps to fund a helpline that had previously been only for health workers and extended it to social care, so that anyone can seek advice about what to do if they want to whistleblow. The culture must be that anyone feels able to blow the whistle and get things done, and the CQC must respond effectively when that happens.

[Robert Halfon (Harlow) (Con)]

The Minister will be aware that we have previously had problems with a care home in Harlow, but we also have some excellent ones, particularly Tye Green Lodge, Alexandra House and a number of others. Does my hon. Friend agree that we should boost the confidential hotline and set it up as a proper hotline like Crimestoppers, to allow people to feel that they can call? Does he also agree that we should ensure that it is advertised properly to everyone who uses care homes and their relatives?

[Norman Lamb]

My hon. Friend makes an important point and it is right to highlight the great places that are providing excellent care. The Care Quality Commission makes it clear that it encourages members of the public to come forward and alert it to concerns, but we must do much more to make it easy for members of the public, so that they understand exactly what they need to do if they have concerns.

[Kelvin Hopkins (Luton North) (Lab)]

I applaud my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) for her comments, particularly on local authorities. A major factor in all this and across the care sector has been the widespread privatisation of very good local authority care homes. In my constituency, three superb homes were forcibly closed. They were loved by their staff, their residents and the families, and admired by local health professionals—all closed; all gone. Is it time to re-establish a role for local authorities in providing care services and making all care locally and democratically accountable?

[Norman Lamb]

Unacceptable standards of care must be condemned and challenged wherever they occur, whether in the private, public or voluntary sector. Mid Staffordshire hospital was an NHS hospital, yet awful things happened. We must be intolerant of abuse or neglect wherever it happens. On local authorities—the shadow Minister raised this point—we have the power to require the Care Quality Commission to inspect on specific issues, including where there are concerns about the commissioning of care. It is important that those powers are there to be used.

[Priti Patel (Witham) (Con)]

The BBC shone a spotlight in its programme on the practices of specific care homes. What message can my hon. Friend give to people whose vulnerable family members have been in those homes and treated so appallingly? What level of reassurance can he give those families that their safeguarding is being taken care of and that this abuse will stop?

[Norman Lamb]

The way I would put it is that we owe it to those families to demonstrate that we are taking effective action to address the very serious concerns they have raised. All the steps the Government are taking, which I have outlined this morning, will go a long way to eradicating such behaviour. Where it does occur—there will always be bad apples in any system—there must be real consequences not only for that individual care worker, but for a company that allowed such things to happen in the first place.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

As a constituency MP I respond to CQC reports by visits or by writing to care homes. On a recent visit to a very good care home, staff talked to me about their new apprentice with great enthusiasm. That apprentice will receive good training and support, and I am sure they will be a good employee. Is the Minister confident that the CQC has the capacity to oversee and assess apprenticeship training to ensure that it is not just cheap labour and that apprentices are getting the best education?

--- Later in debate ---

[Norman Lamb]

First, I applaud the hon. Lady for going to those care homes and seeing for herself what is going on in response to Care Quality Commission reports. We should all be willing to do that. I have already said that the CQC has been given extra funding, and we are completely committed to ensuring that it has the capacity to do its job properly and substantially increase the number of apprentices in that sector. As she says, proper training is vital to ensure a properly trained work force.

[Glyn Davies (Montgomeryshire) (Con)]

Does the Minister agree that the most effective way to raise standards and ensure a culture of compassion and sympathetic care in a full range of care settings is by strengthening corporate responsibility? We need public opprobrium to be aimed at the owners and directors of those companies so that they are persuaded to introduce systems such as lay visitor or advocacy schemes within those care settings, to ensure that examples of this sort do not happen.

[Norman Lamb]

My hon. Friend is right. That is why the Government have taken steps to ensure that the Care Quality Commission can prosecute when there are examples of the new fundamental standards of care we are introducing being breached. In future, no one will be able to get away with allowing poor standards of care in their workplace. We will take action through prosecution and the fit-and-proper-person test to drive up standards.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Minister has spoken a fair bit about the extra powers he will give the Care Quality Commission, but staff at that agency gave the Old Deanery home a clean bill of health in November 2013. Two months later after the “Panorama” revelations they found significant failings. What will the Minister do about inspectors who failed to do their job? Will they be free to carry on as if nothing has happened?

[Norman Lamb]

I am grateful to the hon. Gentleman for raising that point. In a way, he makes the case for why the inspection regime needs to be much more robust and not a tick-box exercise. More effective inspection, with inspectors talking to staff and, crucially, relatives of those in the care home, will provide a much better picture of what is going on there. It is for the CQC as the employer to address any concerns it has about the way in which its staff have conducted themselves, but the new tough inspection regime is being introduced, with 1% of care homes already covered. It will be fully implemented by October this year.

[Mr Philip Hollobone (Kettering) (Con)]

I applaud the Minister for his efforts to change the prosecution regime for residential care home abuse, but is he optimistic that he can get the changes through so that we might see some exemplary prosecutions by the end of this year?

--- Later in debate ---

[Norman Lamb]

I hope that the changes will be implemented in October, but of course criminal investigations take time. The whole purpose is for the changes to act as a deterrent to stop bad things happening, but I take the view that if there is evidence that awful things have happened, the CQC must use its new powers. If it were to do so, it would send a very clear signal to the rest of the sector that this is a serious regulator that will use its powers effectively.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Because of the high turnover of staff in the adult care sector, intelligence on care staff, especially those who have committed abuse and are barred, is very important. Why has there been a 60% drop in the number of people barred from working with vulnerable adults on the basis of information from care home providers in the last three years?

[Norman Lamb]

I will investigate the figures that the hon. Lady mentions. She is right to suggest that it is important that if employers—both in the social care and health sectors—dismiss a worker for abuse of patients or residents, they refer the case to the barring scheme. If employers are not doing that, they are failing in their responsibilities. We have to protect people in such cases and I will look into the point she raises.

[Martin Vickers (Cleethorpes) (Con)]

The CQC has recently published a critical report on some care homes in north-east Lincolnshire that care for people suffering from mental health difficulties. I welcome what the Minister said earlier about the need for better training. Dealing with mental health patients is particularly challenging, so can he give an absolute assurance that more work will be done to ensure that training meets the standards required?

[Norman Lamb]

I am grateful to my hon. Friend for highlighting the fact that it is just as important to protect and provide great care for younger adults who have other needs, be those mental health issues, learning disabilities or autism, as it is for frail older people. All the requirements on compulsory training will apply equally in the former settings as they will in the latter. We have to drive up standards there as well.

[Sir Richard Ottaway (Croydon South) (Con)]

The Oban House health care home is located in my constituency and I apologise to you, Mr Speaker, the House and the Minister for not being here when the Minister made his statement. I hear that the Minister made a comprehensive statement that covered a lot of the issues. When the dust has settled, will he agree to meet me and any concerned constituents to assess how the situation arose and how we can make progress?

[Norman Lamb]

Yes, of course I will.

Pharmaceutical Price Regulation

Norman Lamb Excerpts

Thursday 3rd April 2014 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

My hon. Friend the Under-Secretary of State for Health, Earl Howe, has made the following written ministerial statement:

I am pleased to announce today the publication of “Pharmaceutical Price Regulation Scheme: 12th Report to Parliament”.

The pharmaceutical price regulation scheme (PPRS) is a voluntary agreement with the pharmaceutical industry which is used to control the prices of branded medicines to the health service and limit the profits that companies can make on their health service sales. The Department published the first report on the PPRS in 1996 following a comment by the Health Committee that the

“Department of Health should introduce greater transparency into the PPRS”.

Since then, the Department has published a report to Parliament on the operation and management of the scheme most years, the last report being February 2012. This latest report includes an update on the outcomes of the 2009 scheme which terminated on 31 December 2013 and outlines the early operation of the 2014 PPRS which started on 1 January 2014. In addition, the report provides an update on progress in implementing the provisions under the 2009 scheme supporting the uptake of innovative medicines recommended by NICE, the Government’s broader support for the life sciences industry and commitment to the ongoing implementation of innovation, health and wealth.

A copy of the report has been placed in the Library. Copies are available to hon. Members from the Vote office and to noble Lords from the Printed Paper Office.

