Francis Report

Norman Lamb Excerpts

Wednesday 5th March 2014 Commons Chamber

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

Police cell.

[Paul Burstow]

I am grateful to the Minister for correcting the record from a sedentary position.

There were 350 children on adult wards in 2013-14, including one as young as 12, and the use of restraint has been at a high level. I know that the Minister for care services is championing changes in that area. I very much welcome his leadership on the crisis care concordat. It is very important that the CQC leads on regulation to show that it is not just words, but will be backed by regulatory teeth.

The culture change also needs to be about listening to patients. The evidence again suggests that there is still a long way to go. The Care Quality Commission has found that a quarter of care plans showed no evidence of patient involvement. That cannot be right, whether for a long-term physical health condition or a mental health problem.

We have only just had a tariff for mental health. When I arrived as a Minister with responsibility for it, I found that the task of producing tariffs had already taken five years, having dragged on and on. Yet because of the difference in how we funded mental health services, it was easier to cut them in the past. The picture of spending on mental health is rather more nuanced than it is sometimes portrayed in debates in this place.

Given all that, we might have expected NHS England to ensure that its response to the Francis inquiry and to the Government response recognised that poor care can occur in mental health as well. The chair of NHS England, Malcolm Grant, has put his name to the statement of common purpose that prefaces the Government response to Francis. Yet NHS England has ignored this Government’s mandate to it to deliver parity of esteem. NHS England’s financial experts do not get it: they are delivering Francis’s agenda simply for the acute sector, and taking money away from mental health services through adjustments to how payments are made for them. That cannot be right. I know that the Minister agrees with me, but doing so is not sufficient: there must be a challenge to NHS England’s decision to take away money from mental health, given that both sectors need to make progress and to take steps to deal with the Francis agenda.

[Norman Lamb]

I just want to alert my right hon. Friend to the fact that David Nicholson, the chief executive of NHS England, has made it clear to area teams and therefore to clinical commissioning groups that they must take parity of esteem fully into account in financial settlements with mental health trusts. That clarification of the importance of parity of esteem on finances is critical, and I hope that he welcomes it.

[Paul Burstow]

I very much welcome that and what the Minister says.

The reason I have raised issues about mental health in this debate is that it would be a mistake for Members to see Francis simply through the lens of acute hospital care. As the Government said in their response to Francis, we need to be concerned right across the piece. That is why I make no apology for focusing my speech on mental health, and why I hope that the Government will continue to drive an agenda of parity of esteem and make it a reality.

Adult Autism Strategy

Norman Lamb Excerpts

Wednesday 5th March 2014 Westminster Hall

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

I congratulate my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) on securing the debate, but more particularly on her brilliant work over the years to secure the 2009 Act and the strategy that followed it. I know from my ministerial role that she continues to show an interest and pursue the case for change, and that is incredibly valuable.

Ministers are normally under pressure to respond to requests for meetings, but although I have not had one today, I would like to offer my right hon. Friend the chance to come to the Department, before we reach the final point of the refreshed, revised strategy, to discuss where we are going with it. My hon. Friend the Member for South Swindon (Mr Buckland) spoke passionately as well. I was with him yesterday at a meeting of his all-party group on autism, and he should be part of the discussion. Other Members are welcome too—that would be very valuable.

[Mrs Gillan]

rose—

[Mr Buckland]

rose—

[Norman Lamb]

I will give way to both colleagues, but first to my right hon. Friend the Member for Chesham and Amersham.

[Mrs Gillan]

I thank the Minister for his generous offer. He took the thought out of my head, because I was going to ask whether my hon. Friend the Member for South Swindon (Mr Buckland) could accompany me, alongside someone from the National Autistic Society. That offer will be taken up, and communities across the country will appreciate that. Even if the Minister is unable to meet all the demands we have set out today, it is important that he can set out a path forward, so that we can achieve what we have been asking for across the board, so I thank him for his offer.

--- Later in debate ---

[Norman Lamb]

I thank my right hon. Friend for accepting my offer, and now give way to my hon. Friend the Member for South Swindon.

[Mr Buckland]

I am grateful to the Minister. I will not take up his valuable time, but I want to thank him for the meeting he had on the strategy the other day with me and my hon. Friends the Members for Salisbury (John Glen), and for Cambridge (Dr Huppert). We have already started the work here in Westminster, and I am very grateful to the Minister for agreeing to a further meeting with my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) to push the agenda forward.

[Norman Lamb]

I acknowledge my hon. Friend’s comments. I share the shadow Minister’s view that this issue is entirely bipartisan. There is a massive need to change and increase society’s understanding of autism. Awful things so often happen through ignorance of autism and the entire spectrum. It is crucial to raise awareness, as several Members have said.

My right hon. Friend the Member for Chesham and Amersham raised a number of queries about whether the revised strategy would reinforce the points from the original strategy, and I can confirm that it will do so on all the points she mentioned. It must also go further and look into other areas.

My hon. Friend the Member for South Swindon talked a lot about the criminal justice system, and we must look at how we can improve things there. He made the point that someone with Asperger’s is seven times more likely to end up having some contact with the criminal justice system. We have started to roll out the Government’s liaison and diversion service, which I announced back in January. By 2017, we aim to have a nationwide service for people with mental health problems, autism and learning disabilities who end up in the criminal justice system, often inappropriately and unnecessarily. Getting people diverted to diagnosis, which Members have talked about, and to the right treatment can often prevent further offending and potentially thereby transform someone’s life while protecting others.

[Mr Buckland]

I pay tribute to the Minister for the mental health pilot schemes that are being introduced in Wiltshire and other places; they were recommended by the Bradley review some time ago. Does he agree that community psychiatric nurses need training, particularly in cases of comorbid autism and mental health conditions, which are sadly quite common? We must ensure that the pilot covers autism when it comes to the diversion at the police station.

[Norman Lamb]

I absolutely agree with my hon. Friend. I wanted also to touch on the point made by my hon. Friend the Member for South West Bedfordshire (Andrew Selous) about the parents of adults with autism who, far too often, are told by clinicians that they cannot talk to them about their adult child’s circumstances. Clinicians often hide behind the absolute importance of confidentiality about a condition in order to refuse to talk at all to the parents—the people who know the individual better than anyone. That is an attitude of mind among too many clinicians. It has to change.

I also wanted to refer to the points made by my hon. Friend the Member for Strangford (Jim Shannon). I think I can call him my hon. Friend. [Hon. Members: “Hear, hear!”] Thank you for that. He talked about the pressure on families, and he is absolutely right. Whether one is talking about learning disability, autism or dementia—there are parallels with dementia—the need to raise awareness in society is real. I am also happy to look at the Northern Ireland legislation and at what lessons can be learned throughout the jurisdictions.

Another point in response to the debate was to do with transition. Whether with mental health, learning disability or autism, we so often find that disasters happen at the age of 18. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) alluded to that important point. Too often, people are lost to the system. The age of 18 is the worst possible age to withdraw support, whether we are talking about mental health in general or autism in particular.

[Robert Halfon]

I thank my hon. Friend the Minister for giving way. I gave the figure of 85% of people with autism not having full-time employment, and I mentioned the apprenticeship for autism started by my charity, PACT for Autism. Will the Government’s apprenticeship ambassador, my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones), who is present, work with the Minister with responsibility for apprenticeships to look at introducing such a scheme and rolling it out across the country?

[Norman Lamb]

My hon. Friend beat me to it, because I was about to refer to his comments on apprenticeships. I am interested in that. I am proud of what the Government have done on apprenticeships in general, but their use for people with autism is an interesting area. I noted the points he made about the scheme in his local area, and I am happy to consider it further.

[Mr Burrowes]

On incentivising employers and leading by example, the Government, in the NHS, are among the biggest employers around and will no doubt want to be an autism-friendly organisation and employer. Does the Minister have any information about how autism-friendly the NHS is in employing people with autism? Will he look into how the NHS can take a lead by doing that?

[Norman Lamb]

I absolutely agree that the NHS ought to be an exemplar employer. I suspect that the truth is that it is variable, with areas of good practice, but we do not know enough about the position throughout the NHS. The message should go out from this debate that the NHS has an obligation to lead by example and to demonstrate what can be done. Several hon. Members made the point that employing someone with autism might be quite challenging to start with, but the potential that that individual can offer is often enormous. An organisation could end up with a loyal employee who can contribute massively. The NHS needs to demonstrate that by leading from the front.

Everyone with autism should be

“able to live fulfilling and rewarding lives within a society that accepts and understands them.”

