Medical Implants (EU and UK)

Norman Lamb Excerpts

Wednesday 6th March 2013 Commons Chamber

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

I thank the hon. Member for Ellesmere Port and Neston (Andrew Miller) for the clarity with which he presented the Committee’s findings, and I thank the Committee for its valuable work.

The shadow Minister, the hon. Member for Copeland (Mr Reed), made some interesting points about the challenge of diabetes. I note his diagnosis of type 1 diabetes and the impact it has had, particularly in the run-up to the general election. It beggars belief that he had to cope with that in the middle of a campaign. He made a point about the potential power of science and devices to make a difference to patients’ lives and to save the system money—a double win that we are all after.

Before I go on to talk about points raised in the Committee’s report, let me deal with the specific point about Northern Ireland, which was raised by the hon. Member for Strangford (Jim Shannon). Most issues relating to the regulation of medical devices are UK-wide, and the MHRA operates across the UK. Some issues are devolved if they relate to the operation of the health service, and officials at the MHRA work closely with their counterparts in all the devolved Administrations. I hope that reassures the hon. Gentleman.

I will set out briefly what is currently being done to improve the regulatory system for medical devices. In October 2012, the Government began negotiations with other EU member states to revise the regulatory framework for medical devices, including implants. That will mean completely overhauling the regulatory system that has been in place for more than 20 years. The changes will take effect in 2017 at the earliest. In the interim, member states and the Commission are tightening up the most critical aspects of the current legislation. On top of the legislative changes, member states are implementing a voluntary programme of action that takes on board the lessons learned from the PIP scandal, which was mentioned earlier. However, we are not merely relying on the EU. The UK is taking its own action, including putting in place the recommendations of Earl Howe’s report, which was published in May last year. In addition, Sir Bruce Keogh’s review of the regulation of cosmetic interventions is due to report later this month.

Let me now turn to the issues raised in the Committee’s report. First, I would like to talk about the requirements on clinical data for medical devices. There are legitimate concerns about the quality of manufacturers’ clinical evidence, as well as about how rigorously notified bodies then evaluate the evidence they are presented with. The Government’s response highlights how the Commission’s proposal will address those concerns. In particular, we consider that the requirement on notified bodies to have in-house clinical expertise will be a big and important step forward that will ensure that notified bodies really scrutinise and challenge manufacturers on the quality of their clinical evidence.

I am pleased that the draft legislation requires manufacturers to comply with clear rules on clinical evaluation. It is also much clearer on when manufacturers can use clinical data from an equivalent device when conducting their own investigation—one of the issues discussed during this debate. None the less, by the end of the negotiations, we should have legislation that goes even further to ensure that notified bodies have access to high-quality clinical expertise. We do not have any detailed proposals, at this stage, but one idea is to establish an approved list of clinical experts that notified bodies must consult when assessing clinical evidence.

In addition, clinical data must be transparent, so that the procurement of devices is based on solid evidence. The hon. Member for Ellesmere Port and Neston raised concerns about this point. Current practice in the NHS means that clinicians take into account several factors before using a device, including the clinical evidence provided and the track record of the manufacturer. In the light of issues identified with some brands of metal-on-metal hips, the chief medical officer and the NHS medical director wrote to all NHS trusts in England last March asking them to ensure that there was sound clinical governance of procurement decisions about joint implants—this is the important point I want to make in response to what he said. I would expect these principles for the procurement process to apply to all medical devices used in the NHS.

It is worth highlighting how the UK is taking action, over and above the requirements of EU legislation, to support the safe introduction of new hip and knee implants into the market. Manufacturers, including Johnson & Johnson, Stryker and Biomet, have applied to participate in a pilot scheme that will give surgeons earlier and more accurate data on how well new hip and knee implants performed. This project involves close co-operation with clinicians, the NHS and the UK’s national joint registry. The MHRA is currently considering how this pilot could add value to other categories of device.

[Andrew Miller]

Will the Minister confirm that it would be perfectly reasonable, as part of the regulatory process a device must go through, for a procurement officer to ask to be notified of any failed applications to other countries?

[Norman Lamb]

It would be absolutely in order for a procurement officer to do that. The more searching their inquiries, the better, given the importance of what we are trying to achieve. We welcome the hon. Gentleman’s opinions on this issue and will consider how the system can be further strengthened. He makes a valuable contribution to our considerations.

The Government agree with the Committee about the need to improve the environment for clinical trials in this country, and we are doing a lot of work on that already. Things such as the life sciences strategy are making it easier for patients to get involved in research, and we have also set up the Health Research Authority, which is simplifying the approval process for ethical research.

To return to a point made by the shadow Minister, we wholeheartedly agree on the importance of transparency, which brings numerous benefits. I have always strongly believed that it empowers patients, informs and liberates health care professionals and builds trust in industry, notified bodies and public authorities. The proposed new European regulations will increase transparency, giving the public, patients and clinicians access, first, to clear information on the safety and performance of devices; secondly, registration information on devices and the companies that make, distribute and use them; and thirdly, information on the electronic traceability system for devices.

Furthermore, the outcome of peer reviews between different national authorities—reports from each member state on how they have monitored their notified bodies and statements from notified bodies on their independence and impartiality—will also be made public. The hon. Member for Ellesmere Port—I apologise for abbreviating his constituency—drew attention to concerns about the quality of different authorities across the EU, so this is an important step. The UK is already pushing for improvements in transparency in negotiations with other member states. For example, as we highlighted in our response, we would like to see clinical data from post-market surveillance published, so that the available information on the safety and performance of devices always remains up to date. We can do more as well. The Government’s public consultation on the proposed regulation closed on 21 January. It provided us with a lot of useful ideas, which we are currently considering in detail.

Let me turn to the issue of notified bodies and pre-market assessment. Strengthening the quality of notified bodies is absolutely one of the most important ways to improve the regulatory system. The Government agree with the Committee’s recommendations in this area. We are pleased that the Commission’s proposal goes a long way towards addressing the current weaknesses in the system. Competent authorities will review each other and share ideas on how to improve the way in which they monitor notified bodies. The Commission can take action in response to a member state’s concern about a particular notified body. There is significantly more detail on the criteria that notified bodies must fulfil, and teams of experts from different competent authorities will audit notified bodies every three years. The Government agree with the Committee that a new layer of European bureaucracy is not the solution to problems with notified bodies. We need to focus not on who carries out pre-market assessment, but on how it is carried out.

Regardless of all that, we cannot just sit back and wait for the revised legislation to come into place—it is some way off yet. As I outlined previously, we are acting before then to ensure that notified bodies improve as soon as possible. Interim action is being taken across Europe. It includes, first, joint audits of notified bodies on a voluntary basis. The first of these took place in the UK in January and many more are planned for 2013. Secondly, all member states are auditing the quality of their notified bodies that assess high-risk devices. Thirdly, rules on notified bodies and how they audit manufacturers, including undertaking unannounced inspections, are being put together.

While we strengthen the pre-market assessment of devices, it is equally important that adequate post-market surveillance and vigilance procedures are put in place. My hon. Friend the Member for Southport (John Pugh) entertained us and educated us on some important issues. He drew attention to the complexity of identifying the cause of a problem and whether it is the equipment or how it is used. That is not always easy, and the court action he referred to very much drew attention to the complexity of these issues. I am afraid that I am unlikely to be able to satisfy him on the £1.2 billion, but I liked the effort on his part.

[John Pugh]

I hope the Minister did not think I was being awkward in any way, but the original purpose of estimates day was clearly not to discuss medical implants. However, I have now learnt not only that we do not talk about estimates on estimates day, but that we are not allowed to talk about them.

--- Later in debate ---

[Norman Lamb]

I am very grateful to my hon. Friend for that intervention. I have never known him to be awkward; it is not in his nature.

While we strengthen the pre-market assessment of devices, it is equally important that adequate post-market surveillance and vigilance procedures are put in place. The Committee recommended setting up a black triangle scheme for medical devices approved with equivalence data. I recognise the Committee’s rationale for that recommendation, but we do not think it is the best way forward. A national scheme would place potentially disproportionate costs on industry and risk a loss of competitiveness for the UK. The hon. Member for Strangford (Jim Shannon) correctly drew attention to the enormous potential we have in the UK for generating new business in this area and the importance of giving businesses every opportunity to start up and develop. We do not want to impose disproportionate costs on UK businesses and put that potential growth at risk. Instead, recognising the importance of the point made by the hon. Gentleman and the Committee, we are considering what we can do at the EU level. For example, notified bodies could require manufacturers to carry out post-market studies for certain devices.

Finally, the Committee recommended that the Government consider making the reporting of incidents by health care professionals mandatory. Increasing reporting is clearly critical to ensuring that the regulator has a full picture of emerging problems with devices. Mandatory reporting is an option that the Government are continuing to consider, although it cannot be the only solution. The MHRA is currently leading work to improve reporting and has been working closely with the General Medical Council and the medical royal colleges to consider how to strengthen professional responsibilities in this area.

In conclusion, the Government attach great importance to strengthening the regulatory system for medical implants. I am immensely grateful to the Committee for its work and recommendations, just as I am to everyone who has contributed to this debate or at some other time. I am confident that the work being undertaken now and to improve the European legislation will make a real difference to safety and transparency.

Home Care Workers

Norman Lamb Excerpts

Wednesday 6th March 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Turner.

I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this incredibly important debate. As was pointed out by the shadow Minister, the hon. Member for Leicester West (Liz Kendall), the subject is too often neglected. It is literally hidden behind closed doors, and it does not get the attention it deserves. I also thank my hon. Friend the Member for St Ives (Andrew George), and the hon. Members for Wirral South (Alison McGovern), for Strangford (Jim Shannon)—he drew attention to the brilliant work done by Crossroads in many parts of the country—and for Nottingham South (Lilian Greenwood), who spoke from direct personal experience.

I totally agree with the shadow Minister that the health and care system has not kept pace with the demands and challenges of an ageing society, and that we need a fundamental re-engineering of how we deliver care. I have a passionate belief in the need to shift towards an integrated care model, in which we shape services around the needs of the individual, rather than those of the institution, which is a shift that must happen.

Before I go into details, let me say that I applaud Unison for having undertaken the report that several hon. Members have mentioned. When its staff wrote to me about the report, I asked officials to meet them, and they will meet soon. I, too, asked to meet them, and I will discuss their concerns with them next month. I recently met some care workers, with another hon. Member, to hear directly from them, and I want to experience myself what goes on—often behind closed doors.

The right hon. Member for Oxford East mentioned whistleblowers, and I have a lot of sympathy with the points he made. Last January, the Government extended the Government-funded whistleblowing helpline to the whole of the care sector, so that any care worker can find out how to pursue their concerns. Of course, as employees, care workers have employment law protection, and we should encourage them all to use their rights.

The Government want to do all we can to ensure that standards of care remain as high as possible, and indeed improve. That is the challenge we all face. People who receive home care and their families should be able to expect the highest quality of care every time. I am aware of the many examples of poor care. The right hon. Gentleman and other hon. Members drew our attention to some pretty shocking case studies and to the fact that someone can have up to 13 different care workers over a relatively short space of time. As the hon. Member for Leicester West said, it is completely unacceptable that a person has to receive quite intimate care from someone whom they have never met before. Moreover, the idea of a zero-hours contract is, in most circumstances, completely incompatible with a model of high quality care, in which the individual really gets to know their care worker.

The CQC report “Not just a number” highlighted some serious concerns, which we must take action to address. The responsibility for bringing about improvement rests with all the key players, including the providers, the councils and the regulator. The Government too must take their share of the responsibility here. The trick is to erase the bad, keep the good and improve services across the board.

The care and support White Paper sets out our intentions to improve the standard of social care. We will do that primarily by investing in people—by focusing attention on the staff who provide care in the first place. I want to join the right hon. Gentleman and other hon. Members in paying tribute to care workers, the vast majority of whom do really excellent work, often in difficult circumstances. They work under real pressures because of the way in which care is commissioned over very short spaces of time. We are seeing a race to the bottom, and we must move away from that. It puts care workers under impossible pressure and it does not provide good quality care.

Another matter I feel strongly about, and to which I referred in my response to the Winterbourne View scandal, is that there must be much more effective corporate accountability. Some companies are making very good money out of home care, so accountability must go with that profit making. It is unacceptable that home care providers sometimes allow negligent care to take place under their watch, and they must be held to account for it. Poor care, private or public, should be condemned wherever it exists. We must not have the idea that poor care exists only in the private sector. It was intolerable that hundreds of people died in Mid-Staffordshire hospital, an NHS hospital, as a result of poor care, and it is equally unacceptable when it happens under the watch of a private provider.

