Carers

Norman Lamb Excerpts

Thursday 20th June 2013 Commons Chamber

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

The hon. Lady said that we have so far ignored what she has been arguing for in terms of action. I just wanted to reassure her that I have absolutely not ignored that. I have said, I believe in the debate on the Queen’s Speech, that I would seek to meet the Minister dealing with the Children and Families Bill, and I have done that. I take the point the hon. Lady makes very seriously and I want to see action to address the concerns that she and others have raised.

[Barbara Keeley]

I thank the Minister for that point, but I have to tell him that he and the children’s Minister have to start to accept that making reassuring noises and having meetings is not enough.

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[Sir Tony Baldry]

One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.

[Norman Lamb]

Does my hon. Friend agree that it is not simply about employers having a duty to look after employees who have caring responsibilities; it is also about enlightened self-interest? It is an enormous own goal when so many employers lose really good and experienced employees, who could otherwise contribute so much to a business, because they have caring responsibilities. It is in their interests to keep those employees.

[Sir Tony Baldry]

I entirely agree and hope that all employers see the enlightened self-interest in looking after carers. I think that there is a general recognition that everyone in the system has to start thinking about carers, particularly those who are caught in the sandwich generation and have to look after children and older relatives.

The two colleagues who have spoken in the debate have already set out the broad context of the research done in carers week: about three quarters of carers felt unprepared for their caring role; four in 10 had reduced their working hours because of caring; nearly a third had missed out on the chance of promotion; almost half had used savings to pay basic bills, such as those for heating and food; and more than a quarter had taken out a loan or fallen into debt as a result of caring.

I am conscious that many colleagues wish to speak. I will use the time remaining to highlight some specific concerns raised by Carers Oxfordshire. In anticipation of today’s debate, I asked Carers Oxfordshire about the concerns of local people. Unsurprisingly, there was a huge response from carers. I think that there is a feeling among many carers that one of the most important things is having their voice heard. The sorts of points raised were as follows:

“Carers would like to hear greater clarification about the implementation of the Care and Support Bill along the following lines: ‘Carers are very pleased to see the rights of all carers to have an assessment so clearly defined in law. The concern is that the regulations are written in the spirit of the legislation i.e. of widening the access to help and support for carers. The national eligibility framework needs to reflect this and ensure that the threshold of eligible needs is not set too high. The risk is that local authorities will use the framework to restrict “eligible needs” on the basis of limited resources, which could mean many carers will not be any better off in terms of the help and support they receive. We must ensure there is not a postcode lottery in the way the framework is operated by local authorities.’”

On respite for carers, respondents commented that it is

“too expensive and too hard to get currently as care homes often don’t ‘allow’ bookings to be made well enough in advance to allow carers to book holidays. There is very little financial help for ‘stay at home’ carers. What about care vouchers similar to child care vouchers being issued, or tax relief on care costs?”

With regard to GPs, the identification of carers is a really important issue. There

“needs to be more emphasis from GPs and a greater recognition of carers’ contribution and value, including their health and wellbeing.”

Another point was this:

“Poor quality of care provided by care agencies is a huge concern. Quality, reliability and accountability are ongoing concerns for carers.”

On carers in employment, concerns were expressed about the financial cost of care and the impact on those who have to give up work or reduce their working hours.

The respondents make an interesting point:

“Military carers and their family can suffer a significant disadvantage, to include homelessness due to ‘entitlement’ issues around properties when they take on caring responsibilities. Lack of recognition from the military.”

They continue:

“Carers want to see social care and nursing care fully combined as one discipline. As far as they are concerned they are one and the same thing. During one carer’s experience in the weeks prior to her mother’s hospital admission she had had three different teams visiting her throughout the day. They spent more time completing forms and leaving files than anything else. It was tiring and draining for her to have so many different people coming and going. Full integration of the two disciplines is key for continuity, to prevent duplication of effort and reduce needless bureaucracy.”

Finally, they state:

“Look at simplification of forms for applying for carers allowance and attendance allowance.”

It is really good news that the Care Bill will consolidate and simplify decades of social care legislation in England. We must not lose sight of the fact that it will include significant and welcome new rights for carers to improve access to carers assessments and new duties on local councils to provide care services. I share the concerns of the hon. Member for Worsley and Eccles South (Barbara Keeley) about young carers, but I am confident that those on the Treasury Bench have taken on those concerns and will table amendments to the Bill in the Lords to cover them.

We are making good progress. The direction of travel is a good one, but we have to recognise that a huge amount of distance still has to be covered if we are to be proper advocates and protectors of the millions of carers in the UK who selflessly give themselves to look after a loved one.

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[Sarah Newton (Truro and Falmouth) (Con)]

I am pleased to have the opportunity to speak in this debate. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has made a huge contribution not only today but throughout his parliamentary career—as a Minister and now from the Back Benches—in raising these issues.

I had the great privilege of being parliamentary ambassador for carers week for the Conservative party, along with my coalition partner, my right hon. Friend the Member for Sutton and Cheam. Rather than trying to cover what was an encyclopaedic summary of the issues affecting carers, the excellent research communicated during the week or, indeed, many of the points made by colleagues on the Opposition Benches, I would instead like to back up everything that he said in describing so well the challenges and opportunities and summarising the Government’s position. I will then make some reflections and observations on my time as an ambassador.

I would like to congratulate the organisations that came together to form carers week, because they achieved something quite remarkable. More than 26,000 organisations across the UK came together and put on more than 100,000 events. Why is that important? From the events I attended, I realised it was vital to raise awareness of the services and financial help available for carers. Like many other Members, I am sure, I often find in my casework and when visiting organisations in my constituency that those who most need help are often the least likely to access it, and we have to work hard to ensure that the legislation, the benefits and the rights that we provide for in the House get into the hands of the people who really need it.

When attending the events in my constituency, I was struck by a fundamental problem touched on by the hon. Member for Ceredigion (Mr Williams): many carers do not identify themselves as such. I spent some time in the lobby of the Royal Cornwall hospital trust alongside volunteers and care support workers from the Cornwall Rural Community Council. They would approach people who were clearly carers—elderly people pushing people in wheelchairs, coming into hospital, attending appointments or leaving hospital—and ask them, “Are you a carer?” They would ask them very nicely and in a friendly manner, with a view to engaging with them to ensure they were getting the help to which they were entitled, but the people would hurry on saying, “No, I’m not a carer.”

If, however, we asked whether they looked after someone—a husband, wife, child or loved one—they replied yes. If we asked them, “Do you regularly provide support perhaps through cooking meals or going shopping?”, they replied yes. We need to think about that a bit more in our desire to find out who carers are and ensure they get the support they need, whether from the NHS, councils, employers or the voluntary sector and wider community. We need to think about how we frame the conversation to enable people to identify themselves as carers, because most of the people I spoke to said, “Well, I’m just doing what any family member would do. This is what families do.” If somebody is ill or has a disability or care need, families gather round. I took that from my meetings last week, and it is particularly important in literature. Central Government produce a lot of literature, and a lot of benefits leaflets go out through the Department for Work and Pensions and throughout the health service, so we should think about the terms we use and how we can engage with people in that literature.

Another thing I reflected on after speaking with carers last week—this came out in the reports—was the evidence on the number of people who gave up work to care. This can have a detrimental impact on the carer: they miss the social contact provided at work and can feel quite isolated and often trapped at home, especially in remote rural areas, such as those in my constituency, where it is difficult to use public transport and connect to wider society. It also has a detrimental impact on household incomes and pension provision. The main question that Carers UK is asking the whole nation is the right one: are we prepared to care? It is a question for the whole of society. Are employers prepared to provide those flexible working opportunities to enable people both to attend to their caring responsibilities and to work?

We have to be realistic, however, because many people are worried about their job at the moment, and so, for fear of losing their job, are unlikely to talk to their employer about the need to work flexible hours. The Government need to engage with employers—there are exemplars, such as BT, with a long track record of recruiting and retaining older workers and enabling flexible working—about the research and the issues and to get them thinking about making it easier for their staff to request flexible working. The huge triumph in employment in the past century was to enable women to juggle caring responsibilities for children and work. In this century, as we respond to significant demographic changes, we need a massive shift to enable workers of all ages to combine other caring responsibilities. For older people and people with disabilities, that is a very important lesson from carers week.

Carers told me that even if they wanted to carry on working—if they had the income and were prepared to pay for care, or have a mixture so that they would do part of the caring but pay for people to come into the home to support them, and their loved ones agreed to that—they were anxious about the quality of the care they would be inviting into their homes. All of us were horrified by recent revelations about some of the carers going into people’s homes, whether they were paid for by individuals or local authorities as part of their domiciliary care service. Until we crack the nut of ensuring that high-quality, well-trained and well-paid carers are going into people’s homes, people will have a great fear and reluctance to try and combine caring responsibilities with employment.

We find a sad position in too many local authorities. We all understand that councils’ budgets are under a lot of pressure. I was a councillor and I know that it is difficult to balance all the needs of one’s community with conflicting demands on what the council should be spending its money on. No two people agree on what a council’s priority should be. For me, it is straightforward: a council’s responsibility, like central Government’s responsibility, is to prioritise the care of the most vulnerable people in society. However, in contracting for domiciliary care, local authorities are cutting their payments so low that it is difficult for private care providers to provide a good quality of care while remaining economically sustainable. That reduces the options available for the vast majority of people who self-fund care.

[Norman Lamb]

I agree very much with the points my hon. Friend is making. Instead of commissioning on the basis of a quarter of an hour and a race to the bottom with the lowest bidder winning the contract, does she agree that commissioning that provides incentives to improve the well-being of the individual being cared for—maintaining their mobility and improving their capacity to remain independent—is the way in which local authorities should be contracting providers of care at home?

[Sarah Newton]

I absolutely agree that local authorities should be remorselessly focused on the best possible outcomes for the people they have a duty to provide care for. They should also understand that while the vast majority of people are not eligible for local authority care, local authorities have a responsibility as market shapers in their localities to ensure that private, third and voluntary sector organisations are able to provide the care services that most people pay for themselves. By constantly engaging in a race to the bottom, they are undermining the ability of those organisations to provide services to the community. Most private or third sector domiciliary care providers need a certain amount of contracts or business from the local authority.

[Sarah Newton]

I back what my hon. Friend says. The Joint Committee’s report was excellent and showed Parliament at its best. People with tremendous experience from the House of Lords and this place worked together to scrutinise and improve that excellent Bill. The Government should be commended for introducing it at a time of economic restraint, especially as it has financial consequences: spending more money on supporting carers is a bold thing to do at the moment and it underlines the great value we put on carers. I back my hon. Friend in his call for an amendment, because if local authorities are tempted to avoid doing what we would all regard as the right thing—to look after the most vulnerable people in our society—we need to tighten up the law to remove that temptation from them.

I would like to share another issue that was raised in carers week. The strong message from carers was that they do not always feel involved in the decisions made by professionals about the people they are caring for. The Government have, rightly, enshrined in their health and social care reforms the principle that “No decision should be taken about me without me.” I would like to extend that so that “No decision is taken about the person I am caring for without me.” I have heard far too many cases, in my own case work and during carers week—particularly from parents caring for children with disabilities—where substantial decisions, on whether their children should be cared for away from their home many hundreds of miles away, were considered without proper discussion with the parents. That is absolutely wrong. There is a prevalent attitude among some professionals that they know best: “Trust me, we know what is best for your child. Trust me, we know what is best for your wife or your husband.” While I would like to be able to trust all professionals—we think that by and large they do have the best interests of people at heart—there should be openness and transparency. Carers should be involved in decisions, so that there is a joint agreement and an understanding about what is in the best interests of the person being looked after.

On a more positive note, I would like to share some of the good practice I saw during carers week. I saw great examples of innovation involving the voluntary sector, in particular. We have talked about statutory provision and what employers can do, but broader civil society and the voluntary sector have an enormous role to play too. I would like to share two examples from Cornwall, one of which is from my own constituency.

A group of people in Falmouth in my constituency responded to the Prime Minister’s dementia challenge by wanting to ensure that everybody in the community supported people with dementia. More than 200 organisations in Falmouth got together to make it a dementia-friendly community. I was proud, in my hometown, to be at the launch a couple of weeks ago, and I was proud that it was the first town in Cornwall, and probably one of the first in the country, to be a dementia-friendly community.

What does it mean to be a dementia-friendly community? It means that the shopkeepers in the high street have gone through awareness training. It means that we have dementia cafes and that the people in the youth centre are aware of people with dementia. Overall, it means that people who suffer from dementia, or are caring for someone who suffers from dementia, can go into Falmouth with confidence, knowing that they will receive a warm welcome in the shops, libraries, public spaces and the youth centre. The people there will understand more about dementia and some of the behaviour that comes with it. Some people might find that behaviour a little bit challenging and scary, which often makes the people who care for someone with dementia want to stay at home. They can be fearful of the response they will receive in a public space and end up becoming isolated. I can honestly say that people with dementia will receive a very warm welcome in Falmouth, thanks to the huge amount of work done by a small group of volunteers ably led by the Bridges, who are Rotarians in Falmouth.

The whole community has got behind this exciting project—indeed, so much so that another group of people in Falmouth, led by a former nurse, Lisa Dann, has been working with Dementia UK over the last year to raise enough money for two admiral nurses. For those who do not know, admiral nurses, who are similar to Macmillan nurses, are specialist nurses who work alongside those with dementia and their carers, providing a lifeline for people coping with what can be a very difficult condition. Lisa was motivated to set up the charity and raise funds because of the poor support that her mum and her family received when her dad was suffering, before sadly dying from dementia.

Lisa has created a fantastic legacy in recognition of her father by raising enough funds—£60,000 in one year, which is a great credit to her, her team and the community—for the whole of Cornwall to have two admiral nurses. Her group is working innovatively in a partnership with a large social enterprise in Cornwall—Cornwall Care, which is the largest independent care provider in the county—to make the scheme sustainable. The group will be raising more money for more admiral nurses, which will provide a huge amount of support for carers, as well as people suffering from dementia. That is a good example of how the voluntary sector and volunteers can create a caring environment for carers.

[Norman Lamb]

I came across another example in my hon. Friend’s county called Changing Lives, where GPs work together—

[Sarah Newton]

I was just about to come to that.

[Norman Lamb]

I very much agree with my hon. Friend about the role of civil society. That will be a vital collaboration if we are to meet the challenge, given the rise in the number of people who need care.

[Sarah Newton]

rose—

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[Steve McCabe]

I certainly agree with that, although I would be reluctant for us to have a complex system that the carer has more difficulty accessing. I take on board the right hon. Gentleman’s point, however.

In arguing for a champion, I am looking for someone like a councillor, with sufficient clout to intervene and right wrongs and cut through the madness and bureaucracy that all too often ends up punishing, rather than protecting, the carer. That does not mean we should not also have further review and appeal processes, but I want us to have something simple that people can make use of and that will make a difference.

A champion might also do more to make sure the voices of ordinary carers are heard. I am thinking about the hidden carers that so many Members have mentioned—the people who are too busy caring to have time to attend the consultation sessions, which are organised to suit the convenience and working hours of the NHS and local authority officials, so these people are never heard.

[Norman Lamb]

I totally agree with what the hon. Gentleman says about giving a voice to carers, who sometimes are treated appallingly, not only by providers of care, but by some of the statutory services and local authorities. With providers, we have introduced, through the NHS Choices website, the ability for people, in TripAdvisor style, to speak out and have their say about poor standards of care, and we may need to do something similar for local authorities, because there should be no hiding place when people are let down in that way.

[Steve McCabe]

I welcome what the Minister says. I am able to identify these people in my constituency, and I do not understand why it is so hard for the caring organisations to identify them.

I wonder why we do not say that at the point when an individual qualifies for attendance allowance the local authority should be notified and instructed to commence consultations with the person and their carer, with a view to establishing a long-term care plan and review strategy. That could reduce the occurrence of crisis care episodes, and the authority could simultaneously start to develop a support plan for the carer, so the needs of the carer are at the centre of the care plan.