That was at the heart of the “Fulfilling and rewarding lives” strategy, and I stand firmly behind it. Furthermore, the work of the National Autistic Society’s “Push for Action” campaign has been hugely valuable in helping the Government to focus on the issues that need to be considered. I pay tribute to the society for inspired leadership. Other organisations have worked with us as well, including the Autism Alliance, Autism Plus and Ambitious about Autism, and I pay tribute to the work of all those organisations.

During our review, we ran a comprehensive exercise to listen and learn how the strategy is working. Nearly 2,000 people, including some on the autism spectrum and some who are involved in planning, commissioning and providing services, took part in focus groups, events and conferences, and more than 1,100 people with autism took part in an online survey. Local authorities worked with their partners and local people to complete a self-evaluation exercise on their progress. All this information, including individual returns, will be made available by Public Health England when the update of the strategy is published. As well as cross-departmental discussions, there has been contact with the different parts of the United Kingdom to discuss all four strategies, including that of Northern Ireland, to find common ground and to improve standards across the board.

Foundations for change have been laid and people with autism have increasingly been engaged locally in planning and designing services. Clear national guidance has been issued on the care, management and diagnosis of autism. We have heard about some great experiences that people have had in further education or with particular employers. My hon. Friend the Member for East Worthing and Shoreham made a good point about the need for employers to take the lead and to demonstrate best practice.

In some areas, there are great local autism teams and excellent diagnostic services. I noted what my right hon. Friend the Member for Chesham and Amersham said about her area and the GP who was taking the lead in that county to commission services. That is exactly what needs to be happening everywhere. I also heard of some great services being provided in Swindon, so there are some good things happening, but it was only five years or so ago that low levels of awareness and a lack of services were what led to the Autism Act, back in 2009. There are some real successes, but there is also much more to do to see the foundations translated into a greater difference to peoples’ lives.

When I have talked to people with autism and to families at events that have taken place during the review, I was struck by how variable the position is. In some areas, very little has happened. We now have the legislation in a good place and a good strategy, which is being updated, but translating that into a difference to people’s lives is where an enormous amount of work still needs to be done.

[Mr Jamie Reed]

When the Minister comes to publish the refresh of the strategy, will any care be given—as it should, in my view—to the understanding of NHS front-line staff, in particular in emergency medicine, and their identifying patients with autism? I have a series of examples from my constituency of people with autism accessing emergency services, receiving suboptimal care and getting into some pretty dangerous situations.

[Norman Lamb]

The hon. Gentleman makes a good point. I was going to come on to give an example of that. Sadly, we have also heard from many people with autism, and their families and carers, that things have not yet changed enough, or at all, for them. Gaps in provision or waits for diagnostic services continue to be reported. As my hon. Friend the Member for South Swindon made clear, diagnosis is the start of what can then happen; it is a condition precedent to an improvement in someone’s life, and is of course not enough in itself. Many people have told us that they have skills to offer employers that they cannot use. That is totally frustrating for them, and a waste for the individual and for the economy, as my right hon. Friend the Member for Chesham and Amersham made clear.

[Mrs Gillan]

The Minister has slightly moved on from the point that I wanted to make, but I will make it nevertheless. Will he also look at an initiative that the NAS and I took in my constituency with some parents of children who have autism? I brought them together with the clinical commissioning group in a non-crisis atmosphere, because most of the contact with parents and families with autism happens when they are in crisis. We held a meeting in my office in a non-crisis environment and it was helpful to have an exchange in a calm atmosphere about the issues and problems faced by those individuals and families. They were able to put those across to the CCG and the local authority, which meant that the professionals were then so much better equipped to know what such families and individuals are facing, and to give them the help and assistance that they require. Will the Minister also look at that as a model to roll out across the country?

[Norman Lamb]

I would. Bringing people with autism and people who use services together with those who are commissioning the services is a necessary condition for any good commissioning, but far too often it does not happen. As my right hon. Friend has demonstrated, there is a role for us here: we can act as local champions to bring people together and put pressure on institutions to change attitudes. I very much share that view.

We are in the final period of finalising the update to the strategy and are giving active consideration to ideas that others have contributed, such as the innovation fund, which my right hon. Friend mentioned, to help develop good practice, and an autism awareness scheme to help local volunteers and community groups. Autism should not be seen as an add-on to services or work programmes, and with well over half a million people on the autism spectrum, everyday services will already be seeing or in contact with many people who have autism. Thinking about and engaging with those people more effectively and making reasonable adjustments or adaptations to existing services will lead to better outcomes for people and a better use of public resources, as other hon. Members have said.

Monday was NHS change day. I was made aware, via Twitter, of a short video about a doctor’s pledge to ensure that instructions given to patients are clear and not ambiguous. The video followed a girl called Lucy who has autism. After a consultation in a room in a hospital, she was told to wait outside A and E, and so went outside the building, because she had taken the instruction literally, and sat waiting for hours outside in the cold in the car park, left entirely on her own. I encourage hon. Members to watch it: it lasts about 30 seconds and was distributed via Twitter. That simple and straightforward pledge, made by a doctor who recognised that there had been a complete failure by his service, will help to raise awareness within the service and increase understanding of autism. The hon. Member for Stretford and Urmston (Kate Green) made the point that this is not just a matter for the NHS; other organisations such as banks and other financial institutions have a responsibility to see how they need to raise awareness among their staff.

Many of the changes under way in public services, such as increased personalisation and choice for individuals, are essential to giving people with autism the right kind of support. Support for people with autism may not require huge budgets to achieve improvements, and much can be achieved with a degree of creativity, flexibility and determination.

This issue is relevant not only to health and care, however. Again, we can draw a comparison with the dementia situation. The Prime Minister’s challenge on dementia is about how not only health and care services but society need to change, and how we need to raise awareness across society. The same applies for people on the autism spectrum. It is about changing people’s lives, both where they live and where they work. We know that so much more could be done to promote autism awareness, but our society is becoming more aware of autism. We hear about local schemes to make parts of the community more accessible and welcoming to people with autism. For example, as was referred to earlier, cinema screenings are being made autism-friendly by simple adjustments such as having the lights on low and the volume turned down.

Services based around low-level interpersonal support, such as buddying schemes, have enabled adults with autism—including people who do not qualify for support from their local authorities—to participate in different social and leisure activities and have promoted social inclusion. The example of the special showing of a musical in London is a good demonstration of an organisation prepared to go the extra mile to make life enjoyable for people in those circumstances. Exactly the same can be done for adults as for children, as my hon. Friend the Member for South Swindon said.

The Care Bill also puts a duty on local authorities to develop preventive services for people within communities. The shadow Minister and I have been devoting a lot of our time to the Care Bill. It is great and groundbreaking legislation that puts a focus on individuals’ well-being and happiness. If we can change the way in which organisations such as local authorities behave towards people with care and support needs, so as to focus on their well-being and not the needs of the institution, we can effect real change.

The Children and Families Bill will bring significant improvements to the transition of young people with autism from school, through college and into adult life—a point made by the shadow Minister. It will introduce education, health and care plans for people from nought to 25, which will put greater emphasis on long-term outcomes for young people. We know that caring for someone with autism can be extremely rewarding, but it can also be incredibly challenging, both emotionally and financially. The changes to carers’ assessments that will be introduced if the Care Bill becomes law will ensure that many more carers can get support.

It is also important to improve training on autism for front-line public service staff, a point raised several times in our debate. Since 2010 we have worked with a range of organisations to produce a comprehensive set of resources for staff in the health and care sector. Health Education England has a role to play, along with initiatives from the royal colleges, such as the Royal College of General Practitioners, whose adoption of autism as a clinical priority from April this year is very much to be welcomed. The regulations to support the Care Bill will also require community care assessors to be suitably trained—again, an issue raised in our debate. Having autism-aware police officers, courts and probation services can make a great difference. The existing statutory guidance made it clear that autism training should be available to all staff working in health and social care.

To plan effectively, local authorities need access to data on numbers and needs that are as comprehensive as possible. From April this year, as an outcome of the zero-based review of adult social care data, they will have to record a person’s primary reason for support and any health conditions that person may have, including autism. That provides a basis for possible future measures on autism in the adult social care outcomes framework.

A key challenge for many older adults with autism is that they will have had significant support from their families, but as families age that becomes less possible. We are considering how to build on the recent NAS report that followed work by the House of Lords autism and ageing commission.

As we have heard, most people with autism want to work, and have skills and talents that would be incredibly useful in the workplace. The policy paper “The disability and health employment strategy: the discussion so far” outlines a more personalised and tailored approach to employment support for disabled people, including people with autism. As well as challenging negative behaviours and attitudes, the Disability Confident campaign launched last year by the Prime Minister is designed to help employers who are unsure about the benefits of employing disabled people.