It is impossible to speak about improving standards without also talking about human capital. Care workers who feel valued and encouraged will perform better; it is as simple as that. The more attention the Government pay to the skills, training and personal development of the work force, the better are our chances of improving standards. After all, it is the care workers, not us in Parliament, who ultimately provide the care. We must increase the capacity and the capability of the social care work force, give people better information about care providers and improve the performance of the regulator, the Care Quality Commission. All those things will make social care a more attractive place for people to work and, most importantly, improve the quality of services.

We will shortly introduce new minimum standards to improve training for care staff to make sure that all employees have the foundations for excellence. My focus must be on training and standards, and ensuring that they apply across the board. I am dubious about the idea of creating a new regulator or of using the Nursing and Midwifery Council, which has not had a great record, to regulate some 1.5 million people. The money that is available should perhaps go to the front-line workers, rather than on creating new bureaucratic structures. I will give way to the hon. Lady, and ask her to be very quick if she does not mind.

[Alison McGovern]

I will be speedy. I have listened carefully to what the Minister has said about the causes of the problem. He does not seem to have mentioned funding pressures on local government. Will he respond to that point, because it is a massive constraint on improvements in the sector?

[Norman Lamb]

I will directly address that point. The analysis of the independent King’s Fund said that provided councils apply the money that the Government have allocated to care and undertake proper efficiency savings, which the previous Labour Government recognised had to happen across health and care, they should be able to continue to provide the level of service that exists at present. We need to think more fundamentally about a much more integrated approach between health and care. We can save resources and improve care if we bring the systems much more closely together.

It was, I think, the hon. Member for Wirral South who made the point about looking at care as an aspirational role.

[Alison McGovern]

indicated assent.

[Norman Lamb]

I totally agree with her. If a worker can aspire to something better—perhaps a progression in their career—they will commit themselves very fully to the role. The idea of a vocational progression towards nursing, even if, at the end of the day, a degree is involved, should be opened up much more than it is at present. I completely agree with her on the points that she makes.

I share the concerns that hon. Members have raised about pay. There have been reports that some home care workers may be working for less than the minimum wage, which is an absolutely disgraceful situation for a vast number of reasons, not least because an illegally low wage will never produce excellent results and it is an exploitation of the worker that we must not tolerate. It is the responsibility of all employers, including home care providers, to pay staff at least the national minimum wage. The Government are working closely with the Low Pay Commission and local authorities to address that issue. I can assure all hon. Members that we will not accept anything less than 100% compliance with the regulations.

When I was a Minister in the Department for Business, Innovation and Skills, I wanted to change the rules to make it easier to name and shame employers who fail to pay the minimum wage. We must regard that as completely unacceptable practice, and any employer who indulges in it should be exposed; it is utterly intolerable.

[Lilian Greenwood]

rose—

[Norman Lamb]

I am conscious that time is tight and I want to address the remaining points.

The hon. Member for Erith and Thamesmead (Teresa Pearce), who is no longer in her seat, raised concerns about potentially bogus arrangements in her constituency in Bexley. I think that she is writing to me on that matter, and I will be happy to look into it.

Care providers are also responsible for ensuring that their services meet the requirements in regulations and essential standards. The regulator, the Care Quality Commission, has powers that it can use to make sure that that happens. The CQC has our full support to use those powers as it sees fit to drive improvements in services. It is worth taking a moment to talk about the CQC report, which we have been discussing this morning. Between April and July 2012, the CQC inspected 250 registered home care providers as part of a themed programme to highlight respecting and involving people who use services and safeguarding them from abuse and neglect. To ensure that everything was examined thoroughly, it involved the people who use the services as well as the people who provide them. It looked at how staff are supported and how standards are maintained. Overall, the CQC found that 74% of the services that it inspected met the standards, and about a quarter did not. That is unacceptable and we must all focus our attention on those services.

The right hon. Gentleman referred to concerns about CQC’s capabilities in Oxfordshire, and I am aware of local media attention on that. My officials have raised those concerns with CQC and they were assured that it is on track to achieve its goal of inspecting 100% of adult social care locations across Oxfordshire by 31 March, that its Oxfordshire compliance team now consists of 10 full-time inspectors and that, after a period of recruitment, CQC has had no vacancies in the area since last December. If concerns continue, I urge the right hon. Gentleman to contact me and I will be happy to look into them further.

The importance of commissioning must be stressed. Commissioning over short periods of time—that race to the bottom—is unacceptable. We must commission on the basis of quality, as the hon. Member for Leicester West said. Finally, let me thank the right hon. Gentleman for securing such an important subject for debate.

NHS Commissioning Board

Norman Lamb Excerpts

Tuesday 5th March 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on comments by the deputy medical director of the NHS Commissioning Board on the regulations on procurement, patient choice and competition under section 75 of the Health and Social Care Act 2012.

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

I know that the right hon. Member for Leigh (Andy Burnham) and others have raised concerns about the effect of the regulations and I would like to address them in my response. First, however, I would like to make it absolutely clear that the regulations must be fully in line with the assurances given to the House during the passage of the Health and Social Care Bill. The former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), said to clinical commissioning groups in 2012 that

“commissioners, not the Secretary of State and not the regulators, should decide when and how competition should be used to serve…patients interests”.

That must be the case. I made it clear in Health questions last week that we would review the regulations to ensure that that was the case and that they were not open to any misinterpretation.

The right hon. Member for Leigh himself gave guidance to primary care trusts which made this clear in 2010:

“Where there is only one capable provider for a particular bundle of services or the objective of the procurement is to secure services to meet an immediate interim clinical need there will be a case for Single Tender Action (i.e. uncontested procurement). By definition, an immediate or urgent scenario will be exceptional and likely to only arise on clinical safety grounds or for example, where existing services have been suspended following intervention by the Care Quality Commission.”

The next bit is very important.

“A decision to procure through single tender should always take account of the potential to secure better value by investing in a competitive process, as long as this is justified by the scale and importance of the opportunity (i.e. it has to be worth it).”

[Interruption.] Those were the comments of the right hon. Member for Leigh.

In the Government’s response to the Future Forum report, we committed to ensuring that the regulations would simply continue that approach. However, I fully recognise that the wording of the regulations has inadvertently created confusion and generated significant concerns about their effect. I have therefore listened to people’s concerns and my Department is acting quickly to improve the drafting so that there can be no doubt that the regulations go no further than the set of principles and rules that we inherited from the previous Labour Government. Following our commitment in response to the Future Forum report, the co-operation and competition panel has been transferred to Monitor. That will ensure consistency in the application of the rules.

Concerns have been raised that commissioners would need to tender all services. That is not our intention and we will amend the regulations to remove any doubt and to clarify that the position remains the same as at present and as stated in my right hon. Friend the former Secretary of State’s letter of 2012.

Concerns have been raised that Monitor would use the regulations to force commissioners to tender competitively. However, I recognise that the wording of the regulations has created uncertainty, so we will amend them to put this beyond doubt. Concerns have also been raised that competition would be allowed to trump integration and co-operation. The Future Forum recognised that competition and integration are not mutually exclusive. Competition, as the Government made clear during the passage of the Bill, can only be a means to improve services for patients—not an end in itself. What is important is what is in patients’ best interests. Where there is co-operation and integration, there would be nothing in the regulations to prevent this. Integration is a key tool that commissioners are under a duty to use to improve services for patients. We will amend the regulations to make that point absolutely clear.

[Andy Burnham]

In less than four weeks’ time, new GP commissioners take control, yet today there is complete confusion about the job they are being asked to do. Following comments by the deputy medical director of the NHS Commissioning Board and the statement we have just heard, coalition policy on competition in the NHS is in utter chaos. It beggars belief that almost three years after the White Paper introduced by the right hon. Member for South Cambridgeshire (Mr Lansley) and after all the upheaval he inflicted on the NHS, there is still no clarity on policy today. They are in this mess because the “doctors will decide” mantra was always a fig leaf for their true ideological purpose of driving competition and privatisation into the heart of the NHS.

We notice that the Secretary of State is not here today, but perhaps the Minister will remind him of the statement his predecessor made to GPs:

“I know many of you may have read that you will be forced to fragment services, or to put services out to tender. This is absolutely not the case.”

I am tempted to ask: if the aim is to revert to the position we held, why on earth bring forward a 300 page Bill to rewrite the entire legal basis of the national health service? The truth is that they have been found out trying to sneak through the back door privatisation proposals that the Minister’s predecessors were forced to rule out to save their discredited Bill. In that light, does the Minister accept that it will not be good enough to bring these proposals back with a few cosmetic changes? Will he give a categorical assurance that there will now be a fundamental rewrite to reflect to the letter commitments given to the House and to the professions?

More broadly, we now need urgent clarification, in a full and detailed statement, of what Government policy on competition actually is. Will the Minister today send the clearest message to clinicians that they will control whether or not to use competitive tenders, and will he fulfil the pledge by his leader to protect the NHS from the full glare of EU competition law? If the Government still want to argue for more private providers in the NHS, is he confident that this will not restrict whistleblowing as it has in other outsourced public services?

Will they also respond today to the research of the Nuffield Trust, which shows that more competition in the NHS has resulted in falling productivity? A quarter of a million people who signed the 38 Degrees petition have forced the Government into yet another humiliating U-turn, but there will be lingering distrust at the fact that they had the audacity even to attempt this. The simple truth is this: the British public have never given them permission to put the NHS up for sale. Until they acknowledge that, we will never tire of reminding them.

[Norman Lamb]

I sense that the right hon. Gentleman’s speech was written before he heard what I had to say. If he had listened to it, he would know that we recognise concerns about the drafting and whether it absolutely meets the commitments already made. We want to be certain that the commitments made in this place during the passage of the Bill are met. Indeed, when the Secretary of State wrote to clinical commissioning groups in 2012, he made it absolutely clear that those groups would not be forced to go out to tender. We will make sure that that is met. [Interruption.] If Opposition Members had simply listened to what I said, they would have avoided coming up with a set of questions that completely ignored my points.

The right hon. Gentleman referred to the question of quality of care. From my point of view, poor care should be condemned wherever it happens, and he needs to remember that the scandal of Mid Staffordshire hospital happened under his and his party’s watch. The poor quality of care uncovered in that NHS hospital is completely unacceptable—just as unacceptable as poor quality care from any private provider at all. Let us be clear about that.

There will be no privatisation of the NHS under this Government. Furthermore, there will be no special favours for the private sector, which were provided under the right hon. Gentleman’s Government. It was his Government who gave £250 million to private providers of independent sector treatment centres—whether or not they delivered care. There will be no special favours under this Government’s new rules. No clinical commissioning group will be forced into competitive tender. The rules will be absolutely clear, and we shall publish the amended regulations shortly.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that the effect of his response to the urgent question this afternoon is to say that this Government are pursuing precisely the same policy as their predecessor on competition for the provision of NHS services? Does he further agree that that demonstrates that the cloud of rhetoric surrounding the passage of the Health and Social Care Act 2012 was so much hot air?

[Norman Lamb]

I absolutely agree with my right hon. Friend. There has been a lot of cant and hypocrisy in this debate. The guidance given by the previous Government to primary care trusts in 2010 makes absolutely clear their commitment to competition. That shows how crazy this debate has become. We will ensure that the debate is balanced and that the interest of the patient trumps everything else, as it should.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituents’ view is absolutely clear: they do not want back-door privatisation of our national health service. I am pleased that the Minister is making a U-turn on these regulations, but given the chaos of recent days, how could anyone trust this Government with our NHS?

--- Later in debate ---

[Norman Lamb]

When the hon. Lady talks about back-door privatisation of the NHS, I am not sure of her view of the previous Government’s commitment to spend £250 million on independent sector treatment centres, whether or not they undertook any operations. I am not sure that she agreed with it, but that is what her Government did. There will be no privatisation of the NHS, and the rules we introduce will make it absolutely clear that the power lies with clinical commissioning groups to use the tools available to them—co-operation and integration, but also competition where it drives up standards, just as her Government recommended.

[Chris Skidmore (Kingswood) (Con)]

Last year, the right hon. Member for Leigh (Andy Burnham) claimed that there were less than 72 hours to save the NHS. Yesterday, when referring on his Twitter feed to the regulations, he claimed that there were two weeks to save the NHS. Does not the Minister believe that in fewer than 140 characters, the right hon. Gentleman has shredded any credibility that he might once have had? [Interruption.]

