Progressive Supranuclear Palsy

Norman Lamb Excerpts

Wednesday 23rd January 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bayley, and I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing the debate.

A great value of these Westminster Hall debates is that, on something such as this, Ministers are forced to think about a specific issue that might not otherwise come across the radar and to devote some time and attention to it. They also get officials thinking about things as well, so I am grateful to the hon. Lady for securing the debate and for speaking so clearly and passionately about it. I know that she is a patron of the PSP Association, and I welcome anyone here who is from the association or associated with it in any way. It is so good to have you present this afternoon.

I join my hon. Friend in paying tribute to the work of the association. She described the support that it can give families who have a loved one with this condition. For those individuals, it is a lifeline of critical importance. The great value that disease-specific organisations can provide is in this real attention to detail and an understanding of the condition that the statutory services often cannot offer. Their role in supplementing the formal NHS is therefore of critical value. I pay warm tribute to the work that they undertake.

My hon. Friend mentioned Lord Coe. It is great to have someone such as him as an advocate for the condition and for the PSP Association. It was an extraordinary and unhappy chance that his own mother ended up with the condition and died from it. I should also, of course, pay tribute to the work of Brigadier Koe, who clearly has made a big impact in advancing the cause of better care and treatment of people with this condition.

Voluntary sector organisations will have a crucial role to play, offering their expertise, as in the care pathway guide that I know the PSP Association has pioneered. The expertise of such organisations will be invaluable locally to clinical commissioning groups, to which my hon. Friend referred, and the new health and wellbeing boards, which will be a crucial local forum for discussion of a range of conditions, including rare conditions. Such organisations will also offer their expertise at national level to the NHS Commissioning Board, the National Institute for Health and Clinical Excellence and others.

The Neurological Alliance is the collective voice of more than 80 brain and spine charities and, through its national leadership group and network of regional alliances, is an influential player in this field. I understand that the PSP Association is a member of the alliance and I would encourage it to feed into the alliance’s work as a means of getting its voice heard. That is clearly a very important route.

I turn to the question of research. With no cure as of now, research offers a source of hope for those living with PSP. The Department of Health funds NHS research and development through the National Institute for Health Research. In addition, the Medical Research Council funds a broad portfolio of medical research. Neither the NIHR nor the MRC usually ring-fences funds for expenditure on particular topics. Research proposals in all areas compete for funding, based on their strength as a proposal. Both organisations welcome applications for research into any aspect of human health. Those are subject to peer review and judged in an open competition, with awards being made on the basis of the scientific quality of the proposals made. The principle that decisions on individual research proposals are best taken by researchers through peer review is a cornerstone of science funding in the UK and is strongly supported by the coalition Government. Such decisions are rightly left to those best placed to evaluate the scientific quality, excellence and likely impact of the proposals under consideration.

My hon. Friend asked how people with PSP would benefit in April this year, when our new health and care reforms take effect. Through our reforms, we are aiming to ensure that, as far as possible, people with conditions such as PSP can maintain or enhance their quality of life. This Government are committed to providing the best possible quality of care for people with rare conditions. When we took office in 2010, we endorsed the right in the NHS constitution that says that no one should be left behind just because of the rarity of their condition. I recognise that there is often a problem within health services of a lack of knowledge among the clinicians themselves. I think that point was made in an intervention. It is always a challenge to ensure that we spread understanding and awareness.

From April 2013, the NHS Commissioning Board will directly commission services for people with rare conditions on a national basis. Those new arrangements for commissioning will bring real benefits to people with rare conditions such as PSP. By commissioning these services just once rather than reinventing the wheel all over the country, we will be able to avoid duplication in planning and ensure that the highest level of care is commissioned for patients, regardless of their geographical location. With rare conditions, that is the best way to ensure that there is a real concentration of expertise, so as to ensure that commissioning is carried out in the best possible way.

The NHS Commissioning Board will host four new strategic clinical networks for up to five years, including a clinical network covering mental health, dementia and neurological conditions. These clinical networks are potentially of enormous value. We have seen the value of them in treating cancer and other conditions. Now there is the potential for benefits to be gained in the treatment of neurological conditions. Through this particular network for mental health, dementia and neurological conditions, the board itself and clinical commissioning groups will have access to a broad range of expert clinical advice to inform decisions about the way that care for local populations is planned and delivered.

Through quality standards developed by the National Institute for Health and Clinical Excellence, commissioners, clinicians and providers of services will have evidence-based descriptions of what good care and support should look like. We have asked NICE to develop a quality standard on relatively uncommon neurological conditions, as part of a library of approximately 180 NHS quality standards. In addition, people with PSP will also benefit from the cross-cutting quality standards, which have already been published and which cover end-of-life care and patient experience in adult NHS services, the point being that a number of these standards are applicable across a range of different conditions. So people with PSP will also benefit from the quality standard on long-term conditions and people with co-morbidities and complex needs, which we have also referred to NICE for development.

My hon. Friend also discussed the importance of the patient voice within the local health system. That is of critical importance. As we move away from a paternalistic health system to a personal health system, listening to what the patient actually wants and what their priorities are will be vital. The theme of patient empowerment and voice is central to our health and care reforms, and local HealthWatch organisations—together with their national body, HealthWatch England—will champion patient voice in the health and care system.

I should also mention that in the mandate, which is the Government’s statement of our priorities for the NHS and which the NHS Commissioning Board is legally obliged to seek to implement, there is a specific requirement for people with long-term conditions to have a personal care plan, and they themselves will be involved in the preparation of that plan. That happens in places already, but it does not happen uniformly, and we must make it the norm rather than the exception. We have to absolutely recognise that everything must be focused on the patient’s interests in shaping the system to deliver that care.

Consequently I encourage those with PSP to feed their views into local HealthWatch organisations—the local patient voice—which formally take up their responsibilities on 1 April. Local HealthWatch organisations will have a seat on the new health and wellbeing boards, and through that they will be able to ensure that patient and public views are represented and can help to shape local health and care services.

I turn now to end-of-life care. My hon. Friend also spoke about the importance of palliative care. As she described, rapidly advancing diseases such as PSP may require palliative care throughout the progression of the disease, in order to support patients, as they face a declining physical and mental state, and their families. We know that the current system of care does not work well enough. Some patients receive excellent care and their families receive excellent support, while others miss out. This is partly a reflection of the origins of specialist palliative care as a discipline in the care of people with cancer, and that remains the main focus of palliative care services, but those services must be appropriate for all conditions, obviously including PSP.

We have highlighted the need to extend services to those with other conditions or diseases. The end-of-life care strategy aims to improve care for people approaching the end of life whatever their diagnosis and wherever they are, including enabling more people to be cared for and to die at home, if they wish. About 50% of people still die in hospital, although most people want to be able to die at home if that is possible, and we must ensure that their interests and priorities are respected in that regard. The National End of Life Care Programme has developed an end-of-life care pathway for neurological conditions, working with the Neurological Alliance and the National Council for Palliative Care. The pathway, which was published in 2010, sets out a framework to support the provision of improved care for that group, including those with PSP.

We are committed to increasing awareness of rare conditions—a point made by my hon. Friend in her speech—including PSP. That commitment has been demonstrated through the development of the UK plan for rare diseases. The plan will bring together a number of recommendations designed to improve the co-ordination of care and to lead to better outcomes for everyone with a rare disease, including people with PSP. We have consulted on the rare disease plan, and we published a summary of the consultation responses in November last year. Work is on track to produce the plan by the end of this year, which will help people with PSP and many others with rare conditions.

My hon. Friend also focused on education and training. Our doctors and other staff across the NHS receive some of the best training in the world, and as my hon. Friend recognises, it is important for that to include the right information and techniques to alert them to the possible presence of a rare disease when a patient presents to them. We must recognise that PSP is a rare condition, one among the hundreds that a health professional may see during their career, and it may not be feasible or practical to draw particular attention to it above all those other conditions. That said, we recognise the difficulties and, as part of our consultation on the UK rare diseases plan, we invited ideas on what more can be done to train doctors in the identification of rare diseases and on whether there are innovative ways of familiarising health professionals with rare diseases in their professional training. Furthermore, the consultation identified that training for all NHS staff to raise wider awareness and understanding of rare diseases was also important in promoting equality and in combating the stigma and discrimination sometimes associated with such diseases.

I entirely agree with my hon. Friend when she drew attention to the vital role that carers play in supporting people with conditions such as PSP. Between 2011 and 2015, the Department is providing the NHS with an additional £400 million to support individuals in their role as carers. The “Recognised, valued and supported: next steps for the Carers Strategy” document sets out Government priorities in the area, reinforced in the 2012-13 NHS operating framework, which sets out the priorities for that year.

My hon. Friend described the labyrinth that people with conditions and their carers often find themselves trying to negotiate. One aspect of the reform legislation, which I very much welcome, is the focus on integrated care. Too often, carers are in silos, and people are pushed from pillar to post. They can so easily fall into the gap. If we can develop a much more integrated approach to support people with a rare condition such as PSP, with clinicians at primary and secondary level working together much more closely, everyone would benefit.

I am grateful to my hon. Friend for raising the issue. As I said, the value of this debate is to draw the matter to Ministers’ attention and to obtain a wider airing for and focus on such conditions which would not otherwise be the case. I am happy to continue to engage with my hon. Friend to ensure that people with PSP receive the treatment and care that they deserve.

Question put and agreed to.

Dementia Services (Gloucestershire)

Norman Lamb Excerpts

Tuesday 22nd January 2013 Westminster Hall

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

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

I congratulate my hon. Friend the Member for Gloucester (Richard Graham) on securing the debate and on speaking about his family’s experience—about his mother’s experience of having dementia, and about the role his father played caring for her and the strength that he gained when the moment arose to cope and get through it. My hon. Friend’s speech was moving, if somewhat breathless at the start—it was excellent to see him arriving in the Chamber just in time.

My hon. Friend is committed to ensuring that his constituents have access to high-quality care whenever and wherever they need it. He has demonstrated his commitment through his work as a member of the all-party group on dementia, which does really good work to raise awareness of the condition in Parliament and beyond.

We know that some 800,000 people in the UK have dementia, and that number is expected to double over the next 30 years. The consequences of that growth will be substantial, so we must recognise the scale of the challenge that we face. The Government are committed to meeting that significant challenge by providing high-quality care for people with dementia combined, crucially, with strong support for carers.

My hon. Friend talked about the role of carers, and we often have to stop and remember the impact on a loved one of someone getting dementia and then having that loss of recognition. We must understand how distressing it can be for someone to cope with that, and sometimes with changing and challenging behaviour, when they may have been married for a long time. We owe an enormous debt of gratitude to the army of carers who continue to give their care, love and support, sometimes under difficult circumstances. We will transform dementia services, achieve better awareness of the condition, and offer high-quality treatment at every stage and in every setting.

I will not go over much of the ground that I covered in last week’s debate because I know that my hon. Friend is well versed in many of the things we have achieved nationally. I should recognise the fact that some good work started under the previous Government, who produced one of the first dementia strategies in the world. The work that we are doing means that we are one of the leading countries on this but, as my hon. Friend said, we must recognise that there is much more to do.

My hon. Friend will be conscious of the dementia challenge that the Prime Minister announced last March, but an awful lot has happened since then. For example, we have set aside £54 million for the NHS to support dementia diagnosis in hospitals. We have asked local areas, through the NHS mandate, to set ambitious targets for improved dementia diagnosis over the next two years. Each area must understand its position on undiagnosed cases and set about dealing with the gap.

We have set aside a further £50 million to make health and care environments more dementia-friendly. We have launched a national advertising campaign to raise awareness, to reduce the stigma attached to dementia and to encourage people to contact their GP if they experience symptoms of dementia. Such contact often involves having that first, difficult conversation with a loved one about the need to see their GP to explore whether there might be dementia.

[Jim Shannon]

Does the Minister feel that lessons could be learned from the other regions of the United Kingdom, such as Northern Ireland, where a clear dementia care plan and strategy are in place? If the lessons learned there are beneficial for Gloucestershire and other parts of the United Kingdom, why should we not exchange information?

[Norman Lamb]

I think that the hon. Gentleman said in his earlier intervention that the diagnosis rate is quite good in Northern Ireland. I applaud the work that is done there, but the support services might not be as good as in some parts of England, Wales and Scotland. We are learning about these things together, and there must be close collaboration between England, Northern Ireland, Wales and Scotland. Scotland has done good work to achieve high diagnosis rates. It has also introduced the concept of dementia advisers, which my hon. Friend the Member for Gloucester talked about in relation to his county. We need to be willing to learn from anywhere and, critically, not to reinvent the wheel, so I am absolutely up for collaboration with colleagues in Northern Ireland. Just a week ago, the Secretary of State announced a year of dementia awareness to improve understanding of the condition and diagnosis rates nationally.