Adult Autism Strategy for England

Norman Lamb Excerpts

Wednesday 2nd April 2014 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

In line with duties under the Autism Act 2009, and following the review led by the Department of Health into progress in relation to the 2010 adult autism strategy for England “Fulfilling and rewarding lives”, the Department of Health is today publishing “Think Autism”, the follow up to “Fulfilling and rewarding lives”, the 2010 adult autism strategy for England on world autism day.

The cross-Government adult autism strategy is an essential step towards realising the Government’s long-term vision for transforming the lives of and outcomes for adults with autism.

“Think Autism” is an update to the 2010 autism strategy and reaffirms the importance of the five areas for action aimed at improving the lives of adults with autism identified in the strategy.

An update is being published for three reasons:

in line with the Autism Act, we undertook a review of the autism strategy in 2013-14 and are reflecting what we heard from people with autism, their families and from services in this update;

to reflect progress that has been made since 2010 and commitments that have been delivered; and

to take account of changes in public services and new organisations.

During the review of the autism strategy we ran a comprehensive exercise to listen and learn about how it is working. Nearly 2,000 people took part in focus groups, conferences and events. Over 1,100 people took part in an online survey. Local authorities worked with partners and local people to complete self-assessment exercises looking at the progress they are making.

From this review, 15 priority challenges for action were identified by people with autism, carers, professionals and others who work with people with autism. In particular, “Think Autism” has a new focus on building communities that are more aware of and accessible to the needs of people with autism, on promoting innovative local ideas, service or projects that can help people in their communities and on how advice and information on services can be joined up better for people.

“Think Autism” sets out a clear programme of action we will take across Government to improve the lives of people with autism, primarily through supporting local authorities, the NHS, other public services and their local partners with their local implementation work.

We intend to publish new statutory guidance to support the updated strategy later in 2014, following a public consultation exercise.

Public Health England has also published fuller results and the individual area responses from the second national autism self-assessment exercise, which reported on progress by the end of September 2013 across all 152 local authority areas in England. This information is found at: www.ihal.org.uk/projects/autism2013. This is a key means of identifying progress in implementing the strategy as a whole and for demonstrating local accountability.

“Think Autism: Fulfilling and rewarding lives, the strategy for adults with autism in England: an update” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 1st April 2014 Commons Chamber

[Mr Andy Slaughter (Hammersmith) (Lab)]

15. What progress has been made on achieving parity of esteem between physical and mental health.

[The Minister of State, Department of Health (Norman Lamb)]

The mandate to NHS England requires measurable progress in achieving parity of esteem by March 2015. “Closing the Gap”, which was published in January 2014, contains a reinvigorated system-wide drive to deliver parity of esteem and to hold services to account. That includes programmes in NHS England, Public Health England and Health Education England.

[Andy McDonald]

If the Minister really believes in parity of esteem, how can he possibly justify cutting the funding for mental health trusts by 20% more than has been the case for other hospitals? Six leading mental health organisations warned that that decision will put lives at risk. Will the Minister now rethink the matter?

[Norman Lamb]

It is because I really care about parity of esteem that I described the decision by NHS England as flawed. It cannot be justified. It is not based on evidence. I am pleased to say that since then the former chief executive, David Nicholson, has written to all his area teams to make it very clear that in their commissioning plans and clinical commissioning groups, and in determining contracts with mental health providers, they must apply the principle of parity of esteem. Let us wait to see what emerges from that, but any reduction in funding for mental health this year would be unacceptable.

[Paul Blomfield]

We know that spending on mental health fell for the first time in a decade in the first year in which this Government were in power. Unfortunately, the Department no longer collects or publishes that data, but Sheffield Mind has expressed its concerns about cuts in the two subsequent years despite referrals rising dramatically. Will the Minister assure the House that he will in future publish figures on spending levels and that mental health services will not be subject to a fourth year of cuts?

[Norman Lamb]

We want to make sure that there is complete transparency in the availability of data and to ensure that in future it will be possible to draw those comparisons. I suspect that there is agreement across the House that mental health must not lose out. In the last decade, when the NHS was financially squeezed mental health lost out, as the Health Committee confirmed. It has happened again this time, but I am absolutely determined that we will change the levers to ensure that mental health gets its fair deal. I am delighted to confirm today that we are ending the exclusion of mental health patients from the legal right of choice. It is extraordinary to me that when the Labour Government introduced a legal right of choice in the NHS, they inexplicably left out mental health patients. We are ending that today.

[Mr Slaughter]

Last week, I hosted a reception in Parliament to celebrate the outstanding work of the West London Centre for Counselling and its tireless support for my constituents with mental health issues, and I thank my hon. Friends the Members for Liverpool, Wavertree (Luciana Berger) and for Copeland (Mr Reed) for attending. Organisations such as the centre are, in the words of Mind, “straining at the seams” because demand so far outstrips resources. Why does not this Minister take responsibility for being in government and do something about mental health being a Cinderella service?

[Norman Lamb]

That is precisely what I am seeking to do, but we have to address what I have often described as an institutional bias against mental health in the NHS. For example, when the previous Labour Government introduced a maximum waiting time of 18 weeks, inexplicably, they left out mental health again. What possible justification can there be for that? We are ending that and ensuring that when commissioners determine where funding goes they will have to take into account waiting time standards in mental health for the first time.

[Dr Sarah Wollaston (Totnes) (Con)]

I am proud to be a patron of Cool Recovery, a mental health charity in my constituency that provides vital support and information for sufferers and their families. Will the Minister confirm that as we welcome Simon Stevens to his new role, he will not only discuss how parity of esteem is reflected in the overall funding share but make sure that some of that funding can go to the charities that provide that parity?

[Norman Lamb]

I will absolutely discuss parity of esteem with Simon Stevens when I meet him very soon and I will ensure that the case for third sector organisations is taken into account, as they play an incredibly important role. I was delighted, incidentally, to be down in the south-west at the signing of the crisis care concordat to ensure that people who are suffering a mental health crisis are treated in the same way as people who are suffering a physical health crisis.

[Paul Burstow (Sutton and Cheam) (LD)]

The Minister is absolutely right to talk about the institutional bias and that is why it is absolutely right to introduce choice today and to set access standards for mental health for the first time. Will he go one step further and do something else that the previous Labour Government did not do by introducing the standards that the National Institute for Health and Care Excellence sets for mental health and ensuring that they are must-dos as well?

[Norman Lamb]

I very much share my right hon. Friend’s frustration that when a medicine is determined by the National Institute for Care Excellence as an evidence-based intervention, the system has to allow it, but when NICE determines that a procedure should be followed, it is discretionary. We must address that to ensure that we use the money in the most effective, evidence-based way.

[Mary Macleod (Brentford and Isleworth) (Con)]

Will the Minister have a discussion with his colleagues in the Department for Work and Pensions and the Department for Business, Innovation and Skills to see what more can be done to help patients with mental health issues to get into the workplace and find employment?

[Norman Lamb]

My hon. Friend raises an incredibly important point. One thing that I am very proud of is that under this Government 80,000 more people a year are getting access to psychological therapies through the improving access to psychological therapies programme—something we that should be very proud of. We have also done some joint work with the Department for Work and Pensions on how we can link up IAPT much more effectively with Jobcentre Plus to get people back to work, rather than paying them benefits.

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

The Minister was right to point out that from today people who use mental health services are supposed to be able to choose where they get their treatment. However, the payment mechanisms still are not in place and the guidance has not been issued. Is it not the case that the only choice for many teenagers is whether to be treated on an adult ward or travel hours to the nearest bed? The Health and Social Care Act 2012 was meant to deliver parity of esteem. The Minister is not a commentator or a bystander. I listened to his answers a moment ago. Can he explain what has gone so wrong and how he intends to fix it?

[Norman Lamb]

I agree that I am not a bystander. That is why I have acted to introduce choice for mental health patients for the first time—something that the Labour Government completely failed to do. Perhaps the hon. Lady could explain to the House why on earth they would leave out mental health patients from the legal right of choice. It is extraordinary. This Government are taking decisive action to ensure that there is real parity—real equality—in the way that mental health patients are treated.

[Stephen McPartland (Stevenage) (Con)]

9. What recent steps he has taken to improve maternity care.

--- Later in debate ---

[Mr David Heath (Somerton and Frome) (LD)]

T3. The whole House will have been appalled by evidence from the Winterbourne View case and others of inappropriate methods of controlling patients. Will the Minister now take action to ensure that restraint is only ever used as a last resort, whether in care homes, hospitals or mental health units?