[Norman Lamb]

I think my hon. Friend makes a valuable point. [Interruption.]

[Helen Jones (Warrington North) (Lab)]

Last week, the Leader of the House insisted that the regulations did not—

[Helen Jones]

Last week, during business questions, the Leader of the House said that the regulations would not introduce compulsory competitive tendering in the NHS; today the Minister has said that he will have to revise them in case they do. Is it not a fact that the Government actually do not have a clue about what they are doing? If the Minister wishes to disprove that, will he tell us exactly what changes he will make to the regulations—or will this just be like the pause in the Health and Social Care Bill, after which it carried on regardless?

[Norman Lamb]

The Leader of the House was absolutely correct in stating—[Interruption.] If the hon. Lady will listen to my answer, she may benefit from it. The Leader of the House made it absolutely clear in the House last week that the regulations would not introduce compulsory competitive tendering. We are amending them because there was legitimate and understandable concern about the impact of some of the provisions. We will make the position clear so that the policy intent of the Health and Social Care Act is implemented faithfully in these regulations.

[John Pugh (Southport) (LD)]

The Labour regulations are not perfect, and neither the regulations introduced by Labour nor those initially proposed by the coalition Government in section 75 will do in any sense. Do we not need regulations that embody the assurances given to peers and to GPs themselves during the passage of the Health and Social Care Bill, and not a charter for privatisation?

[Norman Lamb]

We will make absolutely sure that the amended regulations meet faithfully the commitments given in the Upper House during the passage of the Bill, and in the letter sent to clinical commissioning groups by the former Secretary of State following the legislation.

[Mr Kevin Barron (Rother Valley) (Lab)]

During the passage of the Health and Social Care Bill, the Government withdrew clauses that promoted competition and replaced them with clauses that would prevent anti-competitive behaviour. I never understood that at the time. Is it not the case that compulsory competitive tendering is the intention of the regulations and the intention of the original Act?

[Norman Lamb]

The right hon. Gentleman’s own Government had guidance in place precisely to address anti-competitive behaviour. Let me again reiterate that these regulations will not introduce compulsory competitive tendering. The amendments that we will table will make it absolutely clear that the power rests with clinical commissioning groups, and not with the Government, Monitor or anyone else.

[Mr Crispin Blunt (Reigate) (Con)]

My hon. Friend will have heard the charge of audacity from the shadow Health Secretary, whose expertise and qualities in this area should be acknowledged to place him in a league of his own. If there is still no clarity on the competitive position, which has not moved on from that of the last Administration, the responsibility lies precisely over there, on the Opposition Benches.

[Norman Lamb]

I take the point, but I again reiterate that the rules and guidelines for commissioners will remain exactly as they were under the last Government and under the right hon. Member for Leigh as Secretary of State.

[Mr Gregory Campbell (East Londonderry) (DUP)]

The Minister referred to the amending of regulations. Will he tell us first when that is likely to happen, and secondly how it will ensure that the cloud of uncertainty hanging over the NHS is dispelled?

[Norman Lamb]

The amended regulations will be published within days. I entirely agree with the hon. Gentleman that it is important for clinical commissioning groups to have absolute clarity, so that they can prepare for the date in April when they take responsibility.

[Stephen Mosley (City of Chester) (Con)]

What my constituents want is first-class health care, free at the point of delivery. Will the Minister confirm that the Government want that too?

[Norman Lamb]

I absolutely confirm that the patient’s interest must always trump everything else. Sometimes it is right to challenge existing services which are not providing a good enough service for patients, and we must encourage clinical commissioning groups to do that. Whether poor care is in the public or the private sector, it should always be condemned, and we should always put the interests of the patient first.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

If I understood the Minister correctly, he is withdrawing the regulations in order to rewrite them so that we are back where we were under the Labour Government. Does he now wish, with hindsight, that he had never started this?

[Norman Lamb]

Absolutely not. The legislation and the regulations will faithfully implement our policy intent, which is to put clinicians at the heart of decision making in the NHS and to make the interests of the patient paramount.

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

I thank the Minister for his statement, and especially for confirming that the regulations will be rewritten to put it beyond doubt that the patient’s interest always trumps competition in these circumstances. Will he also confirm that any tendering arrangements currently operating in the NHS are operating under legislation introduced by the last Labour Government?

[Norman Lamb]

My right hon. Friend is right on all counts. As he says, the patient’s interest must trump everything else. One of the things that we will reinforce in the amended regulations is the paramount importance of integrated care. We legislated for that for the first time through the Health and Social Care Act, which the Care and Support Bill will reinforce and which, indeed, is reinforced by the mandate of the NHS. The Government’s whole intent is to drive a fundamental shift to integrated care for the benefit of the patient.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The Minister has been put up by the Secretary of State to explain the Government’s incompetence, which he may be ideally placed to do. Will he tell us what will happen if the four accident and emergency units in west London close and replacement services are taken over by companies, such as Harmoni and Care UK, which are unfit to run them? That can still happen under his redraft. Will he confirm that members of clinical commissioning groups who have financial interests in the private providers that are bidding should not decide what should replace public services when they are inevitably handed over to the private sector?

[Norman Lamb]

The regulations as currently drafted are absolutely clear about the importance of avoiding the conflicts of interests that the hon. Gentleman has described.

[Nick de Bois (Enfield North) (Con)]

Does the Minister agree that the mantra that we are hearing from Opposition Members confirms that their party remains obsessed with process and means rather than outcomes for patients, which are what drive this party and our reforms?

[Norman Lamb]

Indeed. That is precisely the lesson to be learnt from Mid Staffordshire hospital and the Francis report. The last Administration and the top-down culture of targets lost sight of the importance of the quality of care for patients, but the current Government are absolutely intent on always putting the patient first, and that is what this legislation is about.

[Kevin Brennan (Cardiff West) (Lab)]

The Government seem to be saying, “There is nothing wrong with the regulations that we have laid, so we must amend them as a matter of urgency.” Will the Minister tell us when that decision was made, and why the Secretary of State has not come to make a statement to the House about it rather than the Minister’s having to come here as a result of an Opposition urgent question?

[Norman Lamb]

I made it clear during Health questions last week that I was anxious to ensure that the regulations faithfully implemented the commitments that had been given in the other place during the passage of the Health and Social Care Bill, and indeed we have worked since then to ensure that the regulations achieve that. I believe that we need to make it absolutely clear that clinical commissioning groups will not be forced into competitive tendering, which is why we are amending the regulations. That is entirely sensible and entirely rational.

[Jason McCartney (Colne Valley) (Con)]

Will the Minister take no lectures from the Labour party, which oversaw the downgrading of the maternity unit at Huddersfield royal infirmary, and will he reassure my constituents that patient care will always be put first in this universal health service, free at the point of delivery?

[Norman Lamb]

I congratulate my hon. Friend on getting an issue of local concern into his question. He is entirely right: I will take no lessons from the Opposition, given what happened when they were in government, and patients’ interests must indeed always come first.

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

Will the Minister tell me which part of the NHS preferred provider status, which was introduced by the last Labour Government, his Government do not understand?

[Norman Lamb]

According to my recollection, at the last general election all three parties committed themselves to any willing provider. The degree of hypocrisy that we sometimes encounter beggars belief.

[Andrew George (St Ives) (LD)]

Because I had feared that the regulations as currently drafted would result in an NHS driven by profit rather than concern for patient care, I welcomed my hon. Friend’s statement. However, he said that he would base the future draft on the principles set out by the last Labour Government, who favoured the private sector over the NHS. Can he reassure me that the redrafted regulations will enable commissioners to encourage collaboration and the integration of health services, and that that will trump competition on many occasions?

[Norman Lamb]

I am grateful to my hon. Friend for that question. I should make it clear that we have enhanced the position that we inherited by absolutely reinforcing the importance of co-operation and integration for the first time—that was not part of any legislation under the previous Labour Government. Our Government are totally committed to legislating on and then enacting the importance of co-operation and integration, as he rightly says.

[Derek Twigg (Halton) (Lab)]

On 15 March 2011, the then Minister of State, the right hon. Member for Chelmsford (Mr Burns), said that in the NHS

“UK and EU competition laws will increasingly become applicable.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]

How can this Minister assure us that the amended regulations he intends to introduce will prevent a successful legal challenge from a private provider against a clinical commissioning group’s decision not to put out a service to tender?

[Norman Lamb]

The regulations will help substantially in ensuring that CCGs maintain control over the judgments they make in the interests of patients. European competition law existed as much under the previous Government as it does under this one, and these regulations will help to protect CCGs against those powers.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his statement. Will he assure us that competition will be at the core of what he is trying to achieve? Will the Government prioritise clinical outcomes, with targets to deliver and an increasing number of patients to be looked after?

[Norman Lamb]

I apologise, but I simply did not hear the question.

[Mr Speaker]

We wish it to be heard. The hon. Member for Strangford (Jim Shannon) must always be heard when he is on his feet. Let us hear it.

[Jim Shannon]

Perhaps I should give a lesson in Northern Ireland-speak. Will the Minister assure us that competition will be at the core of what he is trying to achieve and that the Government will prioritise clinical outcomes, with targets to deliver and an increasing number of patients to be looked after?

[Norman Lamb]

Competition should only ever be used to enhance the interests of the patient and to improve patient care; it is not an end in itself, and that must always be the case. These regulations will ensure that that is the case and that other vital factors such as co-operation and integration must be taken into account by CCGs in making their judgments.

[Alison McGovern (Wirral South) (Lab)]

This top-down reorganisation has, from day one, been a chaotic waste of time, money and effort. Now that the Minister has made a U-turn, will he make things clear, so that I can tell all the professionals and patients in the Wirral what his policy is? Will he say when he will bring to this House a statement of what the Government’s policy is on competition in the NHS?

[Norman Lamb]

I repeat that we will be publishing amended regulations within days and that the Government’s reforms are about putting the clinician centre stage in decisions about how money is spent, rather than unaccountable bureaucrats, as happened in primary care trusts up and down the country. The reforms are also about ensuring that the patient’s interests and patient care are always uppermost in the minds of everyone making decisions about the use of money in the NHS.

[Bill Esterson (Sefton Central) (Lab)]

As my constituent Terry Eastham told me, the regulations, as they stand, make privatisation of the NHS swift and inevitable. The Minister says that he is confident that his changes will guarantee that private companies will not be able to challenge CCGs to demand full and open competition. Will he give that assurance now and explain how the changes he is proposing will make absolutely certain of that?

[Norman Lamb]

It is absolutely not the case that the regulations, as currently drafted, drive the privatisation of the NHS. As the hon. Gentleman will discover in the next few days, the amended regulations will make it abundantly clear that CCGs will be in the driving seat—the letter from the former Secretary of State made that clear back in 2012. They will take into account the importance of co-operation, integration and putting the patient’s interest first.

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

On competition and integration, my hon. Friend the Member for Walsall South (Valerie Vaz) and I spent some time this morning talking to academics from Sweden, who told us how competition and fragmentation were preventing them from moving ahead with integration. The Minister should be concerned about the integration of health care and social care, so will he address that point? We will certainly never make progress on integrating health care and social care if we move ahead with all this privatisation, which will lead to a lot more fragmentation. Leaving that aside, 70 of my constituents also think this is just the wrong way to go.

--- Later in debate ---

[Norman Lamb]

This Government will ensure that there is no unfair competition, such as existed under the previous Government, whereby private providers got handed guaranteed income on a plate, irrespective of whether or not they did the work. I am clear that nothing in our legislation will prevent a real drive towards integrated care, to which the hon. Lady and I share a commitment.

[Valerie Vaz (Walsall South) (Lab)]

Will the Minister say whether there was a mistake in the instructions given to parliamentary counsel in drafting these regulations? Will he also tell us which Minister signed them off?

[Norman Lamb]

This comes down to a question of the legal drafting and a legitimate concern that the regulations did not meet the policy objectives set out clearly in the Health and Social Care Act and during the course of the debates on it in Parliament. We simply want to ensure that that objective is faithfully met.

[Alex Cunningham (Stockton North) (Lab)]

Professor Steve Field, who chaired the NHS Future Forum and is now deputy medical director of the NHS Commissioning Board, has said that the Government must make it clear how the regulations are “consistent with the commitments” they gave him. He said that he was clear that there must be “no backtracking” by the Government on the commitments that they gave the NHS Future Forum. The Minister suggested that he will satisfy those demands, and the demands of commissioners and doctors across the country. Is he really guaranteeing to do that today?