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[Steve McCabe]

One of the penalties of having been a Member of this House for quite a long time is that we get fed up with hearing such excuses. We know fine well they are nonsense; if we want it to happen, we can make it happen. That is the approach we should take.

My hon. Friend the Member for Corby (Andy Sawford) talked about older carers and carers who have been caring for older relatives, and I want to touch on one particular aspect of that. What will happen under the Government’s deferred payment equity release plans to surviving spouses who are carers, or elderly children caring for even older parents—it is not uncommon these days for a 70-year-old to be the carer for somebody who is 95 or 96, for instance? What rights will they have? In such situations, when the person who is being cared for enters residential care, what will happen to a carer whose name is not on the deeds of the house, although it may be their family home and they may well have lived there since marriage, or even childhood?

We must ensure that these carers do not end up homeless, destitute individuals with no pot of money to support them when they end up needing care themselves. I am not sure that the deferred payment scheme as currently structured takes account of the risk for those carers, and it would be the cruellest of rewards if, after a lifetime of care, we left them in this predicament.

[Norman Lamb]

At present, when someone goes into a care home and they have to sell the home to pay for care, the position of the carer could be very precarious, but the arrangements for the right to defer payment potentially provide greater stability for the carer. The hon. Gentleman raises an important point, however, and I will be happy to write to him directly about it.

[Steve McCabe]

I am grateful to hear that the Minister will look at the issue. I acknowledge that the current system is far from perfect, but interest-related deferred payments could mean more of the pot being consumed, and therefore less for the remaining carer.

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to follow the excellent speeches made by Members on both sides of the House today. I thank the Backbench Business Committee for giving us the opportunity to debate this crucial subject, and I particularly congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Banbury (Sir Tony Baldry).

One in 10 of all adults are now caring for an older or disabled person—6.5 million in total, up 600,000 from 10 years ago. The biggest increases are among those aged over 65 and those caring for more than 50 hours a week. This is a huge change in society that we all need to do more to understand and get to grips with. Our care system simply would not function without the vital support family members provide for their loved ones; as many Members have said, their financial contribution is estimated at more than £100 billion every single year. Despite that, all too often, carers go without the support they deserve and desperately need to look after the people they love. That is why today’s debate is so important.

The last Government made important progress in improving support for carers. We introduced new rights for carers, including the right, for the first time, to request flexible working. We improved information and advice, and had training programmes for carers such as the expert carers programme, the benefits of which I have seen in my own constituency through the brilliant work of CLASP, the carers centre in Leicester. We funded breaks for carers. Many Members have spoken powerfully about how important breaks are. If carers who are caring for many hours a week have a bit of a break in sight, it really helps them to carry on. We also introduced financial incentives for GP surgeries to identify carers and refer them to local councils for support. That was part of the quality and outcomes framework, which was introduced as part of the 2004 GP contract, and was the very first step in providing a specific financial incentive for GPs to identify carers.

However, as all Members have said, far, far more needs to be done. Like many Members, I have seen in my constituency and within my own family the often desperate daily struggle that is still faced by too many people who look after a loved one who is disabled, physically frail or has dementia—sometimes all three. I pay tribute to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who powerfully explained her own experience of the physical and emotional demands of caring for a loved one. As she said, there are the physical demands of helping someone to get up in the mornings. Carers can be exhausted from getting up two, three or four times in the night to help someone go to the toilet, and from helping them move around the home. There are also the emotional demands. When a carer sees the person they fell in love with become frail and perhaps lose some of their pride and strength, it is terribly upsetting. If a son or daughter sees the parent who brought them up and taught them about the world—for good or for ill—begin to fade as a result of dementia, and they begin to feel as if they themselves are becoming the parent, it changes something essential in the nature of that relationship. I have always believed that relationships are essentially what make us human. If someone has dementia and begins to forget the relationships they have, it takes something away from the carer, as well. Caring for a loved one is physically and emotionally demanding. Many Members have talked about the role of public services. Health professionals are taught to understand physical and mental illness, but not necessarily the wider emotional and social issues.

I want to talk about three critical areas where we need to make progress, the first of which is identifying carers. If we do not know who they are, we will not get them the help and support they need. The second is ensuring they get the right information, advice and support from the NHS as well as social care. The third is helping carers to stay in employment, which many Members have talked about. That is particularly important as we all live longer and need to work for longer. If the public finances are to remain stable, we must do everything we can to help people in that regard. My hon. Friends the Members for Worsley and Eccles South and for Birmingham, Selly Oak (Steve McCabe) talked about the importance of identifying carers. The hon. Member for Ceredigion (Mr Williams) said that there is a great deal of awareness of carers and of the use of that term, but lots of people still do not realise they are a carer or think of themselves as such; they are simply trying to be a good daughter, son, husband or wife. Others do not ask for support because they worry that people will think they cannot cope; there is a lot of associated guilt. We need to identify these hidden carers.

There are many examples of good practice, but perhaps the best I have seen is in Torbay, where the issue of identifying carers in GPs’ surgeries and hospitals has been closely examined. If someone who has had a stroke comes in with a family member, it is recognised that that family member is likely to be a carer. A great range of support is provided. The approach taken in Torbay starts with the person who may need health care; as a result, they immediately talk about their family member.

I want to offer some practical suggestions to the Minister on how to make further progress. Will he consider amending the quality and outcomes framework? At the moment, it provides a points incentive and a financial incentive for GPs to refer carers to social care services; but why not to other health services, if carers’ health needs are so important? Secondly, will he give guidance on the best questions used to indentify carers? When I recently registered with a new GP, the leaflet provided asked, “Are you a carer?” I knew what that meant because I am familiar with the policy debate, but most people would wonder what that meant—paid carer, unpaid carer?

I spoke at the event that launched the research into attendance allowance claimants by the Strategic Society Centre and Independent Age. There are 1.3 million older and disabled people in England with very high levels of need. The research shows that 35% of attendance allowance claimants are cared for by a son or daughter, 30% by a partner, and 15% by another family member. The DWP has that information. I hope the Minister will talk to his DWP colleagues about drawing up a proper action plan.

Thirdly, I want to join my hon. Friends in pressing the Minister on what action will be taken through the draft Care and Support Bill to identify young carers. Will he update us on his meeting with the Education Minister? What is the obstacle to amending the Children and Families Bill, the draft Care and Support Bill, or both? I tell the Minister that the Opposition will table relevant amendments if the Government do not.

I turn now to improving information and advice for carers. Carers UK says that a third of those caring full time for an older disabled or seriously ill friend or relative receive no practical support, and those who do often find that services do not fit around their particular needs, especially if they are struggling to hold down a job. As many Members have said, these services still too often end up offering last-minute help and support, when families have already reached crisis point. I pay tribute to my hon. Friend the Member for Corby (Andy Sawford), who talked about his nan. Before she got any support, a crisis point had already been reached. That was no good for her, and it is no good for taxpayers. More than one in five carers who have been admitted to hospital as an emergency case in the last three years say that it could have been prevented, had they been helped to look after their own health, or been given a break from caring or other forms of support. Given that money is so tight across the NHS and council care services, we have to get those up-front preventive services and support in place.

I have another practical suggestion for the Minister. As he knows, there is a brilliant national GP patient survey, run by Ipsos MORI, which provides detailed information about the needs of patients registered at a surgery. The last time I looked through it, I do not think there were any questions about whether the respondent was a family carer. It was about the needs of the individual patients, not carers. Such a question would provide us with some brilliant data that could be given back to individual surgeries as the basis from which to start developing support.

[Norman Lamb]

The GP survey is absolutely something that we can consider. If we can demonstrate how individual surgeries are performing against their responsibilities towards the whole family, and not just towards the person who is receiving medical treatment, we might well drive changes of behaviour in the surgery.

[Liz Kendall]

I am very pleased to hear that from the Minister and I will continue to follow it up with him. Including such questions in the survey would not cost any more and the data are collected by individual practice, so we would all be able to look at the GP surgery data in our own constituencies and ask what action plans were being followed. Clinical commissioning groups could be required to follow that up.

The third issue that many hon. Members have talked about is helping carers to stay in paid work. Families need the income carers get from paid work and our economy needs the skills and talents of carers. That challenge will only increase as our population ages and as more people live for longer and have to care for longer.

The biggest group of carers are people aged 50 to 65, many of whom still want and need to work. Many are women who, as hon. Members have said, are stretched at all ends. Some are looking after their children or grandchildren, or sometimes both, as well as caring for a frail partner or elderly relative and trying to hold down a job. To have one in three carers being forced to give up work or reduce their hours because the right services and support are not available does not make sense for our economy as a whole. The right hon. Member for Sutton and Cheam talked about the LSE and Age UK research that shows that that is costing more than £5 billion a year in lost tax revenues and increased benefit bills.

I strongly urge the Minister to talk to his colleagues in the Department for Business, Innovation and Skills about how the Government can do more to promote flexible working among family carers. We have made great progress in arguing that child care is part of our economic infrastructure, and, as the population ages, social care must be too. I believe that from cradle to grave, child care and social care must be the twin pillars of a reformed welfare state.

In conclusion, the draft Care and Support Bill is an important step forward and is very welcome. It builds on the recommendations of the Law Commission’s review into adult social care legislation, established and initiated under the previous Labour Government. Indeed, many of its recommendations were set out in our White Paper on social care, produced just before the general election. On its own, however, the Bill will not be enough.

Rights in law simply will not be delivered on the ground if the services are not available locally to make them a reality. Local council budgets for adult social care have been under pressure for many years, but they are now at crisis point as council budgets have been cut by a third under this Government. The Local Government Association says that councils have had to reduce their adult social care budgets by £2.7 billion over the past three years—that is a staggering 20%. The LGA says that

“eligibility thresholds cannot be raised much higher, 87% of councils are now at the substantial/critical threshold”.

That affects not just the statutory services, but the voluntary organisations that several hon. Members have rightly championed. Cuts from Leicestershire county council mean that CLASP carers centre in Leicester wonders whether it will even be able to survive. Many Members have talked about the important role of the voluntary sector, but without state funding many such organisations will not exist in future.

Will the Minister back calls from Opposition Ministers for £1.2 billion of this year’s NHS underspend, handed back to the Treasury in March, to be given to social care to ease the short-term funding crisis over the next two years? What representations has he made to the Chancellor on council care budgets for the spending review? Has his Department made the clear economic and social justice cases for preventing them from being slashed further? If any NHS funds are to be transferred to local councils in next week’s spending review, will they be specifically ring-fenced so that money gets through to the front line?

Ultimately, we need a bigger and bolder response to meet the needs of our ageing population and to help Britain’s carers. We need a fully integrated NHS and social care system with one budget. We should take the £15 billion spent on social care and the more than £100 billion spent on the NHS and join them together so that we get better care and better value for money for taxpayers. I believe that that is what Britain’s carers deserve.

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

I am grateful to the shadow Minister, the hon. Member for Leicester West (Liz Kendall), for her thoughtful speech, much of which I agreed with. This has been a thoughtful debate in which many good points have been made and I thank Members for raising this very important issue. Many Members who have taken part in the debate have been long-standing advocates for carers and I welcome their interest and commitment. I completely understand why various Members constantly pursue issues such as those to do with young carers and will not accept my determination to help with that problem until it is dealt with. I accept that that is their role and it is their right to do so. The debate has been a good one and I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for securing it, together with his colleagues, and for all the work and championing he has done over the years for carers.

Let me make a preliminary point. Some of the Opposition speeches, including that made by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), focused on the difficult financial circumstances for local government, the impact of welfare reforms and so on. We could have a partisan battle about the issues, condemning the Government and so on. However, the shadow Minister recognised at the start of her speech the scale of the challenge we face, not just today but in the future. The numbers of people growing older with care needs, often with multiple conditions and a mix of mental and physical health needs, just keep growing. If we are all honest, both in this Chamber and with the public outside, we must admit that any Government of any political persuasion would face this challenge.

There is no easy solution. We cannot just find a magic pot of money to throw at the problem. There is an obligation on us all, as the shadow Minister made clear, to find ways of using the money we have available much more effectively than we do. We know that there is massive waste in the system because of the care silos—between health and social care, between mental and physical health and between general practice and secondary care. There is an absolute obligation on us all to engage in a debate about using money more effectively to achieve better care and support for people and to ensure that the system remains sustainable. I want to ensure that we elevate the debate by recognising the challenges we face.

The speech made by my hon. Friend the Member for Truro and Falmouth (Sarah Newton) was, I think, really valuable. Ultimately, we need collaboration among statutory services, which should not abandon their responsibilities, the voluntary sector and, crucially, people—that is, the community, families, neighbours and friends. We need to unleash particularly the power of the many people who have entered retirement fit and healthy and want to give something back, but often do not know how to do so. An army of people out there are able and willing to help to meet the enormous challenges. Some of the schemes that my hon. Friend the Member for Truro and Falmouth alluded to in her county are happening in many parts of the country, and they point us to a better future—a more caring future, where community strength is rebuilt.

I wish to join everyone else in this debate in paying tribute to the extraordinary work that carers do, giving of themselves; it is self-sacrifice, and they get no plaudits from anywhere else. They are just committing to helping someone they love, often doing so in challenging and troubling circumstances, particularly where dementia is concerned, as the loss of recognition can be very distressing for a loved one. We also know that many carers are themselves frail, struggling to cope on their own. My hon. Friend the Member for Ceredigion (Mr Williams) mentioned the challenges in rural areas. My constituency of North Norfolk contains many elderly people who are often living in isolated communities and are struggling to get access to the services they need. We owe an enormous debt of gratitude to the work of every carer in our community. As we have identified in this debate, without carers the cost to the public purse would be enormous.

I therefore very much welcome this debate, coming, as it does, immediately after carers week. It gives us the opportunity to discuss how carers of all ages can be properly supported in their role and helped to have a better quality of life. That is what we should be focusing on: putting quality of life and well-being at the heart of the Care Bill. We should not be thinking about what service we deliver to passive recipients; we should always be thinking, “How do we make your life better? How do we make you happier in your life? What might you, as an older person, be able to offer to other people?” It should be about that, rather than about these people sensing that they have nothing more to offer and just facing dependency as they move towards the end of their life in a rather distressing way.

Carers are central to the Government’s proposals for improving care and support. The Care Bill, currently being discussed in another place, puts carers on the same footing as those for whom they care. We propose to simplify the assessment process for adult carers by extending their right to an assessment. The hon. Member for Birmingham, Selly Oak (Steve McCabe) made an absolute point: people need simplicity and they must not be faced with bureaucratic jungles to fight their way through. Our simplified procedures will consider the impact of caring responsibilities on the carer in order to help them to lead as independent a life as possible. We intend to remove the requirement that a carer must be providing

“a substantial amount of care on a regular basis”—

that is the test—in order to be entitled to an assessment. That will mean that many more carers—in essence, all carers—will be able to access an assessment. In addition, the Care Bill seeks to place a new duty on councils to meet carers’ eligible needs for support. Those measures will be underpinned by a Department of Health commitment to provide new resources for carer assessment and support, rising to £175 million per annum by 2020.

[Barbara Keeley]

Has the Minister really taken on board the message that has come from my colleagues in this debate, which is that assessment is not always the answer? A lot of carers do not go near local authorities and are not likely to know of, hear of or ask for an assessment. The people they are in contact with are GPs, doctors and nurses, so there must be much more onus on the NHS and its staff to undertake the task of identifying carers at the earliest stage and ensuring that they get information, advice and support.

[Norman Lamb]

The hon. Lady asks whether I have taken that message on board—I could not have missed it. I totally agree with what has been said and I am going to discuss the role of health professionals.

I know that there is a lot of concern about young carers, and it comes particularly from the hon. Lady. I said in the Queen’s Speech debate that I would meet the Under-Secretary of State for Education, my hon. Friend the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children and families, and I have done so. I appreciate that until something concrete happens the hon. Lady will, rightly, keep pressing. I give her my assurance, again, that I understand and accept the case she is making. My hon. Friend the Minister and I are entirely clear that our joint aim is to ensure that young people are protected from having to undertake excessive and inappropriate caring responsibilities. During debates on the Children and Families Bill, he confirmed that he and I are of one mind on the need to protect young carers by using a whole-family approach to the assessment of adult care needs.