Let me deal with research. My hon. Friend the Member for Gloucester said that the Government are doubling the amount we spend on research, although it must be said that that is coming from quite a low base, compared with other conditions. One of the difficulties is that we cannot just make a massive increase to the amount that we spend, because building the research community’s capacity to do the work has to happen hand in hand with any increase.

There were several things I was unable to cover in detail during the recent debate granted by Backbench Business Committee because we ran out of time—my hon. Friend was a victim of that. One of them was research, on which we have genuine cause for optimism. A lot of the media narrative has been about high-profile failures of research, but there is positive and encouraging news out there.

Before I give some examples of that, however, I should mention one thing. My hon. Friend talked about the importance of the scientific community and the Government collaborating closely to meet the challenge we face. Last autumn, I spoke at a conference that brought scientists from not just the UK, but around the world, together with the Government and interest groups, such as charities that campaign on this issue. Such a useful gathering is a way of bringing the best brains to bear on this subject, so that collaborative work must continue.

On 21 December, the Government made £22 million available to 21 pioneering research projects to boost dementia diagnosis rates and to trial groundbreaking treatments. The funding was designed to cover all areas of scientific activity that are relevant to dementia across the fields of care, cause and cure, including prevention. For example, we can do a lot to prevent the condition of vascular dementia from ever starting, so if prevention is possible, we must be much smarter. We have also provided £36 million for a new National Institute for Health Research dementia research collaboration to work on better treatments and care for, and understanding of, the condition, as well as £9.6 million to expand the UK Biobank. Last year there were potentially interesting developments in treating early-stage dementia, particularly in Alzheimer’s disease.

As drug companies continue to invest in research, there is now a real prospect of a treatment within the next decade—that seems to be the time frame we are dealing with—that could have an impact on helping to slow or prevent the disorder, if it is caught early enough. For instance, there have been key recent developments from Eli Lilly, which is conducting an additional phase 3 study of a new drug for patients with mild Alzheimer’s disease. I have also heard about promising plans to expand the testing of a drug for patients with pre-dementia.

My hon. Friend rightly emphasised the importance of sharing best practice, of avoiding reinventing the wheel and of encouraging innovation, which is vital for improving dementia care. I am delighted that Gloucestershire benefited from the additional funding of £10 million from NHS South West. It is by learning from the innovative projects that he describes that we will find out what works and how we can improve services.

My hon. Friend asked me to highlight examples of best practice of people taking the lead on dementia. One involves the fire and rescue service, which has made a pledge to take action to increase the safety of people with dementia. That is a critical area, because someone living with dementia can be at risk, and the fire and rescue service can do a lot to help them to remain safe. The service has made a commitment to raising awareness among staff. Already 28 services have signed up, and I applaud them for that work. In addition, Tesco has made a commitment to increase dementia awareness and understanding among its staff and worked with the Alzheimer’s Society to produce a DVD to achieve that. The moment when a customer gets confused about change or forgets their PIN is the one when a caring and understanding approach from the checkout operator who is coping with them is particularly important. It is encouraging that companies such as Tesco are prepared to do such work.

When my hon. Friend mentioned the demographics in his constituency, that rang true for me, because my constituency, similarly, is rural with an elderly population. I am pleased that the diagnosis rate in Gloucester has risen from 40% to more than 45% in the past year but, as in many places, there is still massive room for improvement to match the best performing areas, such as Islington, where the diagnosis rate is 75%. There is an enormous gap between the best and the worst, and a long way to go. We have developed an analytical tool to support the NHS to achieve an increase in local diagnosis rates, and we are working with the Royal College of Psychiatrists to assure and improve the quality of memory services when the actual diagnosis takes place.

I join my hon. Friend in paying tribute to some of the excellent work in his area, which is in many ways mirrored by that of the Norfolk and Suffolk Dementia Alliance, which is led by an inspiring guy called Willie Cruickshank. He demonstrates the difference that can be made by bringing all parts of the system together. In his area, there is now a comprehensive, multidisciplinary memory assessment service that provides support to primary care and outreach to communities. We must ensure that we bring down waiting times, which are far too long in some areas.

Community dementia nurses and advisers are working closely with GPs throughout the country. Last week, I met a group called Uniting Carers, which is part of Dementia UK, which talked about the fantastic work of Admiral nurses in many parts of the country.

[Rebecca Harris]

Sometimes the problem for carers arises when they reach the point at which they admit that they can no longer look after their loved one who has dementia, because it can be difficult to choose the right kind of care home or environment. The gap at such a point might need to be filled by the voluntary sector or Admiral nurses, as the Minister was describing, to help people to ensure that they are putting their loved one into a suitable and dementia-friendly environment.

[Norman Lamb]

I absolutely agree, and that is a role for an Admiral nurse or equivalent, or for dementia advisers, who are now in place in Gloucestershire, my own county of Norfolk, Suffolk and other parts of the country. It is of real value if someone is able to go into the home to provide practical advice to the carer and the person with dementia.

Fantastic work is ongoing to bring district councils, volunteers and community groups together to establish a network of memory cafés. The care home support team supports staff with training, development and management guidance. There is county-wide education for carers and a carer emergency respite scheme, which provides an agreed plan of personal support to the cared-for person.

My hon. Friend the Member for Gloucester raised the important issue of ethnic minorities and faith groups. At last week’s meeting, I met an Indian woman who spoke movingly about how she and her father were cast aside by their local community once he had received a diagnosis of dementia. It is critical that stigma is challenged in all communities. She also explained how her father had reverted to his mother tongue, which further complicated his care arrangements and made a difficult situation more difficult.

I want to consider how we can give specific help to people such as that woman. There is a role for everyone in society to improve the lives of people with dementia, which includes faith, community, and black and minority ethnic groups and charities. My hon. Friend is aware of the plan to sign up 1 million dementia friends by 2015, which will have dramatic effect on spreading awareness throughout the community. All such groups have a role to play in creating the dementia-friendly communities we want to see. Only through all of society—not just government—coming together will we improve the lives of people with dementia and their carers.

Regarding my hon. Friend’s kind invitation to visit, he may be interested to know that the Secretary of State and I are between us embarking on a road show to every region in the country, involving conferences and visits, to bring people together to drive change at a local level. I will certainly pass on my hon. Friend’s suggestions to the team that is planning the visits and the south-west regional event, and I will ensure that he is kept updated.

I am encouraged by the commitment shown in Gloucestershire, as in other parts of the country, to tackle the problems that we face. I was pleased to hear that Gloucestershire county council had ring-fenced funding for social care so that money is prioritised in that most critical of areas. We are expecting an announcement soon on funding for and reform of social care, and that will start to help people to cope with dementia and the costs incurred as a result of it. Although the challenge remains great, the collaborative effort demonstrated by the NHS and its partners in Gloucestershire, including businesses, community groups and volunteers throughout the county, is showing how concrete steps can be taken to improve dementia services and to enhance the day-to-day lives of people with dementia and, crucially, their carers.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 15th January 2013 Commons Chamber

[Nigel Adams (Selby and Ainsty) (Con)]

5. What assessment he has made of the effect of the current NHS funding formula on rural areas with a large elderly population.

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

Age is the main driver of an individual’s need for health care, as reflected in recent funding formulae. This is for the NHS Commissioning Board, but the independent advisory committee recommends continuing to review the case for additional resources in rural areas, particularly as more information on community provision becomes available.

[Nigel Adams]

It is disappointing to hear that the NHS Commissioning Board has decided not to implement a fairer funding formula. What does the Minister suggest I say to my constituents who potentially face having services withdrawn, when, in the same region, areas such as Barnsley receive almost 30% per head more in funding?

[Norman Lamb]

As a Member of Parliament for a rural area with an elderly community I understand the hon. Gentleman’s concerns, but allocations have to be based on solid evidence. The area where we do not have the evidence is on community services. The data will start to be collected on that and we will therefore be able to demonstrate whether community services cost more in rural areas, as I suspect they do. If that is the case, the allocation formula will be able to reflect that.

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

The north-east suffers some of the worst health outcomes in the country, despite having excellent care services. On many occasions, the Government have said that they are committed to reducing health inequality, specifically in the north-east. Why then did Ian Dalton say that using the new advisory committee on resource allocation formula

“on its own would have…moved resources from areas where people…have worse health outcomes to those where people have much better outcomes”.

Does that not show that the Government have no commitment to reducing health inequalities?

[Norman Lamb]

I think the news on the allocations for public health budgets is actually a remarkably positive story. Every part of the country will see real-terms increases in funding for public health. This is an historic moment where we shift the emphasis away from repair to prevention of ill health. The hon. Lady’s own area will see real-terms increases. Across the country as a whole, there will be an average of 10.8% over two years real-terms increases in public health funding. I am very proud that the Government are doing that.

[Priti Patel (Witham) (Con)]

6. What steps he is taking to ensure that patient experience is a priority for the NHS.

--- Later in debate ---

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

We plan to publish our policy document on sexual health and HIV shortly. Improving sexual health is very important for individuals and communities.

[Nick Smith]

Can the Minister explain why the sexual health policy has been delayed for almost two years? Does he accept that this delay is affecting the ability of PCTs to deliver effective sexual health services?

[Norman Lamb]

From April, local authorities will be responsible for commissioning services. Because we have seen this really impressive increase in funding for public health, local authorities will have the ability to maintain and indeed improve sexual health services for their local communities. That is something of which we should be proud.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

On the sexual health strategy, the Minister will be aware that nearly half of the national incidence of HIV is in London, so what steps will be taken from April to co-ordinate the prevention of HIV London-wide?

[Norman Lamb]

I am very much aware of the situation in London, and I acknowledge that some good work has already been undertaken there. Local authorities are very much aware of their responsibility that will apply from April and are already working with clinical commissioning groups in London to ensure that comprehensive services are in place for the London community.

[Mike Freer (Finchley and Golders Green) (Con)]

Pan-London preventive health care is important, but with the devolution of funding to local authorities, there is a great risk of them refusing to pool funds and of preventive health programmes in London collapsing. Can the Minister reassure Londoners that pan-London programmes will continue?

[Norman Lamb]

Yes, I can absolutely reassure the hon. Gentleman that there will be comprehensive services, which will cut across local authorities. We have to remember that local authorities will be under a legal responsibility to provide confidential open access to sexual health services and contraception services. Local authorities in London are aware of the need to ensure that comprehensive services are available from April this year.

[Ian Swales (Redcar) (LD)]

9. What recent assessment he has made of the number of health care appointments and operations which are postponed.

--- Later in debate ---

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

We published the Government’s alcohol strategy on 23 March 2012, and we are taking a comprehensive approach to reducing the incidence of alcohol-related disease and crime. Our strategy includes the introduction of a minimum unit price for alcohol, actions at local level, and pledges from industry under the responsibility deal.

[Kelvin Hopkins]

The number of UK deaths from liver cirrhosis has increased by five times since 1970, while in France, Italy and Spain it has halved, and is now lower than the number in Britain. Even more disturbing is the fact that thousands of babies are still being born every year in Britain permanently damaged by alcohol. When will the Government take urgent, effective action to deal with this crisis?

[Norman Lamb]

I entirely share the hon. Gentleman’s concern. The Government have already taken action: we set out a strategy in March last year, and we are now consulting on the introduction of a minimum alcohol price. That could save up to 700 lives a year in 10 years’ time, which would make a dramatic difference. I am sure that the hon. Gentleman supports what the Government are doing.

[Sarah Champion (Rotherham) (Lab)]

Damage to health as a result of alcohol consumption often leads to wider social damage. I have seen that at first hand when visiting shelters for the homeless in Rotherham. Many homeless people cannot gain access to rehabilitation services because they do not have GPs to refer them. What steps is the Minister taking to ensure that those services are available to everyone, especially those who need them most?

[Norman Lamb]

The hon. Lady has raised a really important point. One of the consequences of the responsibility deal is that by 2015, 1 billion units of alcohol—about 2%—will be taken out of the market, and that will help some problem drinkers significantly. Moreover, the money that the Government are investing in public health gives local authorities an opportunity to invest in prevention services in order to deal specifically with the core group of people to whom the hon. Lady has referred.

[Lorely Burt (Solihull) (LD)]

13. What plans he has to review urgent care services.

--- Later in debate ---

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

T9. Many of my constituents are concerned by the Care Quality Commission’s recent findings at Milton Keynes hospital, which came despite an increase in nursing staff since 2010. What reassurances can my right hon. Friend give my constituents that the problems are being rectified and that they will be able to enjoy high-quality care?

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

First, let me say that substandard care simply will not be tolerated and it has to be taken extremely seriously. I understand that the trust involved is reviewing its staffing levels so that the necessary improvements can be made. It has also started two-hourly checks, during which nursing staff check that patients have everything they need to be both safe and comfortable. There is clearly a big challenge and the trust has to meet it.

[Pamela Nash (Airdrie and Shotts) (Lab)]

T7. The implications of HIV go well beyond health issues alone, yet the Government have so far refused to implement a new, cross-departmental HIV strategy. The Scottish and Welsh Governments have implemented their own such strategies, but 95% of people in the UK living with HIV reside in England. Will the Secretary of State commit to discussing this issue with his Cabinet colleagues, particularly those in the Department for Work and Pensions and the Department for Education?