[Norman Lamb]

I thank the hon. Gentleman for the question. I spoke directly to Steve Field about this yesterday and I am absolutely satisfied that the amended regulations will totally meet the commitments made during the passage of the Bill in the other place.

[Mr Speaker]

I am grateful to the Minister and to colleagues.

Social Care (Bradford East)

Norman Lamb Excerpts

Tuesday 5th March 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the first time, Mr Caton. I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate and on a brilliant piece of work—not just the report, which is fantastic, but the degree of discussion, debate and engagement with ordinary people and all the organisations that he listed, to get an understanding of what is going on in his community. That is immensely impressive. He has gone further than anyone else in understanding what is going on, on the ground. I thank him for his work. He is right to say that although the report looks in depth at a particular community and its needs, wider lessons can be learned from it. The report makes a useful contribution.

Like my hon. Friend, the coalition Government know how important it is to reform the current system of care and support. The voices of the people of Bradford reflect what we have heard from care users, their carers and voluntary organisations across the country, regardless of who they are or where they come from. They say that care and support needs to change. We have to move from an old-fashioned paternalistic system, where the council or the NHS knows best, to a personal system where we give real power to individuals to determine what their priorities are, what works for them and what makes them happy and contented in later life, despite sometimes having acute care needs.

My hon. Friend rightly highlights the significant demographic challenge facing us in years to come. About 14%—more than 71,000 people—of Bradford’s total population is aged 65 and over. Bradford’s local joint strategic needs assessment for 2012 predicts that by 2033 the number of local people over 90 will triple from 2,800 to 8,700. We should celebrate that. It is great that people are living to be older and often enjoying great quality of life for more years, but also many people live for years with more than one acute condition, which presents a challenge for them, but also a cost to society. Such a demographic shift will always be an immense challenge. Only if the care and support system changes and adapts can it meet the new demands and expectations of an ageing population in modern Britain.

The organisations that my hon. Friend mentioned are vital partners. This is not something that Government or local government can do on their own. The care and support White Paper, published in July last year, is an important step towards addressing these challenges. Our reforms will focus more attention on people’s well-being and independence throughout their lives, instead of waiting for them to reach a crisis point. They will also put people in control, giving them a far bigger say in their own care and support, and ensure that services are designed around their needs, rather than the needs of an institution.

The White Paper, together with the draft Care and Support Bill, will shape the care sector for years to come. The draft Bill, which my hon. Friend knows has been subject to pre-legislative scrutiny, sets out how we will put the plans into law. For the first time, we will create a single, modern statute, bringing everything together for adult care and support. It is good that that is written in plain English—English that people can actually understand without being a lawyer—which is quite useful. That statute will be clearer, fairer, and built around people, not processes, and around individuals, not institutions. It will empower people in Bradford and across the country to take control.

My hon. Friend highlighted the importance of the reforms to funding recommended by Andrew Dilnot. Last month, the Secretary of State for Health announced groundbreaking proposals to cap the costs of long-term care. That issue has been in the long grass for far too long. Successive Governments have put it in the “too hard to solve” category and just left it. As a result, ever more people have suffered catastrophic loss, losing everything that they have worked for. There is an acute unfairness in how the system almost penalises people for having been prudent and careful throughout their working life.

Individuals currently have little or no protection against the cost of care in older age. In Bradford, for example, some 5,000 people a year turn 65, and around 500 of those people each year could face significant care costs under the current system. Our reforms will ensure that everyone gets the care they need. We are ending the unfairness of, and fear caused by, unlimited care costs, while making sure that most support goes to those in greatest need. People will be protected from having to sell their home during their lifetime to pay for care.

The Government have committed to a £75,000 cap on care costs across England in 2017. I note my hon. Friend’s concerns about the cap’s geographical impact, and he proposes a regional cap as an alternative. The cap provides the same financial protection for people of equivalent wealth from different regions, and everyone will benefit from more peace of mind. However, I would say to my hon. Friend that, in some parts of the country, the costs of care are higher, so people reach the cap more quickly because they have to spend more of their own money. In a way, it is swings and roundabouts.

The other thing I would stress—my hon. Friend was right to point this out—is the significant increase in the range of means-tested support. At the moment, if people have more than £23,250, they get no help at all; they are on their own. That limit will be extended to £123,000. My hon. Friend said the average house price in Bradford is £94,000, so a substantial number of people there will get contributions towards their care costs.

In the spending review, we made clear our strong and ongoing commitment to adult social care by prioritising an additional £7.2 billion over four years—my hon. Friend raised concerns about tight social care budgets. Independent research by the King’s Fund supported our view that that should be enough for councils to maintain services, provided they make sure those services are delivered efficiently. Since that announcement of £7.2 billion, we have added another £500 million. In the context of a challenging local government settlement, that means that local authorities should be able to protect access to care. Ultimately, however, it is for local people and local authorities to determine their care spending priorities.

We cannot improve care and support simply by shovelling ever more money into the system. My hon. Friend was right to say that we must do things differently and work more efficiently to achieve better outcomes. Critically, that will be about a partnership between statutory authorities and the voluntary sector, including the organisations he spoke warmly of, which can really make a difference.

People have told us that the process of determining who is eligible for care and support is confusing and unfair. Decisions are not transparent, and they vary across the country. The result is that people are left without the support they need. The draft Bill provides for the national threshold my hon. Friend talked about. I understand his concern to protect the moderate threshold that Bradford has managed to maintain, and I applaud it for doing that. However, even if the threshold is set at a higher level—it has not been determined yet—Bradford will still be able to maintain a more generous system, if that is what it chooses.

My hon. Friend rightly focused on prevention as one of the key themes running through our reforms. We want a care and support system that is proactive and preventive, rather than reactive—repairing things when they have gone wrong. Such a system helps people to stay healthy and independent in the first place. We need to help people to maintain their health throughout their lives so that they do not, we hope, have to go into acute hospitals when everything goes wrong.

My hon. Friend might be aware that I recently announced a £300 million fund for specialist housing. Bradford already has seven extra care housing schemes, and it has submitted a bid to the specialist housing fund to develop further schemes. I applaud it on the work it has done locally to secure those schemes.

At the end of last year, the Government made available an additional £40 million across the country for aids and adaptations, and my hon. Friend referred to that. Bradford council will receive an extra £336,000. In total, £785 million will be provided over the four years to 2015. That will enable people to remain independent for longer.

My hon. Friend talked movingly about the problems of loneliness and isolation, and it is critical that we challenge them. If people are on their own, with no human contact, their mental and physical health will deteriorate. That is dreadful for them, but it is also costly for the system. We need to be much more effective at maintaining contact and using the voluntary sector—good neighbour schemes and so forth—to maintain human contact and friendship.

I want to say a word about integration. The White Paper sets out our ambition for health, care and support to be organised around the individual’s needs, rather than focusing on organisations and services. My hon. Friend mentioned the case study involving the ridiculously long wait for a ramp, which demonstrates how dysfunctional the system can be. It is crazy that someone returning home needs that little adaptation to maintain their independence, but it does not arrive for so long. That puts them at risk of a fall, which would result in their returning to hospital. That is a dysfunctional system. The Government’s absolute focus on encouraging and incentivising areas to integrate services across health and social care, and mental and physical health, is critical to providing better care and support for individuals.

[Mr Ward]

The absurd thing about this tragic case is that the gentleman was in Pinderfields for five months, and people knew throughout that time that he would go back to his own home. Yet, when he arrived, it was as if they thought, “What a surprise. He’ll need a ramp.” As I said, the gentleman is tetraplegic.

[Norman Lamb]

That is unbelievably stupid. All the preparation could have been done before he returned home so that everything was ready for him when he came back.

The draft Bill will significantly benefit those with caring responsibilities. It will simplify the process of assessments and, for the first time, place a duty on councils to meet a carer’s eligible needs for support. There will be a new resource of £175 million to ensure that that is implemented.

The Government’s independent advisory body—the standing commission on carers—visited Bradford in 2011 as part of a series of fact-finding visits. It had the opportunity to see first hand some of the valuable initiatives, including the carers information service and the emergency planning service, that have been commissioned by Bradford council from the carers resource.

Let me say a word about personal care. One of the best ways we can improve the quality of care is by getting people to exercise choice and control over how their needs are met. The draft Care and Support Bill will place personal budgets on a legislative footing for the first time. Local authorities should be working to meet the objective set out in the vision for adult social care and provide personal budgets for everyone eligible for ongoing social care. Preferably, that should take the form of a direct payment to individuals, so that they can determine exactly how they want the money to be spent. That should apply from April 2013.

My hon. Friend mentioned the importance of information and knowledge. He said that online information is not always accessible to all. IT and providing information online can be transformational in getting vastly more information out to people who need it, but we must always recognise that some people cannot access it in that way, and we must ensure that it is available in other ways.

Let me reiterate the fact that the White Paper, the draft Care and Support Bill and the Government’s decision to reform the funding of care and support represent a radical transformation of the way we meet the needs of individuals, families and communities. That transformation will require close collaboration and genuine cultural change, involving the Government, local authorities, the NHS, care providers, voluntary organisations, care workers, care users and their families, and communities.

I am therefore really encouraged by the brilliant work that has been undertaken in Bradford and by the local engagement and insight clearly evidenced in my hon. Friend’s report. Again, I congratulate him on the dedication and commitment he and his team have shown on one of the most important issues we face as a country. As our society ages, we face enormous challenges, but there is a message of hope, because these reforms will start to prepare us for the challenges of an ageing society.

Personal Health Budgets

Norman Lamb Excerpts

Friday 1st March 2013 Written Statements

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

On 30 November 2012, Official Report, column 37WS, I informed the House of our intention to roll out personal health budgets, including direct payments for health care, beyond the pilot programme.

In November we committed to publishing a consultation on the policy changes that the Department proposes to make to the National Health Service (Direct Payments) Regulations 2010 in light of the learning from the pilot programme. Today we have published the consultation and we welcome views on it.

Primary legislation will need to be updated in order to allow direct payments for health care in the NHS beyond the pilot programme. An order will be laid before Parliament under the affirmative procedure in the near future which, subject to parliamentary approval, will allow us to make the necessary changes to the regulations following on from the consultation.

“Direct Payments For Health Care—a consultation on updated policy for regulations” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 26th February 2013 Commons Chamber

[Priti Patel (Witham) (Con)]

12. What steps his Department is taking to increase the availability to patients of GPs and specialist health services.

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

The Department of Health is currently working with key partners to support the increase of training numbers in general practice. From 1 April, the NHS Commissioning Board will be responsible for commissioning primary care medical services and specialised services. It will have a duty to commission those services in ways that improve quality and promote integrated care. Clinical commissioning groups will be responsible for commissioning most other services.

[Priti Patel]

The Minister is aware of the need to increase health care provision in Witham town. Can he reassure me that the appalling financial legacy of Mid Essex primary care trust will not hold back proposals to provide much-needed health care in the town?

[Norman Lamb]

I applaud my hon. Friend for repeatedly raising her constituents’ concerns about this subject. We have made it absolutely clear that primary care trusts must work closely with clinical commissioning groups to ensure that they meet the challenges of the current financial year. As for the future, the joint strategic needs assessment and the health and wellbeing boards will provide real accountability locally, and I think that my hon. Friend will be able to feed into that to ensure that her constituents are given the health services that they need.

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

The Limbless Association wrote to Members of Parliament this month expressing concerns about proposals for the commissioning of extremely specialist prosthetic services, which would reduce patient choice and oblige the patient to follow the money rather than vice versa, and would damage some highly skilled professionals in the field. When did the Minister last meet representatives of the Limbless Association, and will he agree to meet them with me?

[Norman Lamb]

I should be happy to meet the hon. Lady and members of the association to discuss those concerns further.

[Mr Stephen Dorrell (Charnwood) (Con)]

There is currently much talk about the importance of integrated services. Can my hon. Friend assure us that when commissioning primary care, the NHS Commissioning Board will emphasise the importance of integrating it with the other community health services supplied by the NHS, and that social care will be included in that fully integrated service?

[Norman Lamb]

I am happy to give my right hon. Friend an absolute assurance to that effect. The Department and I are working closely and collaboratively with both the Commissioning Board and the Local Government Association to ensure that we deliver integrated care, which is much the best way of keeping patients out of hospital and maintaining their condition.

[Fiona Mactaggart (Slough) (Lab)]

What is the Minister doing to ensure that there are enough GPs in areas with high, rapid population growth?

[Norman Lamb]

There are plans to increase the number of training places for GPs, with the aim of providing more than 3,000 extra places by 2015. That will fully meet the needs to which the hon. Lady has referred.