[The Minister of State, Department of Health (Norman Lamb)]

The evidence from Winterbourne View was utterly shocking. The Mind survey subsequently revealed that restraint is used far too much across the health system. We committed to reviewing the guidance, and I am pleased to say that we will publish new guidance later this week to address the very point my hon. Friend raises.

[Liz Kendall (Leicester West) (Lab)]

The Government’s damaging reorganisation has weakened the grip on NHS finances. Figures slipped out the day after the Budget show that NHS hospitals are in deficit for the first time in eight years, hospital trust deficits are three times higher than they were a year ago and twice as many foundation trusts are in the red. Will the Secretary of State now commit to publishing the final year-end figures for all hospitals in one annual account so that the House can hold him to account for his mismanagement of public money?

[Chris Heaton-Harris (Daventry) (Con)]

T5. What progress is being made on ensuring that selective dorsal rhizotomy is available to children with cerebral palsy who need that life-changing operation?

[Norman Lamb]

I remember well the meeting I had with my hon. Friend, other hon. Members and some families, and indeed I remember the testimonies those families gave. I will write to NHS England about his question and report back to him on the progress it is making.

[Grahame M. Morris (Easington) (Lab)]

T2. How does the Minister respond to a warning from the UK’s top cancer doctors that the planned closure of 18 specialist centres for treating the victims of brain cancer is putting patients’ lives at risk by delaying treatment? It is clearly at odds with the Prime Minister’s assurance about improving access. Those top brain surgeons say that it is appalling. Will the Secretary of State stop it and engage in a proper and meaningful review?

--- Later in debate ---

[David Wright (Telford) (Lab)]

T9. Mental health services in Telford are under review and the Castle Lodge facility has been closed for a considerable time. It has been heavily used by people in the community who do not have to be admitted into Shrewsbury. Will the Minister confirm that if local people want to retain Castle Lodge, as I believe they do, it will be retained?

[Norman Lamb]

I understand the issue that the hon. Gentleman is raising. If he wants to discuss it further with me, I shall be happy to meet him. Clearly, local opinion and the making of decisions locally are what our reforms are all about.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Rural surgeries such as Ambleside, Coniston and Hawkshead in my constituency are under threat because of a combination of historical funding difficulties and the removal of the minimum practice income guarantee. Will the Minister agree to look into the setting up of a strategic small surgeries fund, so that rural surgeries have a confident future?

--- Later in debate ---

[Dr Julian Huppert (Cambridge) (LD)]

Health care in Cambridgeshire has been underfunded for years, and mental health care particularly so. This is getting worse as a result of the private finance initiative contracts that were signed, the differential deflator for mental health and physical health, and the simple fact that mental health demand is up. Will the Secretary of State meet me and the mental health trust to work out a way out of these problems that will not harm patients?

[Norman Lamb]

I would be very happy to meet my hon. Friend if that is acceptable to him.

Mental Health Care (Older People in Lincolnshire)

Norman Lamb Excerpts

Thursday 27th March 2014 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate my hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) on securing the debate, and on his speech. I do not think that I disagreed with anything he said. He was absolutely right to highlight the fact that when finances are tight in the NHS it always seems to be mental health that loses out. That happened in the middle of the last decade, and it has happened again now. There is what I describe as an institutional bias against mental health in the NHS, and it must be combated. That is why, as my hon. and learned Friend said, we have legislated for parity of esteem.

The levers—the financial incentives—in the NHS are unbalanced, and that disadvantages mental health. On the physical health side of the divide is the politically powerful guide relating to the 18-week period between referral and treatment, but there is no equivalent on the mental health side. Moreover, payment by results operates in the case of physical health. The combination of those two things sucks money into acute hospitals—it increases investment at the acute end of the spectrum—but takes money away from mental health, which depends on block grants negotiated locally. We must change that, and next year we shall introduce access standards to mental health services so that we can start to address the imbalance in the system.

As my hon. and learned Friend pointed out, the fact that we are all living longer makes the increasing prevalence of these problems inevitable, and, although we have legislated to make age discrimination unlawful, it cannot be eradicated overnight. Because of the way the system works, older people still lose out, such as in access to IAPT—improving access to psychological therapies—cognitive behaviour therapies.

Dementia and Specialist Older Adult Mental Health Services, which is part of the foundation trust in Lincolnshire, provides a range of specialist community and in-patient services and contributes to all key care pathways for older adults with dementia and mental health-related needs. As Members will be aware, these services are designed and commissioned locally so that they can be closely matched with the needs of the population they serve. That does not always happen, but it is the principle.

Crucially, local GPs are ideally placed to know local health needs and they now play a key role in commissioning health services. Lincolnshire Partnership is therefore working with four GP clinical commissioning groups in Lincolnshire and with other providers to improve the services it offers. Aims include reducing unnecessary hospital admissions, facilitating hospital discharge, and delivering more home and community-based services. There is a range of initiatives within this programme, such as having mental health nurse-led clinics in GP practices and care pathways. That is a very important advance. Bringing mental health back into primary care is a necessary reform because very often people get stuck in long waiting lists, waiting for referral to treatment and support. Other initiatives include CCG-aligned community teams with functional mental health and dementia-specific clinical pathways and skills, nursing home support, and developing behavioural psychological support services in the community for people with complex behavioural needs.

In October 2012 we announced a £50 million capital investment fund to support the NHS and social care in improving dementia care. The funding is aimed at expanding the range of health and care services, offering supportive environments to help the growing number of people with dementia get the best possible care. My hon. and learned Friend will be aware of the Prime Minister’s dementia challenge, which was issued in 2012 and which focuses on improving health and care services, making our communities more dementia-friendly and increasing research into dementia, both trying to find a cure and gaining a better understanding of how we care for people with dementia.

Lincolnshire Partnership NHS Foundation Trust was awarded £250,000 from that programme to transform the care environment at the Manthorpe centre, to improve care for people with dementia in Lincolnshire. The Manthorpe centre is a 20-bed assessment and treatment unit located on the district general hospital site at Grantham that offers specialist care to older people suffering from dementia or functional conditions. This is a high-level service provided in hospital to allow for a needs assessment by a range of professionals who provide an appropriate bespoke treatment plan.

Local services always need to be alive to the need to change and improve so that they can meet the needs of the people they serve. Of course this can sometimes be unsettling for staff, and organisations need fully to engage with them in achieving improvement. It is good that the health worker at the Manthorpe centre went to speak to my hon. and learned Friend to raise his concerns directly so that they could be debated here in Parliament. This is all the more important when, as I will discuss in a moment, we are focusing on mental health and older people as never before.

I would encourage my hon. and learned Friend to continue to raise these points with the chief executives of local authorities and NHS organisations in his area. As I mentioned earlier, the success of the managed care network in his area has recently been independently recognised, which is good.

My hon. and learned Friend asked what the Government were specifically trying to do on national policy. We now know much more about the causes of some of the most common mental disorders, such as depression and anxiety. We also know what can, in many cases, prevent them, and we are focusing on raising awareness of the interventions that we know work—for example, reducing isolation in older people. Loneliness and isolation affect people with mental health problems. We know that loneliness has a very negative impact on physical and mental health. The mental health of people who are on their own and not seeing anyone deteriorates, and they may also start to drink too much—that is a common feature of loneliness and it exacerbates the problem. Loneliness is associated with conditions such as cardiovascular disease, dementia, poor sleep and depression. Loneliness and social isolation are problems that government alone cannot solve.

Many of the solutions to combating loneliness lie within local communities themselves, but government has a part to play. One thing that I always stress is that if we are to combat loneliness and focus on well-being, which is the principle at the heart of the Care Bill we have been taking through Parliament, there has to be a richer collaboration between statutory services and the wider community. My hon. and learned Friend mentioned the strong communities in Lincolnshire. One potential solution to the challenges he highlighted is the fact that there are growing numbers of people in retirement. Although some have care needs, many of them are fit and healthy and often they want to give something back but do not know how to do so. The question of how we can unleash the power of our communities and those people who do have time on their hands and want to contribute suggests to us part of the solution to the challenge we face.