[Norman Lamb]

I take extremely seriously the point that the hon. Lady makes. It seems to make more sense to be part of a comprehensive, integrated sexual health strategy, which the Government are planning and which will be published very soon. Services tend to be delivered together in the same units, so it makes sense to have a single strategy to deal with all those issues.

[Mr David Amess (Southend West) (Con)]

T10. In the light of widespread representations from constituents about the proposals for the centralisation of pathology services, will my right hon. Friend the Secretary of State consider the clinical concerns very carefully before any such changes are sanctioned?

--- Later in debate ---

[Norman Lamb]

I thank my hon. Friend for that question. The Government take the development of talking therapies extremely seriously and I can confirm that I met Lord Layard yesterday, together with representatives of the NHS Commissioning Board. There will be a central team and we are absolutely determined to keep driving this approach forward, as there is real evidence of results.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Today’s edition of The Daily Telegraph carries an article on dementia, including a quote from a GP who says that it is not useful to give an early diagnosis when there are no drug or care needs. Does the Minister agree that that GP, like many others, fails to realise that for pre-senile dementias in particular, early diagnosis allows planning and allows families to understand the confusion created by altered personalities, behaviour, emotional responses and language skills?

Dementia

Norman Lamb Excerpts

Thursday 10th January 2013 Commons Chamber

[Paul Burstow]

One of the great things about devolution is that we can try out different things in different jurisdictions, but it is great only if we learn from that by taking the best and using it elsewhere. I therefore agree entirely with the hon. Gentleman that that is an important part of this debate. The ability to exchange and learn—and, yes, sometimes reject things that others are doing—is important.

My final point is about reform. I hope this year might be a tipping point for dementia. Reform of our broken care and support system has never felt closer. For people with dementia and the families who care for them, it cannot come soon enough. When the Prime Minister launched the dementia challenge back in March last year, he acknowledged the catastrophic costs that some people incur as a result of drawing the card in the lottery of life that says “Dementia”. He said:

“We are determined to do the right thing by these people”.

A dementia diagnosis is traumatic enough, without the knowledge that care costs can often spiral out of control as the disease progresses. While care financing is left unreformed, people with dementia face the prospect of losing both who they are and everything they have ever worked for.

I therefore very much welcome the news in Monday’s mid-term progress report that the Government are to press ahead with a cap and increased means test, and the confirmation that the House received on Tuesday from my right hon. Friend the Deputy Prime Minister that the necessary legislation will be enacted in the lifetime of this Parliament. In my capacity as Chair of the parliamentary inquiry into the draft Care and Support Bill, let me tell the Minister that the Committee has made it clear to me—and I absolutely agree—that we expect as much detail as possible on any new clauses or other changes that will flow from the introduction of a capped cost system into the legislation, so that we can do the House the service that we have been asked to perform, which is to report on and scrutinise the provisions and help the Government to introduce the best possible legislation to Parliament.

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

Let me confirm to my right hon. Friend that I want to do everything I can to ensure that the Committee is as informed as possible, so that it can do the important scrutiny work that it is charged with doing. Let me also take this opportunity to pay tribute to the work that he did as my predecessor to push the dementia debate forward and make substantial progress.

--- Later in debate ---

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

I would like to thank the Backbench Business Committee and every right hon. and hon. Member who has spoken, and pay tribute to the former Minister, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), for his dedicated work on the subject and to the work of the all-party group on dementia, which works tirelessly on a subject that, in the past, has been too much ignored but which, at long last, is starting to get the attention it deserves.

I cannot begin to do justice to the many extraordinary contributions made in the debate, so I commit to write to all hon. Members who have taken part to answer each of the specific challenges put to me, if I cannot deal with them now. A forum such as this—less combative than many of the debates on the Floor of the House—is the perfect place to talk about dementia. I have listened with humility to the contributions of many hon. Members and I completely associate myself with the comments of the shadow Minister: the contribution from the hon. Member for Bridgend (Mrs Moon) was remarkable. She spoke with authentic authority, having experienced all these problems—the isolation, the impact on the family and so on.

I have learned much in this debate, as a Minister learning my trade, and will take on board much of what has been said. I should also mention the right hon. Members for Cynon Valley (Ann Clwyd) and for Salford and Eccles (Hazel Blears) and the hon. Member for Liverpool, Walton (Steve Rotheram), who, along with others, paid tribute to the fantastic work of the Alzheimer’s Society, which I have seen in my own constituency. It is a brilliant organisation doing invaluable work. I totally agree also with the shadow Minister about the analogy with cancer. Getting to grips with Alzheimer’s has to be seen as the challenge of the 21st century. I am sorry I missed the contribution from the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), but I have heard all about it and thank her as well.

There is no party political divide on dementia. There can be discussions about the funding of social care and so forth, but there is a consensus about what needs to be done. The work was started by the last Labour Government, who took a lead internationally in setting out a proper strategy for dementia, and this Government have taken on that strategy and developed it. I pay tribute to the Prime Minister for his personal commitment, as others have done. Whatever our political affiliations, beliefs or background, we all know that dementia is one of the most important health and social care issues facing society. It is also one of the most pressing. As mentioned, we know that dementia costs society about £19 billion a year. In 30 years, as the number of people with dementia doubles, even that vast sum will look like chicken feed.

As with all health and social care issues, however, we do people a disservice to reduce dementia to money and budgets. It is about much more than that; it is about people and how we treat them, about the individual with dementia, their families and their friends, all of whom have to live with the effects of what can be the most terrible of conditions, but a condition that many people can and do live well with. That is an important message to get out. It does not necessarily mean the end of the world. People can live well with it.

Dementia affects all of society. It is a universal concern. Study after study shows that it is the condition that people fear the most—more than cancer or anything else—so we need to be better prepared. The Department of Health is doing all it can to stitch dementia awareness into every part of the community—not just GP surgeries, hospitals and other health-focused places, but banks, supermarkets, bus stations, post offices and all the different forms of local public services, and the private sector too. The whole of society has to play its part in changing attitudes and making society dementia friendly. All those places can become more dementia aware and dementia friendly, and if they do, people with dementia will benefit and live better.

On 26 March last year, the Prime Minister gave a speech about the Government’s challenge on dementia. He said that we would do more to translate the national dementia strategy into greater action on the ground in three key areas: first, improving health and care; secondly, making communities more dementia friendly, so that people with dementia are better understood and catered for; and, thirdly, doing more research into dementia. When he launched the challenge, the Prime Minister said we would set out plans to make life better for people with dementia and their carers. Indeed, the hon. Member for Worsley and Eccles South (Barbara Keeley) spoke movingly about carers and mentioned that she had invited me. I think I am going, and I very much look forward to hearing about the good work done in Salford.

That announcement was almost 10 months ago. I am pleased to say that since then there have been significant developments in each of the three strands in the Prime Minister’s challenge. Each has been run by a champion group that includes experts in their fields—Sir Ian Carruthers from the NHS, Sarah Pickup of the Association of Directors of Adult Social Services from social care, Sir Mark Walport and Dame Sally Davies from research, and Jeremy Hughes from the Alzheimer’s Society, as well as Angela Rippon. Those groups have looked at the current situation in their fields and identified priorities for improvement. They include changing how society views people with dementia, improving diagnosis rates and getting researchers to work together in pursuit of better treatments. Several hon. Members have mentioned the stigma of dementia. We face similar challenges in mental health generally. “Time to change” is a fantastic campaign, but the challenge is just as great with dementia. There is still an awful lot of work to do.

I would like to read a quick summary of what we have undertaken since last March. We have launched a new dementia friends scheme to make 1 million people more aware of what dementia is, helping to break down barriers between people with the condition and their local communities. The hon. Member for Liverpool, Walton and many others talked about the importance of raising public awareness; the dementia friends scheme can be an effective way of doing so. Indeed, I urge all hon. Members present to sign up—they can do it now by registering online—and become dementia friends. He made the point that public awareness was, in his words, scandalously low. I share that view.

We have set aside £54 million for the NHS to support dementia diagnosis in hospitals and now to ensure clinical leadership in hospitals. We have set aside a further £50 million to make health and care environments such as hospital wards and care homes more dementia friendly. The Government’s first mandate for the NHS prioritises dementia. We have launched a national advertising campaign to raise awareness, reduce the stigma attached to dementia and encourage people to contact their GP if they experience symptoms of dementia and have that difficult early conversation—the sooner it is had, the better for the person with dementia and their carer. We have developed a toolkit for clinicians to increase diagnosis rates—we have heard about the interesting work in Plymouth and how diagnosis rates have been significantly improved as a result of that clinical leadership.

Through a consultation, we asked the public what action they wanted to see and incorporated those views into the work of the three challenge groups—the hon. Member for Bridgend was absolutely right that people must be involved, engaged and listened to in dementia research. We have also supported the launch of the call to action to create dementia-friendly hospitals. Some 65 hospitals have signed up so far, but I take the view that every hospital in the land should sign up. I urge them to get on with it, because it is so important. The hon. Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Cynon Valley gave powerful testimonies and told some deeply disturbing stories about what happens in some of our hospitals. That reinforces just how important this is and why the Secretary of State is right to be clear that the quality of care is just as important as the quality of treatment.

The hon. Member for Bridgend talked about the crucial importance of communication between care staff, nursing staff and relatives. The hon. Member for Banbury (Sir Tony Baldry) talked about getting compassion back into the NHS. There is actually an enormous amount of compassion in the NHS, but there are sometimes situations where it falls below the acceptable standard. That is what we have to address.

We have provided £36 million for a new National Institute for Health Research translational research collaboration on dementia, with research into better treatments, care and understanding of the condition. We have also provided £9.6 million to expand the UK Biobank.

I am conscious that I am not going to have nearly enough time to deal with all the issues that have been raised today. A great deal of emphasis has been placed on the importance of early diagnosis. The right hon. Member for Salford and Eccles talked about the completely unacceptable regional variations. All clinical commissioning groups will have to set ambitious objectives to close the gaps, and they must be held to account for that. The National Commissioning Board will build up a national picture of the challenges in each local area. The hon. Member for Plymouth, Moor View (Alison Seabeck) talked about the encouraging progress that can be made in that regard. People want timely, good-quality information that helps them to make the right choices about their care. The hon. Member for Bridgend talked about the importance of the GP discussing with the family the approaches that they want.

In conclusion, the coalition Government are doing as much as possible, but there is much more to be done. We will make an announcement soon on funding for elderly care. The Care and Support Bill must, in my view, include paving clauses on Dilnot. We have a real opportunity now to secure the reform that is so long overdue. We should also remember that the Dilnot recommendations included raising the threshold for means-tested support to £100,000, which would help an enormous number of families who are experiencing real difficulties.

To address the challenges of dementia, we need a response not just from the NHS, not just from the Government and not just from businesses, but from society as a whole. There are promising signs. The Prime Minister’s dementia challenge is not only about geeing up the NHS and our local authorities, but about all the resources that our communities have to offer. I completely agree with my right hon. Friend the Member for Sutton and Cheam that we need to develop the strategy beyond 2015. Of course, we will need to assess and learn the lessons from the current strategy, but we must then apply it beyond that date. The same applies to research as well; I completely agree with him on that.

There is a lot of hard work being done by the NHS, by social care professionals and by others across England—work that is increasing diagnosis rates, and reducing the prescription of antipsychotic drugs for people with dementia, to name but two. As a consequence, many more people are getting the treatment and care that they need and that their loved ones deserve. Long may that continue.

I am on a learning curve as a new Minister, and I have found this debate immensely helpful. As I said earlier, I have learned a lot from it. I dedicate myself to doing everything I can, for as long as I have this job, to try to make a difference.

Liverpool Care Pathway

Norman Lamb Excerpts

Tuesday 8th January 2013 Westminster Hall

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

I do not have a Parliamentary Private Secretary sitting behind me, and I am most grateful therefore to you, Mr Weir, for your assistance with some Members’ constituencies.

I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing the debate, and on the sober, serious and rational tone he deployed in his contribution. The whole debate, in fact, has been exemplary in that regard. I suspect that all of us in this room are after the same thing; it is how we secure it that matters so much. I have just over 11 minutes, which is not really enough to do justice to every contribution, so as soon as I possibly can, I will write to all the Members who have taken part, to update them.

I take the Liverpool care pathway extremely seriously. It has been much discussed recently: many hon. Members and members of the public have written to the Department of Health expressing their concerns, and there have been numerous parliamentary questions, too, all of which stems from a lot of media interest over the past few months. Several stories have appeared discussing the ways in which the LCP is used and what it is for. In particular, there have been a number of reports in the media alleging that patients are being placed on the LCP secretly, with no consultation with them or their relatives. It has been suggested that the LCP routinely involves medical staff withdrawing treatment, including food and fluids, from patients. Perhaps most seriously, the LCP has been accused of being a way to kill patients to save the NHS money. There have been suggestions that the Department of Health bribes hospitals with extra money for every patient placed on the pathway.