[Henry Smith (Crawley) (Con)]

13. What steps he has taken to support research on the most common causes of premature mortality.

--- Later in debate ---

[Paul Blomfield (Sheffield Central) (Lab)]

14. What was the change in the level of spending in real terms on adult mental health services in 2011-12.

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

It is the responsibility of local commissioners to ensure that resources are used effectively to meet the needs of their local populations. According to the national survey of investment in adult mental health services for 2011-12, cash investment rose between 2010-11, but real-terms investment fell by 1%.

[Paul Blomfield]

I will meet Sheffield Mind on Friday, and one of the issues we will be talking about is the impact of that fall in spending on crisis care. Mind’s research shows that crisis care teams are often under-resourced and overstretched, with four in 10 trusts having staffing levels below the Department’s own guidelines of 14 staff to 25 service users. Does the Minister think that is acceptable, and if not, what is he going to do about it?

[Norman Lamb]

The Government inherited an institutional bias against mental health in the NHS. [Interruption.] It is absolutely true; when the 18-week target was introduced, nothing was available for those suffering with mental health problems. Mental health patients did not benefit from choice that was introduced elsewhere in the NHS. I completely agree with the hon. Gentleman about the importance of crisis services, and the first NHS mandate has required the Commissioning Board to do work on the availability of mental health services and to ensure that we can introduce access standards so that mental health service users and patients benefit from the same rights as those with physical health problems.

[Patrick Mercer (Newark) (Con)]

First, may I thank you for your earlier guidance, Mr Speaker?

May I thank the Department for its approach to the ravages to which Newark health care has been subjected, principally by the last Government, and thank the Minister for his forthcoming visit to Newark and assure him that mental health care services, which have been diminished in Newark, will certainly be top of the agenda?

[Norman Lamb]

The Minister who will visit Newark is, in fact, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), but I am grateful to my hon. Friend the Member for Newark (Patrick Mercer) for raising this issue and for highlighting the importance of mental health care. The mandate makes it very clear that the Commissioning Board and the NHS must make measurable progress towards achieving parity of esteem by 2015.

[Alun Cairns (Vale of Glamorgan) (Con)]

15. What recent estimate he has made of the potential savings to the NHS of making better use of technology.

--- Later in debate ---

[Graeme Morrice (Livingston) (Lab)]

T10. What steps is the Secretary of State taking to prevent the fragmenting of the national health service through a massive reorganisation that is costing £3 billion, diverting much-needed resources from the front line?

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

The truth is that the Government inherited a completely fragmented NHS; we had managed institutionally to separate health care from social care, mental health from physical health and primary care from secondary care. At the heart of the legislation we have already passed and the proposed social care legislation, which we hope to introduce very soon, is the principle of integrated care. I am determined that that should be central in every area of the country so that we deliver proper care and avoid crises, keeping people out of hospital.

[Mr Adrian Sanders (Torbay) (LD)]

T5. The South Devon and Torbay clinical commissioning group is building on the integrated health and social care system for which many have praised the area. Will the Minister help complete the integration by assisting with the inclusion of mental health care services within the regime?

[Norman Lamb]

I thank my hon. Friend for that question and applaud the brilliant work that has been done in Torbay. There has been a reduction in hospital admissions because they care for people better. As I said in my last answer, it is essential that we integrate mental health in the system as well as physical health so that we give people proper care.

--- Later in debate ---

[Mr Speaker]

I think the hon. Gentleman was seeking an Adjournment debate and is disguising his request as a question, for which we are grateful.

[Norman Lamb]

I thank my hon. Friend for that question. I am happy to discuss it further with him. Value-based pricing will be primarily for new drugs, but obviously I understand his concern. It is the concern of the Government to ensure good access to cancer drugs for patients in the future.

[Kerry McCarthy (Bristol East) (Lab)]

Recent comprehensive research by the international study of asthma and allergies in childhood found strong evidence of a link between fast food and asthma, but when I asked the Minister which public health responsibility deal partners he had discussed that with, he said that evaluating science was not within their remit. Does he agree that if the fast food companies have the kudos of being classed as public health responsibility deal partners, they ought to look into such research and actually take some responsibility?

--- Later in debate ---

[Helen Goodman (Bishop Auckland) (Lab)]

Every year 18,000 epileptic fits are triggered by video games and screen-based activity. Can the ministerial team tell us what research is being done on that and what discussions they have had with the industry to make video games safer and improve the labelling?

[Norman Lamb]

I would be happy to look into that further. I recognise the significant concern that the hon. Lady raises. Often the diagnosis of epilepsy is not good enough and there needs to be much better co-ordinated care. The issue that she raises is important and I am happy to look into it further.

[Andrew George (St Ives) (LD)]

In spite of my right hon. Friend’s earlier comments, I am afraid that the regulation that implements section 75 of the Health and Social Care Act 2012 does not maintain the assurances previously given and risks creating an NHS that is driven more by private pocket than concern for patient care. Will the Secretary of State please withdraw that regulation and take it back to the drawing board?

[Norman Lamb]

We are looking at this extremely seriously. Clear assurances were given in the other place during the passage of the legislation, and it is important that they are complied with in the regulations.

[Several hon. Members]

rose—

Ankylosing Spondylitis

Norman Lamb Excerpts

Monday 25th February 2013 Commons Chamber

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

I congratulate the hon. Member for Ogmore (Huw Irranca-Davies) on securing the debate, and I was also delighted to hear from the hon. Member for Linlithgow and East Falkirk (Michael Connarty). I am conscious that, having allowed an additional speaker, we are quite short of time, but if I cannot deal with all the issues that have been raised, I will be happy to write to hon. Members who have participated in the debate to answer their questions.

I know that the hon. Member for Ogmore has worked tirelessly in this cause and speaks with great personal experience. One of the great values of debates such as this is that they focus our minds on subjects that otherwise do not get the attention that they might deserve, and we all benefit from that. I am grateful to him for that.

The Government fully recognise the importance of early diagnosis, of differentiating ankylosing spondylitis from other causes of back pain and of effective drug treatment. The hon. Gentleman spoke movingly of the impact that anti-TNFs have had on him, and the transformation that they have made on his life, along with regular exercise to maintain mobility, has clearly been quite remarkable. He is putting his words into action with his 50-mile walk. I would love to join him, and I would really enjoy his company, but sadly I do not think it will be possible. However, I absolutely agree to the meeting that he asked for as an alternative —it is an attractive alternative, and I look forward to it.

The Government also understand the importance of accessible information and support so that people can take care of their own condition. The ability to self-care is critical, as is regular follow-up by specialised practitioners. I welcome the lead that the National Ankylosing Spondylitis Society has taken in publishing its good practice guide, and I recognise that there is still too much variation within the NHS in the provision of services for AS and for musculoskeletal conditions in general. The question is what should be done to remedy those deficiencies.

The last Administration sought to improve the quality of care for a number of major conditions by means of a rather top-down improvement model, and I totally understand why. It involved a combination of national standards, a uniform national programme with target dates for achieving standards, ring-fenced funding for specific improvement initiatives, demonstration programmes and top-down performance management to ensure that the NHS delivered. The programme was clearly well intended, and we recognise that it achieved demonstrable improvements in a small number of major conditions—coronary heart disease and cancer, for example. However, that model of quality improvement would be totally impracticable and unsustainable if we attempted to replicate it across hundreds of less common conditions.

I recognise that 200,000 people have this condition—as the hon. Gentleman said, that is more than have Parkinson’s and MS—and such a move could overwhelm the capacity of NHS management, not to say that of national bodies such as the National Institute for Health and Clinical Excellence. The entire NHS budget could be tied up with rather inflexible packages of ring-fenced funding. It therefore seems that we need a general model of quality improvement that recognises that real people are different in all sorts of ways, and that increasingly people suffer from more than one long-term condition and need holistic, not atomised, care that meets their particular needs.

Given that time is tight, I will turn to the specific points raised by the hon. Gentleman. I agree completely about the importance of raising awareness of this condition among GPs, especially given the importance and difficulty of early diagnosis. The hon. Gentleman mentioned his long and winding road to finally getting a diagnosis after 10 years, which, as he said, is the experience of many people. I salute the valuable work done by the society’s GP awareness campaign, but we must also recognise that in their day-to-day work GPs have to deal with and recognise a vast number of different conditions and may meet a new case of ankylosing spondylitis only once every few years. There is no easy answer to that dilemma although in future computerised decision aids such as clinical knowledge summaries may help to prompt GPs to recognise or at least suspect more serious but rarer conditions such as AS.

The hon. Gentleman drew attention to the society’s recommendation that MRI scans should be used in the diagnosis of early AS, rather than waiting for damage to become apparent on a X-ray. I understand that a consensus for that proposal is developing among clinicians, but I am not sure whether there are any further actions that the Department or Commissioning Board could usefully take at this stage to promote a greater uptake of such an approach. In a sense, word is spreading among clinicians about the potential value of such a move.

The hon. Gentleman asked whether we should commission NICE to develop a quality standard or clinical guidelines for ankylosing spondylitis, but I am afraid I cannot offer a lot of comfort. As he may be aware, we have recently published a list of all quality standards that we currently expect NICE to develop, following extensive consultation with professional and patient organisations. The list includes a number of the more common musculoskeletal conditions but not AS. In future, the NHS Commissioning Board will be responsible for requesting NICE to develop additional standards. In the meantime, it is open to the National Ankylosing Spondylitis Society to propose to NICE that the quality standard for chronic pain should include a statement on the need to consider other serious conditions for patients presenting with chronic back pain. That might be a valuable thing to do.

The hon. Gentleman drew attention to the importance of support for self-help in managing this condition, and he leads from the front in that respect. As I have made clear, we are in complete agreement on that point, and the model of care to which I have already referred—which of course applies to other conditions and not just AS —will strongly promote that approach.

Finally, the hon. Gentleman invited me on his walk. I wish him well and hope that he gains great fitness as a result of it. I also think that a meeting would be of great value. I am delighted to have had the opportunity to debate this important issue, and I pay tribute again to the eloquent way in which the hon. Gentleman made his case for better care for people with AS. I hope that this debate will help to bring those issues even more into the public spotlight.

Question put and agreed to.

Backbench business

Norman Lamb Excerpts

Thursday 14th February 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Walker. You are an appropriate Chair for this debate because of your interest in mental health and your willingness to speak out about your own experience, which meant an enormous amount to those who are fighting the stigma of mental health problems. Indeed, my hon. Friend the Member for Braintree (Mr Newmark) has done the same today. Such moments, when people are willing to speak out, are incredibly important in challenging and addressing the stigma of mental health problems in society.

I am deeply grateful to the members of the Backbench Business Committee for convening this important debate. It is good that Parliament has recently been willing to debate a number of different mental health issues in a way that perhaps has not happened in the past. Mr Walker, before Christmas you raised the issue of schizophrenia, on which we had a useful debate. The great value of such debates is that they force people to think about an issue, just as my hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe) has today. His experience of recognising the problem, perhaps for the first time, and talking about it with his children demonstrates the great value of such occasions, because they force all of us to think about an issue. Indeed, they force officials in my Department to think about the issue, too. I am grateful.

I do not want to detain everybody unnecessarily, but I will devote a little time to responding to the specific issues that hon. Members have raised. If the hon. Member for Romsey and Southampton North (Caroline Nokes) does not mind, I will refer first to the speech by my hon. Friend the Member for Braintree. I am so grateful that she persuaded him to come speak in this debate, because he made an incredibly valuable contribution. I was struck by his remarks about the huge stress experienced by teenagers. As the father of two boys who have been through the teenage years, I am acutely aware of the pressure on teenagers and the impact that it can have on their mental and physical health. He discussed huge stress, fear of failure and anger. I was struck by what he said: unless the mind is healed, the body cannot heal. We must look at the problem holistically.

One problem with health care is that we have institutionalised fragmentation. We have managed to separate mental health from physical health, which is ultimately not a good thing. We must consider the whole person. I know that the Opposition have been talking about that. It should not be an issue for political disagreement; it is such an obvious thing to recognise.

My hon. Friend the Member for Braintree discussed the need for education and raising awareness, including among parents. The strain, stress and anxiety that parents go through must not be underestimated. Improved awareness is needed in society of this range of conditions. He said that mental health care was the orphan within the NHS, which is absolutely true. There is an institutional bias against mental health. The way that money flows within the NHS disadvantages mental health. There is an 18-week target for physical health care and a tariff, meaning that every patient takes money with them into acute hospitals. Money is sucked through into acute hospitals, and there is great political pressure from every side to maintain the 18-week target. There is no equivalent in mental health. There is no right of access. Waiting nine months to access care and treatment is completely unacceptable. We must challenge that, and he was absolutely right to raise it. He ended on a positive note. There can be life after anorexia, however tough it is to get through it. Some, terribly sadly, do not. I will return to that point in a moment.