By bringing people together, giving them the right tools and increasing the evidence base on loneliness, we can encourage local commissioners to tackle this important problem. I agree with the points made by my hon. and learned Friend on both parity of esteem and the links between physical and mental health—as he made very clear, one so often causes the other. We have taken action to try to address these problems. We have enshrined in law the equal status of mental and physical health in the Health and Social Care Act 2012. We know that people living with significant and persistent mental health problems have significantly reduced health and quality of life, and that they live on average 16 to 25 years less than the general population—that is extraordinary and, as he indicated, it is avoidable. The reasons people with mental health problems die earlier could be addressed and we could reduce this outrageous gap in life expectancy.

That is why reducing premature death in people with serious mental illness is identified as a priority area in both the public health and NHS outcomes frameworks, and it is why the NHS operating framework specifically focuses on the physical health of people affected by mental illness for the coming year. Let me explain the purpose of the outcome frameworks. That is horrible jargon, but the point of such frameworks is to try to focus on what the results are for people and to measure the performance of organisations across the country in what they achieve for people and whether their performance is improving over time. That starts to enable us to hold the system to account.

We are investing more than £400 million to give hundreds of thousands of people, in all areas of the country, access to psychological therapies. We are supporting local organisations in taking effective action to improve mental health. Our mental health strategy and the implementation framework that goes with it, and our suicide prevention strategy, focus on specific actions that local organisations can take to improve mental health across the life course in their areas. In June last year, we announced the better care fund, and from April 2015 councils and the NHS will get £3.8 billion to work with each other and the voluntary sector. Plans are now being assured—they have been submitted in draft form—and challenged at local and national level. In 2015-16 the fund will receive an additional £2 billion from clinical commissioning group budgets and £800 million from existing health and social care funding streams. This fund is about a new way of working, with joint decisions made locally to deliver joined-up care, pooling the resource that is available, for people who need it most.

My hon. and learned Friend gave an example of one organisation saying, “It’s not our responsibility; it’s somebody else’s.” That sort of silo working has to end. We know that if we harness the public resource that is available, join up more effectively the efforts of different public sector organisations and work collaboratively with the wider community, we can make much better use of our available resources. It really should be a thing of the past that we hear organisations saying, “It’s not our responsibility; it’s somebody else’s.” They must resolve their problems collaboratively. I was encouraged to hear that that now appears to be starting to happen.

Last year, we announced 14 integrated care pioneers to work on ambitious and innovative approaches to delivering person-centred co-ordinated care and support. The pioneers are supported by national partners. They draw on international expertise and work with senior sponsors within the sector, allowing them to innovate, break down the barriers that exist to joining up care and lead the way on integrated health.

My hon. Friend the Member for Gainsborough (Sir Edward Leigh) mentioned the rural nature of Lincolnshire. Well, Cornwall is rather similar, as indeed is my own county of Norfolk. In Cornwall, the integrated care pioneer has a fantastic collaboration between volunteers and GPs. The volunteers give companionship to people who are living on their own, and work collaboratively with GPs. GPs recognise that the volunteers help them in their work and reduce the isolation that so many people feel, and they have seen significant reductions in hospital admissions. So, if we improve lives, we save money, and that must be what we are all after.

Each pioneer is focusing work on its own priorities, which is bringing specific progress on issues. Many of the pioneers, in both rural and urban areas, face the same issues. Partners are coming together and overcoming difficulties for everyone. We want to disseminate, as quickly as possible, the learning from those areas so that everyone can gain the benefit of this exciting pioneering work. We aim to make integrated care and support the norm and to improve the experiences of patients, service users and carers.

“Closing the Gap”, which we launched in January, indicates the importance of equity between mental and physical health for this Government. It outlines 25 priority areas where people can expect to see, and experience, the fastest changes. One priority area is tackling inequalities in access to mental health services.

Older people typically use mental health services much less often than their working-age counterparts. According to IAPT data, only 6% of people who use psychological therapies are over 65. In response, we supported the advertising campaign delivered through Age UK and Carers UK to raise awareness of psychological therapy services among older people.

NHS England is promoting psychological therapy services for adults who have depression or anxiety disorders through the national IAPT programme and, as part of this work, is paying particular attention to access for people over 65 years of age. It funded the advertising campaign to promote IAPT services. The promotional campaign challenges views that depression is natural in older people—that is an old assumption that people make—and encourages GPs to refer older people to IAPT services and older people to self-refer.

Another strand of IAPT development is a project that aims to ensure that psychological therapies are routinely available to people with long-term physical health conditions and medically unexplained symptoms. Given that many older people have such physical health conditions, this project will lead to greater use of IAPT services where necessary. We have also developed a new curriculum for psychological therapists that trains them to work more effectively with older people.

The hon. and learned Gentleman raises a point about substance misuse in the elderly population. We should not be surprised that people who have used illegal substances or alcohol earlier in life do not suddenly stop when they reach 65; better training for all professionals will ensure that help is based on actual need, and not on outdated images of older people.

“Closing the Gap” supports all the objectives set out in the Government's mental health strategy, which is a cross-Government mental health outcomes strategy for people of all ages. It was launched in February 2011 and sets out a clear vision for improving mental health and well-being in England for people of all ages, including older people.

The hon. and learned Member for Sleaford and North Hykeham spoke of the apparent disconnect between services for the under and over-65s and quoted the Royal College of Psychiatrists. We are committed to making sure that adults of all ages are treated fairly, with access to services based on their needs, not on any assumptions about what they might need. When we are developing local services, commissioners and providers have the opportunity to consider how mental health services can be user-led rather than service-led, while recognising the specialist service requirements of some older people with mental illness.

The number of older people in the UK is projected to rise substantially over the coming decades as a result of a combination of rising life expectancy and the large number of births in the period following the second world war—the baby boomer generation. Despite the demographic and additional economic pressures, the Government’s ambition is to make this country a great place in which to grow old. There is an awful lot of work still to do and we have not combated the lack of parity yet, but we are totally committed to doing so. A lot of the things we are doing will help us achieve that.

Question put and agreed to.

Care Bill [Lords]

Norman Lamb Excerpts

Tuesday 11th March 2014 Commons Chamber

[Andy Burnham]

I do not think that the right hon. Gentleman is in a very strong position to talk about Members’ abstaining in votes on amendments. I shall say more about that shortly.

Let me now list three reasons for our argument that the Bill is not what it seems. First, as I have said, it is no answer to the care crisis. It proposes that a cap should be paid for by the restriction of eligibility for care, and the removal of care from some people who are already receiving it. Last week we heard from Age Concern that 800,000 people who had previously received support no longer received it. The problem is that local authorities are being asked to implement the system with no additional resources, and are therefore having to move funding from preventive social care to the administration and funding of the cap and the deferred payment scheme. Rather than taking from one area of social care to give to another, the Government should have put new resources into social care.

[The Minister of State, Department of Health (Norman Lamb)]

The right hon. Gentleman said a moment ago that the Bill removed care from some people by restricting eligibility criteria. Does he accept that although there is a national eligibility criterion—which is long overdue—any councils that choose to be more generous can do so, just as they can now?

[Andy Burnham]

If the Minister gave councils budgets that enabled them to be more generous, they might have a chance, but drastic cuts mean that they cannot provide care that is worthy of the name. He will know of the fears of organisations that represent disabled adults of working age. The Royal National Institute of Blind People, for instance, fears that the move to retrench eligibility criteria to cover only substantial and critical needs will remove care from people with moderate needs whose support currently enables them to continue to work.

--- Later in debate ---

[Andy Burnham]

The Secretary of State says yes, but I am afraid that it will not. The £72,000 cap is based on a local authority average, not on the actual amount that people will pay for care. So no, the Bill will not give them that certainty. The Secretary of State also said that people would not lose everything to pay for care. Let us take him at his word, and assume that £72,000 is the maximum that a person can pay, and £144,000 is the maximum for a couple. In my constituency, that would indeed mean people losing everything that they had worked for, although it might not mean that in the Secretary of State’s constituency or in other parts of the country. The Secretary of State needs to be honest with people. That is why we are saying that the Bill is not what it seems.

[Norman Lamb]

Will the hon. Gentleman give way?

[Andy Burnham]

I will, but I think that the Minister should take account of that point, because it is quite important.

[Norman Lamb]

The right hon. Gentleman says that he would like the eligibility criteria to be more generous. Is he now committing himself to funding that?