The Care Bill itself is not the place to go into the detail of how assessments should be conducted; that will be set out in regulations and statutory guidance. A whole-family approach will undoubtedly benefit children, but I am keen that it also encompasses other significant family relationships. We need to look genuinely at the whole family, whatever the relationships are between those receiving care and those giving it.

In last week’s debate, my hon. Friend the Minister confirmed that his Department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need, and how we can ensure that children’s legislation works with adult legislation to support the whole family. I am clear that we have to address the concerns, and while we significantly advance the position of adult carers, we cannot leave young carers behind. The approaches do need to be different, because we need to recognise philosophically that children should not be caring inappropriately. Of course sometimes they have to do that, but we want to relieve the caring burden as far as is possible, while recognising that sometimes there will be a caring role for some.

[Liz Kendall]

Does that mean that there will be a requirement on schools, and on further and higher education bodies, specifically to identify young carers?

[Norman Lamb]

It is not my job to speak on behalf of the Department for Education, and the hon. Lady will have to be a bit more patient in waiting for further news on that subject.

Key principles to inform that work and discussion over the summer are, first, that the starting point should be assessing the needs of the adult or child who needs care and then seeing what remaining needs for support a young carer in the family has. The presence of a young carer should trigger either an assessment or the offer of an assessment to the person needing care. Secondly, a whole-family assessment is key when assessing an adult needing care where children in the family are providing care to the adult or undertaking wider family responsibilities. The adult’s assessment and eligibility for support should take into account their parenting responsibilities and the functioning of the family. Thirdly, assessments should establish why a child is caring and how to prevent—this is the crucial point—excessive or inappropriate caring responsibilities which could have an adverse impact on their education, social activities, emotional development or health. As much as possible we ought to be enabling a youngster to grow up like any other youngster can, without having inappropriate burdens on them that impact on their education and social life.

[Paul Burstow]

Will my hon. Friend confirm that the Government will be publishing amendments to give effect to this within the next week or two? Will he set out the timetable? Will the Government also address the other gap, which is the one regarding parents who are caring for disabled children? We need to make sure that none of those who have caring responsibilities get left behind.

[Norman Lamb]

I cannot give my right hon. Friend a specific time scale for what might happen—he needs to watch this space, and I am sure he will. On the question of parent carers, the view of my hon. Friend the children’s Minister is that there is sufficient provision under section 17 of the Children Act 1989 to provide for the assessment and support of disabled children and their parents. In addition, special educational needs reforms in the Children and Families Bill will give parents more choice in and control over the support they and their children receive.

[Ian Mearns (Gateshead) (Lab)]

It is a sad fact of life, though, that when a social worker visits the home of someone who needs care, they go with that client in mind. If a child in the household is caring for that adult, for example, but the social worker focuses on the adult client, all too often the social worker does not think to cross-reference the child’s needs with colleagues in the social work department.

[Norman Lamb]

I completely agree. That is why the whole-family approach is so important. When dealing with the care needs of one individual, we need to look at the impact of those care needs on the whole family.

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

rose—

[Norman Lamb]

I will give way, but I then need to reach the end of my speech.

[Grahame M. Morris]

I am grateful, and I compliment the Minister on his response. Does he recognise that, particularly in relation to young carers, it is quite right to place additional duties and responsibilities on local authorities, but local authorities must be given sufficient resources to discharge those additional duties and responsibilities?

[Norman Lamb]

I am not sure whether the hon. Gentleman was present when I said that we need to be much smarter about how we use the money available. One of the things we need to do—I think there is a degree of agreement here—is integrate health and care. It is a crazy silo situation that we face. We are not using the money effectively. We could achieve much better support if we combined the disparate parts of the system to provide support shaped around the needs of the individual and their family.

The last spending round provided local government with a challenging settlement. That is why we decided to provide extra funding to help local authorities maintain access to services. However, local authorities ultimately have discretion over how they use their resources. Improving care and support is not simply a case of more money. Local authorities must look at how they can transform care through innovation and new ways of working. As I said earlier, collaboration with the voluntary sector is critical to this. Many local authorities are successfully integrating health and care services to improve quality, and we are developing the concept of “pioneers” to act as exemplars to support the rapid dissemination and uptake of lessons learned across the country.

Some hon. Members talked about the role of doctors and other health care workers. I agree that much more needs to be done. We can look at incentives such as the GP survey mentioned in the exchange that I had with the shadow Minister, the hon. Member for Leicester West, and we have provided funding for the Royal College of General Practitioners and others to encourage GPs to think about the role of carers, but what we see from examples around the country, such as Changing Lives in Cornwall, is that once GPs start to collaborate and work as a partnership—as a team—with carers and the family, they begin to see that their burden is relieved because others can help them in the role that they have to perform. That is the essential change that it is so important to achieve.

My right hon. Friend the Member for Sutton and Cheam referred to the £400 million funding over four years for carers’ breaks. It is deeply frustrating that that has not been used as intended in all parts of the country. There are some areas, including Surrey and many others, which have done good, innovative things as a result of that. The Department asked the policy research unit in economic evaluation in health and care intervention to conduct a survey of a number of PCTs to gain their views on the benefits of NHS support for carers’ breaks. The findings will be published shortly and will help inform our understanding of what has happened. The early indications are that there may be more good things happening than we sometimes recognise, but clearly there have been significant gaps and much more needs to be done.

I appreciate that time is almost up. I entirely agree with my right hon. Friend and many others about the importance of work. I make the point again that providing help and assistance to enable people to remain in work is in employers own self-interest, as they maintain the skills in the work force while enabling that person to continue their caring responsibilities.

This has been a good debate. There has been some informed discussion and I am very grateful to hon. Members for their contributions.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I call Paul Burstow. We have about 40 seconds.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 11th June 2013 Commons Chamber

[Mike Thornton (Eastleigh) (LD)]

11. What progress he has made in delivering parity of esteem between mental and physical health.

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

One of NHS England’s objectives is to ensure that mental health and physical health are given equal priority. By March 2015, we expect the NHS to demonstrate measurable progress towards achieving parity of esteem, so that everyone who needs them has timely access to evidence-based services.

[Mike Thornton]

Freedom of information figures that were obtained by Mind from Southern Health NHS Foundation Trust reveal that in my constituency, the number of people with mental issues who are admitted to hospital, rather than treated by specialist crisis resolution and home treatment services, is higher than average. What steps is the Department taking to ensure that everyone has access to mental health crisis care services that provide alternatives to hospital admission?

[Norman Lamb]

I applaud the work that Mind is doing to demonstrate the stark differences between the treatment of people with mental health problems who are in crisis and that of people with physical health problems. Its work demonstrates that without proper liaison services, people end up in hospital, at increased cost to the NHS. I have asked all the relevant bodies to get together to agree a plan to ensure that there is urgent crisis care for people with mental health problems, like that experienced by people with physical health problems.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I am most concerned that as well as the problems at the crisis level, there is not enough support for people with low-level mental health issues so that they do not get into crisis. Although I welcome what the Minister has said about improvements by 2015, does he not agree that we need stronger and more defined targets to get the progress that is needed towards the mental health services that are required across the country?

[Norman Lamb]

I agree that the more we invest in preventive care, the more we will save problems down the track and stop people’s health deteriorating. Areas that have managed to integrate mental health with primary care have seen good results, with better treatment, quicker access to treatment and less deterioration of health. That is the approach that we need to take.

[Mr Dominic Raab (Esher and Walton) (Con)]

12. What progress his Department has made on implementing local commissioning of NHS services.

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

By April 2013, 211 clinical commissioning groups were authorised to commission the majority of NHS services for their local populations. CCGs are now empowered to design and deliver services based on the needs and choices of their patients, and NHS England will support CCGs to deliver high-quality outcomes.

[Mr Raab]

I thank the Minister for that answer. My constituency struggled under a particularly inefficient primary care trust. It is, of course, early days, as the Minister has explained, but Surrey Downs CCG is already saving costs in bureaucracy so as to invest strategically in cutting counselling waiting lists, increasing funding for children with multiple disabilities, and setting up virtual wards run by a matron to supervise care in the community. Will the Minister join me in welcoming those important GP-led improvements in local care?

[Norman Lamb]

I applaud the CCG for the priorities it has set. Reducing waiting times for access to psychological therapies is a really good move, and the virtual ward has the potential to keep people out of hospital, maintaining their health better and reducing cost to the NHS.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Hackney CCG was one of the first to be up and running in shadow form. It is now operational but it is still persisting with a tendering approach to out-of-hours services. Will the Secretary of State write to the CCG to explain what has been said in this House—that tendering is not a requirement—and make it absolutely clear where the law lies?

[Norman Lamb]

The point I have tried to make all along is that this is about the judgment of the clinical commissioning groups, and nothing is imposed by the Government in what is required of them. European procurement rules existed under the Labour Government and this Government, but it is up to CCGs, working within the health and wellbeing board arrangements, to commission as they see fit for the benefits of their population.

[Priti Patel (Witham) (Con)]

Despite Witham town’s growing population, our GP ratio remains above the national and regional average. Does the Minister agree that the local commissioning model, and the CCG in particular, would urge GPs to explore ways to expand Witham’s health care provision to meet the needs of the growing local population?

[Norman Lamb]

I know that my hon. Friend has campaigned vigorously and consistently on this issue and the needs of her local community, and I agree that GPs ought to explore all ways they can of improving health care for her community.

[Keith Vaz (Leicester East) (Lab)]

May I declare my interest, and ask the Minister whether he is satisfied with the progress being made by CCGs in the provision of diabetes prevention work?

[Norman Lamb]

I understand that all clinical commissioning groups have a lead on diabetes care, but we can do an awful lot more to improve prevention work. We know that if we guide people in self-care, we can achieve massive improvements in their own health and well-being, and reduce the number of crises that occur. I am happy to work with the right hon. Gentleman to ensure we do everything we can to improve diabetes care.

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

13. What recent representations he has received expressing concern about the service provided by the East Midlands Ambulance Service.

--- Later in debate ---

[Pauline Latham (Mid Derbyshire) (Con)]

14. What recent assessment he has made of the national cancer drugs fund list.

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

In April 2013, NHS England published a national list of drugs available from the fund. The list was updated recently following a meeting of the national cancer drugs fund clinical panel. Clinicians can apply to the fund for the inclusion of a drug within the approved list.

[Pauline Latham]

The cancer drugs fund is due to come to an end in less than a year. Given that more than 28,000 patients have received treatment since the CDF was introduced, what discussions has the Minister had with NHS England on continuing funding for it after the end of the current arrangements?

[Norman Lamb]

My hon. Friend has campaigned vigorously to ensure that as many people as possible get access to the drugs they need. The fund has been a great success. More than 30,000 have I think now benefited from it. We want to do all we can to ensure that the good lessons we have learned from it continue.

[Zac Goldsmith (Richmond Park) (Con)]

15. What progress has been made on implementation of the UK five-year antimicrobial resistance strategy.

Augmentative and Alternative Communication Services

Norman Lamb Excerpts

Thursday 6th June 2013 Commons Chamber

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

I am really grateful to my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for raising this issue, and for his work, together with that of colleagues, as a member of the all-party parliamentary group on speech and language difficulties. An occasion such as this is particularly valuable, as was the meeting that we had yesterday, in ensuring that Ministers focus on issues that might otherwise not get attention. I learned a lot from the meeting yesterday, and from my hon. Friend’s impassioned speech today. He clearly speaks with real authority on this subject. I was struck by his point about the lad who ended up with a PhD as a result of the support that these facilities can provide. He made the point very powerfully that they can change lives.

Augmentative and alternative or assistive communication is one of the more specialised areas of health and education provision. The number of children who will require support in this way is relatively small, perhaps less than 0.5% of the population, so it is important that we do not lose sight of them. My hon. Friend rightly made the point that the ability to speak and communicate is a pretty basic human right, and that it should be recognised as such.

Augmented communication has the potential to have a tremendous beneficial impact on the health and well-being of those whose condition places barriers between themselves and others, which until recently were insurmountable, and indeed, on their families and friends. Technological and therapeutic advances have in recent years revolutionised the support that can be given to those who have lost, or never had, the tools of speech and language that allow us all to interact and that are critical to development, to education, to work and to living one’s life. Augmentative and assistive communication—AAC—aids range from tools for paper-based communication to pretty sophisticated electronic equipment.

Support in the past has not always been of sufficient consistency and quality, and the Bercow review in 2007 and the subsequent work of the Communication Champion, Jean Gross, have helped to identify systemic improvements, culminating in a new approach to the commissioning of AAC that began just a few months ago. It is worth pointing out that the new system is in its very early days. I was pleased that my hon. Friend acknowledged that it had the potential to work effectively. It is perhaps understandable that we have not got it quite as we would want it to be, given the early stage that we are at, but I agree that it has enormous potential. There is significant clinical consensus behind the new approach, and I am proud to say that it has been developed from the new structures of commissioning that this Government have introduced into the NHS.

In April this year, NHS England took on responsibility for the direct commissioning of specialised assessment and the provision of augmentative and assistive communication aids for adults, children and young people. NHS England’s role as an independent national commissioner is particularly suited to the effective commissioning of extremely complex, yet relatively low volume, services of this kind. Let us bear in mind that the patients who require AAC aids have extremely complex needs and in many cases require bespoke equipment that has been designed for them. My hon. Friend the Member for Totnes (Dr Wollaston) mentioned the training involved in the use of such equipment. It could not feasibly be provided by small-scale local services. Assessment and provision is needed by specialised tertiary providers with their concentration of expertise.

Previously, we had no national commissioning of AAC services and improvement across the board was essential. There was no standard or nationally consistent definition of those services, which were the commissioning and funding responsibility of the NHS. The effect of that was variation in the organisations commissioning and funding specialised AAC services and, crucially, inequitable access to them. There was a mix of non-NHS commissioning agencies, including social care and the education sector, to which my hon. Friend referred, and charity and third sector funding agencies that were commissioning the assessment and provision of specialised AAC aids. It was haphazard, depending very much on where people lived. That was unfair to those in need, and far from ideal for commissioners or providers.

That has now changed. NHS England—committed to ensuring national consistent commissioning of high quality, equitable and effective specialised services—has worked with the expert partners on its clinical reference group for complex disability to develop for the first time a nationally consistent specification for specialised AAC aids, which was subject to public consultation. The specification has allowed a clear demarcation of the responsibilities of clinical commissioning groups in relation to less specialised AACs—around 90% of the total provision. The highly specialised services will be commissioned by NHS England. It will be an important role for NHS England to work to support CCGs in their commissioning of the less specialised end of the spectrum and to ensure that we build capacity rather than lose it, as my hon. Friend feared could happen. If we get this right, the potential of having this specialist team working nationally with local commissioners could be significant.

In implementing the specification, NHS England will draw on the recommendations of the Bercow review and the Government communication champion to consider, in particular, how best to ensure more consistent and responsive commissioning of AAC aids across England and the implications of meeting unmet need. We know from recent research from Communication Matters that there is variation in service provision across England—the postcode lottery to which I referred—and inconsistency in identifying, assessing and providing AAC services.

A key priority is therefore to ensure that commissioning arrangements for this specialised service are placed on a much more robust and equitable footing across England. NHS England is working with its clinical reference groups and area teams to identify areas where there may be inequalities and where additional resources may be required to bring about better access. The clinical expertise both embedded in the organisation and accessed through its close association and close partnership working with organisations such as ACE—Aiding Communication in Education—will be decisive in this. I met Anna Reeves of ACE yesterday, and I would like to pay tribute to the amazing work she has done in leading the case for much better access to these services. She has worked tirelessly in that regard and should be credited for doing so.

I would also like to acknowledge the potential benefits of clinically-led commissioning of services for children with special educational needs as part of new joint arrangements, which will also provide far more tailored support, focused on the health and lifestyle outcomes for the child, for the developmental needs of children who require AAC aids. The Children and Families Bill sets out a framework for a new integrated approach to meeting the needs of children and young people with special educational needs. This will include many children, potentially the majority, of children in need of AAC aids.