The hon. Member for Romsey and Southampton North made some incredibly important points. She mentioned her local organisation, April House in Southampton, and the fantastic work that it does, and she spoke about the absolute importance of raising awareness in primary care. Some people are lucky enough to find a GP who understands mental health and is passionate about it, but some are not. Families with a GP who just does not get it can be desperate; they have nowhere to turn. There is a need to raise awareness.

In the first mandate, a set of priorities published by the Government for the new NHS Commissioning Board, mental health has been given a higher priority than it has ever had in the NHS. The mandate makes it clear that the NHS is under a legal obligation to deliver demonstrable progress towards parity of esteem by 2015. That means treating mental health on a par with physical health. By placing the commissioning board under that obligation and disseminating the message to clinical commissioning groups, we will start to make progress on forcing the system to recognise the importance of treating mental health and physical health equally. It will not happen overnight, but it is a journey that we must take to improve the condition of many people. The hon. Lady discussed the impact on families and the unfair sense of guilt that many experience. She also mentioned waiting times, which in many cases are simply unacceptable.

I am grateful to the right hon. Member for Knowsley (Mr Howarth) for his contribution informing me and others about diabulimia. He discussed the rapid weight loss that can occur with diabetes, and how some people use the condition to lose weight in a dangerous way. He also said that in too many cases, a wrong diagnosis is made and the wrong treatment given as a result, and urged me to ensure that the condition was recognised better at a national level and the knowledge disseminated through the system. I urge him to engage with the commissioning board. I am happy to work with him on that, and for him to write to me on the issue.

[Mr George Howarth]

I am grateful to the Minister for the helpful way that he is addressing the problem. I have written to one of his ministerial colleagues on the matter. I arranged a meeting with her that she had to cancel owing to diary commitments, but I would be more than happy to meet him and anybody else he wants, including Diabetes UK and Diabetics with Eating Disorders. I am sure they would be happy to accompany me.

[Norman Lamb]

I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.

The hon. Member for South Derbyshire (Heather Wheeler) made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.

The hon. Member for North Tyneside (Mrs Glindon) mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.

I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.

I pay tribute to the hon. Member for Enfield, Southgate (Mr Burrowes), who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend the Member for Wells (Tessa Munt) spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.

Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.

My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.

The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.

The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.

The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.

This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.

I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.

Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.

According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.

[Valerie Vaz (Walsall South) (Lab)]

I apologise for not attending earlier, Mr Walker; I was in another debate in the main Chamber. I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing this debate.

The Minister mentioned young people. Will he say what services are available for 17-year-olds in terms of continuity of care, as they move to adult services?

[Norman Lamb]

I will talk about that later. In so many respects, we have problems with people falling through the gap between children and adolescent mental health services and adult services, and that is matched in other areas, as well. There is a need to deal with this. The draft Care and Support Bill deals with the transition from teenage to adult services. I will return to that matter. I thank the hon. Lady for her intervention.

A generation of young people is growing up depressed and unhappy with their relationship with food. I want to tell hon. Members about a case in my constituency. Charlotte Robinson was a bright, outgoing young woman who was about to secure straight As at A-level and had dreams of going to Cambridge—between Duke of Edinburgh’s awards and learning to fly helicopters—but tragically, Charlotte was a victim of anorexia, stolen from her family in her prime, with her whole life ahead of her. That is what I meant when I said that for some, thankfully, there is life after anorexia—but not for everyone.

Charlotte’s parents, Christopher and Pauline, who are remarkable people, have campaigned tirelessly to help others. Pauline even ran the London marathon in pink wellies, such is her commitment. They are fantastic people and their attitude was that they did not want other families to experience the same horror that they have gone through, so they have been determined to change things in their county of Norfolk. They discovered that there was no specialist commissioned service at all in their own county. This is what we find. Hon. Members have talked about the enormous gaps in services around the country.

As a result of Christopher’s and Pauline’s fantastic determination, there is now a specialist commissioned service, but it took their efforts to achieve it. Their efforts have helped to fund local centres and a helpline in Norfolk, working with NHS Norfolk and the charity Beat, which I have mentioned. Their focus is on early intervention, helping people like Charlotte—helping children, young people and adults as soon as they need help. Charlotte’s decline was dramatic and rapid and the wait, although nothing like the nine months that we have heard about, still was too long for her.

Speedy access and early intervention are critical. That is why our mental health strategy prioritises early intervention and demonstrates how timely action can help.

In many cases, eating disorders stem from low self-esteem or are linked to stress and emotional problems. That is why our support for local organisations in improving mental health services locally is so important. Our mental health and suicide-prevention strategies both include actions that local organisations can take to improve mental health in their areas: ensuring that children and parents get mental health support from birth; that schools and colleges promote good mental health, alongside targeted support for those at risk of mental health problems; that public services recognise people, of all ages, at risk of mental health problems and take appropriate, timely action; and that health services step in early if there is psychosis or a crisis, to stop more serious problems occurring.

The right hon. Member for Knowsley and my hon. Friend the Member for Romsey and Southampton North raised the problem of transition—moving from being a young teenager at home to a young adult. Often the problem is exacerbated by moving to university, where people suddenly lose contact with services that might have been available to them at home. As my hon. Friend mentioned specifically, that is where things can break down. Away from friends and family, in a new and often stressful environment and, crucially, registering with a new GP, young people can often enter a spiral of decline. The problem must be addressed.

I will now outline some of our ambitions for services. From this April, the NHS Commissioning Board will commission specialist services for eating disorders for adults and children. Having one specialist group to ensure that specialist services are commissioned everywhere has the potential to improve the position in many parts of the country where such services are inadequate or missing. The Commissioning Board will develop a national service specification and encourage better planning, access and outcomes, helping to bridge the gap when someone moves and raising the level of care throughout the country.

We want clinical commissioning groups to commission services with early intervention in mind. We also expect adult social services to work alongside CCGs to focus existing support on early intervention, integration, personalisation and recovery. Social services have a role to play, involving service users as equal partners in commissioning and monitoring services, ensuring that services are designed for the people who use them.

Public health services can articulate the many benefits of good mental health and, because of their pivotal role in the new system, they can talk about mental health directly with members of the public. The transfer of public health to local government, alongside children’s services, social care and other services, with a seat on the health and wellbeing board, potentially gives it a prominence that it has not had in the past. The funding settlement for public health has also surprised many people, with significant real-terms increases this year and next. There is great potential for a focus on public mental health in a way that we have not had in the past, so I hope that we can take advantage in the best possible way of that opportunity.

Of course, the problem cannot be fixed by tweaking the system. A huge stigma remains around mental health, which means that in too many cases children and young people are not getting the support that they need. That is particularly the case with eating disorders, and people affected often feel marginalised and excluded, unable to talk about their suffering. The problems can be compounded if the sufferer is a man or suffering from a less stereotypical but no less serious eating disorder, such as atypical anorexia or a binge-eating disorder. Personal testimony and the courage of individuals in speaking out send a powerful message, and challenge that stigma.

The Department of Health is therefore funding Time to Change, a brilliant campaign that was started under the previous Government but continues now. We are providing £16 million between 2011-12 and 2014-15, the first time that Time to Change has had central Government funding. It will also get a further £4 million from Comic Relief, the second time that that charity has awarded its largest UK grant to Time to Change. Run by the charities Mind and Rethink Mental Illness, Time to Change is England’s most ambitious programme to end the stigma and the discrimination against mental health through activities ranging from education to publicity. It aims to reach 29 million members of the public, explaining mental health and helping them to understand conditions, including eating disorders, that might at first seem alien or scary.

I was delighted that two young women from Time to Change came into the Department of Health recently to speak about their own experiences of mental health. They spoke about how talking about their own mental health had empowered them. One said that it had, “given me my life back”. Their stories were both moving and inspiring and I pay tribute to all those who find the courage to open up and to talk to others. Time to Change aims to increase the confidence of 100,000 people with mental health problems, helping to give them the self-belief that they need to recover.

The Time to Change campaign also works with schools to support children and young people facing problems of integration and bullying that can be caused by mental health issues. I have not only signed up to committing the Department of Health to be an exemplar employer on mental health, but made the commitment to try to get every other Department to sign up as well. We cannot encourage others to behave in the right way unless we practise what we preach. That is a challenge for Government, and I have not yet achieved that aim, but I am determined to pursue it.

The reasons for eating disorders are complex, as has been made clear in the debate this afternoon. Biology and genetics play their part, but so too does the pressure from our celebrity culture and the media. A recent controversy ignited by stick-thin La Perla lingerie models erupted only last week, and it is important to send out the message that organisations that do this sort of advertising have a responsibility; they cannot opt out. Government cannot do everything on its own. Everyone in society has a responsibility to get the right messages out. I was pleased to hear the shadow Minister’s reference to Vogue, which has made a good commitment to avoid getting out the wrong images.

[Caroline Nokes]

This is an important point. Last week, we had a controversy about La Perla using stick-thin models for its lingerie but, before Christmas, Marks & Spencer used some “larger ladies” in lingerie advertising. Some of them were almost a size 12. What would the Minister say to those in the health care professions who cited that advert as Marks & Spencer promoting and celebrating obesity?

[Norman Lamb]

I take the point and I am grateful for that intervention. We have to think before we speak on these things, to ensure that we do not send out confusing messages. There is a problem of obesity in our society and it is causing serious concerns about a drift towards type 2 diabetes and a whole series of health consequences, but let us be balanced in what we say and not confuse youngsters in such an unhelpful way. In the compelling words of Marya Hornbacher, in her memoir of anorexia and bulimia, we are “turning skeletons into goddesses” and teaching our children and impressionable young people to hate their own bodies. That is why I am so grateful to the hon. Member for Romsey and Southampton North and members of the all-party group on body image for their tireless work in addressing the causes and consequences of body image anxiety. Through the Government Equalities Office, the coalition Government are conducting our own body confidence campaign, with three main aims: to raise awareness about body image and encourage a more open and public conversation; to promote a world where all healthy body shapesare represented, and people recognise that their value is far more than merely their physical appearance; and to widen the definition of beauty to include all ages, ethnicities and healthy sizes.

Pro-anorexia and pro-bulimia websites, which were mentioned by the shadow Minister, the hon. Member for Romsey and Southampton North and others, have grown significantly in recent years and are represented on sites such as Facebook. They do not cause eating disorders, but they play a significant role in exacerbating and reinforcing illness. Limited research is available, but what there is shows us that a significant number of teenage girls in particular visit such sites, including a substantial proportion of young people who already have an eating disorder. Disturbingly, nearly all of them report learning new weight-loss techniques from the sites. I am extremely concerned about those sites but cannot take legal action against them as they are not in themselves illegal and might also be hosted overseas, but we continue to explore other, non-legislative courses of action. For example, we recently worked with a media agency to run advertisements directing youngsters to more appropriate sites, because there is much good information out there on the internet, as well as dangerous sites.

A couple of weeks ago, I met security companies such as McAfee and Symantec, and urged them to work with groups such as the Samaritans, Beat and BeatBullying, as well as internet service providers, and to sign up to a concordat, speeding up the reporting of harmful content and blocking harmful websites. They told me they would explore such a concordat. In turn, the Government would be willing to facilitate and support such an initiative in any way we can.

We cannot place all the blame at the feet of the media. That would dramatically underestimate the scale and nature of the problem, but it is something we must challenge. Education and early intervention, keeping an eye out for symptoms, and providing relevant support are simple things that can dramatically increase the chances of recovery.

Sufferers have asked us to listen. My message to them is that we are listening. As I said, I have had personal experience from my work in Norfolk of the horror of this condition and its impact on families. While I am in this job, I want to do everything I can to help others to address this very serious problem and to improve the lives of those who are affected by it.

Suicide Prevention

Norman Lamb Excerpts

Wednesday 6th February 2013 Commons Chamber

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

I shall try to behave, Mr Deputy Speaker, and to address the Chair, as you rightly instructed us to do.