Adults with autism are entitled to benefit from all the Government’s wider initiatives to get working-age people into employment. The Department for Work and Pensions is aware that more can be done to help people with autism make the most of those programmes and of themselves. Only this week, the DWP held an event with my Department and the NAS, for people on the spectrum and for employers, to improve people’s experiences in applying for jobs at the jobcentre and with employers.

We are only at the beginning of the journey to improve all aspects of the lives of people with autism, including when they are seeking employment or are in education, as well as the support they get in health and social care. We need to continue with concerted action and commitment both nationally and locally to make a difference. The update of the 2010 strategy will mark the next step in that journey, but there is still a long way to go.

Mental Health Services (South-East Essex)

Norman Lamb Excerpts

Wednesday 5th March 2014 Westminster Hall

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

It is clear from the contribution of my hon. Friend the Member for Southend West (Mr Amess) how strongly he feels about the matter, and I absolutely respect that. I am not interested in any line to take from the Government. I have a speech here, but I want to address directly what my hon. Friend has had to say. I share his passion for trying to improve mental health services. That is something that I feel strongly about. I never like the idea of sweeping failures of service under the carpet. He has raised some serious concerns, although he did not have time today to go into the detail of all the things that he wanted to raise, and I would be keen to meet him to discuss those issues further.

I want to say a word about what I am trying to do in mental health. I agree that it has always been the Cinderella service, and there is what I would describe as an institutional bias against mental health in the NHS, which manifests itself in all sorts of ways. The spotlight is not on standards in mental health as it is in other areas of the health service. When the Government responded to the Francis report on Mid Staffordshire, we made it clear that addressing the concerns he raised about culture in the NHS was just as important in mental health as it was in any other part of the health service. If my hon. Friend reads the Government response to Francis, he will see that that is the case.

One of the ways in which we have responded to Francis is substantially to change how the Care Quality Commission goes about its work. My hon. Friend sought to make the case—by putting it in such a way, I do not suggest that he is wrong; I am not in a position to judge —that there is a massive gap between what he knows about a local service and what the regulators say about it. I know from my own part of the world, Norfolk, that when one raises acute concerns about, for example, the ambulance service, the response is often that everything is fine even though we know that it is not. We must try to ensure that inspectors and regulators reach a clear and accurate view of the quality of services.

The inspection regime that we are introducing, first in acute hospitals but soon in mental health trusts as well, is much more rigorous than anything that has gone before. One of the things that the previous Government did in 2008 was to remove specialist teams of inspectors, so that everyone in the CQC became a generalist. They might one week inspect a dental practice, a GP practice, an acute hospital and perhaps a mental health trust. That is no good; we must have people who know what they are looking for. It is also critical to involve clinicians and service users, who may well have an insight that others will never achieve. The CQC has appointed a deputy chief inspector who is in charge of the inspection regime for mental health, and I urge my hon. Friend to contact him directly to raise the concerns that he has expressed. At the end of the inspection process, mental health trusts will be rated so that the public has a much better view of the quality of a service in their local area.

Regulation on its own does not change culture; I absolutely get that. There must be carrot and stick. We must do things to change the culture within organisations as well as seeking to secure good standards through regulation. Regulation and inspection are a critical part of the overall picture, however, and we must have confidence in the inspection regime.

Everything that has emerged from the CQC’s work under the new leadership of David Behan and David Prior—a former colleague of my hon. Friend’s whom I happened to beat in North Norfolk to give him the opportunity to become the chair of the CQC—shows that they understand about compassionate care and high standards of care. We will shine a spotlight on mental health services and other parts of the health service in a way that has not happened before. I think that that will be of some value.

[Mr Amess]

Does the Minister understand how frustrating the whole thing is for me? The previous chief executive, Patrick Geoghegan, was in an unusual relationship, which I will not enlarge on, with someone who was first installed in a property in my constituency—there was a dispute about that—and later became a top-earning member of the board. With all this due diligence and inspection, how on earth was that allowed? What has happened is absolutely crazy, and I will need quite a bit of convincing, whoever the Minister introduces me to. It seems to be only when we air things publicly in Parliament that there is any interest—“Yes, Minister. Let’s get a brief ready.” I am not going to let the matter drop because my constituents deserve better than they are getting at the moment.

[Norman Lamb]

I hope that my hon. Friend recognises that I have sought to address his concerns directly, rather than reading from a pre-prepared speech. I share his concern about levels of pay in the upper echelons of the NHS, and I believe that that must be addressed.

On a more positive note, in the short time that I have available let me mention some of the positive things that we are doing. In January, we launched a document called “Closing the gap”, which directly addresses the fact that mental health services always fall behind physical health services. We have stated publicly, and we have put into legislation, that there should be parity of esteem and equality between mental and physical health services. The document identifies 25 areas in mental health services in which essential change is needed. One example is the widespread use of face-down restraint. Such restraint is not acceptable or necessary in a modern mental health service, and many areas have demonstrated how to create positive regimes without the use of such a barbaric approach.

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

I congratulate my hon. Friend the Member for Southend West (Mr Amess) on securing this important debate. There are various shades of mental health problems, and care in the community is an important aspect of looking after those who suffer from such problems. However, day centres up and down the country, including Mundy House in my constituency, are under threat. Will the Minister look at what more can be done to support day centres as a means of caring for not only mental health patients but other patients and community members generally?

[Norman Lamb]

I am conscious that I am close to running out of time, but community services often do enormously good work in their local areas. The focus on mental health must shift towards a prevention approach. We must intervene early rather than allowing a problem to deteriorate and acting only after something has happened. We must also focus much more on recovery. So often, we seek to contain people’s ill health rather than helping them to recover in a meaningful sense.

Finally, I would like to mention our crisis care concordat, which will set high standards of crisis care in mental health that have never existed before. We expect every area to implement that concordat to ensure that people, wherever they are in the country, get access to the right standards of care.

[Mr Peter Bone (in the Chair)]

Order. I apologise to Members for having to curtail the debate, because I am sure that it could continue.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 25th February 2014 Commons Chamber

[Laura Sandys (South Thanet) (Con)]

3. What progress has been made on introducing a cap on care costs.

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

Everyone will be protected against catastrophic costs by the insurance that the cap will provide from April 2016, in line with the Dilnot commission’s recommendations. We are currently putting the legislative framework for the cap in place, and will consult on draft regulations and guidance to implement the cap in autumn of this year.

[Laura Sandys]

Best behaviour, Mr Speaker.

Does the Minister agree that greater investment in pre-emptive and preventive measures, such as GP annual assessment for those who are getting older, might keep the new old just a little younger?

[Norman Lamb]

I start by paying tribute to my hon. Friend for the work that she has done while she has been a Member of Parliament. I know that she has announced her decision to stand down, and she has done excellent work campaigning for elderly people and others in her constituency and beyond. She is absolutely right. The cap will, first of all, help people to prepare and plan for old age, which is an incredible advance. Also, the £3.8 billion better care fund is the biggest ever shift towards preventive health care and GPs will play a critical role in that.

[Mr Jim Cunningham (Coventry South) (Lab)]

What is the Minister doing to encourage local authorities to provide more places for care, particularly with the reduction in costs? Is he aware that local authorities are finding it difficult, because of Government cuts, to fund those places?

[Norman Lamb]

I am conscious that finances in local government are tight, but the better care fund, which I mentioned just now, has been widely welcomed. I was with a director of adult social care last Friday, who told me that his authority was planning to pool not just its share of the better care fund but the whole of its social care budget with the local health budget. That sort of radical, innovative thinking is exactly what we want and it will ensure that we protect services for vulnerable people.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does the Minister agree that the steps that the Government are taking to reform the funding of care for the elderly represent long overdue action to deal with an issue that has bedevilled this world for more than 20 years? Tony Blair promised the Labour conference in 1997 that he would deal with it, and he did precisely nothing about it.

[Norman Lamb]

I remember the quote from Tony Blair well—he did not want to live in a country where people have to sell their homes to pay for care. However, over 13 years of the last Labour Government nothing happened. There were lots of commitments—manifesto commitments and so on. However, I am proud of the fact that this coalition Government are implementing reform, and it is long overdue.

[Nic Dakin (Scunthorpe) (Lab)]

4. What assessment he has made of the role of dispensing doctors in the NHS.

--- Later in debate ---

[Ms Karen Buck (Westminster North) (Lab)]

14. What recent assessment he has made of the number of available mental health crisis beds for young people in England.

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

NHS England has a rapid review under way to identify commissioning solutions to pressures on specialist beds for children and young people. It inherited varied provision across regions and a lack of capacity in some parts of the country for particular need. For the first time, available beds are monitored weekly, and small increases in capacity have already been secured.

[Rushanara Ali]

I thank the Minister for that answer, but 1,500 mental health beds have closed since 2011, which is causing a wider crisis, and a recent Care Quality Commission report found that, in one area over the previous year, 41 children had been detained in police cells because health-based places of safety were either not available or not staffed—and one of those children was 11 years old. How can that be acceptable?