Those accusations paint a misleading picture of the purpose of the Liverpool care pathway, yet I take seriously the concerns raised by the families of patients who have experienced extremely poor end-of-life care. I am horrified by some of the stories that people have told me about the withdrawal of food and fluids from sick relatives in hospital and about the failure to inform loved ones that the patient has been placed on the pathway.

The hon. Member for Congleton (Fiona Bruce) spoke movingly of her experience, and I am pleased that she came to the round table that I held to discuss those concerns. As the hon. Member for Gainsborough (Mr Leigh) made clear, the concerns are legitimate and should be taken seriously, not dismissed because of exaggerated reporting. What happens on the front line and how we translate theory into practice are so important.

I agree with my hon. Friend the Member for Southport (John Pugh). I dislike the jargon: what on earth does “Liverpool care pathway” mean to patients and their families? We must use language that ordinary people understand, particularly at a most traumatic time for all involved. That is one thing we need to address.

One aspect of care that receives almost universal praise, as the hon. Members for Banbury (Sir Tony Baldry) and for Hackney South and Shoreditch (Meg Hillier) have made clear, is the hospice movement, which grew from Dame Cicely Saunders’s belief that, however ill, people matter at the end of their life and should never be abandoned. That is why the Marie Curie Palliative Care Institute Liverpool, led by Professor John Ellershaw, developed the Liverpool care pathway in the late 1990s. The pathway was designed to transfer the principles of hospice care—the shadow Minister, the hon. Member for Leicester West (Liz Kendall), made this point—so that terminally ill patients always get the best treatment, even if they do not receive specialist palliative care.

The Liverpool care pathway is not a treatment but a framework for managing treatments, which is important to understand. As the hon. Member for Montgomeryshire made clear, the LCP, when used correctly, is one way to ensure that the last hours or days of a patient’s life are as comfortable as possible. The guidance for using the LCP makes it clear that the aim is to support, not replace, clinical judgment. Sometimes there are questions about clinical judgment, but not about the pathway itself.

The Liverpool care pathway guidance sets out the following objectives and considerations for taking care of patients: determining whether any further medications and tests would be helpful; ensuring that the patient is as comfortable as possible—surely we all agree with that; helping the patient to take on food and drink for as long as possible, which means not denying them food and drink, as we sometimes hear; and taking care of the patient’s spiritual and religious needs, which is of acute importance to many people. The guidance reminds clinicians that unnecessary treatment or tests may cause harm rather than good.

The guidance states that regular review is acutely important. If their condition improves, the patient should be taken off the pathway. The 5% figure to which the hon. Member for Gainsborough referred is of concern and should be considered; it is essential that the medical team discusses the pathway with the patient, their family or their carers. Those people need to be fully involved in decisions about end-of-life care, even though those discussions may be very difficult. Obviously, those conversations need to happen as quickly as possible.

The Liverpool care pathway can work as intended only if each patient is fully consulted, unless that is not possible. Even then, the family must be fully involved. Through his interventions, the hon. Member for Stoke-on-Trent South (Robert Flello) made that point strongly. The opening section of the information sheet that comes with the pathway cites the absolute importance of discussion with the family. Staff must talk to the patient and their family as much as they need and want, to explain what is happening and why. That is non-negotiable. Any failure to do so is completely unacceptable.

The hon. Member for West Lancashire (Rosie Cooper) mentioned documentation, which is best practice and should always happen so that everyone can see what has been discussed. She also mentioned the constitution, and we are considering how we can give it greater traction. There is a sense that everyone agrees with the constitution, but what value is it? How can we make the constitution provide real power to patients in the NHS?

I agree with the shadow Minister’s concerns about translating across the whole system something that has been designed by experts. Such translation can be problematic and needs further attention.

[Rosie Cooper]

rose—

[Norman Lamb]

I am conscious that time is tight. I will write to the hon. Lady. If she wants to raise issues with me later, I will be happy to address them, but I need to respond to the debate.

From what people have said, it is clear that there are too many cases where patients have been put on the pathway without proper explanation, without the involvement of their family and sometimes without any notification, which is totally unacceptable. Yet again, we see how right Dame Cicely Saunders was when she said:

“How people die remains in the memory of those who live on”.

The impact is profound. My wife works for Cruse Bereavement Care, which does magnificent work helping people who have suffered bereavement. We have a duty to give such people the best possible experience as they lose a loved one.

On 26 November, I hosted a round-table meeting with patients, families and professionals—both supporters and critics of the pathway were represented—and at that meeting I announced that we will appoint an independent chair to consider how the LCP is used and experienced and to examine the accusations made in the press. We expect to announce the chair of that review very soon, and we expect that the chair will want to identify a small panel of independent experts from a range of backgrounds, including representatives from faith groups, which is important. I reassure hon. Members that the review will be independent.

The Liverpool care pathway is internationally recognised as good practice, and it is widely supported by organisations involved in end-of-life care. If people do not feel that they have received the best care or, worse, if patients cease to trust the pathway, that is a problem that needs to be addressed.

Training is fundamental, as the hon. Members for Hackney South and Shoreditch and for Congleton and the shadow Minister said, and it will be considered as part of the review. The review will systematically examine the experience of the Liverpool care pathway by patients, families and health professionals, and it will seek evidence to support or refute the accusations and to see where improvements might be needed. The review will hear directly from families. There will be a session dedicated to families so that they can tell the panel about their experiences.

The review will also consider the role of financial incentives in the use of the LCP. Like my hon. Friend the Member for Southport, the hon. Member for West Lancashire and others, I have concerns about the use of financial incentives. The review will report both to the Department of Health and to the NHS Commissioning Board by the summer.

Everyone wants their loved ones’ final hours to be as pain-free and dignified as possible. Used as intended, the Liverpool care pathway can help achieve that. The pathway prioritises comfort, dignity and appropriate care, but all that is undermined if the public distrust the pathway and if clinicians do not apply it properly. We do not dismiss people’s concerns, which I take extremely seriously. Instead, we have to ensure that care in the last few days and hours of life is always of the highest standard. Reinforcing the absolute importance of involving patients and their families in discussions on their care and treatment is essential.

Thalidomide Trust (Grant)

Norman Lamb Excerpts

Thursday 20th December 2012 Commons Chamber

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

With permission, Mr Speaker, I should like to report to the House on a new 10-year grant to the Thalidomide Trust to help it find more personalised ways of meeting the health needs of thalidomide survivors.

The current three-year grant, which comes to an end in March 2013, was introduced by the previous Government as a pilot scheme. Its aim was to enable the Thalidomide Trust and its members to explore more innovative ways of preventing further deterioration in the health of thalidomide victims and to help preserve their independence.

This Government are committed to improving outcomes for all disabled people and to supporting them to live independent lives. That is why we are pleased to be able to continue the excellent work begun by the pilot scheme through this 10-year commitment. Over the next 10 years, the grant will be in the region of £80 million. It will be paid on an annual basis, rising each year in line with inflation.

I was privileged to speak on this very subject on my first day as a Health Minister and then met, along with the hon. Member for Elmet and Rothwell (Alec Shelbrooke), the Thalidomide Trust and its national advisory council. They impressed on me the complex and highly specialised needs that thalidomiders have, particularly as they approach older age. At the meeting, members of the trust and a number of thalidomiders stressed the need for certainty and that any future grant would need to be for longer than just three years. I am delighted that we are able to give them that certainty.

Many thalidomiders have had to use their bodies to compensate for the damage to their arms or legs in such a way as to cause severe musculoskeletal problems, including lower back pain, sciatica, damage to the coccyx area and shoulder pain and stiffness. Treatments to relieve those symptoms, such as massage and physiotherapy, not only help to maintain their independence, but often mean that they can stay in work.

The Thalidomide Trust has provided evaluation reports for the first two years of the pilot scheme. I have read with interest how it has invested the money. It is clear from the reports that this scheme is the best way to continue to meet the complex needs of thalidomide survivors. One recipient of the grant has improved her independence by installing a table that rises and falls by remote control, enabling her to reduce overstrain on her muscles. Another recipient describes how regular physiotherapy and visits to the gym, paid for by the grant, have led to him losing weight, thereby relieving stress on his joints, reducing the pain and improving his mental well-being.

A small number of people said that they had reduced their need for prescription painkillers and the frequency with which they need to see their GP. The reasons for that varied, and included successful surgery, lifestyle changes and improved access to complementary medicines, but all of them were linked to the use of the grant. The continued funding will help individual thalidomiders to maintain control over their own health needs, because they are the experts in what really makes a difference.

There will be clear principles for the use of the money. It must be used only for health-related needs and it cannot be used to duplicate support provided through a different source, such as personal health budgets. The grant must also be used only for the benefit of thalidomide survivors living in England. Separately, the devolved Administrations will each consider how they will support thalidomiders after the end of the current three-year pilot, which is in March next year.

Naturally, the Department of Health will review the scheme annually to ensure that it remains the most appropriate use of funding and the best way of distributing it to those who need it. The trust will use its extensive expertise and knowledge of its members to distribute the funds to thalidomide survivors in England.

I pay tribute to the Thalidomide Trust. The contribution of both the trust and its national advisory council, many members of which are in the Public Gallery to hear this statement, cannot be overstated. The trust uses its expert knowledge to provide invaluable support to survivors of the thalidomide disaster and their families, while members of the national advisory council work tirelessly, despite their own impairments, in the cause of all thalidomiders.

Finally, I reiterate the regret and deep sympathy first expressed three years ago by the then Minister of State, Department of Health, the former Member for North Warwickshire, Mike O’Brien. We acknowledge the physical hardship and emotional difficulties faced by the children affected by this drug and their families, and the challenges that many continue to endure, often on a daily basis.

I commend the statement to the House and wish everyone, including all thalidomiders, a very happy Christmas.

[Liz Kendall (Leicester West) (Lab)]

I thank the Minister for the advance copy of his statement.

Thalidomide survivors waited far too long for Governments over many years to address the appalling physical and emotional difficulties that they faced as a result of thalidomide prescribed by the NHS from 1958 to 1961. The last Government took the first steps towards addressing this unacceptable situation. In January 2010, the then Minister of State rightly offered our sincere regret and deep sympathy for the injury and suffering endured by all those whose expectant mothers took the thalidomide drug. I want to repeat that sincere regret and sympathy today.

The previous Government also acknowledged the urgent need for extra help for thalidomide survivors to meet their care and support needs, by putting in place a three-year pilot scheme. The pilot, as this Minister said, has helped survivors to improve the quality of their lives and to cope with their increasing loss of mobility and independence as they get older by helping them to buy and put in place the things that they say make the most difference to their lives.

I welcome the Minister’s announcement that the Government will continue the scheme for 10 more years with a grant in the region of £80 million. That will mean a huge amount to the 431 thalidomide survivors living in the UK today. As the Thalidomide Trust says, the money will allow one survivor with no arms to buy the special adaptations she has been unable to afford, and a man with no legs to make a down payment on a van adapted so that he can drive it from his wheelchair. It will allow a deaf thalidomide survivor to continue to employ someone to be her signer when she goes out so that she can retain her confidence and ability to remain active and mobile.

I have a number of questions about the scheme that I hope the Minister will answer. He will be aware that Scotland, Wales and Northern Ireland made proportionate contributions to the fund set up by the previous Government. Will the devolved Administrations make similar contributions to the fund he has announced today? He says that the grant will be reviewed annually, but there might be concern that that is not as stable as some survivors would like. Will the Minister guarantee that the views, needs and concerns of survivors will be at the heart of those reviews, and will he explain why we need an annual review, and not a three-year review as under the previous Government?

Will the reviews look specifically at the increasing needs of thalidomide survivors as they get older? Evidence collected over the past two years confirms that their health and mobility is deteriorating rapidly now that they have reached their 50s. Because of those increasing needs, will the Minister commit today to ensuring that there will be no less funding in the years ahead?

I will conclude, as the Minister did, by thanking and paying tribute to the work of the Thalidomide Trust, its national advisory council, and all campaigners who have fought to make successive Governments face up to their responsibilities. Members across the House sincerely regret how badly thalidomide survivors were let down, and we will strive to ensure that that never happens again.

[Norman Lamb]

I appreciate the shadow Minister’s support for today’s announcement and she is right to say that people have waited far too long for an acknowledgment of the tragedy and for practical action. I acknowledge—as I did in my statement—the actions of the previous Government in initiating the pilot scheme, and the expression of regret made by the former Health Minister. One powerful thing about the scheme, as designed in the original pilot, is that it gives maximum power to the individual to determine and respond to their priorities and needs. That means that the money can be used in a host of different ways, as the hon. Lady described.

The hon. Lady raised a fair point about the devolved Administrations, and we must be equally concerned about thalidomiders in Scotland, Wales and Northern Ireland. The devolved Administrations did not feel able to commit to the 10-year period here and now, but they are fully committed to continuing that help and we will work closely with them to ensure that individuals in those Administrations are not left behind in any way.