We in the House of Commons frequently find ourselves at loggerheads, and common ground is often hard to come by, but we unite—as a Parliament and as a country—in lamenting the number of people who die by suicide every year. I pay tribute to the hon. Member for South Antrim (Dr McCrea) and his colleagues for selecting this issue for debate, because it is so easy to go for other less difficult issues. The hon. Gentleman has done the House a service by choosing this subject and giving it a proper airing so that we can debate it and demonstrate to the country that we are focusing on things that matter a great deal. I thank him genuinely for that.

I noted what the right hon. Member for Wythenshawe and Sale East (Paul Goggins) said about the importance of families and their role. As he said, it is important to listen to them, to understand their perspective, and to recognise what they go through. Once someone has taken his or her own life, the impact of that lost life lasts with the family for the rest of their lives. We owe it to families to listen to them, and to do better in preventing suicide.

The hon. Member for South Antrim produced the shocking statistic that 1 million lives are lost globally, and told us that in many countries young people are now the highest-risk group. He also told us that males are more susceptible to suicide—both middle-aged and young men—and that suicide is the biggest single killer of men under the age of 35. That in itself is deeply concerning. We need to stop and think about the turmoil that is often associated with individuals in the lead-up to the moment when they make their decision. We have a responsibility to do all we can to address that.

The hon. Gentleman spoke of the importance of recognising the prevalence of self-harm and the disturbing trends that we are seeing. That is of real concern, and, as the hon. Gentleman said, it is a serious problem in Northern Ireland. My hon. Friend the Member for Beckenham (Bob Stewart) wondered whether it was sometimes a post-conflict issue. I know that a lot of work has been done in relation to post-traumatic stress following conflict, wherever it takes place in the world, and the risk that young men and young women may take their own lives as a result. I join others in paying tribute to organisations such as the Samaritans and Papyrus for their work in helping people at moments of real risk.

[Simon Hughes]

I think it is important to provide signposting, so that young people, from secondary school onwards, know where they can go for help. It should not necessarily lead to teachers, family or pastoral care workers, because young people may not want to share their problems with them, especially when the first signs of self-harm appear. We should also do much more to ensure that university health services provide cognitive behavioural therapies and similar services much more quickly than many are able to at present, because the lack of such services has been a real cause of crisis, tension and, indeed, increased suicide risk.

[Norman Lamb]

One of the things that I am determined to do while I am in this job is give mental health services, and access to them, the real priority that they deserve. Our first mandate to the NHS Commissioning Board gives mental health a much higher priority than it has ever had before. In establishing the principle of parity of esteem, we have asked the board to pay particular attention to access to mental health services in order to ensure that people with those problems have the rights of access that people with physical health problems have had for some time. Every life taken by suicide is one too many.

[Lady Hermon (North Down) (Ind)]

I am grateful to the Minister for taking a second intervention so soon after the first. He has rightly paid tribute to the work of the Samaritans, who undoubtedly prevent a huge number of people from taking their own lives and who do tremendous work in Northern Ireland. What public funding do groups such as the Samaritans, who do such tremendous work, receive from the Government?

[Norman Lamb]

I cannot give the hon. Lady precise figures here and now, but I will write to her and make sure she gets a full response to that legitimate point.

This debate serves as a timely reminder that suicide continues to be a major public health issue, particularly at a time of economic and employment uncertainty. The suicide rate in England is relatively low on international comparisons, and good progress has been made in reducing the rate in England over the past 10 years. That is something to be proud of, but it must not be the end of the struggle. We must be vigilant. About 4,500 people took their own lives in England alone in 2011, an increase on the previous year of about 6%. Although the three-year average suicide rate has remained steady since 2005-07, the rise in the number of people dying by suicide in 2011 is deeply worrying.

We know that suicide rates vary across the UK, and the hon. Member for South Antrim made the point that the suicide rate in Northern Ireland is higher than in England. In fact, it is the highest in the United Kingdom, and Scotland and Wales also have their own very real challenges. The coalition Government are working with the devolved Administrations to share evidence on suicide prevention and effective interventions. Suicide is still a major taboo. The hon. Gentleman highlighted the importance of our collectively speaking up about the subject. The way to reduce the number of suicides is not to comply with that taboo and keep it under wraps; on the contrary, we must tackle the problem and the surrounding issues head on.

We published a new suicide prevention strategy for England in September last year. It was written to help to reduce the suicide rate and it prioritises the importance of supporting families, so that those who are worried about a loved one know where to go for help, and supporting those who are bereaved as a result of suicide. They must receive help. There are excellent organisations such as Cruse Bereavement Care—I should declare an interest as my wife works for it—that provide support for people who are bereaved.

The strategy is backed up by up to £1.5 million for research, and it highlights the importance of helping the groups at highest risk of suicide by targeting interventions in the right way and at the right time. In-patient services are getting better at that. The most recent national confidential inquiry into suicide and homicide shows that the long-term downward trend in patient suicides continues.

Giving greater priority to mental health services is also critical. We are championing parity of esteem for physical and mental health, and through our improving access to psychological therapies—IAPT—schemes we are treating more people than ever before for mental health problems. Through the Government’s NHS mandate, we have gone much further than ever before in emphasising the priority the NHS must give to mental health. The mandate also makes specific reference to the need for mental health services to seek to reduce the suicide rate among users of their services, although I take on board the point made by the hon. Member for Bridgend (Mrs Moon): we must also be acutely aware that many people—I think she gave the figure of 75%—who take their own lives are not known to the statutory services. It is very important that the statutory services do everything they can, but that is not the whole problem; there is a very significant issue beyond that.

We also need to make sure there is enough information about treatment and support, and that it is freely available to those who need it, including those who are suffering bereavement following a suicide. A lot of that planning and work will happen locally, with local agencies deciding on how best to reduce the suicide rate and support families. Our recent strategy is not an instruction manual; it is more a tool to support local agencies in working out what is needed.

Suicide prevention will also be a priority for the new public health system. The public health outcomes framework has the suicide rate as an indicator. That is a horrible piece of jargon, but this project addresses what outcomes and results the whole system is trying to achieve, and one of them is the need to reduce the suicide rate. A shared indicator with the NHS outcomes framework also focuses on reducing the number of premature deaths of people with serious mental illness—such deaths also, of course, include suicides.

We are tackling stigma in relation to mental health, which the hon. Member for South Antrim rightly mentioned, with the brilliant Time to Change programme led by the charities Mind and Rethink Mental Illness, which is designed to reduce stigma and break isolation. A few months ago, we had a brilliant debate in this House when Members talked about their own experiences of mental health. That, in itself, was very important in bringing the issue out into the open and recognising that successful people, as well as many others, suffer from mental health problems and it is nothing to be ashamed of.

Children and young people have an important place in the new suicide prevention strategy. The suicide rate among teenagers is below that in the overall population, but that does not mean it is not a problem. For example, suicide is still the most common cause of death in young men, as I mentioned earlier. In addition, about half of mental health problems begin to emerge by the age of 14.

[Bob Stewart]

I apologise for intervening, as the Minister was perhaps going on to deal with this matter. We have now heard four or five times that the level of suicide among young men is much higher than that among young women, but nobody has said why that might be. Is there an answer to that question?

[Norman Lamb]

I thank my hon. Friend for that intervention. I would not want to indulge in cheap speculation about that. The statistics are clear on the prevalence of suicide among young men and clear that it is significantly higher than among young women. It is important that we carry out the research, which is why the Government have also committed to that as well; it is so that we gain a better understanding.

[Mrs Moon]

The Minister will be aware that research suggests that women and young girls are less vulnerable to suicide because they are help seekers, whereas young men are not and they will not articulate the problems they are facing. That is the major difference. Women and girls will go to their friends and talk about their problems, whereas men bottle things up so that they grow and grow and they can no longer manage them.

[Norman Lamb]

I thank the hon. Lady for that helpful intervention. What she says makes sense and I am most grateful to her for coming to my rescue on that—

[Several hon. Members]

rose—

[Norman Lamb]

More people are coming to my rescue.

[Simon Hughes]

I am always ready to try to rescue, but on this occasion that was not necessary. If sufficient research does not exist on the extent to which people know where to access services, it would be really helpful if the Minister worked with local government and the health and wellbeing boards to try to ensure that such research was carried out. I have a strong feeling that lots of young people, including young men, do not yet know where to go. If they did know, there would be a much better chance that they would do something about their problems and not keep them all inside, with the worst consequences.

[Norman Lamb]

I am grateful to my right hon. Friend for that intervention, and he is right to say that ensuring that youngsters know exactly where to go to find help is really important. Gaining a better understanding of that must be a priority.

[Mr Nigel Dodds (Belfast North) (DUP)]

I wish to support the point made by the hon. Member for Bridgend (Mrs Moon) a moment ago about the reasons why suicide is more prevalent among men. It was backed up for me by a recent piece of work carried out in my constituency that showed it is much more difficult to get young and middle-aged men to visit a GP or confide in someone about their health problems than to get women to do the same. The work showed exactly the same problem: a lack of willingness to seek out help early enough. That is a major problem and it needs to be dealt with by more education and information, particularly for young men.

[Norman Lamb]

I thank the right hon. Gentleman for that constructive intervention, and he is absolutely right.

The suicide prevention strategy also recognises that the media have a significant influence on what children do and think. As well as promoting responsible reporting in the media, the strategy emphasises the importance of working with the industry to tackle websites that encourage suicide. That is, in a sense, at the heart of the motion and of the points raised by the hon. Member for South Antrim.

Misuse of the internet to encourage vulnerable people to take their own lives is utterly wrong. It is deeply worrying that young people can easily be exposed to such pernicious material, but we should not dismiss the internet as a source only of harmful material. It also provides an opportunity to reach out to vulnerable people who might otherwise refuse support or information, including those young men who might not come forward. It is worth remembering that when used well the internet can be an incredibly valuable way of helping vulnerable people.

Only last week, I convened a meeting bringing together internet security companies, charities and Departments to explore how to protect children and young people from harmful suicide-related internet content. The industry representatives at the meeting told me about some of the good work they are already doing. For instance, McAfee informed me that it has valuable learning to share from its work with the Australian Government on an online safety campaign in schools. I think my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) will be interested to hear about that. McAfee has campaigned to get the message out to schools in Australia so that youngsters have information about how to seek help. There is a lot we can learn from that.

At that meeting—

[Lady Hermon]

I am grateful to the Minister for giving way; it was terribly rude of me to interrupt and I apologise. Will he reassure us that when he convened that critical meeting with those who provide internet services, representatives from the devolved Administrations and from the Health Departments in Northern Ireland and Scotland were invited to attend? When we debate the United Kingdom, even though we have a devolved Administration in Northern Ireland I like to know, as someone who feels passionately about remaining in the United Kingdom, that we have joined-up government.

[Norman Lamb]

I am very grateful to the hon. Lady for her intervention. Those representatives were not invited to the meeting, but let me make a clear commitment that we will work with the devolved Administrations. I mentioned that earlier and it is in all our interests that we tackle the problem together.

At that meeting, I urged the security companies, such as McAfee and Symantec, to work collaboratively with interest groups who were present, such as Samaritans and BeatBullying, and internet service providers to sign up to a concordat that would help to speed up the process for reporting harmful content and the blocking of harmful websites. They gave me positive assurances that they would explore such a concordat, and in turn we as a Government would be willing to facilitate and support such an initiative however we can.

The UK Council for Child Internet Safety is already making parental controls more accessible so that children can access less harmful content. The Under-Secretary of State for Education, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson), who is the Minister responsible for children and families, will explain more about the work his Department has been doing when he sums up.

As I said at the outset, this is one of the issues that unite us all.

[Tracey Crouch]

I thank the Minister for giving way, as he has been very generous in doing so. We have heard that there are a host of reasons why people are driven to suicide, one of which is alcohol dependency. Is the suicide prevention strategy working alongside the alcohol strategy so that there is a holistic, joined-up approach to dealing with some of these complex issues?

[Norman Lamb]

Yes, very much so. I am grateful to my hon. Friend for her intervention. In each area in England, the health and wellbeing boards will be able to co-ordinate all that work. In considering their strategic needs assessments, they will be able to identify issues relating to suicide and alcohol and drug dependency.

I hope that I have satisfied the House that the Government take suicide extremely seriously indeed and that we are taking real action to help. I am grateful to the hon. Member for South Antrim for bringing the matter to the House’s attention.

Epilepsy

Norman Lamb Excerpts

Tuesday 29th January 2013 Commons Chamber

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

I think I must have broken the record for the time it takes to get from Committee Room 11 to the Chamber. It took under a minute, even though I bumped into our Chief Whip on a staircase and came off worse.