[Norman Lamb]

The reduction in the number of mental health beds has been a long-term trend—it happened under the previous Labour Government—and rightly so, because we have to move away from institutional care. However, crisis beds must always be available. I completely agree that it is intolerable for children to end up in police cells, but that is not new; it has happened for many years and did not start in 2010. When we talk about parity of esteem, we mean it. There must be absolute equality between the ways in which mental and physical health are treated. Last week we launched a crisis care concordat to ensure that children do not end up in police cells.

[Ms Buck]

The clinical director of child and adolescent mental health services in my mental health trust recently said:

“Sometimes we have to make 50 to 100 phone calls around the country looking for a bed… young people shouldn’t be shunted around the country into inappropriate facilities.”

Another psychologist dealing with a case in my constituency told me:

“It is very difficult to get young people into in-patient services at present due to the high number of cases and reductions in funding from NHS England.”

Is that not an intolerable situation in which to leave traumatised young people? How quickly will the Minister’s review be completed so that we can end that tragedy?

[Norman Lamb]

The review being undertaken by NHS England will report in March. I agree that that situation is intolerable, but I have made it very clear on many occasions that there is an institutional bias against mental health in the NHS. Interestingly, the Health Committee report on deficits in 2006-07 specifically made the point that mental health was particularly targeted, so that always happens when NHS finances are tight. However, it cannot happen, because there has to be parity of esteem, including in the way in which money is distributed in the NHS.

[Jeremy Lefroy (Stafford) (Con)]

In Stafford hospital, many young people with mental health problems are extremely well treated in normal in-patient wards. That should not be the case, but no other facility is available. What will happen if those in-patient beds are no longer there?

[Norman Lamb]

As far as possible, we should be trying to ensure that children with mental health crises can remain at home; it does not make sense, in very many cases, to put them into in-patient care. However, we have made it clear, as has NHS England and as was confirmed in the crisis care concordat last week, that beds should be locally available whenever they are needed.

[Sarah Champion (Rotherham) (Lab)]

19. Will the Minister indicate when a clear strategy for the commissioning of tier 4 mental health beds will be determined and what additional resources will be made available to support the mental health needs of children and young people? The current situation is intolerable.

[Norman Lamb]

I mentioned earlier that the rapid review that is being undertaken by NHS England will report in March. It is essential that we have sufficient beds available, as close to home as possible, for children and young people. As I also said earlier, as far as possible children should be cared for at home, and only as a last resort should they go into in-patient care.

[Liz Kendall (Leicester West) (Lab)]

The pressure on children’s mental health beds is now intolerable. Earlier this month, the 14-year-old daughter of one of my constituents desperately needed a bed but the local trust’s chief executive told me that not a single bed was available anywhere in the country in the NHS or the independent sector. The Minister has said that this is unacceptable as though it is nothing to do with him, but he voted for an NHS reorganisation that is wasting time and money as vulnerable children are forced on to adult wards or transported hundreds of miles across the country. When the review reports, what action will he take and by when will it be implemented?

[Norman Lamb]

For a start, we now have 15,000 more clinicians working on the front line than when this Government came into office in 2010. Also, in the reforms that the hon. Lady mentions, we legislated for parity of esteem so that mental health is treated equally with physical health. However, I have accepted her case and agree that the situation is intolerable. We have to make sure that beds for children and young people are available when they are needed.

[Mr Andrew Turner (Isle of Wight) (Con)]

7. What proportion of medicines prescribed in the NHS are alternative medicines; and what the annual cost is of dispensing such prescriptions.

--- Later in debate ---

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

Our mandate to NHS England makes it clear that everyone who needs it should have timely access to the best available treatment. NHS England is currently gathering information about access to and waiting times for mental health services. We will use this information to set new national access standards for the first time, to be introduced from 2015.

[Andy Sawford]

The Safe Haven in Corby provided crisis out-of-hours support to 1,300 people with mental health problems last year. For the first time ever, it has been asked to tender for its future funding. It was eight minutes late with its tender, and the service is going to be cut. What will happen to the people who need that service in the future? Will the Minister meet me to discuss it?

[Norman Lamb]

I am very happy to talk to the hon. Gentleman about that. My understanding is that the local CCG undertook a retendering exercise with a view to maintaining and, indeed, improving mental health services locally. As he says, Safe Haven did not submit its tender in time. It had a right to appeal, and it chose not to appeal. The CCG is absolutely committed to ensuring that it improves mental health services locally.

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

Not only do mental health services not get the attention that they sometimes deserve, but the condition of individuals is often exacerbated by the inability of the benefits system to recognise episodic illness and by the insensitivity and incompetence of Atos in work capability assessments. Will the Minister talk to his colleagues in the Department for Work and Pensions so that we can have a system that is suitable and fit for people with mental illness?

[Norman Lamb]

I thank my hon. Friend for his question. Indeed, I share the concerns that he raises, and I have recently met my hon. Friend the Minister responsible for benefits specifically because I have those concerns. There needs to be much closer working between mental health services and the benefits system locally.

[Mr Kevan Jones (North Durham) (Lab)]

The Minister knows that early intervention therapy or talking therapies can relieve pressure not only in access to beds, but in helping individuals. He has just told the House that he will look at assessments of waiting times. Will he tell the House exactly what force or lever he will have to ensure that local trusts implement such targets?

[Norman Lamb]

I think it was a big mistake to leave out mental health when the 18-week maximum waiting time limit was introduced for physical health services. To me, that is inexplicable, so I am determined to correct it: from next year, there will be waiting times standards for mental health. Indeed, when the Care Quality Commission inspects and regulates providers, it will ensure that those access standards are met, in the same way as applies for physical health.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

11. What reports he has received on the possible reclassification of ME/CFS by the World Health Organisation.

--- Later in debate ---

[Penny Mordaunt (Portsmouth North) (Con)]

T2. There is great unmet need among older people in our communities, particularly for dementia care and support. In Portsmouth we are holding a community summit to join up local agencies to meet that unmet need. Will the Minister meet me to discuss what central Government can do to ensure that advice on additional funding streams is clearly and readily available?

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

I thank my hon. Friend for that question and pay tribute to the agencies in Portsmouth that are coming together to hold the summit and discuss that critical issue. The Prime Minister’s challenge on dementia has made real progress in improving diagnosis rates and the way that society treats dementia, and I would be happy to meet my hon. Friend to discuss the issue further.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

T4. Further to the answer given earlier to my hon. Friend the Member for Wansbeck (Ian Lavery), the lobbyist John Murray and an organisation funded by large pharmaceutical companies led a consultation and co-wrote a report for NHS England on the future of commissioning for £12 billion of NHS services. Will the Secretary of State tell the House whether it is now Government policy to have lobbyists and big drug companies drafting reports that directly influence the commissioning of NHS services?

Suicide Prevention Strategy

Norman Lamb Excerpts

Thursday 6th February 2014 Ministerial Corrections

The following is an extract from the Written Ministerial Statement presented by the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), on 17 January 2014.

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

...Sadly, since 2007 we have seen signs that the suicide rate has risen in England, as it has in many countries. There were 4,524 suicides in 2012.

[Official Report, 17 January 2014, Vol. 573, c. 39WS.]

Letter of correction from Norman Lamb:

An error has been identified in the Written Ministerial Statement on Suicide Prevention Strategy issued on 17 January 2014.

The paragraph should have read:

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

...Sadly, since 2007 we have seen signs that the suicide rate has risen in England, as it has in many countries. There were 4,513 suicides in 2012.

NHS

Norman Lamb Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

My hon. Friend’s point was also made powerfully by ambulance staff at an A and E summit held by the shadow Front-Bench team in Parliament before Christmas when a paramedic spoke of the phenomenon she has just described. He mentioned an occasion when staff were at the door of A and E waiting to hand over a patient to A and E staff, when the patient had a heart attack. The staff did not know what to do and had to go back to the ambulance to try to stabilise the patient. Those sorts of joining points or disconnects in the system are leading to real pressure on staff who do not know what to do in those difficult circumstances. The system is in danger of being overwhelmed, and the pressure on staff must be addressed urgently.

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

I share the right hon. Gentleman’s view that delays in handover at A and E are not acceptable, and I remember well that last decade, under the previous Government, ambulances were stacking up outside the A and E at the Norfolk and Norwich hospital. Does he welcome the fact that this winter, delays of longer than 30 minutes are down by more than 30% compared with last year?