The hon. Lady rightly mentioned the annual review, which is a question of proper accountability. The trust has done a brilliant job and I acknowledge its work. It is a completely responsible organisation that knows better than anyone how best to deploy the available resources, but as it acknowledges, it is right for it to be held to account for how public money is spent. There is no intention at all to question the purpose of the grant, and we want to give the certainty provided by the 10-year period. The fund will be index linked so that the value of money from the pilot scheme is maintained throughout that period. The review is simply to ensure that the scheme still makes sense and that we are using the available resource in the best possible way. I have every confidence that that will be the case and, as the hon. Lady requested, the needs of the thalidomiders who benefit from the money will be put at the heart of the reviews. We will not let those people down in the commitment that we are making today, and the funding will be maintained.

The hon. Lady rightly talked about deteriorating health because the body has been under such extraordinary strain. I spoke to thalidomiders earlier today. It is remarkable what their bodies have been able to do, often in the absence of limbs, but that puts an enormous strain them, and the wear and tear is now having its effect. We do not know what the prognosis is going forward. It is therefore right to take stock and see what their needs are after a 10-year period, but the commitment to those people must remain.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

On 23 November, the first ever memorial to thalidomide victims was unveiled in Harrogate—a tree was planted and a plaque was unveiled to mark the 50th anniversary of the withdrawal of the drug. Thalidomide victims were present at the unveiling, which was carried out by Mr Guy Tweedy, a Harrogate resident and leading thalidomide campaigner.

The victims have waited a very long time for recognition, including financial recognition. I very much welcome the Minister’s comments, particularly those on the certainty required and the 10-year period, the challenges the victims face as they grow older and the sheer bravery that some have had to show during the course of their lives. I simply urge him to do all he can to support this special group.

[Norman Lamb]

I absolutely commit, on behalf of the Government, to do everything we can to support that group of people. As a society, we owe it to them to support them—they are often in very difficult circumstances. He is right to note the bravery that they have shown—not just the individuals, but their families too—in facing those circumstances.

[Mr Frank Field (Birkenhead) (Lab)]

I pay tribute to victims of the drug and to the trust that so admirably serves them, and thank the Minister for his statement, but how did he fix on that sum? Was it the sum that the trust asked for? Does it meet all the trust’s demands, or are other forces at work?

[Norman Lamb]

The right hon. Gentleman is right to pay tribute to the work of the trust over many years. We have based the sum on the amount of money provided as part of the pilot scheme, which appeared to work very well. It does not meet all needs, but many individuals get help in other ways—some have personal budgets, and so on. However, it is acknowledged that the amount is a massive help and support and gives them the reassurance for a lengthy period that continuing support will be available.

[Richard Fuller (Bedford) (Con)]

I join other right hon. and hon. Members in praising the dedicated, intelligent and sensitive leadership of the Thalidomide Trust over many years. The news from the Minister will be welcomed by thalidomide survivors throughout the UK, including in my constituency by a friend of mine and his wonderful family. The issue for many thalidomide survivors is the pursuit of an independent everyday life. Will the Minister advise me and the House why the decision was made to have a 10-year grant rather than a lifetime grant, which would have eliminated all uncertainty? I am very interested in the Minister’s comments on that.

[Norman Lamb]

We had a genuine judgment to make. On the one hand, I wanted to provide a good deal of certainty for a lengthy period, but this is a unique group of people. Their health is deteriorating, but we do not yet know what the prognosis is for the rest of their lives. It therefore might have been dangerous to allocate a sum of money for the rest of their lives. For all we know, their needs may grow considerably. It is therefore right to take stock in 10 years’ time and make a judgment on their needs at that stage.

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

I have met victims of thalidomide over many years, and I had the privilege of being Parliamentary Private Secretary to the former Member for North Warwickshire when he introduced the pilot scheme, so I really understand some of the difficulties that the Minister has faced. I therefore congratulate him, as I know that it was a difficult and emotional decision to take. The trust should also be congratulated on its efforts and tenacity over many years.

[Norman Lamb]

As I indicated in my statement, I had to respond to an Adjournment debate on the subject in Westminster Hall on my very first full day in the job. The presence of so many thalidomiders at that debate sent a very powerful message to me about the need for us to face up to our responsibility to support those individuals.

[Mel Stride (Central Devon) (Con)]

I very much welcome my hon. Friend’s statement, which will mean a huge amount to sufferers up and down the country, including those in my constituency. I wish to pay tribute to Ruth Daniels, one of my constituents, who has campaigned very hard on this issue.

The Minister mentioned that money would be made available for physical health needs. Can he confirm that it will also be made available for those suffering from mental effects as a result of thalidomide?

[Norman Lamb]

Ruth Daniels and many others have campaigned long and hard for justice, and it has taken too long for that to be properly acknowledged. I absolutely confirm that the money can be used for any health-related matter, and mental health can be affected as well as physical health, and is just as legitimate as any other health need.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

The Minister will be aware that the trust has also called for the manufacturer finally to acknowledge its culpability, something that it has repeatedly failed to do. Will he update the House on his assessment of the likelihood of getting those cowards finally to take responsibility?

[Norman Lamb]

Talking earlier to people from the Thalidomide Trust, they are deeply frustrated—as am I—by the failure of the manufacturer to face up to its responsibilities. I cannot provide a positive update that suggests that it is about to do what it should do, but I think we would all agree that it should acknowledge its culpability without delay.

[Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)]

I thank the Minister for responding so positively—it was my Westminster Hall debate to which he responded on his first day in the job. I am glad that he has listened to the views of the thalidomiders. I also join in the tribute to the Thalidomide Trust, especially Mikey Argy and Liz Buckle, who first brought the information to me that persuaded me that a debate was needed.

The Minister mentioned the position in the devolved Administrations. Will he give the House an update on the discussions that he has had with the Cabinet Secretary for Health and Wellbeing in Scotland? Has he had any indication of when a statement or announcement will be made by the Scottish Government so that thalidomide victims in Scotland can have the same peace of mind as those in England?

[Norman Lamb]

I pay tribute to the hon. Lady for her campaigning on this issue, along with several other hon. Members, which has played a part in ensuring that the needs of thalidomiders are properly acknowledged. I cannot tell her that there will be a statement at any particular time, but I confirm that we are in touch with the Scottish Government and there is a desire to help. I will write to her to provide as much of an update as I can.

Science and Technology Committee Inquiry

Norman Lamb Excerpts

Tuesday 18th December 2012 Written Statements

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

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

The Government have today laid before Parliament their response to the House of Commons Science and Technology Committee inquiry into the regulation of medical implants in the UK and the EU (Cm 8496).

The Government welcome the Committee’s report and its focus on the importance of increasing transparency and accountability in the regulation of medical implants. The Government agree with the Committee on:

strengthening transparency;

improving the consistent quality of notified bodies across the EU;

increasing access to scientific expertise;

limiting the burden on small and medium-sized enterprises;

building on the current regulatory system;

introducing stricter rules on when manufacturers can rely on clinical data which is sourced from studies on a similar device; and

improving the environment for clinical investigations.

The Government are committed to further considering the Committee’s recommendations on requiring health care professionals to report serious adverse incidents and introducing a “Black Triangle Scheme”, which currently exists as a voluntary scheme for medicines, to medical devices. The Government will continue to consult with the National Joint Registry for England and Wales (NJR) on the Committee’s recommendation to publish raw data from the NJR.

As regards the Committee’s criticism that the Medicines and Healthcare products Regulatory Agency (MHRA) reacted too slowly to Australian data on the safety problems of metal-on-metal hips, the Government would like to reiterate that the MHRA was the first regulatory authority in the world to issue advice on monitoring and patient management in April 2010. The analysis of data from the National Joint Registry for England and Wales was key to the worldwide action to recall the particular metal-on-metal hip system in August 2010.

NHS Funding

Norman Lamb Excerpts

Wednesday 12th December 2012 Commons Chamber

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

I am sorry that the Secretary of State is leaving because, before going on to discuss what is happening in my local health community and local hospital, I want to pick up on a couple of the things that have been said. First, I am pleased that this very dry motion has been tabled because I hope that it will concentrate our minds on what is happening in the national health service and, in particular, to spending.

The Secretary of State said that spending is related to budgets. He did not respond to the point posed by my right hon. Friend the Member for Leigh (Andy Burnham) that in 2010-11, there was a £1.9 billion underspend in the national health service budget. No use was made of the budget exchange scheme, so none of that money was moved into the following financial year. We can assume that £1.9 billion went back to the Treasury.

In the following year, 2011-12, the underspend was £1.4 billion, and £316 million was carried over into 2012-13. An underspend in the region of £3 billion from the first two years of this Government—including the year they won the general election—has gone back to the Treasury. Those are the facts; I do not know if any Front Bench Member wishes to dispute them.

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

Does the right hon. Gentleman also acknowledge that the average underspend in the last four years of the Labour Government was £1.9 billion?

[Mr Barron]

I recognise that there has been underspend, but I take this debate, and the debate we had running up to the general election, a bit more seriously. The chairman of the UK Statistics Authority said that there had been an underspend, and what we have just heard is not true. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the Conservative party manifesto stated:

“We will increase health spending in real terms every year.”

--- Later in debate ---

[Mr Barron]

The issue of allocation has been looked at by many Select Committees, including by the Health Committee when I chaired it in the last Parliament. We did not find the level of unfairness that people, particularly those from rural areas, used to say there was. We looked for it but we did not find it.

Let us look at what is happening in the real world. My local Rotherham hospital foundation trust is not a bad hospital trust in any way and scores quite well in many areas. It received foundation trust status a number of years ago, and when this Government took office, it is fair to say that the efficiency factor was there already. On 16 March 2011 the trust announced that more than 60 jobs were to be axed at Rotherham general hospital, and confirmed a potential reduction of 62 posts in medical and surgical areas. Earlier this year on 6 March 2012, the local BBC announced that more than 70 NHS staff were facing the threat of redundancy, and the trust is seeking to save about £4 million. On 26 October 2012, an internal report given to the local media stated that the trust now intends to cut 750 jobs—about 20% of its work force—by 2015.

The NHS trust said that it needed a smaller hospital with substantially fewer beds and a smaller work force to save £50 million over the next four years. The internal report—aptly named, “Creating Certainty in an Uncertain World”—said that it was necessary to save £50 million from the £220 million budget before 2015 to meet Government targets. That was confirmed by the trust in a press release.

On 5 November 2012, the chief executive of the trust said that it would show staff the plans and invite them to come back with alternative views on how things might be done differently. The trust stated:

“We’ve made it very clear that there may have to be redundancies, but to be honest with you until we have gone through the process, I don’t know how many we will be able to lose through natural turnover and how many will have to be made redundant.”

What type of planning is there in any of this when we have such a situation in a district general hospital on which about 80% of my constituents rely if they have to go into secondary care?

On 20 November 2012, the chief executive announced his retirement. On 3 December 2012, the hospital announced that staff will be informed about the decision to postpone the formal consultation launch into work force restructuring. It went on:

“We realise this an anxious time for all members of staff, but it is imperative that we do what is right for the Trust, our staff and our patients. This means that we need to take more time to ensure our workforce proposal is exactly what the Trust requires and we anticipate the launch to take place later in the month.”

On 7 December 2012—last Friday—a headline in the local newspaper stated that the trust had recently engaged the services of a director of transformation on a time-limited basis. The acting chief executive said:

“It is important that the trust acts quickly to take the action required to safeguard the future clinical and financial sustainability of the Trust. This appointment, which was made after a competitive process, is required to provide additional expertise and impetus to the changes we need to make, whilst allowing others to remain focused on delivering the healthcare services that the people of Rotherham need and deserve.”

I do not stand here and support the way the NHS has been structured now or in the past, and I have been critical about many areas of that. I agree with the chief executive of the NHS, David Nicholson, who said at the NHS confederation conference this year:

“We need to change the model of care to one which supports patients and focuses more on preventing ill health from happening in the first place...and move away from the default position of getting someone into a hospital bed.”

At the same conference the then Health Secretary said that closure decisions were not an issue for national politicians, and my right hon. Friend the Member for Leigh said that the current Health Secretary said very much the same thing—“It’s nothing to do with me, guv.”

Let me say to the Minister, and other hon. Members who have made relevant interventions, that if changes and reconfigurations inside the national health service are getting better care to more patients, that is fine. However, the chaos in my local health service is about cutting back and saving money. I have played an active role in health care in my constituency over many years and, as far as I know, there has been no debate with local Members of Parliament, patients, patient groups, local doctors or people engaged in health provision in Rotherham. There have been no discussions whatever about reconfiguring the district general hospital to improve the position of patients and of the people of Rotherham and the surrounding area. Instead there is a drive to save money, which is creating chaos in my local health service.