In brief, the Bill’s provisions will get clinical commissioning groups and local authorities—and, in some cases, the NHS Commissioning Board, where it is acting as a commissioner of services for a child or young person—to enter into joint arrangements to assess, plan and commission the services needed by children and young people with special educational needs. Each child’s improvement outcomes, and the services they need to deliver them, will be captured in the education, health and care plan, to which the relevant commissioners will contribute. That is a much more joined-up approach than we have ever had in the past.

The new arrangements will be introduced in 2014, Parliament allowing. Twenty pathfinder local authorities are piloting new approaches to integrated assessments and the plans currently. The amended Bill now includes a duty on CCGs to secure the services that they agree the individual needs and which comprise the education, health and care plan. We have specifically required in the mandate for the NHS—the Government’s priorities—the need for improvement, through partnership working, to support children and young people with special educational needs and disabilities, and for ensuring that children have access to the services identified in the agreed care plan. AAC support will be a significant part of these plans for many children.

NHS England and CCGs will need to work closely with local authorities and, of course, health and wellbeing boards, which will include the local authority director of children’s services and the local healthwatch. That is the vehicle for a consensual local identification of needs and a local strategy for meeting them. The health and wellbeing board must, as our guidance makes clear, have particular regard for hard-to-reach groups and those with complex conditions, which will require more specialised health services, as well as ensuring it has an in-depth understanding of more widespread health needs among the population.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on initiating this important debate. In the allocation of resources and the approval of plans, what mechanisms for appeal will there be for individuals who feel that they have not been fairly treated, or indeed for areas that feel that?

[Norman Lamb]

There will be the potential to challenge and question to ensure that the individual is satisfied that their case has been properly heard, but I will also write to the right hon. Gentleman to fill in the details further to ensure that he understands the position fully.

Let me make a quick point about the historical budgets to which my hon. Friend the Member for Blackpool North and Cleveleys referred. To start with, NHS England has worked on the basis of the amount spent hitherto. It is important to say that work is very much ongoing on this matter, and it is absolutely recognised that it is important to get it right and to assess the level of need so that we can identify how much needs to be spend on it. This is not a done deal and he should not assume that this is the end of the story. He also made a point about organisations with great expertise which could be excluded from being able to play a part in this. I can reassure him that they will be able to bid to do work. He also made the point about loss of equipment on leaving school, and it is really important that that is avoided; that sort of thing is utterly crazy and we must ensure continuity. As he rightly said, this is a health issue and it must be recognised as such. He talked about the hub-and-spoke issue. The relationship between the expert team nationally and the CCGs has the potential to work well to build capacity within the system to improve the level of expertise available and to ensure a more consistent approach.

I hope that what I have said today provides significant reassurance to hon. Members about the robustness of the new approach to deliver AAC aids, not least in the role of NHS England in leading the development of expert service specifications and implementing them in a national programme of commissioning to deliver improved and responsive communication support. We are not complacent and, together with NHS England, we understand that more needs to be done to ensure absolute consistency across England, so that everyone who needs it has access to high-quality, equitable and effective AAC support. We have in place the right system to deliver that; my profound belief is that we will shortly be able to recognise NHS England, in this regard, as an exemplar of the effective design and commissioning of specialised services.

Question put and agreed to.

House of Memories Programme

Norman Lamb Excerpts

Tuesday 4th June 2013 Westminster Hall

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

I congratulate the hon. Member for Liverpool, Walton (Steve Rotheram) on securing the debate. I remember his speech in the Chamber during the debate he referred to earlier. He talked passionately about the House of Memories initiative in Liverpool, and I think I am right in saying that he also spoke about his mother’s battle with dementia, so I know he cares a lot about this issue. I am keen to work with him and to talk to him further about how we can maximise the benefits of such an approach.

I should also refer to another institution in Liverpool—Everton football club. I am not sure where his loyalties lie in that great city, but Everton have done great work on reminiscences and dementia. I have had people from Everton come to the Department, together with other representatives of football and sport. The hon. Gentleman talked about long-term memory and the power of reminiscence, and sporting memories can be incredibly valuable in bringing people back who are suffering from dementia. I am absolutely with him on that.

[Steve Rotheram]

I thank the Minister for giving way, and for mentioning Everton football club and the Everton in the Community project. During my visit to the museum, Everton were represented, and they had their football reminiscence material there. It does exactly what the Minister has outlined, and stimulates conversation like nothing else because of people’s memories of great moments in their lives. Some of those will obviously be sporting-related, and that could be part of what the House of Memories project is about.

[Norman Lamb]

I am grateful for that intervention. I have been asked to give my own footballing memory, and it is Jeremy Goss scoring a fantastic goal away at Bayern Munich. Norwich City were for a long time the only club that had beaten Bayern Munich away. I am looking to see whether we can extend the work of Everton to other premier league and football league clubs, because they have a powerful position in their communities and can be opinion leaders in developing these ideas powerfully in their communities.

I am wholly supportive of the House of Memories. It is an exceptional project that has been funded in part, as the hon. Gentleman said, by the Department of Health; more than £220,000 has been allocated during the last two years. As we have heard today, National Museums Liverpool provides an innovative training programme that is making a real difference for social care staff by helping them to connect with the people with dementia whom they support every day. They use the objects that the hon. Gentleman referred to and the stories linked to the museums’ collections. Museums across the country have a rich collection of objects and art that can be so powerful in helping people to live well with dementia. It is a very powerful partnership with care providers. I think the hon. Gentleman said that 3,000 care workers had already participated. That demonstrates the reach of this project. It is fantastic that the cultural sector is involved in work on dementia; it is a great collaboration. Getting the medical profession to consider new and different approaches beyond pure medicine can be very powerful. The work to which I have referred is critically important in supporting our drive to create more dementia-friendly communities.

The hon. Gentleman is right about the value of early intervention and the savings that can be secured for the NHS in this way. My understanding is that the money from the Department of Health has already helped to roll out this approach to museums across the north of England. There is a funding application in at the moment for 2013-14. That is being considered by the dementia work force advisory group. It could extend the roll-out to museums and galleries in the midlands. I think the decision on that will be communicated to National Museums Liverpool over the summer. Obviously, I cannot pre-empt the outcome of that application, but clearly, as I have said, I am wholly supportive of this project and keen to work closely with the people involved to develop this initiative and concept further.

There are 670,000 people in England with dementia. That number is increasing year on year, as is the £19 billion cost to society of dementia. Faced with that, the Prime Minister launched in March last year the challenge to which the hon. Gentleman referred, which builds on the dementia strategy the Labour Government initiated in, I think, 2009. It is a powerful and good initiative and was one of the first globally to be developed. This condition is the biggest fear for people over the age of 55—as someone who has just turned 55, I am acutely aware of that.

A year on from the launch of the Prime Minister’s challenge, dementia remains a priority for the coalition Government, for their partners in health and care and for me personally. The House of Memories was I believe referred to in the updated report on the Prime Minister’s challenge last November, so its effect has been recognised. In the first year, we have achieved a lot, not only laying the foundations for delivery but making progress across all three areas of the challenge: first, improving health and care services for people with dementia; secondly, creating more dementia-friendly communities, where this work can play such a valuable role; and thirdly, the importance of research and committing more resources to research into finding cures and prevention mechanisms for dementia. That is creating a momentum that will lead to real improvements in the lives of people with dementia and their carers.

For the first time, there is a quantified ambition to increase the diagnosis rate for dementia from the current 45%, which is far too low. Our aim is that by 2015 two thirds of people with dementia should have a diagnosis, with appropriate post-diagnosis support. We are also seeing real action on the creation of dementia-friendly communities, with 50 areas expressing an interest in becoming dementia friendly. An awful lot is going on in Liverpool, and I do not know whether the city as a whole is exploring that, but clearly there is good leadership in that city.

The launch of the Dementia Friends initiative has already captured the imagination of thousands of people, and the number of people attending the awareness sessions is growing every week. I participated in a session in Warwick in April, so I have become a dementia friend—I have the badge to show it. If the hon. Gentleman has not done that yet, I encourage him to do so and, indeed, I encourage others to take up that challenge locally.

The UK will use its presidency of the G8 to identify and agree a new international approach on dementia research. A specific G8 dementia summit will be held in London in the autumn. It will bring together Health and Science Ministers alongside world-leading experts, senior industry figures and the Organisation for Economic Co-operation and Development. The event will look to secure more co-ordination and collaboration on dementia globally. I suspect that initiatives such as the one from Liverpool could play a part internationally, through this G8 process, in teaching other countries about what could be learned from them.

A skilled work force is vital to delivering compassionate care for people with dementia. That is why we are taking forward work to ensure that we have front-line staff who are capable and competent in dementia care. The Department of Health and NHS England are working closely with Health Education England to put in place a forward work programme for the delivery of the work on dementia set out in their mandate. That includes ensuring that 100,000 NHS staff have undertaken foundation-level training on dementia by March 2014, so that they can better support people with the condition. A new e-learning package has been published that will lead to 100,000 nurses and health care assistants receiving dementia training via e-learning by 2015.

In March, the Department launched a new nursing vision and strategy for dementia care that sets out what is expected of all nurses in order to meet the level and quality of care expected in all settings. In social care, the dementia pledge builds on the care and support compact by supporting social care employers to develop their work force’s understanding of dementia and to adapt their services to meet the needs of people with dementia. More than 900 care providers have already signed up to the pledge and almost 150 to the compact.

The hon. Gentleman asked one or two questions at the end of his contribution. In the spending review discussions, the focus on and the priority that the Government give to dementia will remain central to our thoughts in ensuring sufficient funding to maintain the momentum we are starting to build. As I said, in this Parliament we are building on the last Government’s strategy through the Prime Minister’s challenge.

I confirm again my absolute support for the House of Memories initiative. I want to maintain the liaison and collaboration that has been developed in the last year or so. The hon. Gentleman mentioned the possibility of meeting in Liverpool, which I would love to do if time allows. My diary is a complete nightmare, but if it is possible I will be very happy to do that. I certainly want to do all I can to ensure that the valuable lessons learned from this exciting and imaginative initiative, bringing together two sectors, are learned elsewhere, so that people with dementia really benefit from it.

Mental Health

Norman Lamb Excerpts

Thursday 16th May 2013 Commons Chamber

[Paul Burstow]

I note that the Minister paid close attention to that intervention and I am sure the hon. Gentleman will enjoy the exchange of correspondence on the matter.

I want to discuss the health care aspects of parity of esteem. Curiously, not all general hospitals have 24/7 access to a mental health liaison service offering immediate support, yet we know that when that works well it can make a big difference to the quality of care, help to reduce the length of stay in hospital, especially for older people, and generate savings four times greater than the cost of running the service. There are good examples of where this has been done, particularly in Birmingham, and it is odd, given such obviously compelling evidence, that it has not yet been taken up more widely.

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

I completely agree with my right hon. Friend. There is some very good practice, including RAID—rapid assessment interface and discharge—at Heartlands hospital in Birmingham, but there are too many places where there is a complete absence of such services. The starkest aspect of the lack of parity of esteem is that there is a good emergency service—it may be under pressure but it is there—for people with physical health problems but not for those with mental health problems. That has to be addressed.

[Paul Burstow]

I am grateful to the Minister. Perhaps in his own speech he can say a little more about how we might better incentivise this change. Despite the compelling economic and medical benefits, these services are still not being provided widely enough.

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[Paul Burstow]

The hon. Gentleman makes a good point. Indeed, that has been part of the approach taken in the talking therapies strategy, which is about moving the resource to where it will make the most difference at an earlier stage, and helping to promote recovery in the first place.

The Minister said that the emergency service is a stark example of where parity of esteem has not been achieved, and I want to give another example. The Royal College of Psychiatrists and its president, Sue Bailey, have been looking, on behalf of the Department of Health, at the whole issue of parity of esteem and what practical steps could be taken to address it, and it has recently published work on that. How can it be right, for example, that a recommendation by the National Institute for Health and Clinical Excellence on the availability of a drug is a must-do for the NHS but a NICE recommendation on the availability of therapies is not? This means that evidence-based non-pharmacological treatments that are clinically effective and cost-effective are often left unimplemented. I hope that that bias will soon be brought to an end.

The same can be said for access standards. There has rightly been uproar when even small changes occur in the amount of time people wait to attend accident and emergency departments. NICE has said that a person experiencing a mental health crisis should be assessed within four hours, yet only one in three people is so assessed. I am puzzled by the decision not to set a 28-day access standard for therapy, because the NHS constitution should embody parity of esteem, and that is a tangible way it could do so. Having said that, I take heart from the revised NHS constitution handbook, which said albeit it in a footnote:

“The Mandate indicates that we will consider new access standards, including waiting times, for mental health, once we have a better understanding of the current position. We need to do this work and consider carefully the implications of introducing any new standards, before we can make any firm commitments in this area.”

Why on earth is this problem still not being understood? Why do we need yet more reviews? Will the Minister give an indication of the time scale?

[Norman Lamb]

We clearly need to understand the scale of the problem of access. It is a bit shocking that we do not know the figures across the country for the number of people waiting and how long they are waiting. The mandate of the commissioning board requires that it must establish that and then set access standards. That is really important work, because there is a legal obligation to seek to meet the requirements of the mandate.

[Paul Burstow]

rose—

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[Mrs Moon]

The hon. Gentleman is right that a number of universities are doing excellent work in this area. The centre at Oxford has done wonderful research, as have Bristol and Manchester. I have referred several times to King’s college London because of its expertise in defence medicine. I am not denigrating the work that is taking place elsewhere; I am merely highlighting the importance of the work at King’s college London.

The King’s college London research has looked at the importance of decompression, whereby serving members of the armed forces have the opportunity to spend time together and take part in physical activity before they reach home. That has made a huge difference in the mental health outcomes of serving personnel.

Interestingly, the research has identified the groups that are most at risk of problems. They are not those who have served for the longest or most frequently in the armed forces. They are the early service leavers—those who leave the service shortly after their initial training. The risk is higher among those who fulfil combat roles. We forget how small a percentage of our armed forces is made up of people who go out through the gate and pursue combat roles. That work is of great benefit to the military, but it is also important that it is sustained and utilised in our wider understanding of mental health.

I want to talk briefly about TRiM, which is about trauma resilience. It was developed and utilised by the Royal Marines. It trains individuals to identify signs of distress within their own units and within themselves. It means that problems can be identified early on, and help provided quickly. Interestingly, the trauma and resilience handbook that is given to serving personnel and their families provides advice on looking after themselves, talking about their experiences, and how to deal with returning home—coping skills such as dealing with anger and alcohol, combating stress, and sleeping better. It provides tips for spouses, partners, families, friends and parents of returning serving personnel, as well as for the returning reservist. It is a prime example of how we help prepare people for what they are going to experience. We do too little in this country to prepare people for the risks of mental health problems. We do not tell people; we are not educating our young people in how they can identify within themselves, or within their families and friendship groups, some of the risks they will inevitably face in times of difficulty throughout their lives.

I am pleased that the work of TRiM has gained traction elsewhere and been adopted by many other organisations and employers. Even a cursory internet search demonstrated that a number of organisations are using TRiM to help their employers, in particular the blue-light brigades. The police force and Departments including the Foreign and Commonwealth Office frequently train their officers in TRiM.

US research into factors predicting psychological distress among rape victims has shown that initial distress was a better predictor of subsequent psychological functioning than other variables, as well as in the treatment of rape and other types of post-traumatic stress disorder. The use of TRiM and post-traumatic stress disorder management is extending into areas that we had not previously recognised would impact on the general mental health of people in the wider community.

Another area in which the military has taken time to expend its capabilities is the Big White Wall—an online 24/7 early intervention service for people suffering from mental distress. It is free for serving personnel veterans and their families, and as of December last year, 2,500 members of the armed forces community were registered. Seventy-five per cent. of members talked about an issue for the first time on the Big White Wall, 80% managed their psychological distress, and 95% reported an improvement in their well-being as a result of using that service.