[Andy Burnham]

Yes, there has always been pressure on the ambulance service at this time of year, but if the Minister wants me to join in with his complacency, I am afraid I will not. The past 12 months have been the worst in A and E in a decade, and there are reports of ambulances across the country held in queues. Is the Minister satisfied with the performance of the ambulance service in his region of east England? Was he satisfied with the way the case I mentioned was handled? I do not believe he was or that his complacency at the Dispatch Box will be appreciated by his constituents.

--- Later in debate ---

[Grahame M. Morris]

I am grateful to my hon. Friend for that intervention, and I hope that her point will not be lost on Ministers. That is a significant factor.

The lack of adequate support in the community and in the home has stored up problems in the NHS, and I am convinced that they will be exacerbated by what is now happening. I know that we have done some good work on the Care Bill—there is good intent there—but I have real concerns about whether the resources necessary to make social care really work will be provided. We have seen attendances at hospital A and Es continuing to rise.

[Norman Lamb]

We have had this discussion on the Care Bill. The hon. Gentleman talks about the need for additional resource, but in Committee there was no indication from the Opposition that they would make a commitment to provide extra resources. Is he now saying that they would do so?

[Grahame M. Morris]

I cannot thank the Minister for that intervention. We have had many exchanges during the passage of the Care Bill, but that decision is above my pay grade. It would be for those on our Front Bench to determine the level of such resources. The purpose of this debate is to consider the A and E crisis. I would like to think that that commitment could be made, however, and if the Minister is asking me personally whether I support it, the answer is that I do. I believe we should also support free end-of-life care, which I know the Minister and many others on the Government Front Bench support. However, I must make some progress with my speech.

The lack of adequate support in the community has had an impact. It has contributed to increased attendances at A and E departments. I hope that Members will not have forgotten that, two years ago, the Prime Minister said:

“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E”.

Well, I am afraid that we have gone back to those days. Sadly, by removing the social care needed for many elderly people to avoid unnecessary trips to hospital and to return home when their stay should be over, the Prime Minister is bringing back those days. I urge hon. Members to support the Opposition motion today.

--- Later in debate ---

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

This afternoon, we have been presented with more of the same from the Labour party—the same scaremongering, the same misinformation, the same unwillingness to offer solutions. In short, it is the same old Labour party.

Earlier this week, we heard from the right hon. Member for Leigh (Andy Burnham) that the N was being wrenched off the NHS and that it was being sold to any company, but in reality only 6% of expenditure in the NHS goes to private providers. He talks about “market madness running riot through the NHS”, but listen to the facts: between 2006 and 2010, under Labour, total spending on the independent and private sector more than doubled; and between 2007-08 and 2010-11, under Labour, the number of operations conducted by the independent sector tripled. Since then, the figure has been around 46%.

Labour is desperately trying to make the public believe that its skewed vision is the reality of the NHS, but this view is of course total nonsense, and I am happy to try to set the record straight.

[Andy Burnham]

I think the Minister was in the Chamber when his predecessor as care Minister held his hands up and admitted he got it wrong on competition when the Health and Social Care Bill went through the House. He has given hints to newspapers that he feels the same way. Would he care to step into the confessional and admit that the Liberal Democrats got it wrong on competition in the NHS?

[Norman Lamb]

I certainly think we have to avoid any repeat of what happened in Bournemouth. It is absolutely right for politicians to make that clear.

The Labour party has tried to paint a picture of crisis in A and E. We know that there is more pressure on this vital service.

[Margot James]

My hon. Friend is making some excellent points about Labour’s record of inviting competition into the NHS when in office. The success of that record might have been the reason why Labour’s manifesto in 2010 promised:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs”.

[Norman Lamb]

If I am right, that is called “any qualified provider” or “any willing provider”, which is exactly what this Government have pursued. Labour’s rewriting of history is breathtaking.

There are 1.2 million more people visiting A and E than three years ago—the hon. Member for Stretford and Urmston (Kate Green) is right that the system is under pressure—but the increase in the number of A and E attendances peaked in 2009-10, under the previous Labour Government, when there was a year-on-year increase of 4.7%. Since then, the increase has been slower, and in the last full year for which data are available it was just 1.2%—clear evidence that the Government’s policies are starting to work.

Doctors and nurses in our A and E departments up and down the country are doing brilliant work. Last week the NHS not only met the four-hour A and E target, but improved on its score from the same time last year. By contrast, in Labour-run Wales, A and E targets have not been met since 2009. The College of Emergency Medicine has said that Welsh A and E departments are on their knees, at the “point of meltdown”, and are putting patients at risk in Labour-run Wales. The college has complained of the ruthless

“pursuit of targets and financial balance at the expense of quality of care.”

In England, we have already met the target for more weeks this winter than when the right hon. Member for Leigh was Health Secretary. He missed his A and E target for two of his three quarters—was that a crisis in those days?—whereas we are seeing 2,000 more patients every day in under four hours than when Labour was in government. Ambulance performance is better than at the same time last year, meaning more ambulances arriving on scene in under eight minutes. Across the country, delays in handing over patients at A and E have dropped by a third compared with last year as a result of new sanctions, so we are not complacent.

As my hon. Friends the Members for Suffolk Coastal (Dr Coffey) and for Witham (Priti Patel) rightly said, we are sorting the problem. Opposition Members would like people to think that the NHS is going to ruin. They are so desperate—using the examples of scurvy and rickets. Of course, when that happens it is incredibly serious, but to suggest that that is part of the problem is outrageous. We heard the figures for scurvy, but there were 66 admissions for rickets in 2010-11 and 65 in 2012-13, so the figure has gone down. The truth is that we inherited a dysfunctional system that was crying out for reform—too many people ending up in hospital because of crises in their care, and far too much money spent on bureaucracy, as my hon. Friend the Member for Witham made clear.

For years I have argued the case for a different approach. We are making the essential changes and supporting NHS staff through difficult times. For this winter we are investing an additional £400 million in total—more than ever before. Having put plans in place earlier than ever before, with urgent care boards deciding what works in local areas, we are already seeing the benefit of those additional funds, with 320 more doctors, 1,400 more nurses, 1,200 other staff—occupational therapists, physiotherapists and so on—and more than 2,000 additional beds.

Throughout this debate we have heard that urgent and emergency care needs to change, and rightly so, but may I remind the House that we are the Government who are making that change? We have asked Bruce Keogh to undertake a fundamental review of urgent and emergency care, but there are still far too many people ending up in hospital because of crises in care. There are too many people with long-term conditions who are still receiving unco-ordinated care. That is frustrating for the patient, it wastes money for the system and it can lead to worse health outcomes, as we fail to prevent such conditions from getting worse. It is our aim in government to join up services, fitting them around people’s lives and providing better care closer to home.

The right hon. Member for Leigh seems to have had a recent damascene conversion to the case for integration. It is a shame that in the 13 years his party had in power, it did nothing significant to achieve it. In fact, many of the things it did and the decisions it made took the NHS in the wrong direction—on tariffs, on incentivising more activity in hospitals, on the disastrous private finance initiative and on the equally disastrous GP contract. I am proud to say that it is this Government who are taking the practical steps to make integration more commonplace throughout the country. We have selected 14 integrated care pioneers and we now have the £3.8 billion better care fund to achieve joined-up care throughout the country.

The truth is that the right hon. Gentleman and the whole of the Opposition have systematically dismissed the real issue with empty rhetoric. They want better care in A and E, yet we have started the reforms that will revolutionise urgent and emergency care. They want the health and care services to become more integrated. We are leading the charge to make that happen, and to improve care and support for people throughout the country. They want us to change competition law. We have made it clearer and easier to understand, and have balanced that with the need for integration, and the need to help doctors to know how and when to use it.

The Opposition are fighting their own shadow. Well, they can shadow-box all they want. They can waste time complaining rather than coming up with solutions, but this Government are actually tackling the issues, and making the changes to the health and care system that patients so desperately need.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

“Closing the Gap: Priorities for Essential Change in Mental Health”

Norman Lamb Excerpts

Monday 20th January 2014 Written Statements

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

We are today publishing “Closing the Gap: Priorities for Essential Change in Mental Health”.

At least one in four people will experience a mental health problem at some point in their life; one in 10 will do so before they are 18. An estimated one in six adults has a mental health problem at any one time; there are also many who experience poor mental well-being but do not have a diagnosable mental disorder.

Mental ill-health can mean people are out of work. It can lead to family breakdown and homelessness. It can mean leaving school with poor qualifications, or none at all. It can directly impact on parenting, and in particular on the relationship between children and their parents in those critical early years. It also has a direct impact on physical health. Life expectancy for those with severe mental illness is on average 20 years less for men and 15 years less for women.

All of this places an enormous strain on the health service, and on other public services: mental illness is now the cause of over 40% of sickness benefit claims. Businesses feel the impact: the average cost of poor mental health to business is just over £1,000 per employee per year, or almost £26 billion across the UK economy.