[Norman Lamb]

Does that not demonstrate a complete failure at local level to address the real problems that we are trying to grapple with? There is therefore a case for a changed system whereby a health and wellbeing board brings all the parts of the system together to debate such issues.

[Mr Barron]

The events of the past two months suggest to me that the people in whom the Minister has faith to reorganise health care in Rotherham do not know what they are doing. They have brought in new systems and produced a report inside the hospital, which I understand was given to the trade unions. It ended up on the front page of a local newspaper and was countered by a press release by the hospital itself. Where is the debate about improving health care for my constituents and others? It is absent.

I say to the Minister that it was wholly wrong for the previous and current Secretaries of State—he is not the Secretary of State himself, but we never know, he may be one day—to say “These are not matters for Ministers”. I have not been consulted about them. The three local MPs had an appointment with the chief executive of the trust about two weeks ago, but it was cancelled because he had announced his retirement the week before. That is not acceptable.

The hard reality on the ground is that no matter what we would like to happen in health care, trusts are charging into cutting budgets. They are cutting jobs, because that is where the major expenditure is in health care, and that is creating the chaos that I have described. It is not acceptable. My constituents pay their taxes to pay for health care—it does not come out of the budget down here in Westminster—and they deserve better than what they are getting at the moment.

--- Later in debate ---

[Andy Sawford (Corby) (Lab/Co-op)]

I am grateful for the opportunity to speak in a debate that is incredibly important to my constituents. I thank my right hon. Friend the Member for Leigh (Andy Burnham) for opening the debate. He is aware of my grave concerns about the future of hospital services that serve people in Corby and east Northamptonshire.

It has long been the ambition of people in Corby—a large, important town that is growing—to have their own hospital. I hope that in future we can realise that ambition. For a long time, however—and for the foreseeable future—we will be served by Kettering general hospital for most of our hospital needs. At Kettering general hospital there are 650 beds and more than 3,000 staff. The hospital is more than 115 years old, and received massive investment, including under the Labour Government. I make that point not so much politically point but as a local person who remembers driving down Hospital hill in Kettering and seeing the fundraising barometer outside the hospital and wondering why we relied on car-boot sales to fund vital hospital services.

My right hon. Friend the Member for Leigh, a former Health Secretary, and his predecessors began to put that right, and there was huge investment. Kettering general hospital now has 17 operating theatres and an obstetrics unit that delivers more than 3,500 babies a year. It has something that serves only a few of my constituents but is incredibly important to all of us—a neonatal intensive care unit, or special care baby unit. My own family has had cause to be grateful to that unit and its brilliant staff.

Kettering general hospital offers a 24-hour accident and emergency service, with level 2 trauma services, which sees more than 2,000 trauma patients a year. There are concerns, however, and I have agreed with the hospital and local people to champion certain issues in the House as the local Member of Parliament, including per capita funding of Kettering general hospital, which we believe is inadequate and lower than average compared with other areas. With a growing population and growing health needs, that must be addressed.

Recently, a report on the hospital by Monitor raised serious concerns, particularly about accident and emergency. I have met the hospital chief executive and the chair of the trust to discuss those concerns, and to assure them that I will seek to do whatever I can, including making sure that a case for adequate funding for the hospital is made, so that those concerns are addressed.

The big issue that causes us all concern locally is a major review of health services—the kind of review that other Members have experienced in their areas. In Kettering, the Healthier Together review of five hospitals has already cost more than £2 million; that was the figure in the summer, and I have no doubt that it is rising rapidly. The review has also taken a great deal of time and effort. In early September, together with local nurses and others, I met the people leading that review, as a public member of the trust, and I was incredibly worried about what I heard, both as a user of the services, and as a representative of local people.

The Healthier Together team gave us a pledge card telling us about their plans and giving us some assurances. The context was also set. We were told that the review was driven by a desire for the best clinical outcomes, by expertise, and by research on how local people could be provided with the best health care. We were told that there were considerations to do with more services being provided in the community, and a shift to prevention, which are things I recognise it is important for our local hospital and its partners—the clinical commissioning group and the other hospitals—to consider.

It was slide 2 that really got to the heart of the problem. It told us that the five hospitals face a combined funding gap of £48 million, and that my local hospital, Kettering general hospital, faces a future funding gap of £6 million a year. I have no doubt that the comments that Andrew Dilnot recently made about the real-terms reduction in funding are very much connected to that, but I do not want to make that wider political point again; it has already been made eloquently by my right hon. Friend the shadow Secretary of State. I simply say that all local people recognise that resources are getting tighter and tighter at the hospital.

[Norman Lamb]

Does the hon. Gentleman share my view that in many local health economies, private finance initiatives are causing a massive strain on resources?

[Andy Sawford]

I want to keep my remarks to Kettering general hospital, and I do not think that PFI is the issue there.

--- Later in debate ---

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

I start by acknowledging the moving contribution of the right hon. Member for Cynon Valley (Ann Clwyd). Her testimony was shocking and should force the whole system to recognise that such experiences are utterly intolerable and have no place in a modern health system in which kindness and compassion must always take first place. My right hon. Friend the Secretary of State is absolutely right to put that at the top of his agenda. The hon. Member for Strangford (Jim Shannon) also spoke about that point.

I have sat in this Chamber for many debates on the NHS; I have spoken in many of them too. I have heard many arguments about a lot of different things, but unfortunately this is one of the most misguided motions I have ever seen. I get on well with the right hon. Member for Leigh (Andy Burnham), but on this occasion he is completely wrong. As my right hon. Friend the Member for Charnwood (Mr Dorrell) said, the debate should be about the massive challenge we face in caring for people with long-term chronic conditions.

The right hon. Gentleman blames us for his spending plans when he was in office—plans that he signed off when he was in government. Let us have a quick reality check. The coalition’s spending plans kicked in in 2011-12, not before, and in that year there was an increase in real-terms spending. However, hon. Members should not take my word for it: they should ask Andrew Dilnot, the chair of the UK Statistics Authority and a highly respected and eminent economist. He confirmed that in 2011-12, NHS spending increased in real terms compared with the previous year by 0.1%. It says it all that the right hon. Gentleman refused to complete the sentence from Andrew Dilnot’s letter and give the complete picture. Spending will carry on going up for years to come, despite the legacy of financial irresponsibility left us by the last Government—the billions frittered away on a failed IT programme; the vice-like grip of PFI schemes mortgaging—

[Lucy Powell]

Will the Minister give way?

[Norman Lamb]

I have very little time.

Seventy-three billion pounds outstanding on PFI projects, mortgaging the NHS’s future and causing a massive strain on local health economies—that was something alluded to by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Members for Lewisham East (Heidi Alexander) and for Corby (Andy Sawford). The problems of PFI are massive. Labour also had 25,000 people working in health quangos. That is Labour’s legacy, but now, under the coalition, over the four years to 2014-15 the NHS budget will rise by more than £12.5 billion.

[Nigel Adams]

May I appeal to the Minister to ensure that rural areas such as North Yorkshire are given a fairer funding formula when the Secretary of State reassesses the formula shortly?

--- Later in debate ---

[Norman Lamb]

I understand the concern about rural areas and I will write to my hon. Friend about that. That £12.5 billion will go into improving services, hiring staff and keeping people well. That money will help to protect our health even as the age of the population goes up.

[Lucy Powell]

I thank the Minister for giving way. [Interruption.] Let me tell the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) that I am not going to read anything out. After such a long and lively debate, I just want to know whether the Minister will now clarify the matter that is before the House. Was NHS expenditure, in Dilnot’s words, lower in 2011-12 than it was in 2009-10? Yes or no?

[Norman Lamb]

The letter from Andrew Dilnot—the part that the right hon. Member for Leigh did not read out—also said that

“it might also be fair to say that real-terms expenditure had changed little over this period.”

In 2011-12, it went up according to Andrew Dilnot.

My right hon. Friend the Secretary of State for Health has already gone through the numbers outlining what is happening in the NHS today. He has already mentioned all those areas where the NHS is now healthier than under Labour—60,000 fewer people waiting longer than 18 weeks than under Labour; a determination to give access rights to those with mental health problems, as well as those with physical health problems, which was something bizarrely left out by Labour; more than 3 million more out-patient appointments every year than under Labour; more clinical staff, including 5,000 more doctors; and better access to drugs than ever before, including £600 million for the cancer drugs fund. On the cancer networks, the budget for networks as a whole is going up by 27%, which includes dementia and maternity—something that was also left out by Labour. Had the Labour party had its way and cut NHS spending, what would have happened to the networks in those circumstances?

Here is the important point, a point that Labour Members have unsurprisingly chosen not to mention throughout the length of this debate—that money would not be there under Labour. I have no doubt that they will protest, but it is there in black and white, immortalised in Hansard and in the press: for years, they have consistently advocated spending less than us on the NHS. In 2010, the right hon. Member for Leigh, in an interview with the New Statesman, said:

“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us.’”

The interviewer fired back:

“Which is true, isn’t it?”,

and the right hon. Gentleman admitted ,“Yes, it’s true”. In the same year, as reported in The Guardian, the right hon. Gentleman said:

“It is irresponsible to increase NHS spending in real terms”.

Yet it goes even further than that. A year before those interviews, in 2009, he could not even promise that the NHS would be protected from cuts. The chief economist from the King’s Fund agrees. Commenting on Labour’s plans, he said that the implication of the overall budget for the NHS was that it would be cut in real terms from between a very small amount to up to 5% over two years. That is what would have happened, had Labour won the election. It will fool no one: it will not fool the public, patients, the professionals or this House. We all know that the coalition is moving heaven and earth to protect the proud heritage of the NHS and drive up standards for everyone—whoever they are and wherever they live.

As my right hon. Friend the Member for Charnwood rightly says, the challenge is how we rethink how services are delivered across the health and social care divide to prevent crises from occurring. Prevention is what we should be doing, as the right hon. Member for Rother Valley (Mr Barron) rightly pointed out. If Labour Members do not like our plans, it is up to them, but if they think the NHS would be doing better with less money, more mixed-sex wards, longer waiting times and fewer clinical staff, they are more than welcome to that position. They can cling on to that as long as they wish, but what is unforgivable is for them to try to hoodwink the public into belittling an NHS that is getting better and better all the time. We have an NHS that is treating more people than ever better than ever, an NHS that is preparing itself for new challenges every day.

Let us compare that with Labour’s real NHS project in Wales, where we see cuts—cuts that have resulted in half a billion pounds taken out of the NHS in Wales by Labour. Waiting times are longer than in England and a higher proportion of patients is waiting for treatment. That is the true face of Labour on the NHS, and in England we should fight it as passionately as we can.

We have seen clearly today the desperation of the Labour party—a desperation that has led it to try to misinterpret inconvenient statistics. Frankly—

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.

Winterbourne View

Norman Lamb Excerpts

Monday 10th December 2012 Commons Chamber

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

With permission, Mr Speaker, I wish to make a statement about Winterbourne View.

The scandal that unfolded at Winterbourne View was devastating. We were all rightly shocked, angered and dismayed by the appalling abuse uncovered by the “Panorama” programme in May 2011. Straight after the programme was aired, my predecessor, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), commissioned an in-depth review to ensure that we learned the lessons and took action. Today, I am publishing the review’s final report.

The abuse at Winterbourne View was criminal. Staff whose job was to care for people instead routinely mistreated and abused them. Management allowed a culture of abuse to flourish. Warning signs were not picked up by health or local authorities, the residents’ families were not listened to, and the concerns raised by a whistleblower went unheeded. The fact that it took a television documentary to raise the alarm speaks volumes.

The abuse that was uncovered at Winterbourne View is only part of the story. This case has made us look again at how we care for one of society’s most vulnerable groups. Winterbourne View hospital provided care for people with either learning disabilities or autism, together with either mental health problems or challenging behaviour. Around the country, at any one time, there are about 15,000 people with similar needs, about 7,000 of whom live with their families. Of the remainder, many live in the community, but about 3,400 are in in-patient settings. Their behaviour can sometimes pose a risk to themselves, and sometimes also to others. There will therefore be times when they require intensive treatment and support.

However, hospitals are not where people should live. There are far too many people with learning disabilities or autism in hospital, and they are staying there for too long—sometimes for years. We should no more tolerate people being placed in inappropriate care settings than we would people receiving the wrong cancer treatment. What is necessary is nothing short of a fundamental change of culture.

We have known for more than a decade that, with the right support, the vast majority of such people can live happy, fulfilled lives, close to their families and in their own communities. I saw that at Tower Hamlets just this morning. Much of what we know works in this area is based on the pioneering work of Professor Jim Mansell. Professor Mansell helped to set up our review and supported us right up until his death in January this year. I pay tribute to him for his tireless work in this area and for the huge contribution that he has made to improving people’s lives.

We know what change is needed; it is now time to ensure that it happens. Today, we are setting out how we will address poor care and abuse, and ensure that excellent care becomes the norm. First, we need to send a clear message to those who provide care. Owners, boards of directors and senior managers must take responsibility for the quality and safety of their services. When they fail, they should feel the repercussions.