[Andy Burnham]

I am not writing a budget at the Dispatch Box this evening. I will stand by our record of giving real-terms increases to local government. I warned at the start of this Parliament that if the effect of the Government’s promise of real-terms increases for the NHS—which have actually never materialised—was a raid on local government, that would be a short-term policy. It would mean more older people ending up in hospital and who then could not be discharged because there was not the care at home. That is exactly what is happening. It is a false economy. That is what we warned them about and they failed to listen.

NHS Charges

Norman Lamb Excerpts

Tuesday 11th March 2014 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

My hon. Friend Parliamentary Under-Secretary of State for Health, Earl Howe, has made the following written ministerial statement:

Regulations have been laid before the House to increase certain national health service charges in England from 1 April 2014.

This Government have made tough decisions to protect the NHS budget and increase it in real terms, but charges for some items remain an important source of revenue to support the delivery of high-quality NHS services. This is particularly important given the increasing demands on the NHS, with spending on medicines alone almost doubling since 2000.

Over 90% of prescription items are dispensed free. This includes extensive exemptions from charging for people on low incomes, such as those on specific benefits or through the NHS low-income scheme. We want to ensure that, of those who pay, people with the greatest need are protected, such as those with long-term conditions. As such, we have decided to freeze the costs of both prescription prepayment certificates (PPCs) for the next two years. This means the price of the 12-month PPC has been frozen for the lifetime of this Parliament. The three-month certificate will therefore remain at £29.10 this year and next, and the cost of the annual certificate will remain at £104.

This year, we have increased the single prescription charge by 20p from £7.85 to £8.05 for each medicine or appliance dispensed. We also intend to increase the charge by 20p to £8.25 in the following year.

The regulations will also increase NHS dental charges from 1 April 2014. The dental charge payable for a band one course of treatment will increase by 50p from £18 to £18.50. The dental charge for a band 2 course of treatment will increase by £1.50 from £49 to £50.50. The charge for a band 3 course of treatment will increase by £5 from £214 to £219.

Dental charges represent an important contribution to the overall cost of dental services. The exact amount raised will be dependent upon the level and type of primary dental care services commissioned by NHS England and the proportion of charge paying patients who attend dentists and the level of treatment they require.



Charges will also be increased, by an overall 2.7%, for wigs and fabric supports.

The range of NHS optical vouchers available to children, people on low incomes and individuals with complex sight problems are also being increased in value. In order to continue to provide help with the cost of spectacles and contact lenses, optical voucher values will rise by an overall 2%.

Details of the revised charges are in the following tables.

Care Bill [Lords]

Norman Lamb Excerpts

Monday 10th March 2014 Commons Chamber

[Bill Esterson (Sefton Central) (Lab)]

Social services are under huge funding pressure, which has a knock-on effect on the NHS. New clause 9 highlights the crucial issue of funding and will contribute to addressing it. Just 10 days ago, I experienced at first hand those pressures on the NHS. I would have added my name to this new clause, but I was unable to be here because I spent three days in Southport and Formby district general hospital. I saw the pressures in the accident and emergency department resulting from beds not being available for the transfer of patients to the wards; the pressures arising from chronic staff shortages; the difficulty in helping patients to return home because of a lack of support in the community; and general practitioners sending older people to A and E with complex needs as there was a lack of other choice or care available. In large part, the cuts in social services funding meant that I saw all those things. Meanwhile, staff in the NHS are working incredibly hard, often doing double shifts to look after patients, for which I am extremely grateful, as are many others. I take this opportunity to thank them and everybody in the ambulance service for what they did for me and have done for many other people.

The evidence I collected during those three days shows just why we need to be confident that funding is in place. Unless the funding is adequate, both in social care and in the NHS, the challenges faced day by day, hour by hour in our NHS will grow worse. We need greater integration, provided through the all-party approach advocated by Sir John Oldham in the report by his Independent Commission on Whole Person Care. As the report says, practice needs to move on so that we can see more care provided at home, with professionals working closer together in the interests of the individual. The whole-person care approach would reduce the number of hospital admissions; it would keep more people at home for longer, reducing hospital admissions and avoiding the huge pressures that I witnessed. In the context of the Bill, we need to be confident that the funding is sufficient to deliver the new responsibilities, which is why we tabled new clause 9. I hope that Members will support it this evening.

New clause 19 calls for health bodies to promote the health and well-being of carers. As the independent commissions report states:

“Most care is delivered by people themselves and their families.”

That makes the health of carers vital. My dad cares for my mum, and his health is a major concern. Carers up and down the country face declining health as they care for loved ones. Caring for the people who care is also a vital aspect of care provision, and paid staff in the health and social care sectors are also carers. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) talked about priority treatment going to volunteer carers—family members, friends and other volunteers. We should also consider that approach for everyone who works in the NHS or in social care. If we read the new clause in its widest sense, we should consider paid carers too, be they in the NHS or in social care.

Some 1.3 million people work in the NHS, and 1.5 million in social care. We should promote the health of NHS and social care staff as well as that of unpaid carers who do a fantastic job up and down the country. I hope that new clauses 9 and 19 receive the support of the House.

[The Minister of State, Department of Health (Norman Lamb)]

I share the frustration of many Members at the shortness of time that we have had to discuss such important issues.

Part 1 of the Bill brings in a long overdue and fundamental reform of care and support. It has been brought before the House after around five years of one of the most collaborative processes ever used to develop legislation, and I am very proud of this historic set of reforms.

I hope to have time to explain Government amendments 1 to 7 and 14, relating to clause 123 on regulations, but before that I shall try to address some of the key points that have been made. I fear that I do not have time to do justice to all the points, but I shall do my best.

On new clause 1 on power of access, which was tabled by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), it is my view that there is no gap in powers that would prevent care or other professionals from accessing those in urgent need of assistance. I am not alone in that view. The Association of Chief Police Officers says:

“Powers of entry are provided to us under both common law and PACE and I am satisfied that these would afford us access to premises where vulnerable individuals are considered to be at risk.”

The Association of Directors of Adult Social Services, which is an important organisation, agrees:

“We have no evidence that the proposed powers of entry would add significantly to the range of tools currently available to practitioners, rather we are concerned that this would encourage a coercive rather than negotiated approach to complex and difficult situations, and increase risk of harm or abuse. Any such power would not assist the complex next steps in assuring and supporting individuals, who have capacity, to stay safe.”

That view is confirmed by the chief social worker for adults, who said:

“An additional power of entry or access on its own would be insufficient, and indeed could make the situation worse.”

The inherent jurisdiction of the High Court to intervene provides a crucial final safety net. Beyond that, the critical thing is to issue, as we intend to do by the end of March, clear guidance on existing powers to ensure that all professionals working in this important area understand what powers they have available to them. I know that my right hon. Friend has been assiduous in pursuing that issue, and I am happy to involve him in the process of confirming those final guidelines that we intend to publish by the end of March.

On amendment 27 about the definition of abuse, the Joint Committee on the Draft Bill stated:

“Abuse is an ordinary English word, capable of being understood without being defined…to attempt an exhaustive definition always has the danger of omitting something which, as subsequent events make clear, should have been included.”

We agree and believe that the Bill is clear as drafted. Last week, I spoke to the all-party group, which is chaired by my hon. Friend the Member for South Swindon (Mr Buckland). I promised to go away and look at the matter and to talk to officials, but I am absolutely satisfied that the plain English words are very clear. The explanatory notes will be expanded to ensure that it is made clear. The guidance and explanatory notes will both have legal force, and courts will use them to interpret the intentions of the Bill.

Turning to amendment 28, the overarching well-being principle applies to safeguarding duties. Where partners become aware of abuse or neglect, it is imperative that they act, and the guidance will be absolutely clear on that point.

On new clause 26, I completely agree that police cells are a totally inappropriate place for someone in a mental health crisis. The crisis care concordat, which, for the first time ever, sets standards of crisis care, lays out our clear expectation that the use of police cells will drop by half by 2014-15. However, that must only be a start. The Home Secretary announced last year that there will be a review of the operation of sections 135 and 136 of the Mental Health Act 1983 on places of safety, and that is the right approach to take. However, I agree that we must end this awful practice of people ending up in police cells completely inappropriately.