The time is long overdue for us to take a bolder, broader approach to tackling mental ill-health and promoting well-being. In 2011, we published our mental health strategy, “No health without mental health”. This set out a long-term ambition for the transformation of mental health care—and more importantly, for a broad change in the way people with mental health problems are supported in society as a whole. This was reinforced by the mental health strategy implementation plan in 2012 which provided detailed recommendations for action to deliver the objectives.

Two years on from the publication of our strategy, important progress has been made. Crucially, we have taken firm steps to narrow the gap between the way in which physical and mental illnesses are viewed and responded to. The Health and Social Care Act 2012 sets out, in law, that mental health should be on a par with physical health. And we have put mental health at the core of our mandate to the NHS, setting out what the NHS is tasked to deliver—and the NHS constitution. This means that improving mental health, and treating mental illness are key priorities for NHS England. These are also central to our mandates to Health Education England and Public Health England.

We can see that in many areas, real change is already happening to deliver the strategy objectives.

Change is also visible beyond the health and care sector. Many areas of Government policy and public service delivery, from education to employment, the justice sector to housing, are addressing mental health. There is strong cross-Government support for, and actions to deliver, the objectives in the strategy as demonstrated by the children and young people’s health outcomes forum, and the forthcoming crisis care concordat.

Crucially too, there is already a clear change in society. The time to change campaign, set up to tackle discrimination and remove the stigma associated with mental illness, has made real impacts. Research has shown that, since the launch of the campaign, people with mental health problems already experience less discrimination from friends (14% less than in 2008), family (9% less) and in social life (11% less).

All of this amounts to important progress towards achieving the long-term objectives set in our strategy. But we recognise too that for many people with mental health problems, this progress has not yet translated into significant change in the care and support they receive. Much of the work to date has been around laying foundations for further change which means the impact of what has been done is not always clear and relevant.

Our goal is that progress will accelerate and outcomes become more tangible. This document aims to bridge the gap between our long-term ambition, and shorter-term action. It therefore sets out 25 areas where people can expect to see, and experience, the fastest changes. These are our priorities for action; issues that current programmes are beginning to address and where our strategy is coming to life.

While we are highlighting these priorities, it is important to underline that they are only part of a much bigger picture—and a much broader ambition for improved mental well-being. We are determined that achieving these priorities serves not as a distraction from the greater ambition, but instead as a catalyst for further and faster change.

It is right to assert that mental health must have equal priority with physical health, that discrimination must end and that everyone who needs mental health care should have the right support at the right time. These are issues which demand our collective response. I am confident by focusing on the priorities identified in this document we can achieve real and lasting benefits both for mental health services and, more importantly for the people who use those services.

“Closing the Gap: Priorities for Essential Change in Mental Health” 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.

Suicide Prevention Strategy

Norman Lamb Excerpts

Friday 17th January 2014 Written Statements

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

Today I am publishing the first annual report on the suicide prevention strategy for England.

“Preventing Suicide in England: One year on”, 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.

In September 2012, we made clear our commitment to suicide prevention by publishing a new cross-Government strategy for England. Over the last decade, good progress has been made in reducing the suicide rate in England. But we knew that the likely impact of the financial crisis meant that we needed to be prepared for possible upturns in suicide rates. The strategy set out very clearly what actions we can all take to reduce the toll of suicide in our society.

Sadly, since 2007 we have seen signs that the suicide rate has risen in England, as it has in many countries. There were 4,524 suicides in 2012.[Official Report, 6 February 2014, Vol. 575, c. 1MC.]

The annual report summarises developments at national level, identifies key research studies and their findings, and is accompanied by a report of statistical information on suicides.

The suicide prevention strategy placed a new emphasis on families bereaved or affected by suicide.

Family and friends of people who are having suicidal thoughts are often the first to notice when something is not right. We have heard from families bereaved by suicide that sometimes doctors can seem reluctant to take information from families or are hesitant to let families know their loved one might be at risk of suicide.

We have worked with the royal colleges and professional organisations to agree a joint statement designed to ensure information is shared appropriately, within the legal framework, to help prevent suicide.

Today’s report also highlights the importance of responsive and high-quality care for people who self-harm. We know that the risk of suicide is considerably higher among those with a history of self-harm. We also know that, too often, people who self-harm experience negative attitudes and lack of knowledge from staff in general hospitals. We are determined to tackle the negative attitudes surrounding self-harm.

The first annual report on the strategy has been prepared with the input of leading experts in the field of suicide prevention, including the members of the national suicide prevention strategy advisory group, under the chairmanship of Professor Louis Appleby CBE. I would like to thank all members of this group for sharing their knowledge and expertise. Their continued support and leadership is central to our efforts to prevent suicide in England.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 14th January 2014 Commons Chamber

[Angela Smith (Penistone and Stocksbridge) (Lab)]

6. When he expects to publish a revised adult autism strategy for England.

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

The Department of Health is currently leading a review of the 2010 adult autism strategy for England, “fulfilling and rewarding lives”, and we will publish a revised strategy by the end of March.

[Angela Smith]

Given some of the difficulties encountered by local areas in developing and sharing innovative practice in progressing the strategy he has just talked about, what consideration has the Minister given to the National Autistic Society’s proposal for an innovation fund as laid down in its “Push For Action” report?

[Norman Lamb]

I thank the hon. Lady for her question. The National Autistic Society is doing fantastic work, working closely with the Government. It has put this idea forward and we are considering it seriously; it has real merit. We shall announce our decisions when we announce the results of the consultation in March.

[Mr Robert Buckland (South Swindon) (Con)]

What plans does my hon. Friend have to use the review as an opportunity to bring forward programmes that will increase autism awareness among the general public?

--- Later in debate ---

[Damian Hinds (East Hampshire) (Con)]

8. What progress his Department has made on introducing a cap on care costs.

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

Everyone will be protected against catastrophic costs by the insurance that, in line with the Dilnot commission recommendations, the cap provides from April 2016. We are currently considering the responses to the recent consultation on how the cap will work, and will publish draft regulations and guidance later this year.

[Damian Hinds]

Thanks to tough decisions from this Government, we can look forward to a time when people will no longer have to sell their home to afford care, but what can be done to raise awareness of this landmark policy so that older people, and indeed younger people, can be reassured?

[Norman Lamb]

I thank my hon. Friend for that question, and I am immensely proud that this coalition Government are reforming a grossly unfair system—something that should have happened a long time ago and is massively overdue. This Government completely recognise the absolute importance of an awareness-raising campaign, which will be carried out by local government, national Government and the financial services industry.

[Bill Esterson (Sefton Central) (Lab)]

Ministers have repeatedly claimed that no one will pay more than £72,000 in care costs, but given that the cap will be based on the rate local authorities charge for care and not the actual amount people have to pay, will the Minister confirm that people will have to pay more than £72,000 and that the so-called cap is not a cap at all?

[Norman Lamb]

People can always choose to spend more than local authorities deem it necessary to spend in order to secure care. However, we are implementing exactly the scheme that Andrew Dilnot recommended, and when he announced his proposals they were welcomed by the hon. Gentleman’s own party as a significant advance.

[Sir Edward Leigh (Gainsborough) (Con)]

9. What steps he plans to take to improve the quality of health care provision in the east midlands.

--- Later in debate ---

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T2. Will the Secretary of State join me in congratulating the UK Chronic Fatigue Syndrome/Myalgic Encephalopathy Research Collaborative for providing a mechanism for ME charities, researchers and clinicians to work together in a co-ordinated way? What support will his Department give research into the causes of and treatment for ME?

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

I am not the Secretary of State, but I would be very happy to join my hon. Friend in congratulating the collaborative, which is doing excellent work to generate more CFS/ME research. Spend by the National Institute for Health Research has already doubled in two years, and more funding applications are welcome. The NIHR has awarded nearly £0.9 million to the collaborative’s deputy chair for a senior fellowship studying paediatric CFS/ME.

--- Later in debate ---

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

Although I support the principles of the Better Care Fund, does the Minister recognise that, in the context of severe cuts to local authorities and cuts in the NHS, the top-slicing of existing budgets is not sufficient? To encourage the kind of innovation that we need to get better integration, we must have additional funding.

[Norman Lamb]

The Government are getting on and implementing integrated, joined-up care. I remember talking about it constantly when the hon. Lady’s party was in government, and nothing ever happened. We are taking concrete steps to join up the system with the benefits of the £3.8 billion Better Care Fund.

[Iain Stewart (Milton Keynes South) (Con)]

T9. The Secretary of State is aware of the plans being developed by Milton Keynes hospital to expand its A and E capacity. In the interim, will he set out what assistance he can provide to ease short-term pressures?