There is consensus that reservists are more likely than other serving personnel to experience mental health problems as a result of their service, which is thought to be because when they return from tour they return to civilian life, away from the support network that a regiment offers. Academics at the King’s Centre for Military Health Research, in conjunction with others, conducted a five-year study of 500 reservists who worked in Iraq, which showed that they were twice as likely as regular soldiers to suffer from post-traumatic stress disorder.

Current drives to recruit 30,000 reservists as part of the Future Reserves 2020 programme mean that we will need further research in that area. A number of Members will have an interest in this issue, because reservists come from across the country and live and work in all our constituencies. The most recent figures Combat Stress could give me showed that it had received 1,558 approaches from veterans from Iraq, 123 of whom were reservists. From Afghanistan it had received 752 approaches, including 55 from reservists. With the discharge of large numbers of serving personnel as a result of cuts, I am concerned that high levels of alcohol misuse within the services may be transferred into their civilian life. Service personnel are not a group that readily seek help, and much remains to do in relation to mental health. Our wider society and its services must be ready for the discharge of large numbers of serving personnel into our communities.

Every hon. Member who speaks today will no doubt be aware of the difficulty of working with general practitioners and of making them aware of the mental health services that are available. One problem is that GPs see few veterans. There is a heavy reliance on individuals to make their GP aware of their military service. In 2011, the Royal College of General Practitioners issued guidance to GPs on how to meet the health care needs of veterans, but the onus is on the GP to be aware of it. According to the last figures I have, only 320 GPs had accessed an e-learning package on help to identify veterans with mental health problems. We need to work to increase that number.

Our police forces need to be helped and supported in understanding how often they will come across veterans. Figures show that they are coming across veterans who are dealing with alcohol problems and having episodes of self-harm, which in military terms means looking for fights in which they will receive physical injuries. Alarmingly, a recent independent commission on mental health and policing showed that the Met police have a particularly poor record of dealing with people in mental distress. A quarter of calls to the Met police each year—600,000 calls—were linked to mental health. We need to tidy up the link between mental health and the police.

[Norman Lamb]

The hon. Lady makes important points on people in the armed forces and veterans. Is she aware of Lord Adebowale’s valuable work and report on the link between police and mental health, which was published last week? It was commissioned by the police and dealt with how to improve the way in which they operate. It is good news that the police were prepared to commission Lord Adebowale’s report and are prepared to listen to his advice.

[Mrs Moon]

I am very aware of that research; the point I was about to make comes from it. The problem is that we often use the police as our first line in dealing with people with mental health problems, but they are not trained and equipped to carry out that role and function. We must do something about that. Otherwise, the person with the mental health problems is often dealt with as a disruptive element, and treated as if they are someone violent and aggressive, rather than someone who has a mental health problem. We must deal with that problem.

Words and anecdotes can be dangerous, particularly in the military. Research was published this week by the Defence Analytical Services and Advice agency on Falkland veterans. It found that 95 veterans had taken their own lives since the end of the conflict. That figure is lower than previously assumed, although each death is a tragedy for the individual and family involved. The research showed that, of the 26,000 mobilised, 255 died in conflict and 95 took their own lives, but 455 died of cancer. We sometimes forget that our armed forces community has problems we need to address that are not necessarily mental health problems.

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[Mr Walker]

My hon. Friend makes a fine point. I want to touch, at the end of my speech, on resilience and the terrible tragedy of suicide among young men and women, so I will come back to that.

I remain terribly concerned about psychosis and schizophrenia. I mentioned a few minutes ago that anyone with a diagnosis of psychosis or schizophrenia is likely to be unemployed. If one is not unemployed at the time, one will end up unemployed. Life expectancy, which has already been mentioned today, can be up to 20 years shorter than for someone who does not have that diagnosis. That is not acceptable in a civilised society and should not be tolerated. I have spoken about this before in an Adjournment debate and I want to revisit it because it is so important.

My concern, having talked to people who care for loved ones with schizophrenia—sons, daughters, mothers or fathers—is that sometimes the NHS is more interested in managing the illness than with the overall health needs of the patient. Symptoms are managed down so that patients do not make a nuisance of themselves and take up time, but when one stands back and looks at them, one sees they are desperately unhappy. It does not matter if they are smoking 70 or 80 cigarettes a day, because they are not making a nuisance of themselves. It does not matter if they weigh 20 to 25 stone, because they are not making a nuisance of themselves. It does matter, however, because that patient is slowly killing himself or herself and we have to address that.

I know that the Minister and other colleagues share my concerns, but as a civilised society we just cannot allow this to continue. Yes, progress is being made in the advancement of drug therapies, but not fast enough in mental health. We still have treatments that were breakthroughs in the ’70s and ’80s, but we have not moved on to the 2010s and beyond. The hon. Member for Bridgend rightly said that we have to be very careful about the language we use today and not frighten people. I do not want to frighten people and I hope that she does not think I am, but I get terribly moved when a constituent, who is very ill and being cared for in hospital, writes to me and tells me that once every other week he is held down on the bed and has an eight inch needle injected into his backside. I just think that that must be terribly demeaning, distressing and awful—I am sorry, I am a bit upset about it. We need to get to a place where that does not happen anymore. It will take time, but we need to get there.

[Norman Lamb]

I pay tribute to the work my hon. Friend does on mental health, and the extent to which he argues the case for a fair share of resources and attention to be given to it. Does he agree that it is important for clinicians, who he was talking about earlier, to listen to loved ones and family members to hear their perspective? Of course there is the issue of confidentiality, but sometimes clinicians hide behind that and are not prepared to listen to those who know the patient best of all.

--- Later in debate ---

[Mr Jones]

The hon. Gentleman makes a very good point: schools are important in this regard, and it is important to get young people to talk about the issue. I have a fantastic charity in my constituency called If U Care Share, run by Shirley Smith. It was created following the tragic circumstances in which Shirley’s 19-year-old son hanged himself. Her organisation goes into schools, youth groups and football clubs—Shirley is working with the Football Association and others—to get people talking about their emotions. We need to get more of that kind of work going.

The workplace is important. Although he is not in the Chair at the moment, I want to pay tribute to Mr Speaker, as well as to the House of Commons Commission. Following our last debate on this issue, they earmarked some funding for our own mental health in this place. Dr Ira Madan, the head of the unit across the road that MPs and staff can access, has told me that that was valuable in that it allowed her to assist Members with mental illness, and that there had been an uptake of the services since the money was made available. I would recommend that anyone who wants to go and have a chat with her should do so, as she is a very good and open individual. We must give credit to Mr Speaker and the Commission for that funding, because that was not an easy decision to make, especially as he was getting criticism from certain newspapers for giving special treatment to MPs. It is not special treatment; it is a vital service. Unfortunately, it is still not open to many MPs because of the stigma that surrounds mental illness.

[Norman Lamb]

I pay tribute to the hon. Gentleman for the incredible contribution that he has made to this subject over the past year or so. It was encouraging to hear what he said about Mr Speaker’s actions, and I want to alert him to the fact that I am trying to get every Government Department to sign up to Time to Change, so that they can all make the commitment to be an exemplar. If we are talking about what employers in the private sector should do, it seems to me that we should be taking the lead here.

[Mr Jones]

I have spoken at a few events with the Minister, and I want to thank him for his interest in, and understanding of, this subject. Getting Government Departments signed up to Time to Change would be a very good move, and he should please ask if he requires any assistance from me.

I want to talk about an issue that affects many of our constituents—namely, the work capability test and the ongoing issue with the company Atos. Is work good for people’s mental health? Yes, it is. Should people be in work if they can work? Yes, they should, with the right support. The problem with the work capability test, however, is that it is still not looking at people with mental illness with any sympathy or understanding.

I believe that individuals with long-term mental illnesses should be taken out of the current work stream, and that there should be a dedicated system for dealing with such people. I am not saying that we should write them all off and leave them at home without making any assessment, but we cannot continue with the present ludicrous system in which they are assessed by the same people who assess claimants with bad backs and other injuries. There are assessors with no expertise at all in mental illness. The assessment process is leading to some people’s conditions being made worse, and, in some cases, to people taking their own lives. One of my constituents has taken an overdose because of the trauma of being asked to attend an interview.

--- Later in debate ---

[Mr Steve Reed (Croydon North) (Lab)]

It is a pleasure to follow many moving and thought-provoking contributions. I want to raise the case of Olaseni Lewis, known to his family as Seni, who died after his family left him in the care of the mental health service. Seni was a 23-year-old young black man living in Croydon North, the constituency that I now represent. He had a degree in IT and plans for further postgraduate study.

Seni had no history of mental or physical illness when, on 31 August 2010, he started to behave in an uncharacteristically odd and agitated manner. His parents did what they thought was the right thing by taking him to hospital. He was admitted as a voluntary patient for a few days’ assessment and care. His family left him, when visiting hours ended at 8 pm, with reassurances that they would be contacted if anything happened.

Seni became agitated in his family’s absence, and even more so after he was told that he could not leave the hospital even though he understood he was there voluntarily. It appears he was sectioned in order to detain him against his will, and was then restrained and held face down on the floor by several members of staff and by police officers who had been called after he kicked a door, although there is no evidence that he was violent towards anyone.

Seni was held face down in a seclusion unit by up to 11 police officers for a total of 40 minutes in a way that appears to contravene international conventions on human rights and torture. During the course of that restraint, Seni slipped into a coma and was eventually put on a life support machine, which is how his family found him when they were eventually called four hours after they had left him. He was pronounced dead four days later.

The Independent Police Complaints Commission is responsible for investigating the events leading to Seni’s death. Its investigation began in September 2010. Instead of conducting its investigation under criminal proceedings and interviewing the police officers under caution, it chose instead to accept written accounts which were never challenged. It now accepts that that was a serious mistake.

In August 2011 the IPCC referred the matter and its report to the Crown Prosecution Service to decide whether to prosecute, with a recommendation against. In the meantime, the IPCC had received new information that led it to believe that a criminal prosecution should in fact be pursued. That new information, received in July 2012, was the pathologist’s report, which raised fresh concerns about the extent of restraint used against Seni Lewis. Frustratingly, the CPS refused to accept that new evidence because it was not included in the IPCC’s original report—even though it was the IPCC that wished to amend its own submission. The IPCC claims it has repeatedly raised that point with the CPS, but to no avail. The CPS refused to prosecute.

The IPCC, eager to put right its own admitted mistakes, tried to persuade the Metropolitan police to reopen its investigation in order to trigger a fresh investigation by the IPCC. Following legal advice, the IPPC believed that that would allow it to interview the police officers under caution and include the pathologist’s findings in a new report to the CPS. The Met, unfortunately, had contradictory legal advice telling it that the IPCC could not overturn its own original report and refused to open a fresh investigation. The IPCC is now accusing the Metropolitan police of blocking the investigation that the IPPC wants to reopen.

So we reach a highly unsatisfactory impasse. The police will not reopen the investigation, the CPS will not accept the fresh and potentially compelling evidence, and the IPCC is not allowed to overturn its own decision not to investigate under criminal proceedings even though it believes that the original decision was wrong. In the meantime, a bereaved family have been waiting, with astonishing patience and great dignity, for over two years and eight months for an answer to how and why their beloved son now lies dead after they placed him in the care of a hospital when he showed early signs of mental ill health.

The questions that this case raises are profound and frightening. The organisation Black Mental Health UK is concerned that black people are 44% more likely to be subject to detention under the Mental Health Act than their white counterparts, even though there is no higher prevalence of mental illness among the black community. Once in the system, black people are more likely to be labelled psychotic than their white counterparts for exhibiting exactly the same behaviour. They are also more likely to be given a diagnosis of schizophrenia and to be considered an immediate threat than non-black people. This group is 29% more likely to be subject to restraint and 49% more likely to be placed in seclusion. Black Mental Health UK believes this may be the result of prejudicial assumptions made about young black men in general, and in particular those labelled as suffering from mental ill health.

If black people are being treated differently from other people in a way that threatens their well-being, the community needs reassurance that the mental health service is not institutionally racist. We need a public inquest to establish exactly what happened to Seni Lewis in the four hours after he was first taken by his parents to A and E in Croydon. To date the Lewis family have been failed by the mental health service and the entire criminal justice system. Instead of the open inquiry this case deserves, we are treated to the unseemly spectacle of the IPCC, the CPS and the Metropolitan police fighting with each other and unable or unwilling to work together in the public interest to allow an effective investigation to take place.

I have raised the case of the Lewis family with Ministers over recent months but I am dissatisfied with their responses. When I asked when an investigation would be progressed, I was told this was an operational matter, but this case points to a wider systemic failing that requires Ministers to act and address it. When I asked the Home Secretary what advice was given to the police over how to operate in a mental health setting, I was told none. When I asked what discussions had taken place between the Home Secretary and the Health Secretary about the use of the police in mental health settings, I was told none. When I asked the Health Minister how many patients were restrained in a mental health setting and what their ethnicity was, I was told that the Department of Health does not collect these data. I do not wish to impugn the intentions of Ministers, but I have concluded that they are failing to give this matter the priority it deserves.

[Norman Lamb]

I apologise that I came in halfway through the hon. Gentleman’s contribution, but he is making extremely serious points. I would be happy to talk further to him about the case after the debate.

[Mr Reed]

I thank the Minister for his intervention. I am grateful for his generous offer, which I will certainly take up.

--- Later in debate ---

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

I thank the shadow Minister for her contribution. I feel that this subject brings out the best in this place—we have had a well-informed, civilised and rational debate. There has been no political point scoring, just thoughtful concentration on an important subject, and I am grateful to all hon. Members.

Before I come on to the contribution of my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I will say that I completely agree with the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that the arrival of public health in local authorities presents us with an opportunity. The establishment of Public Health England brings its expertise to bear on its relationships with local practitioners in public health, working alongside other services. The potential for public mental health, which has been largely disregarded or ignored in too many places in the past, is real. At the conference for the directors of children and adult services in Eastbourne last October, I attended a presentation by an academic from the London School of Economics on the economic case for interventions in public mental health. There is a powerful return on investment, which means that people are benefiting from it. We have a great opportunity, and I am grateful for the hon. Lady’s comments.

The hon. Lady made important comments about black and minority ethnic communities and the mental health system, and I will come back to that. I appreciated the comments made by the hon. Member for Croydon North (Mr Reed), and I will refer to them later.

The hon. Lady raised the issue of suicide and young people. There are too many cases in too many hospitals where people who have self-harmed turn up and do not get a psycho-social assessment. We know that having that assessment, with the therapy that can follow, massively reduces the risk of suicide, yet only about 50% of A and E departments ensure that that happens. That has to change, because lives are literally at stake. We have to take this issue very seriously.

I am tremendously grateful to the Backbench Business Committee for giving us another chance to talk about mental health. I again pay tribute to my right hon. Friend the Member for Sutton and Cheam for leading the debate and for the great work he did in office to lay the foundations for the progress we are now tangibly making. The previous Government invested heavily in mental health, as well as the rest of the health service, and it is right to acknowledge that progress was made in that period. The focus on parity of esteem, and making it a reality, is potentially exciting. I was struck by an interview with Angela McNab, the chief executive of the Kent and Medway mental health trust, which is one of the larger mental health trusts. She said that the Government were

“prioritising mental health like never before, making sure that it fits on a par with physical health”—

and that this had come as a welcome step change to mental health professionals. That is an encouraging view from the front line.

My right hon. Friend raised several important points, including about recovery colleges. I am very interested in the whole recovery model and the role of recovery colleges. He also talked about the importance of the inspiring Time to Change campaign, which is part- funded by the Government. I mentioned earlier that I am encouraging all Departments to sign up to that campaign, so that we can lead from the front. We cannot expect private sector and other public sector employers to act properly if the Government do not lead, so it is important to demonstrate parity of esteem in the way that the Government treat employees.

My right hon. Friend also referred to the adult psychiatric morbidity survey. I can confirm that discussions are taking place between the Department and the Health and Social Care Information Centre and that it should take place in 2014. He also referred to the intelligence network. NHS England and Public Health England are developing plans and using the cancer intelligence network as a model, not necessarily to replicate, but to learn from. I am grateful to him for raising those issues.