I sympathise with new clause 11 on the Human Rights Act, but do not feel that it adds anything in terms of protection for individuals. None the less, I recognise the strength of feeling on the matter, so I expect that it will be discussed further in the final stages of the Bill’s passage in the other place. In the meantime, I am prepared to reflect on the points made and consider whether legislative clarification might be justified in order to make the Government’s position clear.

--- Later in debate ---

[Paul Burstow]

That is a helpful way forward, but I ask the Minister to say a little bit more about new clause 11 and the Human Rights Act issue.

[Norman Lamb]

I have already confirmed that we will return to the matter later in the process, and I hope that we will then end up in a satisfactory place.

Turning to new clauses 7 and 9 to which a number of hon. Members have spoken, the spending review considers spending pressures across adult care and support, the NHS and public health. In the current spending review period, we allocated significant additional funding to local authorities for adult care and support, including a transfer from the NHS of £1.l billion a year by 2014-15 to be spent on social care with a health benefit. That is not to say that I do not recognise how challenging the financial environment is for local authorities, but we know from figures provided by the local authorities themselves that the vast majority of cost savings have been achieved as a result of efficiencies and not of cutting services for people.

However, as the hon. Member for Leicester West (Liz Kendall) said in Committee, the answer is not just to throw more money at the system, but to look at how public funding is spent and to deliver a more radical reform of health and social care. That is why, in the spending review for 2015-16, we announced the better care fund, which is a £3.8 billion pooled budget for health and social care. That not only provides the resources needed to protect access to social care, but breaks absolutely new ground in establishing structures that will drive further and faster integration between health and social care.

As hon. Members have noted, the better care fund includes £135 million of additional funding for implementing the Bill in 2015-16. Some have argued that including that in the better care fund means that local authorities will face a choice between implementing the Bill and investing in integrated services. In my view, that is a false choice. On the contrary, our reforms are part of the same agenda, and we cannot afford to see those as separate issues. Both systems need to work more effectively together to help people live independently for longer.

[Barbara Keeley]

rose—

[Norman Lamb]

I am conscious that I owe it to hon. Members to respond to all the issues that have been raised.

The reforms in the Bill to extend assessments and support for carers can play a big part in keeping people out of hospital. The spending review provided £335 million in 2015-16 to help local authorities’ transition to the capped cost system and to offer universal deferred payments. Locally, health and wellbeing boards have a statutory responsibility to analyse current and future health and care needs and to develop a strategy to address them. Given such an approach, there is no need for the proposed amendments.

[Paul Burstow]

rose—

[Norman Lamb]

I am sorry; I must ensure that I get through all the amendments.

On new clause 13, I am clear that the current lack of good information on deferred payment agreements is not acceptable, given the importance of the scheme. That is why we are working with national partners in local government and the National Association of Financial Assessment Officers to develop a range of questions that will improve and expand the data we already have. The new clause is therefore unnecessary as we already have plans under way to achieve a similar goal.

On new clause 4 on local authorities making “reasonable charges”, the Government’s proposal to set a clear amount beyond which a person’s income cannot be reduced is much clearer and provides stronger protection. I have written to my right hon. Friend the Member for Sutton and Cheam and other Committee members on this subject, and I would be happy to share the letter with other Members. I have nothing to add to that analysis and do not agree that the new clause is required.

On amendment 21 and new clause 15, the Bill makes it clear that local authorities must work to maintain a sustainable market that delivers a wide variety of high quality services for people who need care and support in the local area. Local authorities’ own commissioning is an important part of this process. Additionally, local authorities will have to have regard to the well-being of individuals when commissioning services. Therefore, any local authority that commissions inappropriately short care visits or does not consider the actual cost of care when setting fee levels is highly unlikely to be fulfilling their duties. These matters will be set out fully in statutory guidance. It would not be appropriate to have a nationally set formula that would lead to standard rates or “tariff prices” for care and support, as this is best left to local negotiations in the open market.

On new clause 24, local authorities are already under a duty to work with their local clinical commissioning groups and others through the health and wellbeing boards to undertake joint strategic needs assessments and to develop joint health and well-being strategies. Statutory guidance published in March 2013 makes it clear that these must be published and have specific regard to

“what health and social care information the community needs, including how they access it and what support they may need to understand it”.

Awareness-raising will be an important part of the Bill’s implementation. The Department will co-ordinate involvement of wider interests, including local authorities and the private and voluntary sectors, to raise the public’s awareness of the new arrangements, specifically on the need for people to plan for care costs. We will add to what is already available to monitor the effectiveness of information and advice, public accessibility and public awareness.

On new clauses 22 and 23 about financial advice, the Financial Conduct Authority already has a responsibility to keep under review the financial advice market as regards how it is serving customers, and qualifications for advisers, and this includes those looking to fund long-term care costs. These requirements are published in FCA rules. Such an addition to the Bill would therefore be unnecessary.

I understand the intention behind new clauses 17, 18 and 32—it is to ensure fair payment for care sector workers. In response to the Cavendish review, statutory guidance for the Bill will include guidance to local authorities on commissioning services and arranging contracts that will explicitly require them to have regard to ensuring that provider organisations adhere to minimum wage legislation, including, crucially, the payment of travel time between social care visits. We are also working closely with Her Majesty’s Revenue and Customs to ensure that the national minimum wage guidance is appropriate to the care sector. We have amended the Bill to enable specified bodies to provide training standards for groups of workers, initially focusing on health care assistants and social care support workers. This will form the core of the new care certificate.

New clause 31 is outside the remit of Health Education England, which has a delegated duty under the National Health Service Act 2006. The duty relates to education and training in relation to persons working, or considering working, in connection with the provision of services as part of the health service in England. The duty does not extend to regulated social care, which is taken to mean social care delivered by providers registered with the Care Quality Commission.

On new clause 5, given the inherent complexity presented by the different legislative frameworks operating in the different territories of the United Kingdom, we will look to develop principles on cross-border continuity of care that achieve the same practical effect as further legislation. I absolutely agree with the hon. Member for Edinburgh East (Sheila Gilmore) about the importance of this issue. We have started discussions with colleagues in the devolved Administrations and we will aim to publish the principles by November. I hope that that helps her.

On new clauses 3 and 19 about NHS work to identify and promote the health of carers, I can confirm that the guidance will absolutely reinforce the importance of co-operation between the NHS and local authorities on local authorities’ duty to identify carers. NHS England is developing its own action plan for identifying and supporting carers. In addition, our vision for out-of-hours hospital care, which will be published in April, will build on changes to the GP contract for 2014-15. All patients aged 75 and over will have a named accountable GP with responsibility for their care, and we will consider how we can extend this approach to all people with long-term conditions. The plan will emphasise the importance of GPs identifying carers and supporting them in their caring role by directing them to information, advice and support.

On new clauses 20 and 21, a legislative approach that compels schools, universities and colleges to identify young carers and student carers would not be in keeping with the Government’s drive to reduce burdens. The Department for Education has already been doing a lot in this regard, and it is now working with the National Governors Association in raising awareness in schools. The Department of Health has invested in many initiatives to help to identify and support young carers. We have trained over 150 school nurses as young carers’ champions. Along with other Departments, we will also explore the factors that are challenging in young adult carers’ transition from school to college or university. Along with ministerial colleagues, I will shortly write to Universities UK and the Association of Colleges to seek their engagement in this work.

Amendment 20, tabled by the hon. Member for Islington North (Jeremy Corbyn), is not required because the scope of the new powers in clause 12 already allows for the collection of such information if we choose to require it.

On amendments 31 to 33, we have carefully considered the issue of time frames in the care planning process, including reviews. On balance, we feel that a flexible approach is best. It is important for local authorities to retain the ability to be proportionate to the needs to be met. For some people—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The Minister must be heard. Hon. Members are being rude in speaking.

[Norman Lamb]

Thank you very much, Madam Deputy Speaker.

For some people, the care planning process may be relatively simple, but for people with complex needs it is important that the plan is carefully produced and agreed with the person in order to meet their care and support needs effectively and appropriately.

[Mrs Lewell-Buck]

Will the Minister give way?

[Norman Lamb]

I do not have time, I am afraid.

We will set out in guidance best practice on conducting care plans. I hope that that reassures the hon. Member for South Shields (Mrs Lewell-Buck).

Amendment 26 is unnecessary because the concepts of independent living and inclusion in the community are already core parts of the duty to promote individual well-being. We have merely captured them in more concrete ways rather than using those terms, which are too unclear, as the Law Commission agreed.