--- Later in debate ---

[Huw Irranca-Davies (Ogmore) (Lab)]

Does the Minister believe that social isolation, which is a key contributor to the health and well-being of older people living on their own, has got worse or has improved under this Government?

[Norman Lamb]

I think that social isolation, if we are honest about it, has got worse over quite a long period, particularly as extended families have been dispersed far and wide. The answer has to be for the whole of society and must involve statutory services working together with the voluntary sector. In Cornwall, one of the pioneers in integrated care, there is a fantastic collaboration between the voluntary sector and the statutory sector to ensure that they directly address the problems with loneliness.

[Mr Speaker]

Last but not least and I hope with exemplary brevity, I call Tessa Munt.

Dementia Care and Services

Norman Lamb Excerpts

Tuesday 7th January 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) on securing another debate on dementia. It is important that we maintain the pressure, keep talking about this subject and keep challenging ourselves to take the necessary further steps. I am delighted to hear he is a dementia friend. I hope that everyone in the Chamber this evening is a dementia friend. [Interruption.] There is lots of nodding, which is encouraging.

[Bob Stewart]

Will the hon. Gentleman define exactly what a dementia friend is so that those of us who are not yet one can understand what we should do?

[Norman Lamb]

I am delighted by that intervention, because it gives me the opportunity to say something very quickly about the initiative being taken by the Alzheimer’s Society. If someone applies to be a dementia friend, they can go along to an hour-long session on understanding dementia better. It is very illuminating to go through that process. We got the initial idea from Japan, where it has gathered enormous momentum. If we can get a million people across society who better understand dementia, it could have an enormously powerful impact by making our communities more dementia-friendly and understanding and giving people with dementia a better life. I would therefore encourage my hon. Friend to become a dementia friend.

The right hon. Member for Salford and Eccles (Hazel Blears) talked about her constituency office. I will accept the challenge she laid down. I absolutely accept the case she makes. We are all serving the public, and it is critical that we make our own facilities friendly for people with dementia and their carers. My constituency office staff do not know this yet, but I will encourage them to go through this process, as all right hon. and hon. Members should.

I was struck by the constituency examples that my hon. Friend the Member for Elmet and Rothwell gave. He mentioned Paul Mancey of Orchard Care Homes, which is ensuring that people entering care homes get proper care and support and that their particular needs are met, and the Springfield Healthcare initiative.

[Glyn Davies (Montgomeryshire) (Con)]

I thank the Minister for allowing me to intervene on an issue that, usually because of personal experience, is close to our hearts. He speaks of the importance of care homes, understanding dementia and caring for sufferers properly, but does he agree that the best treatment is care in the home of the person suffering from dementia? In my experience, a change in circumstances advances dementia faster than anything else. By far and away the best way to treat people suffering from dementia is to make it Government policy to support people to stay in their own homes.

[Norman Lamb]

I broadly agree with my hon. Friend. The most important thing is that the care and support should always be right for the individual. Whatever they need they should be provided with. I recently visited the most amazing GP surgery in Gnosall, Staffordshire, which has managed—this demonstrates a point that my hon. Friend the Member for Elmet and Rothwell made about the variability of dementia diagnosis rates—to achieve diagnosis rates of close to 100%. That demonstrates what is possible. Most of the diagnosing is done in the community within primary care without referral to a memory clinic. What they have found is that by getting early diagnosis and then having very good community follow-up and support—the general practice is central to that—people are staying in their own homes and maintaining a good life for far longer and admissions to care homes and nursing homes are significantly reduced. That demonstrates what is possible and confirms the point that my hon. Friend the Member for Montgomeryshire (Glyn Davies) made.

[Steve Rotheram]

Will the Minister give way?

[Norman Lamb]

I will. I am still on page one of my speech.

[Steve Rotheram]

I thank the Minister for giving way. He is absolutely right about the individual care package that somebody who, unfortunately, has dementia or Alzheimer’s gets. Thankfully, long gone are the days when somebody was given a couple of tablets in the hope that that might somehow affect their condition. Is he aware of the House of Memories project in Liverpool? Is he also aware that there is an event that I am hosting here on 17 June that Members of this House are welcome to attend?

[Norman Lamb]

I thought for a moment that the hon. Gentleman was not going to mention the House of Memories. He always does. Of course I am aware of it because he keeps talking to me about it and knows what I think. I am incredibly impressed by it and there is a plan for me to visit and see it for myself. He is right constantly to make the case for it and for spreading what has been demonstrated is possible in Liverpool to other parts of the country.

It is less than two months since the last debate on dementia and it is a measure of the importance that Members put on the subject and the extent of the challenge that we face as a nation that, thankfully, the House has recognised the importance of debating it regularly. It is also less than two months since we published our dementia state of the nation report, which sets out the progress that we have made on dementia and the challenges we are facing.

The report is an incredibly important document because it also includes online a set of interactive maps that, for the first time, allows someone to enter their postcode to see how their local dementia services are performing and how that performance compares with the rest of the country. Having this level of transparency, as well as the extent to which people will be able to hold their own local areas to account, will have a big impact on driving up diagnosis rates. I have already made the point that some parts of the country have demonstrated that high diagnosis rates are possible. There is no rocket science here and no reason why other parts of the country cannot follow suit, understand and learn that best practice and, critically, apply it to ensure that people get the support they need.

My hon. Friend the Member for Elmet and Rothwell is absolutely right when he makes the point that unless someone has had that diagnosis, they do not get access to the advice, guidance, support and services that are potentially available in a local area to make the life of that individual better and, critically, to provide more support for the carer as well. The maps highlight the variation in dementia care across the country and allow people, but also commissioners and providers, to use the data to see how they compare against other areas and then work to deliver improvements.

Around the world, someone is diagnosed with dementia every four seconds. Over 35 million people have it and as people live longer than ever before that figure is set to double every 20 years. Among them, 58% live in low to middle income countries and this proportion is projected to rise to 71% by 2050. We cannot ignore the pressure on our health and care systems and dementia costs society as a whole as much as £23 billion in the UK alone. The cost of dementia worldwide has been estimated at about £400 billion, or 1% of the world’s GDP. This is why dementia is a major priority for the UK Government and why the Prime Minister launched a dementia challenge in 2012. But we must fight back on an international scale, breaking down barriers and joining forces to address this issue, which has such an enormous human and economic cost.

Five years ago, the national dementia strategy was developed. It has achieved a lot, laying the foundations for real change. We are currently evaluating progress on dementia and on how we have achieved improvements in dementia care, and we are looking at both the national dementia strategy and the Prime Minister’s challenge. I shall come back later to the point about what comes after, and it seems to me sensible first to understand—

--- Later in debate ---

[Norman Lamb]

That was unexpected; I have never had this happen to me before, so I apologise for looking confused! I shall carry on.

It makes sense to understand the success—and, indeed, sometimes the failures—of the current strategy and the Prime Minister’s challenge before designing what follows on afterwards. It is absolutely clear—I have tried to demonstrate this on other occasions—that something must follow; there must be a continuation. This disease has such a profound impact on people and on society that we have to keep developing our understanding and maintaining the momentum.

[Hazel Blears]

I am grateful for the Minister’s commitment that there will be a follow-on from the dementia strategy. He is right to look at what has worked and what might not have worked quite so well. My concern is that whatever comes next must find a way of uniting the whole system. In proceedings on the Care Bill, we debated integration and how important it was, particularly for dementia, because it will save us money. When the Minister looks at the next set of strategies, I urge him to bear in mind that the country must not have in place a set of fragmented relationships that are not bringing the system together to make things better for people with dementia and their carers. The economic impact on the country is also important.

[Norman Lamb]

I very much agree with the right hon. Lady on that. I think that what she argues for is developing. We are not there yet, but it is important that we have developed this ambition to achieve a diagnosis rate of two thirds, which encourages every part of the system to focus on what it needs to do. It is not a nationally imposed arbitrary target; it was based on getting every part of the system to think about what it can achieve by setting ambitious objectives. Collectively, that amounts to an ambition to achieve a two-thirds diagnosis rate, but in itself, of course, a two-thirds diagnosis rate is not good enough. We should not be satisfied when we achieve that; we have to press on. We know that the community in Gnosall has a diagnosis rate of close to 100%, so we should not be satisfied until everyone is getting properly diagnosed on a timely basis. I agree with the right hon. Lady’s point. Under the new system, with the health reforms making clinicians much more involved in the commissioning of care locally, there is a greater chance of getting the engagement of general practice across the country than we perhaps had in the past through the primary care trust route.