The impassioned words that we have heard today show that within these walls lies the ambition, across all parties, to make the necessary changes, and I thank all hon. Members who have spoken about their experiences, views and, yes, even their criticisms. This sort of open debate can help to challenge stigma, scrutinise services and scrutinise commissioning decisions, which are critical in terms of how much money is allocated to mental health as against physical health and to ensuring that mental health remains a core priority not just for the Government, the House and the NHS and care system, but for the whole of society.

We have heard many good contributions. I shall write to hon. Members to respond to the substantive challenges and questions they have raised, but let me touch now on several quick points made today. The hon. Member for Bridgend (Mrs Moon) mentioned the importance of recognising the link between alcohol abuse and mental health. She talked about people who have left the armed forces with problems of post-traumatic stress disorder, which has become prevalent with the conflicts in Iraq, Afghanistan and so forth. Simon Wessely and his colleagues are doing some fantastic work on that.

The hon. Lady also mentioned the role of the police, particularly the Metropolitan police, and made the valid point that they are not trained well enough or systematically enough. Lord Adebowale, whom I met this week to talk about his report, makes the point that the police will always have to deal with mental health. It is not a question of it being wrong that they are dealing with it; the critical point is that there should be close working between the police and mental health services so that there is an immediate referral, not an inappropriate placing of someone in a police cell. Just imagine suffering from a mental health crisis and ending up in a police cell. It is the worst possible thing that could happen. Even children sometimes end up in police stations. It is totally inappropriate and avoidable—that is the important point.

The hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones), who have done so much to challenge stigma, have performed a valuable service in speaking out about their own experiences of mental illness. They have demonstrated, very visibly, that someone can be successful and make an enormous contribution to society, yet also have mental health problems. That is an incredibly important point. The hon. Member for Broxbourne talked about the role of employers and mentioned some really good employers, such as BT. This is about enlightened self-interest, not just about being kind to people. It is in companies’ and employers’ interests, including the Government’s, to treat mental health issues seriously. The cost to employers when those suffering from mental health problems lose their jobs—the loss of all the training and experience or just the sickness absence—is enormous, but it can be significantly reduced with a smarter approach. The hon. Member for North Durham talked about a number of individuals who have had mental health issues, but also been very successful. He talked a lot about the importance of tackling stigma.

The hon. Member for Croydon North (Mr Reed) made an important contribution about the treatment of black people by mental health services—the shadow Minister talked about that as well. There is something wrong that has to be challenged. The hon. Gentleman raised the case of Seni Lewis, which I am happy to talk to him about—I have surgeries on Monday night and we can discuss this. I have agreed to attend the Black Mental Health conference on police and mental health in June, because I felt it was important that I should engage in this whole issue and take it as seriously as it deserves to be.

The hon. Member for Totnes (Dr Wollaston)—I apologise for missing her contribution and a number of others—raised a number of issues. I will ensure that she receives proper responses to them. She talked about liaison psychiatry. While we are talking about emergency services, one thing that has become more and more apparent to me is the complete disparity between what happens to people with mental health problems and what happens to those with physical health problems. I was utterly shocked—but sadly not surprised—by a letter that a Member of Parliament in the south-west wrote on behalf of a constituent. The constituent had rung the crisis number for mental health services in his area and had not got a reply. No one was answering the crisis helpline. On another occasion they rang and were asked to ring back in half an hour. In the meantime that person could have committed suicide.

Then we come to what happens in A and E and the fact that in too many hospitals there is no mental health specialism available. Last Saturday I met a constituent who had found her son at home with ligature marks round his neck. She took him to A and E, where there was a half-hour conversation with a junior doctor before he was discharged home. The next day she found him hanging in her home. She is determined to pursue the complete failure of the system when something so dreadful can happen.

Whether we are talking about what happens when someone is picked up in the middle of a mental health crisis by the police and taken to a police station inappropriately, what happens when someone tries to get in touch with crisis services or what happens at A and E, we have to have an effective emergency mental health response system in place. This is a matter of real urgency, so I have asked all the relevant organisations—the Home Office, the Association of Chief Police Officers, the Department of Health, the Royal College of Psychiatrists and so on—to come together and draw up an agreed plan to tackle the most stark differences between the treatment received by people with physical health needs and that received by those with mental health needs.

[Paul Burstow]

That is a welcome announcement from the Minister about achieving parity of esteem in emergency and crisis care. However, in the wake of the Francis inquiry, which rightly drew our attention to serious patient safety and dignity issues in our physical health care system, I suspect that we will need to ensure that we are not distracted or led into not addressing the same issues—which clearly exist—in our mental health systems.

[Norman Lamb]

My right hon. Friend makes a very good point and I completely agree.

The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke again about eating disorders—I took part in a debate that she secured in Westminster Hall. She talked about the role of parents, the nightmare of a child—I will call them a child—over the age of 16 deciding to refuse treatment and the horror that parents sometimes go through when they are not listened to sufficiently by clinicians dealing with their loved one’s condition. She also mentioned type 1 diabetes sufferers, and I would be interested to hear more about that.

My hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) is no longer here. Oh, yes he is! He has moved to a different place, just to confuse me. He talked about the low diagnosis rate for Alzheimer’s and dementia in his area. He also stressed the importance of the recognition of mental health by the Government, which I think he welcomed.

The hon. Member for Bolton South East (Yasmin Qureshi) talked about the importance of accessing appropriate and culturally sensitive care and treatment. That is incredibly important, as is getting the approach right for each individual and giving them the power to determine their priorities. She made those points well. She also stressed that the picture round the country was very variable. That is more the case in mental health than in physical health. Some areas have great services, some of which I have witnessed, but in others they are simply not good enough.

[Ms Abbott]

On the question of culturally appropriate care, does the Minister agree that it can extend to quite mundane matters? There are mental health wards in this country with large numbers of BME people in them. Those people sometimes do not have the right hair care or the right music, or they might not have their culinary needs addressed. Those things can be really disturbing for someone who is already in a mentally fragile condition.

[Norman Lamb]

Yes, I completely agree. This is about treating people as individuals, and with dignity and respect. Those things are important to people and they should be treated as such.

[Jeremy Corbyn]

My hon. Friend the Member for North Durham (Mr Jones) and I raised the question of the work capability interviews being undertaken by the Department for Work and Pensions with people with mental health conditions. I do not think that the Minister was in the Chamber at the time, but we suggested that it would be better for the DWP to have access to those people’s medical reports rather than conducting rather bald interviews. Would the Minister be prepared to undertake discussions with the DWP about the treatment during those interviews of people who suffer from mental health conditions?

--- Later in debate ---

[Norman Lamb]

I am grateful to the hon. Gentleman for his intervention. I was going to mention his contribution, even though I was not present to hear it, for which I apologise. As a Member of Parliament, concerns have been raised with me about the suitability of those tests for people with mental health problems, and I was going to suggest that I should talk to the appropriate Minister at the DWP. I am of course happy to do that. Someone else made the point that this is not a question of not addressing the need to help people get back into work. Work is particularly important in relation to people suffering from mental ill health, and the idea that we should simply leave them undisturbed and out of work for the rest of their lives is totally wrong. The way in which we handle this is incredibly important, however, and if we have more to learn in that regard, we should be prepared to learn the lessons.

[Mr Kevan Jones]

I made the point in my speech that work was good for people with mental illness. The problem is that the present system is inefficient and costly, and that it is creating absolute agony for many people. I know that the Minister has a great understanding of, and a deep passion for, the subject of mental health, and I urge him to put pressure on the DWP to change the system. We are not asking that people should be excluded completely from work capability tests; we are just asking for the system to be changed.

[Norman Lamb]

I am grateful to the hon. Gentleman for reminding me that he, too, had made that point. I knew that someone else had talked about it, but I could not remember who it was. I take his point; I have heard it.

My hon. Friend the Member for Southport (John Pugh) made a thoughtful speech in which he talked about reminiscences. Oh! He has gone! Even though it pains me, as a Norwich City supporter, to talk about Everton, it appears that Everton and even Southport have done some very good work in these areas. My hon. Friend talked about a continuum of mental health. That was a good point, well made. He also mentioned community treatment orders and the need to look at how they are working. I will certainly reflect on that.

My hon. Friend the Member for Battersea (Jane Ellison) made a powerful contribution about the mental health aspects of female genital mutilation, a most horrific experience suffered by so many young girls. I really pay tribute to her for the work that she has done on that issue. The fact that there are 66,000 females in this country who have suffered this assault was an extremely striking point.

The hon. Member for Finchley and Golders Green (Mike Freer) talked about waiting times for access to treatment. He asked if he could gently challenge the Minister—I appreciated that approach. On the mandate for the NHS Commissioning Board, NHS England has been very clear that we expect it to assess the scale of the problem of access, including for IAPT. Other Members have raised the question of whether we are meeting the IAPT programme’s four-week target. We want the NHS Commissioning Board to assess the scale of the problem with a view to setting access standards.

One of the big problems relating to what I regard as the institutional bias against mental health is that on one side of the equation we have the 18-week maximum waiting time for physical health, which is a very powerful political driver of where the money goes, yet we have nothing equivalent for mental health on the other side. That, to me, is a lack of parity of esteem. For people with mental health problems, early access is particularly important to ensure that their condition can be halted, if possible, and the deterioration stopped. The hon. Member for Finchley and Golders Green made a good point there, and he also rightly talked about the importance of consistency and continuity of care.

I want to mention four of the most important things that this Government are doing to create the environment and incentives for improving mental health across the system as a whole. The first is the Health and Social Care Act 2012, which creates a “parity of esteem” so that mental and physical health share the same importance, as we have discussed this afternoon. Changing the law is just the start, but it sends a clear signal—that mental health is important, and that the health and care system can and must play a leading role in changing attitudes across society as a whole.

Secondly, there is the mandate the Secretary of State has issued to NHS England. It shows the importance we have ascribed to mental health and makes it clear where improvements are needed. The mandate makes clear our overarching goal—that mental health must have equal priority with physical health across all aspects of NHS work. In particular, we have highlighted the need to close the gap in outcomes between people with mental illness and the population as a whole, as well as the absolute imperative to ensure that people can access the services they need when they need them. Neither of these facets of good mental health treatment is entirely up to scratch at the moment. I think we all recognise that.

[Mr Andrew Smith (Oxford East) (Lab)]

The Minister is generous in giving way, and he is making some very important points. Would he include within this the importance of access to family therapy both to repair broken relationships and to aid recovery—an issue that Oxford Mind raised with me?

[Norman Lamb]

Yes, absolutely; I understand the importance of that. Incidentally, I visited children and adolescent services in Oxford and I was very impressed by the work under way there. I am getting a message that I am under some pressure from Mr Deputy Speaker to make some progress—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I may be able to help the Minister there. It is not a question of pressure from me; it is a question of the Backbench Business Committee suggesting that Front-Bench contributions should be up to 15 minutes. If he looked at the clock, he would recognise that he has spoken for more than 20 minutes. He should not suggest that the Chair is interfering; it is the Backbench Business Committee.

[Norman Lamb]

I am sorry for putting the blame in the wrong place; I take full responsibility; I have tried to be responsive to Members as I have proceeded.

We are working with NHS England to decide how best to measure progress in these areas. Because, as we all know, words are not enough, we have to be certain that the objectives we have set out on paper actually translate into better, more accessible care for those who need it.

Thirdly, I mention the three outcome frameworks: for the NHS, adult social care, and public health. These frameworks will enable us to hold the health and care system to account for achieving what matters most—good outcomes for the people who use services and for the population as a whole. In the NHS outcomes framework, there are four measures that relate specifically to mental health and many others that include mental health just as much as physical health. The other outcomes frameworks contain other measures designed to ensure that we improve well-being and tackle the wider determinants of mental health, and that we provide the best possible care and support to those people with mental health problems who need it.

Finally, I want to mention our continuing commitment to the IAPT programme. Since the programme began, it has treated more than 1 million people with depression and anxiety, and as a result nearly 75,000 people have moved from benefits into work. Nevertheless, we need to do more. We are currently involved in a joint programme with the Department for Work and Pensions, which involves commissioning work to find a way of providing much speedier access to psychological therapies for people with mental health problems who are out of work. It seems crazy that we are spending money on benefits when giving those people access to therapy might help them to recover and return to work.

[George Freeman (Mid Norfolk) (Con)]

Will the Minister give way?

[Norman Lamb]

Very briefly.

[George Freeman]

I am sorry that I was not able to be present earlier. I pay tribute to the Government for the work they are doing, and to the Backbench Business Committee for raising this issue. Does the Minister agree that, on the role of mental health in mainstream health, there is important evidence concerning outcomes and compliance with mainstream medicine? Important work carried out in America by the United States Veterans Association and the American dementia and mental health societies has shown the importance of positive psychology in helping people to recover and play an active role in society.

[Norman Lamb]

The hon. Gentleman has made some extremely good points.

The Government are implementing a diversion service to ensure that, as far as possible, people are diverted from the criminal justice system and from prison if that is not where they should be. If they are suffering from mental health problems, they should ideally be given treatment rather than being locked up inappropriately in prison.

Personal health budgets are a really good innovation, started by the last Government and continued by this one. Giving people—particularly those with mental health problems—power to determine their own priorities, and giving them some control over the resources available for their treatment, is an incredibly important development, for which I shall continue to proselytise at every opportunity.

In order to avoid any further trouble from the Backbench Business Committee—rather than from your good self, Mr Deputy Speaker—I shall draw my remarks to a close.

Today’s debate allows us to explore what more we can do to improve services for people with mental health problems, but as I said earlier it also allows us to encourage others to follow suit. We all have the same ultimate ambition—to provide excellent services and support for all who need it, when they need it—but if we are to achieve that ambition, all groups need to do their bit. We will not be able to do this alone. However, we can lay the groundwork to ensure that local leaders and local people can develop the excellent mental health care and treatment that can turn our common ambitions into reality.

I thank all Members who have spoken today. I also thank the Backbench Business Committee for allowing me to speak beyond my “guideline” time, and to explain what the Government are trying to do to improve access to, and the quality of, mental health treatment. Again, I congratulate my right hon. Friend the Member for Sutton and Cheam on securing the debate.

I am pleased to be able to count on my parliamentary colleagues to maintain the momentum of discussion of mental health in public forums, and I pay tribute to all who have spoken for their incredibly valuable contributions. I look forward to our third convention.

Health and Social Care

Norman Lamb Excerpts

Monday 13th May 2013 Commons Chamber

[Paul Burstow]

I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

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

I agree that the quality of commissioning needs to be addressed as well as the quality of provision if we are to get better care for the people who need it.

[Paul Burstow]

I welcome that comment from the Minister and look forward to seeing more detail.

My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

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[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

[Norman Lamb]

I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

[Barbara Keeley]

Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.

The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?

I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

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[Kate Green (Stretford and Urmston) (Lab)]

It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I, too, want to talk about social care. First, however, let me reinforce the comments made by my right hon. and hon. Friends about the announcement on compensation for sufferers of mesothelioma. That devastating illness affects a number of families in my constituency, as well as many workers in Trafford Park over many decades. Work was begun by Labour on a system of compensation for asbestos-related illness where employers and insurers cannot be traced, and we now at last have a proposal from the Government although it is disappointingly limited in its reach.

The proposed scheme will apply only to diagnoses made after 2012, and it completely misses half the victims of asbestos-related cancers because it is limited to mesothelioma sufferers and a cap is imposed on the level of payments. The deal favours insurance companies; it is not good enough for victims or for the public purse because many sufferers will continue to rely on payments from the Department for Work and Pensions as they will not be eligible for the compensation scheme. Although the proposals in the Queen’s Speech for a system of compensation are welcome, I hope we will be able to improve the legislation as the Mesothelioma Bill passes through the House.