Schedule 2 to the Children Act 1989 requires local authorities to keep registers of sight-impaired children, and amendments 22 to 25 would only duplicate that. We have committed to explicitly reinforcing this duty in the forthcoming code of practice for children and young people with special educational needs or disabilities.

I turn briefly to the Government amendments. Amendments 1 and 2 simply clarify the scope of the regulation-making powers as set out in the other place by Lord Howe, the Under-Secretary with responsibility for quality. They ensure that regulations can specify where local authorities do have the power to be more generous and contribute to the costs of an adult with resources above the financial limit, as well as where they do not.

Amendment 3 allows regulations to specify where certain costs do not have to form part of the personal budget and thus do not count towards the cap on care costs. It has always been the intention that some provision, such as reablement, should be a universal, free service and therefore should not be incorporated in the personal budget. Such exemptions will not apply to general care and support that a local authority can charge for.

Amendments 4 and 5 correct small drafting omissions in clause 34. Amendment 6 will enable us to make provision in the regulations for the appeals system for the investigation of the appeals body itself—for example, regarding allegations of maladministration. Amendment 14 sets out that, as per usual practice, we will use affirmative regulations if we need to amend primary legislation as part of the appeals regulations.

Finally, on amendment 7, the feedback from local authorities is that it would make sense for them to have flexibility to be able to delegate functions relating to direct payments if they so wish. We agree and have accordingly tabled an amendment to remove the prohibition related to that.

[Paul Burstow]

I give notice that I would like to press new clause 9 to a vote and beg leave to withdraw new clause 1.

Clause, by leave, withdrawn.

--- Later in debate ---

[Mr Dorrell]

No, I do not believe that simply empowering the Care Quality Commission to go into that space is the answer to the question that I am posing. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) is closer to the right answer in identifying the health and wellbeing board at a local level as the beginnings of an organisation that can deliver a more joined-up commissioning process, joining up the social care system, the community health system, the primary health system and, of course, the hospital service—and I always add the social housing people. In a properly joined-up service, they would focus their attention on the needs of the individual patient service user—an awful piece of terminology; we cannot work out precisely what to call them.

I wish to highlight a bit of institutional tension. My right hon. Friend the Member for Sutton and Cheam proposes that this is a function for the CQC, but I am not entirely convinced. A tension underlying several contributions this evening relates to whether the CQC is the regulator of a provider, or an organisation with responsibility for charting the course, which I am looking for from the Minister, towards a new form of commissioning. The CQC has a full job to do responding to some of the things that my hon. Friend the Member for Bristol North West was talking about—culture and service quality on the provider side—and I am not persuaded that trying to manoeuvre it into the space of developing the kind of joined-up commissioning service I am describing is the right answer to that question.

[Norman Lamb]

I reassure my right hon. Friend that I want to chart the course with him. I completely agree on the need to bring commissioning together. The better care fund is a good nudge in the right direction, but we need to go much further in due course.

[Mr Dorrell]

I am grateful to the Minister for his encouragement that I am on the right path.

There is a serious question here. I agree with my right hon. Friend the Member for Sutton and Cheam that, at a local level, the health and wellbeing board is the organisation best placed to move forward with the process of more joined-up commissioning. How we, as MPs, satisfy ourselves that this is happening to the required standard, with the required levels of economic efficiency across the system as a whole and above the level of the health and wellbeing board, is one of the questions left unanswered by the institutions we currently have. I am not entirely persuaded that the CQC should be encouraged into what I regard as a vacuum.

--- Later in debate ---

[Norman Lamb]

Let me begin by thanking all Members for their contributions to the debate.

Part 2 of the Bill contains a range of measures to implement the Francis recommendations following the awful events at the Mid Staffordshire NHS Foundation Trust. The changes that we are introducing are intended to make a reality of Robert Francis’s recommendation that the NHS, and indeed all care services and those who work in them, should adopt and demonstrate a shared culture in which the patient is always the priority.

I accept the principle that lies behind new clause 8 and amendment 19, but the oversight of commissioning is not the core purpose of the CQC. I want the CQC’s main focus to be on providers and the quality of care provided for patients and service users. Any review or investigation of commissioning of services by the CQC will have an impact on its capacity to oversee service provision, and should be selected with care. It is therefore right for any CQC special review or investigation of commissioning to continue to be either at the request of, or subject to the approval of, Ministers—in the case of reviews of local authority commissioning, the Secretaries of State for both Health and Communities and Local Government.

I want to make my position absolutely clear. If there is strong evidence of a link between commissioning and poor care, the CQC will be able to examine it.

[Paul Burstow]

rose—

[Mrs Lewell-Buck]

rose—

[Norman Lamb]

I will give way to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) first.

[Paul Burstow]

I apologise for getting in just before the hon. Lady.

May I return to a point that I raised in my opening remarks? At present, inspectors disavow the opportunity of providers to give them the evidence to which the Minister has referred. They say that they are not interested in it. Will the Minister ensure that the CQC and its inspectors are open and receptive to such evidence when providers offer it to them?

[Norman Lamb]

Subject to the fact that the CQC is an independent body, I will certainly reinforce that point in my discussions with it. In the context of mental health, we were discussing with the CQC only last week the importance of the role of commissioning as well as that of provision. I entirely accept that good care can be provided only if we get both the commissioning side and the provider side right: the two must go together.

Is it appropriate to set out the specifics of a review of commissioning in the Bill? I do not believe that it is. Flexibility is vital. While the CQC has a power to conduct special reviews and investigations of commissioning, that must be set in the context of other measures in the Bill that will strengthen the duties that local authorities must fulfil in exercising their care and support functions.

[Mrs Lewell-Buck]

Perhaps I am being impatient—the Minister may deal with this point later in his speech—but I should like to know who will routinely review local authority commissioning. If no one will be doing that, how will the CQC know that poor commissioning is taking place in a local authority area?

[Norman Lamb]

I take very seriously the point that the hon. Lady has raised, but if she will allow me to continue to present my argument, I shall be happy to return to it later if necessary.

The important new measures include an express duty to promote people’s well-being—a duty to shape local care markets to ensure that they are sustainable and diverse, and offer high quality care and support. The Department will work with the local government and adult social care sector to produce statutory guidance on local authority commissioning of care and support. However, a CQC review of commissioning remains an option. I reassure right hon. and hon. Members that we will review evidence of concerns about local authorities’ commissioning practice to establish whether it is appropriate to ask the CQC to undertake a targeted review under section 48 of the Health and Social Care Act 2008. Getting the message out to commissioners that the powers will be used is important in itself to concentrate minds. They will be under the spotlight if they fail in their commissioning responsibilities.

New clause 12 would require the CQC to consider integration of care as part of its performance assessments of registered providers of health and adult social care. In Committee, my right hon. Friend the Member for Sutton and Cheam made a strong case for the new system of performance ratings to be carried out by the CQC to look at care pathways, rather than focusing on separate institutions in isolation. He makes a very good case. I explained that a central tenet for the Government is that the independence of the CQC improves its effectiveness as a regulator. Clause 89 removes nine separate powers for the Secretary of State to intervene in the day-to-day workings of the commission, and we have deliberately removed the Secretary of State’s power to devise or approve the system for performance assessments and ratings.

The CQC has to be responsible for the system of performance assessment that it introduces, and placing specific requirements on the commission in legislation would not help in that regard. That is not to say that the CQC should not look into the integration of care. I told the Committee that I would pursue that matter in my discussions with the CQC, and I have done so. I have spoken to the CQC chair, David Prior, and to the chief executive. I am pleased to say that in that regard we are pushing at an open door. They absolutely understand the case that my right hon. Friend makes.

In recent weeks, the commission’s chief executive, David Behan, has set out plans for the CQC to carry out thematic inspections to look at the care pathways for different conditions. One such thematic programme will look at how people with dementia are handled by relevant services in a geographical area—acute health care, primary health care and adult social care, for example. Another is looking at how people move across transition points, such as when a disabled child becomes an adult—a point at which too often services fall down.

[Mr Tom Clarke]

The Minister has outlined that he wants to work with the commission, local authorities and others in these important matters. Does he agree that there are issues on which organisations such as Mencap have a lot to contribute? Would he see the Government’s approach on those matters as being inclusive in that respect?