[Jim Shannon]

Has the Minister had an opportunity to consider the point I made in my intervention on the hon. Member for Elmet and Rothwell (Alec Shelbrooke), which was about the exchange of good practice and information between the four regions of Scotland, Northern Ireland, Wales and England? Ever mindful that the highest levels of diagnosis for the whole of the United Kingdom are found in Northern Ireland, has the Minister had a chance to discuss these matters with the Health Minister, Edwin Poots from the Northern Ireland Assembly, for instance, to take the issue forward? We all gain from good practice across the whole of the United Kingdom of Great Britain and Northern Ireland, and we all gain from the exchange of good ideas.

--- Later in debate ---

[Norman Lamb]

I completely agree. This disease knows no country boundaries. We all face the same challenge across the whole of the UK and, critically, across the world. That is why we pursued the matter in the G8 summit of December. There should be good collaboration across the UK through all of the devolved Administrations and the Government here. I am always happy to engage with colleagues from Northern Ireland to understand what we can learn from Northern Ireland and also because the exchange of information helps everybody to improve.

We recognise the need to build on the strategy. That is why the Prime Minister’s challenge on dementia is now the main vehicle for change and improvement across health and care, in the community and for the purposes of research. The Prime Minister’s challenge runs until 2050, not just outliving the dementia strategy, but broadening its vision and providing better accountability.

Last year we hosted the G8 dementia summit. I was delighted that the right hon. Member for Salford and Eccles participated in it, and challenged me during one of the sessions. The summit attracted interest all over the world, and harnessed the efforts and expertise of the G8, health and science Ministers, the World Health Organisation, the OECD, industry, researchers, philanthropists and civil society to secure much greater international collaboration in order to tackle and defeat dementia. The declaration and communiqué announced at the summit set out a clear commitment to working more closely together on a range of measures to improve early diagnosis, living well with dementia, and research.

The G8 announced an ambition to identify a cure or a disease-modifying therapy by 2025, which we hope will focus minds internationally. It is backed by a commitment to increase significantly, together, the amount spent on dementia research—we know that at present it is a fraction of the amount committed to research in other areas of medicine—and to increase the number of people involved in clinical trials and studies of dementia. The United Kingdom has committed itself to funding a global dementia innovation envoy to draw together international expertise, stimulate innovation, and co-ordinate international efforts to attract new sources of finance. That will be incredibly important if we are to crack this disease.

In partnership with the OECD, the WHO, the European Commission, those involved in the EU joint programme on neurodegenerative disease, and civil society, the G8 will hold a series of high-level forums throughout 2014 on social impact investment—it will be critically important to attract new sources of funding—new care and prevention models, and academia-industry partnerships, which will also be extremely important. The G8 will meet again in the United States in February 2015, along with other global experts including the WHO and the OECD, to review the progress that has been made on the research agenda. That will enable us to focus minds and try to increase the momentum.

The G8 is an exciting global initiative, and I am immensely proud that the United Kingdom led the way in that regard. However, we are also keeping our focus on dementia in England, and we have made progress since the launch of the Prime Minister’s challenge. We have launched a new dementia friends scheme—which has already been mentioned—to make a million people more aware of what dementia actually is, thus helping to break down the barriers between people with the condition and their local communities. It is important to challenge the stigma that still exists in many places. The Alzheimer’s Society has published guidance setting out the criteria for becoming a dementia-friendly community. I was pleased to hear that Rothwell, near Leeds, is becoming a dementia-friendly community: that is very good news.

The NHS continues to support dementia care in hospitals through its CQUIN scheme—commissioning for quality and innovation—which is generating between 3,000 and 4,000 referrals for diagnosis each month. We have allocated £50 million to 116 schemes to make health and care environments such as hospital wards and care homes more dementia-friendly. Making the environment in which people live with dementia more dementia-friendly is critical to the provision of a calm atmosphere. When we see places to which attention has been given and in which investment has been made, we realise what a difference can be made. The Government’s mandate for the NHS prioritises dementia, and, as I said earlier, includes the ambition of a diagnosis rate of two thirds. My hon. Friend was right to say that the current rate is far too low. We are letting people down in many parts of the country by not securing early diagnosis.

[Mr Ward]

Obviously there is an opportunity to do something once a person has been identified as needing a diagnosis, but in my experience the problem is that other things are usually taking place in people’s lives, and GPs often assume that they are just part of the ageing process. There is a failure, often because of the lack of skills of the GPs, to recognise that diagnosis is required.

[Norman Lamb]

My hon. Friend is absolutely right and there are still GPs who do not really believe in the importance of a timely diagnosis. I have heard GPs say, “What’s the point, because it will make no difference?” However, we know it does make a massive difference not only to the person with dementia but to the rest of their family, in understanding the condition and what they can do to help. Education among GPs is incredibly important, and attitudes are changing but we still have a way to go.

Clinical commissioning groups are working with their local councils and other partners to better understand how widespread dementia is in their communities, including among people living in local care homes. This will mean they can identify and support people with dementia in a timely way. GPs are now able to use the new directed enhanced service to improve the diagnosis of dementia by asking people in certain at-risk groups about their memory. This proactive approach should help to identify patients who are showing the early signs of dementia.

Health Education England has prioritised dementia training and has already delivered 100,000 dementia-trained staff. Again, ensuring the work force within health and care have a proper understanding of dementia is critically important.

[Hazel Blears]

I am pleased the Minister has now come on to the area of the work force. He will know that many of the carers in this area are paid the national minimum wage if they are lucky. Many of them are on zero-hours contracts. Many of them do not get paid for travelling between the appointments they undertake. We ask them to do some of the most difficult work that one can ever imagine but the rewards and the training and support they get is minimal. Is the Minister committed to tackling some of these issues in the care sector, which in my view are unacceptable?

[Norman Lamb]

I feel as strongly as the right hon. Lady does about this. We can never get good care on the back of exploiting very low-paid workers. It is not acceptable to not pay a care worker when they are travelling from one home to another. That is a breach of the minimum wage legislation unless their rate overall comes above that level. HMRC has specifically targeted the care sector and has found quite widespread abuse of, or failure to comply with, the national minimum wage. It is very important that it is complied with.

It is also important for councils commissioning care to be absolutely clear with those they contract with that they expect total compliance with the law. If a council is commissioning in a way which almost becomes complicit in a breach of the law, that is completely unacceptable. Some of the commissioning around the country is very poor and we have got to move on from commissioning on these 15-minute, short-time periods resulting from contracts being opened up for bids and there being a race to the bottom with the cheapest offer winning the contract. We have got to move on to commissioning for quality and for better outcomes.

Wiltshire has now introduced commissioning for home care based on outcomes and quality. One of the care providers now pays salaries to its care staff. So the whole attitude and approach changes and the incentive on the care provider is to improve care, not to get away with the quickest possible care visit.

It comes down very often to the way in which the care is commissioned. That is what has to change and we are working with the Association of Directors of Adult Social Services and the Local Government Association to change the way in which commissioning is undertaken. There is also an amendment to the Care Bill which will require that commissioning takes into account an individual’s well-being. Councils cannot commission on the basis of 15 minutes of care when important care work needs to be undertaken. They will not meet their obligation under the Care Bill if they are doing it in that way. That change will also help to drive up standards. Care workers need to be respected. They do incredibly important work, and they are undervalued by society.

Since 2009-10, Government-funded dementia research in England has almost doubled, from £28.2 million to £52.2 million in 2012-13. Over the same period, funding by the charitable sector has increased, from £4.2 million to £6.8 million in the case of Alzheimer’s Research UK and from £2 million to £5.3 million in the case of the Alzheimer’s Society. In July 2012, a call for research proposals received a large number of applications, the quality of which exceeded expectations. Six projects, worth a combined £20 million, will look at areas including: living well with dementia; dementia-associated visual impairment; understanding community aspects of dementia; and promoting independence and managing agitation in people with dementia.

The hon. Member for Liverpool, Walton (Steve Rotheram) made the point about doing research into how we can prevent the onset of dementia in the first place. We know that vascular dementia is often related to lifestyle, including factors such as heart condition, smoking and alcohol consumption. If we can understand better how to prevent dementia from occurring, we will achieve a massive advance. Research needs to focus on that as well as on finding a cure and on living better with dementia, which is another critical area of research. It is essential that we do all this collaboratively and internationally. We cannot simply find all the results by ourselves, here in the UK. There needs to be an international effort.

The coalition Government have clearly demonstrated their commitment to dementia, but there is a massive amount still to do. We are not looking inwards to solve the problems that we are facing. At the G8, we brought the world together to work collaboratively and to look for solutions. By leading the way with the G8 summit, and with our own domestic agenda of the Prime Minister’s challenge, the UK is mobilising all available resources. We should be proud of the leadership we have shown as a nation to date, but as ever, we will continue to push much further, and we must never be complacent.

Question put and agreed to.