On social care, everyone agrees that people would prefer to be cared for in their own home for as long as possible, but community-based provision must be in place for that to happen. As many right hon. and hon. Members have said, a lack of community provision is placing excessive strain on the NHS with regard to A and E and bed blocking, and my local authority in Trafford has received repeated reports that a lack of access to rehabilitation, physiotherapy, speech and language therapies—for example, after a stroke—and to support and care packages means that it is often impossible to discharge someone, even when they are medically fit to go home. That backdrop is of particular concern at a time when a significant reconfiguration of our national health service is being proposed in Trafford. There must be real concern about a squeeze on NHS services when community provision is not in place.

I am pleased that the Secretary of State has recognised the need for a single named professional to have oversight of an individual’s health and social care needs, but the fragmentation and contracting of NHS services does not help. Competition works against the integration of primary, secondary, tertiary and social care and, as many colleagues have said, cuts to local authority budgets are having a massive effect. Trafford is cutting nearly £3 million this year from social care budgets, which means cuts to day services, for example, or increased costs for meals. Curiously, the local authority intends to achieve a large part of those savings through the introduction of personalised budgets, which we understood were not intended as a savings measure.

Families want to help and keep loved ones at home, but they are under great pressure and rely particularly on day services and respite care. They tell me that assembling a personal package is complex. One constituent —a highly resourceful and articulate businessman—told me of his struggle to use a personalised budget to assemble a care package for his partner. He called seven potential providers, but most could not cope with assembling the package she needed to meet her complex needs. If my constituent could not put together that package, how—as he rightly asked me—will the more marginalised and excluded manage? He pointed to the importance of decent brokerage services, yet at the same time we are seeing cuts to advocacy services. There is already evidence that personalised budgets do not work so well for elderly people or those without family and friends to help.

It is not clear what the long-term effects of spreading personal budgets will be, but they could lead to further fragmentation of services or exacerbate inequalities. For example, there is evidence of a lack of cultural awareness among brokers and providers, and the complexity of putting together a personal care package may leave the most excluded even further behind. I invite Ministers to tell the House what steps they will take to monitor the impact of personal budgets on inequality and outcomes for the elderly and most vulnerable.

[Norman Lamb]

rose—

[Kate Green]

I am pleased the Minister is seeking to intervene.

[Norman Lamb]

Does the hon. Lady accept that there has sometimes also been a lack of cultural awareness in the traditional way of delivering services when people make assumptions about someone’s care needs and the right way to deliver them? Putting the individual in charge and letting them determine their priorities gives us a better chance of getting it right and meeting the cultural choices that are so important to people.

[Kate Green]

I accept what the Minister is saying but evidence suggests that for certain more disadvantaged and vulnerable individuals, articulating those needs is very difficult and so culturally appropriate advocacy, representation and brokerage services will be of huge significance. Evidence from research carried out so far suggests that the effects of personal budgets are patchy. I am sure the Minister will wish to raise standards across the board, and I look forward to the further work that we—collectively and with local authority colleagues—can do to ensure that that is the case.

Work force issues relating to social care are also a concern. As others have pointed out, many of those working in social care earn the national minimum wage and contract pressures mean that they have little time to do more than rush in and out of appointments and provide the basic physical care that clients need. There is little time to stop for a chat or a cup of tea, or for some of the social interaction that is so valued by those in receipt of social care. Many providers have told me they are anxious and that they are being screwed down on pricing as a result of local authority spending pressures, which could lead to their contracts becoming unviable. Poor levels of pay— as my hon. Friend the Member for Bridgend (Mrs Moon) said, staff are often not paid as they move from one appointment to the next—mean that they will not be motivated to provide the best care in those circumstances, and some will be forced to give up their jobs.

Finally, I welcome the development of extra care for those in need of residential care, and some good projects are under development in Trafford. I hope the proposed development in Old Trafford will receive approval. As colleagues have pointed out, the Dilnot recommendations, as taken forward in a more limited form by the Government, will leave many families in my constituency with substantial costs but without liquid savings with which to meet them, meaning they are still likely to be forced to consider the sale of the family home.

Overall, the Queen’s Speech needed a much bolder approach to prepare us for an ageing society, including policies for maximising saving in working age—difficult when the Government are putting family budgets under such pressure—and a bolder approach that looks at combining health and social care budgets, investment in primary and community health provision to keep people out of hospital longer, integration over competition, personalisation accompanied by a service investment programme, and serious attention to work force development. I regret the many missed opportunities in those areas in the Queen’s Speech.

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[John Woodcock]

That is a good point, and it remains to be seen. We hope so, but the system has yet to be put to the test.

I am disappointed that no move towards genuine localism was outlined in the Gracious Speech. It is time for a people’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto that ought to be heeded. That would require a step change in our NHS away from a model that, yes, might have helped deliver improvements in health outcomes of which the country should be proud, but which has done so—

[Norman Lamb]

Will the hon. Gentleman give way?

[John Woodcock]

I will give way, if the Minister is quick, because I do not have much time left.

[Norman Lamb]

I am interested in what the hon. Gentleman is saying, and I accept the point about the importance of accountability. [Interruption.] He has just realised that he has got an extra minute of time, so I have done him a favour. Does he accept, however, that the old NHS, which we reformed, had no local accountability at all and that we have introduced some accountability through the health and wellbeing boards, bringing together local authorities and the NHS?

[John Woodcock]

It is an interesting point. I am not claiming that the system operating now is fundamentally different from that of three years ago, but around the country people who were promised a say in local decisions have been devastated to find out that they have none. Unquestionably, what has been put in place is not adequate. It is a sop to localism that does not do what it says. It would be a step change to move away from the current model.

Following the current model has meant alienating many local people who understood the trade-offs, but nevertheless fervently desired to keep services local. Whatever happens, surely the current tension between national planning and local unrest is unsustainable in the long term. In opposition, the Conservative party told the public that it understood that and pledged to end local hospital service closures, but of course its promises turned out to be a cheap election con trick. Instead, Ministers have forced through an expensive, chaotic and divisive health reform package that ultimately has pushed NHS decision making still further from the people it serves. We need a change of direction. Local communities pay for the health service they receive, and they deserve to be treated with greater respect.

--- Later in debate ---

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

I thank hon. Members for their contributions to the debate.

Despite all the knocks that Opposition Members like to give it, the NHS is performing remarkably well, with 3.3 million more out-patient appointments, more than 500,000 operations, 1.5 million more diagnostic tests, the number MRSA infections halved and record low numbers of people waiting more than a year for their operations—just 665 people, down from 18,000 in 2010. These are real achievements for the NHS, and we should applaud and pay tribute to a really remarkable work force who have achieved these things despite tough economic times. The last Government rightly set in train £20 billion of efficiency savings, and those savings are being achieved despite the tough challenges.

Despite the doom and gloom heard during the debate, some brilliant things are happening in social care, including in some Labour authorities. In Leeds and Barnsley, for example, great things are happening, with people looking at new ways of doing things and redesigning services, recognising that times are tough and that, even under a Labour Government, they would face the same challenges. I recognise, however, that the system is facing real pressures, so it is disappointing that the Opposition, including the shadow Secretary of State and shadow Minister, the hon. Member for Leicester West (Liz Kendall), sought to polarise the debate by making exaggerated claims about the state of the NHS, when we all know the truth, which is that pressures are growing and have been for a long time. We have people living with long-term conditions, often for many years, and with a mix of mental and physical health problems. Those are the difficult cases sometimes clogging up our A and E departments, so let us have a mature debate about how we deal with the challenges.

We have a completely fragmented system and we are not spending money effectively to achieve the best possible care. Mental health is institutionally entirely separate from physical health, health care is separate from social care, and primary care is separated from hospital care. The whole urgent care system is under significant pressure. [Interruption.] I tell the shadow Secretary of State that on some of these issues we in fact agree more than he would sometimes like us to believe. The system is dysfunctional and we have to change it. We have had 4 million more people visiting A and E since the disastrous renegotiation of the GP contract by the last Labour Government. The hon. Member for South West Devon (Mr Streeter) talked about the significant pressures on A and E. Let me reassure him that Monitor and NHS England have issued a call for evidence on how the tariff system is working, with a view potentially to reforming it.

[Liz Kendall]

Does the Minister agree that in 2009, five years after the GP contract was agreed, 98% of patients were seen in A and E within four hours?

[Norman Lamb]

What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

[Barbara Keeley]

The Minister is back on his point about the Bill creating a single statute, but it will not do that for young carers, who will be left with the protection only of the private Member’s Bills I mentioned earlier. It is not good enough for young carers to face a higher threshold than other carers before their needs are assessed. That has to be looked at. The children’s Minister has let the House down on this issue; I hope that this Minister will not do that.

[Norman Lamb]

I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

[Frank Dobson]

Does the Minister accept that a generalised rating for a hospital is not going to be valuable because, within one hospital, some departments might be doing a brilliant job while others are not? It would be stupid if an overall rating persuaded people not to go to a particular hospital for treatment if the specialty they required was being practised brilliantly.

[Norman Lamb]

I disagree. We brought in Jennifer Dixon of the Nuffield Trust to advise on this matter. There will be ratings for specific services within hospitals to identify areas of great care, but the single rating will give the hospital the incentive to bring up to a proper standard those areas that are falling short, and that will be a good thing.

[Alison Seabeck]

Will the Minister give way?

[Norman Lamb]

I want to make some progress; I am conscious of the time.

The Bill will introduce a single failure regime, so that, for the first time, a trust can be put into administration because of quality failure as well as financial failure. Until now, it has been only the finances that can put a trust into administration. This Government recognise that quality failure is just as important, if not more so, and that such failure must carry consequences.

The stories recounted by the right hon. Member for Cynon Valley (Ann Clwyd) and the hon. Member for Bridgend (Mrs Moon) reinforce our determination to make improvements and to ensure that people get the best possible care. I again pay tribute to the impressive work carried out by the right hon. Lady, and I thank her for her work on complaints procedures. The hon. Member for Mid Bedfordshire (Nadine Dorries) also talked about the importance of compassion in good nursing care.

The Bill will make it a criminal offence for providers to provide false and misleading information. My hon. Friend the Member for Stafford (Jeremy Lefroy), who has done great work representing his constituents in the most honourable and responsible way, drew our attention to the importance of mortality statistics being accurate so that we can rely on them. Alongside this Bill, we will introduce the statutory duty of candour—something of which I am personally proud. It does not require primary legislation, but the Government will introduce it.

The funding of care is to be reformed so that there will be a cap on the care costs that people will pay in their lifetime. This is long overdue. Reform has been in the long grass for too long. Several hon. Members, including the hon. Members for Worcester (Mr Walker), for City of Chester (Stephen Mosley) and for Lancaster and Fleetwood (Eric Ollerenshaw), made the point that people will no longer have to sell their homes during their lifetime to pay for care. So often people have had to sell their homes in distress at the moment they go into a care home. When they cannot organise their affairs properly, they have to sell up to pay for care. No longer will that be the case. They can delay all those issues because of the right to deferred payments.

It is this coalition Government who have bitten the bullet on a very important reform. I am very proud of the fact that we are doing this, introducing a long overdue reform. Andrew Dilnot himself has strongly supported the Government’s action. That is happening together with a very significant extension of support—I take on board what the hon. Member for Leicester West said—to help people of modest means with their care costs. Each one of those measures would be significant by themselves. Together, they provide real optimism that we can shake off the shackles of the past and look towards the future, not with fear, but with optimism. The Opposition are wrong to dismiss the importance of this Bill. They should recognise just how much it could improve the lives of some of the most vulnerable people in society.

[Liz Kendall]

rose—

[Norman Lamb]

I am going to conclude.

We are two thirds of the way through this Parliament and we have already addressed big challenges that were ignored during Labour’s three terms in office. We have been and will always be 100% committed to an NHS that is not satisfied with mediocrity, but is always searching to be better, more focused, more helpful than ever before. Society is changing, drug costs are increasing and expectations are higher. The NHS and the social care system must change to meet those challenges and we are helping to make that happen, safeguarding the NHS now and in the future.

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

Debate to be resumed tomorrow.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 16th April 2013 Commons Chamber

[Mark Durkan (Foyle) (SDLP)]

11. What steps the Government plan to take to ensure that patients with rare and very rare muscle-wasting conditions have access to high cost drugs when such treatments become available.

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

Our priority is to ensure that patients in England, including those with rare and very rare muscle-wasting conditions, have access to new and effective treatments on terms that represent value to the NHS and the taxpayer.

[Mark Durkan]

The all-party parliamentary group for muscular dystrophy, which has been conducting an inquiry, was told recently that patients who are experiencing muscle-wasting conditions, and their families, are concerned about the possibility that they will be denied access to potential treatment because of regulatory barriers, and/or on cost grounds. Will the Minister meet the all-party group to discuss measures for the removal of any such impediments?

[Norman Lamb]

I am certainly willing to meet the all-party group, but I think that significant new opportunities are emerging. For example, from this month the National Institute for Health and Clinical Excellence will be responsible for the evaluation of new drugs for the treatment of rare conditions, and I think that that is a very good thing.

[Mr Gary Streeter (South West Devon) (Con)]

One of my constituents, a seven-year-old boy, has Duchenne muscular dystrophy. His family are pinning their hopes on a new drug called ataluren, which has not yet completed its trials. Can the Minister give me any idea when it might become available?

[Norman Lamb]

I understand that the manufacturer of ataluren has applied for conditional approval from the regulatory authorities. We await the outcome of that process, but I am afraid that I cannot give a time scale for it.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

Eculizumab is a high-cost drug that makes a profound difference to the lives of people with a rare kidney disorder, yet the Department has rejected the recommendation of the Advisory Group for National Specialised Services to make it available to all patients, instead referring it to the National Institute for Health and Clinical Excellence, which will delay any decision by at least a year. Will the Minister meet me and specialists from my Newcastle constituency to discuss how we can ensure those patients are not adversely affected by this delay?

[Norman Lamb]

I am certainly happy to have a discussion with the hon. Lady, and to look into the concerns she raises and get back to her on them.

[George Freeman (Mid Norfolk) (Con)]

As the Minister is aware, the active involvement of patients in biomedical research is one of the areas in which Britain is increasingly leading. Yesterday, I chaired a meeting with my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) and the Empower: Access to Medicine group and Les Halpin, who is suffering from a terminal disease and is launching a campaign for greater patient involvement in access to rare drugs. Will the Minister meet me and my hon. Friend to take that forward?

[Norman Lamb]

I seem to be ready to agree to several meetings and I will certainly add that one to my list. I will be delighted to meet my hon. Friend—and I should also pay tribute to him for the work he is doing in this area.

[Sir Tony Baldry (Banbury) (Con)]

13. What steps he is taking to make the services of hospices more available to NHS patients.

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

We are supporting NHS England to develop a fairer and more transparent funding system for hospices, to be in place by 2015. We have made £60 million in capital available to hospices to improve their physical environments, and will continue to provide over £10 million in central funding for children’s hospices.

[Sir Tony Baldry]

Will my hon. Friend confirm that the new NHS commissioning arrangements should increase the opportunities for hospices in the voluntary sector, such as the excellent Katharine House hospice in my constituency, to provide palliative care and terminal care for NHS patients?

[Norman Lamb]

I pay tribute to the hospice movement, including Katharine House in my hon. Friend’s constituency. It is crazy that we are spending a lot of public money on caring for people at the end of life in places where they do not want to be. Most people do not want to end their life in hospital, yet about 50% of people still die in hospital. We are looking to create a new funding regime where money will follow the patient, to ensure people’s choice is respected so they can die where they want to, and so that hospices have fair funding.

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

I recently had a case of very poor care of a terminally ill patient in the last few days of her life. She was let down by a GP who refused to prescribe the pain relief she needed and a district nursing service that provided wholly inadequate support. Given what the Minister has just said and that 20% of people want to die at home, what action will be taken to ensure that such cases do not happen and that instead we start to provide much better support for people so they can die peacefully at home?

[Norman Lamb]

My ambition is that the UK have a global reputation for the best possible care at the end of life. Whether we are talking about the Liverpool care pathway and concerns that have been raised about some care in hospital or care in the community and caring for people at home at the end of life, it is essential that people have a dignified death and the best possible care. Everything we are doing is aimed at achieving that. Where there are specific cases such as the one the hon. Lady raises, the relatives have the right to pursue a complaint, and ought to do so if care has fallen below an acceptable standard.