[Norman Lamb]

I totally agree with the right hon. Gentleman. The more that we talk to organisations with expertise such as Mencap when we are designing the commissioning and inspecting of facilities, the better we are at the job that we do. We must not think that we have all the answers in Whitehall.

A future thematic review could consider the integration of health and social care services either in a particular location or across a particular condition. I am keen that the commission pursue that further, but, as I say, I think that we are pushing at an open door in that regard.

New clause 33 would create the new post of candour commissioner for England. The commissioner would be tasked with protecting and promoting a culture of candour and disclosure in the health and social care sectors, an ambition that I think we would all share. The Government are taking steps to make a culture of candour and openness a reality. We will put in place a statutory duty of candour on providers registered with the CQC—I am personally delighted that we are doing that. That will require providers of health and social care to be open with patients and service users where there are failings in care.

I commend to the House the excellent review of the duty of candour by Professor Norman Williams and Sir David Dalton, which was published last week. We will consider the recommendations of the review—I repeat that I thought it was excellent—as we develop regulations to implement the duty of candour as a requirement for registration with the CQC. We are also enhancing the professional duty of candour through changes to professional guidance and codes.

Effective whistleblowing and complaints systems are vital parts of an open and transparent culture. As the Committee Chair, my right hon. Friend the Member for Charnwood (Mr Dorrell), pointed out, what we are after is a system in which whistleblowing is no longer necessary because the culture is open. That will help to improve public and patient safety and the quality of services provided.

This Government support the right of staff working in the NHS to raise concerns and expect all NHS organisations to support staff who wish to do so. NHS organisations have to have in place policies that are compliant with whistleblowing legislation. Also, the CQC’s new inspection system will include discussions with hospitals about how they deal with whistleblowers, and the CQC is reviewing its arrangement for handling whistleblowing concerns. The CQC’s national adviser for patient safety has recently established, and chairs, a forum of whistleblowers, so the CQC understands the issue and recognises its central role in this regard.

I am sure that my hon. Friend the Member for Bristol North West (Charlotte Leslie) will agree with me that we will only achieve the change in culture that we are seeking by creating champions for candour and openness throughout every tier of every organisation—people who really believe in openness in both health and adult social care. Promoting and protecting candour is the business of every member of staff in health and social care. Indeed, the Dalton-Williams review prefaced its discussion of the candour threshold with a clear recommendation to establish a culture of candour based on training and support of staff and more accurate reporting of safety incidents.

I would also point out that the creation of a new office of candour commissioner would need funding. Given the measures we are already putting in place to support candour, I am not convinced that a candour commissioner would be the best use of finite resources.

New clause 28 would require the Secretary of State to commission an independent review of whistleblowing arrangements within six months of this Bill coming into force. I recognise that reviews, as suggested in this amendment, can play a key role in ensuring that legislation is operating as intended—a form of post-legislative scrutiny. It is for this reason that the Government, through the Department for Business, Innovation and Skills, have recently carried out “The Whistleblowing Framework: Call for Evidence”. This call for evidence is part of a review of the effectiveness of the legislation around whistleblowing, specifically considering whether the protections available in the Public Interest Disclosure Act 1998 for those wishing to raise concerns are effective. Members of the public and experts have been asked to submit evidence to BIS’s review. The findings will be published this spring. My Department has submitted evidence to this review on behalf of the health and care sectors, having taken the views of the professional regulatory bodies, but I do not support putting a commitment in primary legislation to undertake a review such as the one suggested in the amendment.

New clause 10 relates to the single failure regime for NHS trusts and foundation trusts. I repeat the assurance given in Committee that where the chief inspector of hospitals finds that patients are exposed to an immediate risk of harm, he will continue to be able to take swift and decisive action under section 31 of the Health and Social Care Act 2008. This new clause would prevent the CQC from being able to trigger trust special administration on quality grounds while it was using its powers under section 31. The chief inspector needs to be able to draw on the full range of the CQC’s powers to ensure regulatory action is appropriate in each case. We must not set unnecessary constraints on the CQC’s ability to address failings in quality. There may well be situations where the CQC needs urgently to suspend a particular service and also to consider trust special administration to ensure that high quality services can be sustained.

Let me make it clear that the CQC will be able to trigger trust special administration only where there has been a serious failure of quality and it is appropriate to do so. There are a number of ways to support trusts to improve, ensuring that special administration is only the last resort. Monitor and the NHS Trust Development Authority have a range of intervention powers and can also place trusts and foundation trusts in special measures to provide a package of measures to support improvement.

[Paul Burstow]

The Minister mentioned that a number of measures may be taken pre-failure in order to avoid the failure regime being triggered. Before tomorrow’s debate on clause 119, will he supply the measures by way of example, so that we can debate those very issues?

[Norman Lamb]

I am happy to ensure that a note goes to my right hon. Friend and other Members, as he requests.

New clauses 29 and 30 would introduce a power to create new requirements for registration with the CQC, one requiring providers to minimise the risk of harm to patients and service users, and the other requiring providers to inform patients and their representatives where treatment leads to harm, and to prepare a safety management plan. Section 20 of the Health and Social Care Act 2008 sets out the areas in which the Government may impose, through regulations, requirements on providers registered with the CQC. It is a broad power and expressly allows regulations for

“securing the health, safety and welfare of persons”

for whom services are provided. This is broad enough to include minimising harm to patients. In addition, it expressly includes a power for the registration requirements to cover

“the manner in which a regulated activity is carried on”,

which would cover a requirement to prepare a safety management plan.

Clause 80 also places a duty on the Government to introduce a new registration requirement of informing patients and service users where there have been failings in their care—the duty of candour. I hope that I have reassured my hon. Friend the Member for Bristol North West that the power already exists to include the proposed areas in the CQC registration requirements.

My Department is consulting on draft regulations to put in place new fundamental standards as requirements for registration with the CQC. These would require providers to take “appropriate steps” to mitigate the risks of service users receiving care that is “inappropriate or unsafe”. We plan to consult shortly on a new duty of candour requirement. We will, of course, develop the final regulations, which will be subject to the affirmative procedure, in the light of the comments received in the planned consultation.

Finally, I support the sentiment behind new clause 27, that providers of care services should be held to account where they allow abuse or neglect, and that there should be serious consequences where this occurs. Under the fundamental standards on which we are consulting at the moment, all providers registered with the CQC must take steps to avoid abuse and neglect, and take action where those occur. Where providers are responsible for abuse, the CQC will be able to prosecute them. In fact, in response to Winterbourne View, I took the view that there was a gap in the regulatory framework, which did not allow for proper corporate accountability. I felt that we had to change the arrangements to ensure that companies, trusts and other providers were held to account where they were responsible for abuse or neglect. We are achieving that objective.

In addition, we have brought forward proposals to respond to the most egregious failures of care. On 27 February, we published our consultation on the detailed proposals for a new criminal offence of ill-treatment or wilful neglect. The Berwick report was clear that this offence should apply to individuals and organisations, whether or not they are registered with the CQC. We agree with that approach, and are consulting on the proposal. The new criminal offence, together with the CQC’s responsibility to respond to poor quality care, is sufficient to ensure that action is taken against unacceptable standards of care, and that there are serious consequences where this occurs.

[Paul Burstow]

I am grateful for the Minister’s responses to my three new clauses. I look forward to hearing what other hon. Members have to say about their provisions, but on the basis of the assurances I have been given, I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.



New Clause 27

Corporate responsibility for neglect

‘(1) This section applies where a person registered under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (a “registered care provider”) in respect of the carrying on of a regulated activity (within the meaning of that Part) has reasonable cause to suspect that an adult in their care is experiencing, or at risk of, abuse and neglect.

(2) The registered care provider must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case and, if so, what and by whom.

(3) Where abuse or neglect is suspected, the registered care provider is responsible for informing the Safeguarding Adults Board in its area and commits an offence if (without reasonable cause) it fails to do so.

(4) A registered care provider is guilty of an offence if the way in which its activities are managed or organised by its board or senior management neglects, or is a substantial element in, the existence and or possibility of abuse or neglect occurring.

(5) A person guilty of an offence under this section is liable on conviction to imprisonment for a term not exceeding two years, or to a fine, the range of which will be specified by regulations, or to both.’.—(Nick Smith.)

Brought up, and read the First time.

Question put, That the clause be read a Second time.