I congratulate the hon. Member for Vauxhall (Kate Hoey) on securing this important debate and on setting out the issues so clearly. I also thank hon. Members for their valuable interventions, which have been helpful. Occasions such as this are valuable because they expose to public attention issues that do not get debated enough in this place. They also force Ministers to think about particular conditions and their consequences. If I do not have ready answers to all of the issues that the hon. Lady has raised, I would be very happy to write to her to ensure that everything gets a proper and full response.

By way of introduction, I join the hon. Lady in paying tribute to Epilepsy Action for its work and the excellent report it has produced. It is great that we have this opportunity to highlight the issues that it has raised. She referred to the low level of engagement at the local level. She pointed out that there is good practice in many areas, but that there are also too many places where not enough is being done. In a sense, the thing that causes frustration is also the prize: the fact that we know that if we do things better we can improve the lives of people so much. That is a great prize to be secured. Along with Epilepsy Action, the Joint Epilepsy Council, which is the overarching group, also does very important work.

I should also mention that I met representatives of Epilepsy Bereaved before Christmas to discuss sudden, unexpected death resulting from epilepsy, and I found it an incredibly useful session. I learned a lot about the extent to which, through better care, we could significantly reduce the number of people who die in such circumstances. It is, therefore, incumbent on the whole NHS to ensure that we raise the level of care to the standard of the best. If we can do that, we will make a real difference.

I was concerned to hear the hon. Lady say that mortality in epilepsy is rising. Given that we know that if we do the right things we can significantly reduce mortality, that is a real concern. Epilepsy Bereaved made the case for a national register of deaths, which I strongly supported when I met its representatives. It would be a good innovation, because we need to understand much more why things are happening and where failures have occurred.

Epilepsy is the most common serious neurological condition and it affects almost 500,000 people in the United Kingdom alone. Each year a typical GP will treat 10 people with epilepsy, diagnose one or two new cases and care for 20 people who have had seizures in the past but who are currently not in treatment.

The hon. Lady mentioned Jemma, who had spoken at the launch of the report about her experience of good primary care and about the difference that it makes to have a doctor who shows an interest and understands. When one hears stories directly from such individuals, it is so much more powerful.

I should also mention the hon. Lady’s constituent, Ashleah Skinner, who sounds like a true expert patient. The more that we can spread such understanding and allow people to self-care more effectively, the better.

[Bob Stewart]

If we know pretty accurately the number of people who are suffering from epilepsy in our country, would it be crass or wrong for the Government to write to each of those individuals to ensure that they know exactly what they can do to improve their circumstances and for what benefits they might be eligible? Perhaps that is happening already. If it is, forgive my intervention.

[Norman Lamb]

I am very grateful to my hon. Friend for that intervention. Whether it is provided by the Government or at a local level by primary care general practices, he is right to highlight the importance of much better guidance on how people can self-care. The role of expert patients can also be powerful. It can be of great value to somebody who is diagnosed with epilepsy to get guidance and support from somebody who already has the condition.

I am aware of the historical problems in this area and acknowledge that the services have not always been good enough for those living with epilepsy. Indeed, I acknowledge that the services are still not good enough in some parts of the country. There was some uncertainty, and perhaps some scepticism, over whether the coalition Government’s reforms would deliver the improvements that were so desperately sought. That was understandable, given that epilepsy has rarely found itself in the same starting position as other long-term conditions.

I am pleased to report that the Department of Health has taken a number of steps recently to improve the diagnosis and treatment of epilepsy. It will work with the NHS Commissioning Board, which takes on its full responsibilities from April, to drive further improvements for those living with the condition.

[Laura Sandys]

As the Minister rightly recognises, epilepsy has been a Cinderella condition. It has been ignored and has not received the profile that the numbers warrant. He is saying that there will be a step change in how the Department looks at the condition. Will he ensure that there is an understanding of what outputs we expect and that there are barometers to measure them, particularly given that the report states that only a third of commissioners currently put in place programmes for people with epilepsy?

[Norman Lamb]

I am very grateful to my hon. Friend. Clearly, the role of the Commissioning Board will be central in holding clinical commissioning groups to account. The register that Epilepsy Bereaved is calling for could, combined with action from the Commissioning Board, be powerful in helping us to understand more about the condition and in driving better practice.

I understand that there are no specific tests for epilepsy and that it can be difficult to diagnose. The hon. Member for Vauxhall talked about the problem of mis-diagnosis. Some people are diagnosed as having epilepsy who do not have it, and some people who have epilepsy are diagnosed as having a different condition. Such mistakes result in poor or substandard care. Increasing the awareness of the condition among health care professionals is a key factor in improving its early diagnosis and treatment. Detailed advice on epilepsy has therefore been made available on the NHS Evidence website. That is supported by the updated clinical guideline on the diagnosis and management of the condition that was published last year by the National Institute for Health and Clinical Excellence.

The treatment of long-term conditions is one of the NHS areas prioritised by the Secretary of State for Health, and it has featured prominently in the mandate to the NHS Commissioning Board and the NHS outcomes frameworks. The hon. Member for Vauxhall mentioned the awful jargon with which we all have to deal. I have my own personal war against jargon in the Department of Health, confronted with it as I am on a daily basis. As a quick aside—given that we have a bit more time than usual—we need to use language that people understand, rather than jargon that too often excludes people.

The mandate and outcomes framework set out the Government’s objectives for the NHS, and highlight the areas where we expect to see the biggest improvements. The mandate sets an objective for everyone with a long-term condition to be offered a personalised care plan by 2015 that reflects their preferences and agreed decisions. There is a legal requirement for the Commissioning Board to seek to meet the terms of the mandate, and it is potentially powerful to say that everyone with a long-term condition should have a personal care plan that they have been involved in designing and drawing up. Too often, whether for epilepsy or mental health—another area I have great interest in—people simply do not have such a plan and have never been asked for their views on their care and treatment. If we can effect the transition so that everyone with a long-term condition benefits from it, we can make a real difference. Epilepsy Action and other voluntary sector organisations have been requesting such a plan for some time now, and it should be seen as a positive step.

The NHS Commissioning Board has responded to the mandate and the outcomes framework by incorporating long-term conditions into the structure of the organisation with

“enhancing the quality of life for people with long-term conditions”

as one of its five areas of focus. Strong national leadership for epilepsy services has been raised time and again in the House, and I am pleased to announce that, as part of this work, the NHS Commissioning Board is appointing a national clinical director for chronic disability. They will not deal specifically with epilepsy, but having such a director for chronic disability, including epilepsy, is a positive step.

The NHS Commissioning Board is setting up four strategic clinical networks, which is important. We have seen the benefit of such networks with cancer, and those benefits are now being spread to other areas, including neurological disorders. The networks bring together groups of health professionals to improve services for neurological disorders and other specific conditions. They will receive an investment of £42 million and play an important part in driving up quality and consistency in treating those conditions. If everyone within the service is linked into expert networks, the chances of improving treatment on the ground become greater. Health and well-being boards will play an important role in driving up standards locally, given their role in agreeing local priorities and influencing commissioning decisions.

This year will see the publication by NICE of new quality standards for children and adults with epilepsy—that has been called for repeatedly in this House. Those quality standards, which are expected to be published in February and March, will help clinicians make informed decisions about referrals, tests and ongoing care, and ensure a more consistent application of NICE guidelines in that area.

The Department also understands the importance of providing the best possible information to people with epilepsy and promoting better self-care—the point correctly raised by my hon. Friend the Member for Beckenham (Bob Stewart). GPs have an important role to play in that, and in ensuring that those living with epilepsy have their condition kept under control with correct medication. Ultimately, however, responsibility for self-care lies not with health professionals, but with patients. Through NHS Choices, the expert patients programme, and support from health professionals and voluntary sector groups, people with epilepsy can receive the information they need to stay safe and independent, and to manage their condition on a day-to-day basis.

On the wider Government response, the hon. Member for Vauxhall referred to the role of education and schools. I understand that the Department for Education is working to support children and young people with epilepsy, as some are not reaching their full potential in school and further education. For example, the Department has issued guidance to schools on how best to manage medicines for pupils diagnosed with epilepsy and other conditions. For those pupils who cannot attend school because of their condition, the Department has provided guidance on what alternative provision should be made.

In addition, the forthcoming children and families Bill will introduce a duty on local authorities and clinical commissioning groups to commission services jointly—a much more integrated approach than we had in the past—to meet the needs of young people with special educational needs and disability, including those with epilepsy. The Bill will introduce a streamlined, single assessment for the young person. It will also inform an education, health and care plan for the individual. The plan will enable families and young people to buy services through direct payments—we are putting the individuals in charge and giving them real power—thus extending their choice and control. That approach is currently being piloted across 20 pathfinder sites. I understand that the lessons learned will inform the development of secondary legislation and codes of practice, and help with implementation.

For many adults with epilepsy, employment is a major quality-of-life issue—the hon. Lady rightly raised the importance of employment. Studies have shown that people with epilepsy are up to twice as likely as people without the condition to be at risk of unemployment or under-employment relative to their skills and experience. The Department for Work and Pensions has confirmed that, although it does not target employment programmes exclusively at individuals with particular conditions, its programmes, including specialist disability employment programmes, aim to identify and meet the needs of the individual, including those with epilepsy.

The Department for Work and Pensions also recognises the important role that cash benefits can play in supporting people with a disability or long-term condition to remain independent. Entitlement to disability living allowance, and to its planned replacement, the personal independence payment, is not based on a specific health condition. However, my understanding is that people with epilepsy may be eligible for support, depending on the severity of their condition. The hon. Lady mentioned the Atos-conducted work capability assessments and made the legitimate point that they should concentrate on the individual. We can have guidelines to help to steer assessors, but the individual’s needs should be properly and fully assessed. That is outside my departmental responsibilities, so I will refer her remarks to the right place.

The Department for Work and Pensions has advised that, throughout the development of the new personal independence payments policy, it has engaged and consulted with a wide range of disability organisations. That includes a discussion with Epilepsy Action on the assessment criteria for the new policy. For those who face barriers to work because of their condition, financial support may also be available under the employment and support allowance—that, too, is subject to eligibility.

I should refer to some of the hon. Lady’s specific questions—I will ensure I give her a full reply later. She mentioned bus passes. I understand that some local authorities in England have implemented their own bus pass concessions and extended the hours of free travel to include peak times, but the majority have not. Ultimately this has to be a matter for local decision making. I recognise that such variations are not ideal, but the local authority has the power to do this, and pressure can be put on the local authority in any particular area to do what others have already done.

I was slightly confused because the hon. Lady referred to both the National Audit Office and the Audit Commission. The point is that we should focus on the important issue. She argued the case for some sort of inquiry into epilepsy care to see where we can improve its quality. The right approach is probably through the work that NICE is doing. If we can establish what good care looks like, we can encourage all clinical commissioning groups to seek to deliver that quality of care.

The hon. Lady also talked about outcome indicators, and I will look at that and come back to her. We need to try to understand the jargon, but the important point is that we should, as far as possible, be seeking to focus on the results for individuals. Too often in the past we have focused on processes and not enough on what we seek to achieve through health care. If we can, through the outcomes framework, identify things that we are seeking to achieve for patients—improving their quality of life—and that can then drive the system, that would be a good thing. We will look specifically at that.

The hon. Lady talked about the constitution and the right of involvement. We have been updating the constitution and putting patients’ rights much more centre stage—focusing on the personal rather than a more paternalistic approach. That is the right approach, and through the combination of what the constitution will say with what the mandate will require of the NHS in providing the personalised care plan—with the involvement of the individual and based on their priorities, not just presented to them—we can make real progress in putting the patient centre stage.

The hon. Lady talked about the lack of engagement of CCGs. That point has been heard, and it is good that she has had this opportunity to make the point. The Commissioning Board will do what it can to ensure that the quality of care is improved at local level, and it will be the board’s responsibility to engage with CCGs on that.

The hon. Lady also mentioned children and the fact that they are not achieving their full potential. I think that I have addressed that point already, but I will come back to her if I have missed anything. She and others referred to the absolute importance of a speedy referral from GP to specialist, and the hon. Member for Walsall South (Valerie Vaz) also mentioned the action plan for children in schools. She is right to raise both those issues, which were addressed in her ten-minute rule Bill.

I hope that I have addressed the key issues that were raised in the debate and I apologise if I have missed any. I thank the hon. Member for Vauxhall for introducing this debate, which has given me an important opportunity to highlight some key concerns, as well as the fact that much work remains to be done to improve the quality of care across the country. The Government are working to support people with epilepsy and to keep those living with the condition as safe and independent as possible.

Question put and agreed to.