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

14. How the NHS will be held to account on the experiences of cancer patients using the NHS.

--- Later in debate ---

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

We have made earlier diagnosis a clear objective in our mandate to the NHS. It is for NHS England and local commissioners to undertake appropriate awareness campaigns on arthritis. We very much welcome the appointment of Professor Peter Kay as the first national clinical director of musculoskeletal disease to advise on specific initiatives.

[Mrs Riordan]

I thank the Minister for his reply. May I ask him for another meeting to discuss this very important matter and take forward further action on it?

[Norman Lamb]

The meetings are stacking up, but I would love to meet the hon. Lady. She should just get in touch with my office and we will get it arranged.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

I will spare my hon. Friend a meeting, but will he tell me what evidence there is to suggest that there was more awareness and earlier diagnosis when spa towns such as Harrogate and Bath provided spa facilities for those most badly affected by rheumatism and arthritis?

[Norman Lamb]

My hon. Friend makes an extremely interesting point. Although I have not agreed to meet her, I would be happy to have an informal discussion with her at some later stage.

[Mr Speaker]

I think we will take that as a meeting.

--- Later in debate ---

[Mrs Mary Glindon (North Tyneside) (Lab)]

T5. Evidence from the all-party muscular dystrophy group’s inquiry into access to high-cost drugs for rare diseases has highlighted the importance in clinical trials of centres of excellence, such as the International Centre for Life, which is based in Newcastle. Will the Minister, with NHS North of England, meet me to discuss changes to specialist neuromuscular care in my area as a result of the new NHS set-up?

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

I am tempted to say no, but I would not get away with it—so, yes, of course the hon. Lady can join all the rest and arrange to meet me. I would be very happy to discuss her concerns. While I am at the Dispatch Box, may I pay tribute to the International Centre for Life, which does really important work?

[Mr Speaker]

The Minister can report to his family just how popular a fellow he is.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

Here comes another request for a meeting with the very obliging Minister. Last month he promised the House that he would rewrite the section 75 regulations to rule out enforced competitive tendering in the NHS. However, before Easter the respected House of Lords Secondary Legislation Scrutiny Committee said this of his redraft:

“The substitute Regulations are substantially the same as the original Regulations.”

It is no surprise that it seems to many that the Government are intent on privatisation by the back door, putting large parts of the NHS up for sale. With a crunch vote in the Lords next week, it is turning into another shambles. I make this offer to the Minister: will he again agree to withdraw the regulations and to sit down with us and the professions this week and come up with wording that is acceptable to all?

[Norman Lamb]

This really is the most outrageous scaremongering from the Labour party. In March 2010, the Labour Government issued guidance on European procurement law that described the limited circumstances in which one could avoid going out to tender. The wording used in these regulations is exactly the same as that used by Labour in March 2010, yet Labour Members will not admit that. There are also added safeguards in the redrafted regulations to ensure that there is a clear incentive for integrating and co-ordinating services for the benefit of patients.

--- Later in debate ---

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

T7. Further to the question from my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah), several of my constituents with desperately ill relatives are very angry about the Government referring to NICE a decision on the use of eculizumab. The continuing delay is risking lives and also means that people have several invasive treatments that could well cost more. To save space in the Minister’s diary, may I add a request to join the meeting with my hon. Friend to talk about how this dangerous delay is causing very great distress to many constituents?

[Norman Lamb]

The hon. Lady raises a very important point, and I would be delighted for her to join the meeting rather than my having another one.

[Mr Philip Hollobone (Kettering) (Con)]

T8. Kettering general hospital’s new £30 million foundation wing has a new 16-bed intensive care unit, 28-bed cardiac unit and 32-bed children’s unit, and it opens to patients for the first time this coming Saturday. Will my right hon. Friend the Secretary of State take this opportunity to congratulate all those at Kettering general hospital who have brought this project to fruition?

--- Later in debate ---

[Mr Stewart Jackson (Peterborough) (Con)]

I am delighted to learn that there will shortly be a new national clinical director for neurological conditions, focusing in particular on conditions such as Tourette’s syndrome. Will the Secretary of State reassure us that that appointment, which is so long overdue, will be expedited at the earliest opportunity?

[Norman Lamb]

I agree with the hon. Gentleman about the real value of this appointment and I think that the clinical director’s work will emphasise the importance of addressing conditions such as that to which he referred. I am delighted that the hon. Gentleman is showing such clear support for this initiative.

Community Pharmacies

Norman Lamb Excerpts

Monday 15th April 2013 Commons Chamber

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

I congratulate the hon. Member for Ealing North (Stephen Pound) not only on securing this debate on community pharmacies, but on entertaining us. At the end of a long day, it has been appreciated by the gathering before me, small though it might be. I can assure him that I am not often found talking about domains and the outcomes framework. He and I are at one on that. He talked about the quiet revolution he has witnessed in his constituency and the several fine pharmacies there. They do incredibly valuable work, and I can assure him absolutely that I see a critical role for community pharmacies. He talked about integrated care. They can play a central role in an integrated service for patients, particularly those with the long-term, chronic conditions he referred to, so I am completely at one with him on that.

Today, more NHS community pharmacies than ever offer health care treatment and healthy lifestyle advice and support in England. As I think the hon. Gentleman said, they dispensed 885 million prescription items last year—up 56% from 10 years ago, with nine in every 10 items prescribed. Pharmacies are also involving accessible. Research has shown that 99% of people can get to a pharmacy with relative ease, especially in more deprived communities, perhaps including parts of his constituency. Because of that, many people use their local pharmacy team as the first port of call for all sorts of health problems, both minor and major. Indeed, that might be the first point at which a serious condition is identified. For that reason, pharmacies are incredibly important. For example, many pharmacies now offer services that help patients to get the best from their medicines or provide support for patients with long-term conditions such as asthma who are starting a new medicine.

However, this goes beyond mere statistics. A graph or chart cannot represent the relief of an elderly person who gets help with a niggling cold or cough, the comfort that a pharmacist can provide a young mother worried about her child’s health or the benefits that people with diabetes or heart disease get from good lifestyle advice. This is all because people trust the community pharmacist. That trust is a vital commodity that should be very much valued. As the hon. Gentleman said, community pharmacies help people to live healthier day-to-day lives. I know he saw that for himself when he visited a pharmacy in his constituency recently. Indeed, I visited a pharmacy in my constituency in Sheringham recently. For a photo opportunity, I had a blood pressure test done on my arm. It came out that I had high blood pressure, so I was immediately referred to my GP. It happens that my blood pressure is all right, but that kind of reminder or shock to the system—in this case experienced by me—is of enormous value to many people, and he was right to highlight that.

The pharmacy that the hon. Gentleman visited has, like many others, helped thousands of people to quit smoking. He talked about his own experience. I am not sure whether he got help from a pharmacy, but I remember as his next-door neighbour over in Norman Shaw North that he used to smoke like a chimney and he has now stopped. That is an admirable achievement. Nearly three quarters of all pharmacies in England gave out quit kits last year, many as part of the Stoptober campaign, which was an enormous success.

Our pharmacies show how they can be proactive, not reactive places, genuinely improving people’s health and well-being on a daily basis, so I welcome the endorsement that the hon. Gentleman gave to the pharmacy’s history of good service. Demand for health care will increase. An increasing population, with people living longer and needing more treatment, means that we must harness every available resource to meet those needs. We want to see pharmacy’s contribution flourish in the future, very much as a central part of local health provision.

Only a fortnight ago, far-reaching changes to transform commissioning health care in England came into effect. Clinicians, not managers, are now in the driving seat. The NHS Commissioning Board—now NHS England—has responsibility for commissioning all NHS primary care services, including pharmaceutical services. We expect NHS England to involve clinical commissioning groups where appropriate, because they know the needs of their local populations best. To meet those needs, CCGs are free to commission further services over and above what NHS England commissions. If they want to, and if it is appropriate, CCGs can commission those services from pharmacies. Local authorities now have the powers and funding to commission public health services, such as stopping smoking or sexual health services, and are free to commission from pharmacies. That provides an enormous opportunity to pharmacies. There is an increase in the public health budget this year and next. It is important for pharmacies to get stuck in and make their case to local authorities about the service they can provide—accessible to all, on the high street and trusted, as we have agreed.

These are far-reaching and necessary developments. It is therefore important that new commissioners are fully aware of pharmacy’s potential. That is why the pharmacy and public health forum, chaired by Professor Richard Parish, has been working on how pharmacy can best enhance its role in public health, with more research into pharmacy’s contribution.

Our goal is to allow the new commissioning arrangements to make people healthier. The hon. Gentleman referred to integrated care, which I also mentioned earlier. The Government intend to focus on trying to achieve an integrated care model across the country, moving away from the fragmented nature of health care delivery towards a much more integrated model, and pharmacies can play an absolutely central role in that approach. Pharmacy has an excellent reputation when it comes to integration. I know that pharmacies have a track record of providing quality services that people value, and that patients and consumers hold pharmacy in high regard, so all commissioners should recognise the potential of community pharmacies. It is also clear that the relationship should work the other way, too. Just as commissioners support pharmacies, pharmacies should also be ready to support commissioners by making available their professional experience and specialist clinical expertise. Pharmacies should make the case to commissioners as to why they should consider the role of community pharmacies.

The hon. Gentleman referred to community pharmacy’s concerns about the new commissioning arrangements, and I hope that I can address some of those concerns and reassure him. The first big concern involves the availability of senior pharmacy expertise and pharmacy’s role in commissioning. I want to assure the hon. Gentleman that the chief pharmaceutical officer for England is already part of the senior management team at NHS England. NHS England is looking at how its regional and area teams can make use of appropriate pharmaceutical advice.

The hon. Gentleman also pointed out that some pharmacists are concerned that they are not represented on CCGs. We deliberately did not prescribe set lists of other health professionals who should be on CCGs’ governing bodies. CCGs must be free to decide that for themselves, because it is they, not us, who know exactly what is suitable for their communities. If every single profession were represented on every single board, that would make for bloated and top-heavy organisations, which is exactly the opposite of what we want to achieve. However, CCGs have a duty to get advice from a broad range of health experts. CCGs can involve pharmacy, and I would expect that involvement to be commonplace, given the extent to which pharmacies are involved in people’s care. I am sure that the existing local pharmaceutical committees and the new local pharmacy networks will be more than willing to offer advice and support to commissioners. I hope that they will do so, and that they will make the case to the commissioners that they can improve care.

The second big concern involves the potential for pharmacy-led care to stop. I understand that concern—it is natural at a time of transition and significant change—but I do not share the apprehension. I see a potentially greater role for pharmacies, if they can make their case effectively. NHS England is legally required to commission pharmaceutical services that meet health care needs. It bases that on the assessments of pharmaceutical needs for which the health and wellbeing boards are now responsible. As I said, pharmacy’s reputation is well established. Commissioners are not going to stop effective and proven pharmacy services overnight. I can reassure the hon. Gentleman that, as CCGs have no power under the Health and Social Care Act 2012 to commission pharmaceutical services, they cannot cut or decommission those services either.

Will some things change? Yes, of course they will. We would not have embarked on our reforms of the NHS if there had been no need for change. For example, local authorities have already taken over responsibility for public health services such as smoking cessation services. Pharmacy absolutely has its place in the new NHS. Not only that, but in my view it must surely grow to meet the increasing needs of our communities. The reformed commissioning environment provides new opportunities for pharmacies. If they remain passive and do not seek to make their case, they will suffer, but if they go out and make the case for the central role that they can play, for their accessibility and for the trust that the community has in them, they will be able to thrive and prosper, particularly given the focus on a new integrated care model. They can demonstrate how they can improve health and improve people’s well-being.

The third big concern is that CCGs’ commissioning decisions will be unduly influenced by people with a vested interest in securing contracts and cutting pharmacies out of the equation. The Department’s view is that this is unlikely to happen. The idea that members of CCGs will secure all the profitable and lucrative services for themselves is a pretty negative view, and one that I do not share, but of course we have to be vigilant.

We will not allow a situation to develop where profits come before patient care or patient choice. That would be in direct contradiction of the founding principles of the NHS, and it must not happen. We have put robust governance arrangements in place and guidance was issued last year to all CCGs. Registers of interests must be maintained and available for public scrutiny. Members and employees must declare any conflict or potential conflict in relation to a decision to be made by the group, and there are effective sanctions if those principles are breached. In addition, the General Medical Council published updated guidance for doctors last month. It comes into effect a week from today, on 22 April. It includes a section on doctors’ financial and commercial arrangements and conflicts of interest. The GMC has provided supplementary guidance explaining how doctors can put those principles into practice.

I conclude by thanking the hon. Gentleman once again for the opportunity to discuss the crucial role of community pharmacies in the new health and care system. The new arrangements will allow commissioners and pharmacists to work closer together, not in opposition. There will be new opportunities for better and more flexible pharmaceutical care arrangements that are both relevant and accessible to local people. Underpinning these will be effective governance—

Revised NHS Constitution

Norman Lamb Excerpts

Tuesday 26th March 2013 Written Statements

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

The NHS constitution sets out the principles, values, rights and responsibilities that underpin the NHS. It sets out the enduring character of the NHS as a comprehensive and equitable health service. It is intended to empower the public, patients and staff to know and exercise their rights to help drive improvements throughout the NHS. The constitution sets out rights to which patients, public and staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities which we all owe to one another to ensure that the NHS operates fairly and effectively.

Between November 2012 and January 2013, the Department ran a full public consultation on a package of amendments to strengthen the NHS constitution. This consultation followed advice from a NHS Future Forum working group, which advised on options for strengthening the NHS constitution to support the fair and effective operation of the NHS.

Today we are publishing a revised NHS constitution, which strengthens a number of areas, including:

patient involvement;

feedback;

duty of candour;

end of life care;

integrated care;

complaints;

patient information;

staff rights, responsibilities and commitments; and

dignity, respect and compassion.

In addition, the public inquiry report into the failings at Mid Staffordshire NHS Foundation Trust, chaired by Robert Francis QC and published in February 2013, emphasises the role of the NHS constitution in helping to create a positive and caring culture within the NHS. Of the 290 recommendations made in the report, nine of them relate specifically to the NHS constitution. We are carefully considering these recommendations and have already acted on two them. So, as part of our initial response to the public inquiry report into the failings at Mid Staffordshire NHS Foundation Trust, we have made changes in the revised NHS constitution to reflect that the most important value of the NHS is for everyone to work together for the benefit of patients, while also giving the values more prominence in the constitution and accompanying documents.

Alongside the NHS constitution, we are publishing the following documents today:

a Government response to the consultation, which sets out detail about the changes being made to the constitution and follows an earlier report on what we heard from the consultation that was published on 15 February 2013; and

an updated handbook to the NHS constitution.

Copies of “The NHS Constitution”, and “Consultation on strengthening the NHS Constitution: Government response”, have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

“The Handbook to the NHS Constitution” has also been placed in the Library.

National Institute for Health and Clinical Excellence

Norman Lamb Excerpts

Thursday 21st March 2013 Written Statements

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

My noble Friend the Parliamentary Under Secretary of State, Department of Health (Earl Howe) has made the following written ministerial statement.

We have today laid before Parliament the “Government response to the House of Commons Health Select Committee’s eight report of session 2012-13 on the National Institute for Health and Clinical Excellence” (Cm 8568).

The Government welcome the Health Select Committee’s report and recommendations.

In April 2013, the National Institute for Health and Care Excellence (NICE) will be established as a new statutory body with an extended remit covering adults’ and children’s social care, as well as health care and public health. The Government’s plans for NICE build on its strong track record and a re-established NICE will continue to play a key role in supporting the delivery of high-quality health and social care in the NHS through the production of robust, evidence-based advice and guidance.

NICE will also continue to have an important role in providing independent and authoritative advice to clinicians and commissioners on how new and existing treatments best fit into the treatment pathway for a particular condition. The Government response confirms that NICE will be responsible for the full value assessment of medicines under new arrangements which we plan to introduce for new medicines from January 2014.

Copies of the Government’s response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.