A number of front-line staff at Winterbourne View rightly received criminal convictions, but the case revealed weaknesses in our ability to hold to account those who are higher up. We will address that. We will examine how corporate bodies and their boards of directors can be held to account under law for the provision of poor care and for any harm that is experienced by people using their services. We will also explore whether we can ensure that directors are “fit and proper persons” to oversee care, including through consideration of their record with other providers.

We will also tighten regulation. The Care Quality Commission will include reference to the best model of care in its revised guidance about compliance, and will consider it as part of the regulation and inspection of services from April next year. The CQC will also check whether all providers are following the established national guidance or similar good practice, including by carrying out unannounced inspections involving people with learning disabilities or autism and their families. Where standards are not met, it will take enforcement action.

Secondly, we will tackle the wider failings. We must stop people being placed in hospital inappropriately and ensure that services are commissioned which properly meet people’s needs. That requires the NHS and local government to work together.

All current hospital placements will be reviewed by 1 June 2013, and everyone who is there inappropriately will be moved to community-based support as quickly as possible and no later than June 2014. We will also ensure that in future health and care commissioners design services that allow people to live safely with support in their communities, with the individual and their family included in the development of their care plan. By April 2014, every area will have developed an agreed plan to ensure that that group receives high-quality care. As a result, we expect to see a dramatic reduction in hospital placements.

The report sets out specific actions that we will take to support that high-quality care, including tackling the excessive use of physical restraint, addressing concerns about the over-use of antipsychotic and antidepressant medication, and improving safeguarding arrangements. We will support a positive and open culture in which staff provide excellent care but feel able speak out when care is poor. We will support providers to achieve that, including in relation to staff training.

Creating a positive culture means listening to and involving people and their families. At Winterbourne View, families’ concerns were ignored. However, we must go further than heeding warnings or complaints and ensure that people and their families are involved at every stage of their care, and that they get the support they need, including advocacy support. We will make these changes as quickly as possible.

The organisations responsible for delivering change share our commitment to making it happen and are working nationally and locally across health and social care. A concordat signed by more than 50 organisations sets out the specific actions that each organisation commits to deliver. The NHS Commissioning Board and Local Government Association will come together to lead a joint improvement programme, with financial support from the Department of Health, to ensure delivery of the changes. I will chair a programme board to oversee that progress is made.

Winterbourne View fills us all with sorrow and anger but we are using it as a spur to make things better. Some places are already getting things right—I have seen some of them for myself, including at Tower Hamlets this morning, and the report discusses many more. They show what can, and should, be done for all, and that a better life for people with learning disabilities and autism is possible. I regard it as a national imperative that we transform care for those with learning disabilities or autism and behaviour that challenges, and I commend this report to the House.

[Liz Kendall (Leicester West) (Lab)]

I would like genuinely to thank the Minister for advance sight of his statement and the briefing I received earlier today. Members on both sides of the House were appalled and angered by the terrible incidents at Winterbourne View, and we share a determination to ensure that all necessary steps are taken to prevent a similar tragedy from happening again. Our goal must be to ensure that everyone with a learning disability or autism, including those with challenging behaviours, receives high-quality, decent and humane care and support, and that we finally end the practice of sending people to long-stay institutions, far away from their family and friends.

The Minister has announced a number of welcome measures that are a step in the right direction, but I remain concerned that some of the proposals are not clear or strong enough to guarantee the fundamental changes that people with learning disabilities urgently need. The NHS mandate published two weeks ago states there should be

“a substantial reduction in reliance on inpatient care.”

Can the Minister give a figure for that reduction? Without one, that laudable aim will be open to such wide interpretation that it risks appearing meaningless. Similarly, the Government say they want every local area to provide “appropriate” care and support. Will the Minister tell the House who will define what care is “appropriate” and how that will be measured?

How will the Minister ensure that all local commissioners have the necessary skills to make these changes? That was a problem with 150 primary care trusts, yet in future there will be 212 clinical commissioning groups. Those can, of course, draw on expertise in local councils, but the authorisation process for CCGs does not even mention learning disabilities as an area in which competence is required. If this is such an urgent national imperative for the Government, will the Minister explain why that is the case?

Some parts of the country continue to use long-stay institutions because they have not developed alternative care in the community and at home. In a time of constrained resources, when we need to make the best use of taxpayers’ money, there should be one budget for people with learning disabilities, not separate budgets for NHS and council care. Will the Minister explain how he will make that happen on the ground? For example, will he require the NHS Commissioning Board to instruct CCGs to provide funding to local councils if they are slow to do so or if they refuse?

The serious case review of Winterbourne View said that light-touch regulation by the Care Quality Commission was not appropriate for closed establishments, and that they should be treated as high-risk institutions, requiring frequent, unannounced probing investigations. The review says that the investigations should involve speaking to residents’ families and patients, and in particular to people who have left the institution, who may feel more able to speak out. The CQC recently completed a focused programme of inspections of long-stay institutions. Will that specific programme continue along the lines the serious case review recommends? Will the Government, in their review of the use of restraint, consider banning t-supine restraint, as the serious case review recommends?

One of the most disgraceful aspects of Winterbourne View is that vulnerable people were neglected and criminally abused while the hospital’s owners, Castlebeck, charged huge fees and made huge profits. The serious case review says that Castlebeck made decisions about profitability, including shareholder returns, over and above decisions on the effective and humane delivery of treatment. The average weekly fee for residents at Winterbourne View was £3,500—the fee rose to £10,000 for one patient. The review could not determine how much of that money went back into the hospital and how much was creamed off for profit because of the company’s complex financial structure—Castlebeck is owned by private investors based in Jersey and Geneva. That has made it virtually impossible to hold the company to account. Will the Minister confirm that the company has so far failed to meet two of the serious case review’s key recommendations —that it should fund therapeutic services for all ex-Winterbourne View patients, and that it should pay for the costs of the serious case review, which have so far been borne entirely by the taxpayer?

I welcome the Government’s commitment to examining how corporate bodies and their boards of directors can be better held to account. As a first step, will the Minister consider requiring private companies to publish the names of their owners, the members of their boards, and the details of their financial structures, before they can be licensed and registered to provide publicly funded care? The excuse that such information is too commercially sensitive should not be acceptable when the care of vulnerable people is at stake, and when it is paid for using substantial amounts of taxpayers’ money.

How we care for the most vulnerable people is the hallmark of a decent society. I do not doubt the Government’s commitment to addressing this issue. I hope they listen to our concerns and strengthen their proposals, so that people with learning disabilities get the decent and humane care and support we would all wish for our families and friends.

[Norman Lamb]

I thank the shadow Minister for her contribution and appreciate the welcome she gives for the main thrust of the Government’s response. This is a moment when everybody must come together to be clear that a change of culture is necessary from top to bottom. This is not a party political issue. The culture must change, and everyone within the system—from top to bottom—must recognise their personal responsibility to achieve that.

The shadow Minister raised a point about the mandate. One very good thing about the mandate is that it gives us accountability and transparency in the system for the future, and enables us to hold the NHS Commissioning Board and other parts of the system to account on delivering what is in it.

The hon. Lady asked how we will measure success in relation to the reduction in numbers in long-stay institutions. There must be a focus on assessing an individual’s personal care needs—that is what counts. The arbitrary setting of a target on numbers would be completely inappropriate when we should be focusing on the needs of individuals. The guidance we have received is that while there are 3,400 people in in-patient facilities of one sort or another, we are talking about probably reducing that down to 300 or 400 people. That is the best assessment that has been made, but I stress again that it must be based on assessment of individual needs.

The hon. Lady rightly makes the point about the skills of commissioners. One of the big failures has been that of commissioners properly to look after the interests of highly vulnerable people. The programme, which will be led by the Local Government Association and the NHS Commissioning Board and funded by the Department with between £2 million and £5 million of support, will be there to provide support and guidance to ensure that local commissioners get this right. We should applaud the parts of the country where this is being done brilliantly at the moment. They can demonstrate best practice to areas that need to change.

The hon. Lady asked whether the Commissioning Board will hold CCGs to account. The answer is, absolutely. This is part of the transparency of the new system and they must deliver on what they will be required to do.

I agree with what the hon. Lady said about the budget. The report makes it clear that the starting point should be that pooled budgets are the appropriate way forward. This is patchy at the moment. If there are not pooled budgets, they should explain why. In my view, there is no good justification for not pooling the resources of the NHS and social care to ensure the best and most appropriate care for individuals. There is also a duty for the two sides—social care and NHS—to work together. The health and wellbeing boards help to bring them together, and that is valuable.

The hon. Lady asked about Care Quality Commission inspections. Unannounced visits will continue, and they will include people with learning disabilities and their families, so that their perspective is gained. This is not a time-limited programme—it will continue. I think that the CQC recognises that this is an area that requires focus because of the vulnerability of the individuals concerned.

On physical restraint, we will look at all elements, including those mentioned by the hon. Lady, so that the best possible guidance is given to ensure that the excessive use of restraint, which currently happens in too many places, comes to an end.

On Castlebeck, I absolutely agree that it should consider financial support for the costs incurred following the scandals uncovered in its care settings. The hon. Lady rightly points out the responsibility that goes with charging an average of £3,500 per week per patient. One of the great failures of the current system is that there is not sufficient corporate accountability to ensure that people are held to account when things go wrong. When we consider proposals to address that lack of corporate accountability, we will look at the hon. Lady’s transparency proposal on publishing a lot more information about financial structures. Indeed, in the consultation we announced a fortnight ago on the follow-up to Southern Cross, we are proposing that there should be transparency regarding financial structures and that that information is shared to ensure that we avoid being caught by surprise, which is what happened under the system in operation when Southern Cross crashed, leaving many people in an unacceptable state of anxiety.

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

May we have an assurance, first, that local agencies, such as the police and local government, have to take a large chunk of responsibility for this situation occurring in the first place and, secondly, that there will never be a repeat of the situation where the local council can fail to pick up on up to 40 alerts over several years? That could have avoided much of the pain and suffering at Winterbourne View.

[Norman Lamb]

I agree absolutely. One of the great scandals of this whole saga has been the extent to which local authorities and primary care trusts let people down. The father of a patient at Winterbourne View told me how the concerns he raised were ignored, how he watched as his son became more zombie-like because of the use of antipsychotic drugs and how he felt guilty himself—how shocking that a parent ends up feeling guilty through no fault of his own. He was powerless to do anything. It is shocking that public authorities let people down in that way. That is why I say that everyone in the system has to step up to the plate and recognise the need for a complete change of culture to recognise that everyone with learning disabilities has exactly the same rights as the rest of us.

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

I thank the Minister for his statement and hope that he will reflect on some of the questions posed by my hon. Friend the Member for Leicester West (Liz Kendall), who made a powerful case for private providers being subject to freedom of information requests—I draw his attention to early-day motion 773, which embodies that principle.

On the failings that brought about this terrible tragedy, the Care Quality Commission was overly concentrating on process rather than its main job of ensuring that the required standards were met and looking at quality and risk profiles. There was a big disconnect between the perceptions of carers and families and the views of the CQC. Fundamentally, unless we address the lack of resources, will we not see a series of these disasters in the future?

[Norman Lamb]

In the aftermath of Southern Cross, we have seen the need for much greater transparency in these large corporate bodies to ensure that we know exactly what their financial structures are like and where the risk exists. The hon. Gentleman mentioned funding. The great scandal is that we are spending vast sums of public money putting people at risk and into inappropriate care settings. Visiting places such as Tower Hamlets, we discover that the right care package for individuals—most often, supported living in their own community—is much cheaper and gives them a quality of life they never experienced in these institutions. This is not about money, therefore, but about the system stepping up to the plate and ensuring that individuals are respected in their own right.

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

The Minister is absolutely right that transparency is essential, but there is also a recognition—I think—that that is not sufficient; accountability is essential as well. In this case, the company, Castlebeck, has hidden in the shadows and left everyone else to take the blame. I welcome what he has said about corporate responsibility, therefore, but I urge him—and commend to him—to make a much closer examination of the corporate legal framework to ensure that there is a corporate legal offence. It is not good enough for the thugs who did this to be in the dock and receive a criminal conviction; the company itself has a criminal responsibility, and it should be held to that standard and brought to court as well.

[Norman Lamb]

I commend my right hon. Friend for the work he did on this subject. When I started this job, it struck me that there was an absence of effective corporate accountability in the law and that that had to be addressed. I was determined to ensure that the Government response addressed that issue head on. In doing that, we need to look both at the regulatory framework—issues such as whether there could be a fit-and-proper persons test for those on the boards of companies—and at the criminal law. It is striking that in the Winterbourne View case the authorities determined that it was not possible, under existing law, to bring prosecutions. I am absolutely clear, however, that responsibility rests at the top of the company for facilitating this sort of outrage. That is why the law needs to change. We need to look both at criminal offences and the regulatory framework.

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

May I press the Minister on one aspect? Will he look much more closely at the role of the third sector, particularly charities, in providing services? Hollybank school and community in Mirfield in west Yorkshire, close to my constituency, does a brilliant job. Does he recognise that, in considering the report, it is the quality of management that one worries about and the fact that the most vulnerable people in our society are so often looked after by poorly trained people on the minimum wage working 12-hour shifts? That is often at the heart of the problem.

[Norman Lamb]

I thank the hon. Gentleman for that question and completely agree that we have to address the issue of skills. It is worth pointing out that there are some fantastic providers in the voluntary sector, and in the private sector as well. We should applaud that and recognise that there are many well trained people on low wages providing a fantastic quality of care, but there are also places where that is not the case. That needs to be addressed.

I absolutely agree with the hon. Gentleman that we should look closely at the voluntary or not-for-profit sector. I had a meeting recently with the head of Shared Lives, an organisation that places people with learning disabilities into people’s homes. Surprise, surprise—when people are treated with dignity and treated as human beings, their behaviour improves and sometimes all the complex problems subside. There is an awful lot we can do. In the new year I will bring together the providers of the best care available so that we can learn the lessons from them.

[Sir Tony Baldry (Banbury) (Con)]

As patients had come from different parts of the country to Winterbourne, there was a sense that they had got lost in that locality. Whatever happens, it is a tragedy that it took a television programme to discover all this. We are now going to have health and wellbeing boards and HealthWatch. Can my hon. Friend tell the House how, between them, they can ensure that they inspect and have a grip to ensure that something like this never happens in my county of Oxfordshire? It has never happened there because the structures of local government and health and social services are constantly monitoring and inspecting whatever is happening in our areas, irrespective of whether they are delivering health or social care.

[Norman Lamb]

I thank my hon. Friend for his question. He is absolutely right. The new structure provides far greater local accountability than we have ever had. One of my great criticisms of the old primary care trusts is that they are, in effect, completely unaccountable to their local communities. Health and wellbeing boards scrutinising what clinical commissioning groups and the local authority are doing can be very powerful. He also mentioned HealthWatch. Like its predecessor organisations, the local involvement networks or LINks, it will have the power to go into all care and health settings and inspect what is going on, often behind closed doors. We encourage HealthWatch to use those powers to shine a light on what is happening in some of those places.

[Helen Jones (Warrington North) (Lab)]

The Minister has rightly referred to the amount of money paid for patients in Winterbourne View, but does he also recognise that good-quality care in a community is also expensive and requires a lot of highly trained staff? Given the cuts to local authority budgets, is he convinced that sufficient resources are available, even if budgets are pooled? When he knows how many patients need to be transferred back into the community, will he commit to come to the House to make a statement on whether the right resources are available?

[Norman Lamb]

I thank the hon. Lady for that question. What was striking when I visited Tower Hamlets this morning and talked to the leaders on the health and local authority sides was that, despite being the third most deprived borough in the country, Tower Hamlets is one of the lower spenders on institutional care because it is doing things the right way. Tower Hamlets has not referred a single person from the borough to an assessment and treatment centre for three whole years. Tower Hamlets has demonstrated not only that that is possible, but that it often ends up costing much less to provide the right care in the community—[Interruption.] Well, that is what the borough leaders find. That is what I have been told by them and by many other people in the sector. An individual should have the care that they need, and if the cost of that package in the community is substantial, it should be met. We should never compromise on that. All I am saying is that the overall cost of providing the right kind of care in the community often looks lower, when compared with those institutions in which the cost is extraordinarily high—as much as £3,500 per week per patient.

[Rehman Chishti (Gillingham and Rainham) (Con)]

The Minister mentioned unannounced inspections. Will they involve speaking at random to patients at the centres? Linked to that point, some hospitals around the country have a whistleblower policy that allows people who work in them and others to take their concerns to senior officials in confidence.

--- Later in debate ---

[Norman Lamb]

I thank my hon. Friend for his question. I am quite sure that those inspections will involve talking to the people in those settings. The fact that the Care Quality Commission is saying that it will involve people with learning disabilities and their families in those inspections will help to ensure that they have a human face. My hon. Friend also mentioned whistleblowing. It is essential that individuals feel able to blow the whistle when they see examples of abuse or neglect. Indeed, the Government have funded a helpline for any whistleblower in either the health or the care setting to ensure that people can always get access to guidance on how to go through the proper process of blowing the whistle on unacceptable standards of care.

[John Healey (Wentworth and Dearne) (Lab)]

I welcome many of the steps that the Minister has announced today in response to the shameful scandal at Winterbourne View. He says that he wants those who are high up in the organisations to be held to account. Does he therefore accept the argument put forward by my hon. Friend the Member for Leicester West (Liz Kendall) that now is the time to regulate for the best business standards, as well as for the best care standards? He also says that he wants to use regulation to secure higher and tighter standards. Will he ensure that, in putting those standards in place, any regulation of physical restraint deals not only with the excessive use of such restraint but with the appropriate use of the best techniques and with the best training?

[Norman Lamb]

I thank the right hon. Gentleman for his welcome for the broad thrust of my proposals, and for his questions. On standards of business in the sector, it strikes me that the levels of corporate accountability seem to be significantly lower in this sector than in many others. How bizarre is that, in a sector in which the protection of individuals is absolutely vital? In our response to Southern Cross and to this case, we will require owners to adopt a much more transparent approach and to disclose details of their financing arrangements. We are introducing that level of engagement and transparency as well as addressing the need for accountability. The right hon. Gentleman also asked about restraint, and we will certainly look at the appropriate methods of restraint. It should really be used only for the protection and safety of an individual or of others. It should not be used for chastisement or punishment, as appears to have been the case in some locations. That is completely unacceptable.

[John Pugh (Southport) (LD)]

One of the big problems is the fact that many local authorities house vulnerable people at a considerable distance from their families. What element of the proposals will constrain that unfortunate practice?

[Norman Lamb]

I thank my hon. Friend for that question. He is absolutely right that one thing uncovered, both at Winterbourne View and in the Care Quality Commission survey of similar institutions, was that people were sometimes placed hundreds of miles away from their families. That still continues; that is what we have to address. My hon. Friend asks about what in the proposals will address that and ensure that it does not happen. Every part of the system is signed up through the concordat to changing what has been an unacceptable practice. People will be held to account. I said in my statement that I will chair a programme board throughout this period of change, and we will publish regular updates so we can, in a sense, hold to account every primary care trust or clinical commissioning group and every local authority that fails to change in the way expected.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

I welcome the Minister’s pledge—made twice during his statement—that the Government will go ahead with a review of those “inappropriately placed” and to make it available by 2014. Will there be any element of advocacy during the review, including that endorsed under the Disabled Persons (Services, Consultation and Representation) Act 1986? Finally, do the Government think it possible—if not by this means, by other means—to consider the fairly large number of people inappropriately placed in prison?

[Norman Lamb]

I thank the right hon. Gentleman for his important questions. First, we want to ensure that advocacy is available to help those families and individuals, ensuring that they are placed in appropriate settings and away from these long-stay institutions that we all find completely unacceptable. I very much agree with him on that, and I find myself in agreement with him again on prisons. We shall come forward next year with some clearer proposals on approaches to diversion—assessing someone’s needs before they end up in prison, diverting them, if at all possible, to much more appropriate settings.

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

I was not sure I heard the Minister correctly when he said that the average fee was £3,500 a week, which is £182,000 a year. Is it not possible to pay some of the caring staff slightly more and demand not only the highest level of skills, but the highest level of compassion for that level of fee from the state?

[Norman Lamb]

I thank my hon. Friend for that question. He is absolutely right that an extraordinarily high sum was being paid to put people at risk of abuse —and to be abused, as it turned out in Winterbourne View. Pay rates are not ultimately the responsibility of Government, but one would hope that responsible organisations look to train their staff to a high standard—that is absolutely a prerequisite and they will be held to account by the Care Quality Commission for proper training—and, wherever possible, to provide better pay rates so as to ensure that people are rewarded for the incredibly important work in our care sector.

[Mrs Anne McGuire (Stirling) (Lab)]

Before I became an MP, I worked with parents of learning disabled adults to establish supported community care homes, as those parents would have done anything rather than allow their adult children to go into institutional care. I welcome the Minister’s comments today. There is an emphasis on process, which is important, but does he agree that there is a challenge in the wider cultural sense? As long as we do not give those with learning disabilities the respect to which they are entitled as equal members of society, we almost create an environment in which people think they can with impunity do the sort of things they did in Winterbourne. Will the Minister work with the Minister for Disabled People, the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey) and look at how we can challenge those attitudes, which are sadly still around in the 21st century?

[Norman Lamb]

I thank the right hon. Lady for that. She is absolutely right in what she says about institutional care. I keep mentioning Tower Hamlets, as it was rather inspirational to visit and see how things are done there. I was told that Tower Hamlets has one of the lowest rates of children going into care because of the support for families that it provides, preventing that from ever being necessary.

As for the right hon. Lady’s second point, she is absolutely right: this is moment that demands a change of culture, not just in the health and care system but in society as a whole. There must be a change in all our attitudes. We will make progress only if we understand the fundamental point that someone with learning disabilities has exactly the same rights as anyone else, and should be treated with dignity and respect.

[Glyn Davies (Montgomeryshire) (Con)]

We are for ever reading in reports such as this about poor behaviour in social care. In the last year or so, we have had Southern Cross and then Winterbourne View, which is probably the most shocking example of all. We greatly welcome the measures that the Minister has announced, but can he tell us what arrangements exist to enable us to share the knowledge that we have gained and the lessons that we are learning with the Welsh Government? I am sure that there are very good examples that we can pass over Offa’s Dyke, and that Wales has very good examples from which we can learn.

[Norman Lamb]

I know that some people from Wales were placed in Winterbourne View. This issue is important and relevant to Wales, Scotland, England and Northern Ireland. I would encourage officials of the devolved Administrations and the United Kingdom Government to liaise closely in order to ensure that the lessons that we are learning here can be applied elsewhere, and that good lessons from Wales and elsewhere can be learned in England.

[Mr George Mudie (Leeds East) (Lab)]

The Minister is a very humane man, and I entirely accept the fine things that are in the report. However, we are ultimately responsible for the proper treatment of vulnerable people, both in hospitals and in care homes, and fine words go only halfway. We have seen people in that sector take advantage of and abuse vulnerable people who cannot speak or fight back.

One of the key points raised by my hon. Friend the Member for Leicester West (Liz Kendall) concerned unannounced inspections, which the Minister seemed to suggest were a matter for local authorities or other public bodies. Can he tell us whether real resources will be put into that part of the operation? Whatever has been signed up to, vulnerable people have been treated so badly that we should be ashamed. If we do not provide resources that will enable us to know that someone independent has the power to enter premises at any time or on any day and inspect the treatment of vulnerable people who are in our care, we cannot be taking this issue seriously.

[Norman Lamb]

Let me respond first to the hon. Gentleman’s observation about fine words by saying that this is just the starting point. It does not do the job; it merely sets out the scale of the ambition that is necessary to address a national scandal. It is good that all parts of the system are signed up to it, because that gives it a better chance of success. I will chair a national programme board that will keep a close watch on what goes on and hold every part of the system to account.

The hon. Gentleman spoke of the horrors of what goes on in some care homes and in hospitals, but we must remember the horror of family members who went to local authorities or the NHS to complain and were ignored. That, in a way, is just as scandalous, and it must be addressed.

I have talked to the chief executive of the Care Quality Commission, David Bearn, who has confirmed that he has enough resources to maintain a programme of unannounced inspections. They will continue; they must continue, and they must include people with learning disabilities and their families. I mentioned the role of HealthWatch earlier. In every local area, its representatives will have the power to go into these places to see for themselves what is going on behind closed doors. That too will introduce a new accountability.

The final point I would make is that we are developing the idea of online quality indicators for every care and health setting, with user reviews so that individuals who have been in those care settings and their families can give their views. That scale of transparency can be transformational in driving up standards.

Schizophrenia Care

Norman Lamb Excerpts

Monday 10th December 2012 Commons Chamber

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

I sincerely congratulate my hon. Friend the Member for Broxbourne (Mr Walker) on securing this debate on an incredibly important subject. It is good that in this House today we have debated people with learning disabilities and how they get treated by the system, and now we are debating people with schizophrenia. In the past, those two very important groups of people have often been rather neglected, and it is good that Parliament is focusing on them and how the system treats them. I pay tribute to my hon. Friend’s work as an advocate in mental health. It is very important that people speak up for those with mental health problems, and he and one or two other MPs have done us a good service by being prepared to talk about it openly. I pay great tribute to his work in this field.

This is a timely debate. The premature mortality that my hon. Friend mentioned, the stigma, the human cost and the statistics are as well known as they are shocking. Together they add up to a compelling call for action, and that makes the recent report, “The Abandoned Illness”, very important. It sets out how things must change, how services have to be more accessible, how staff have to be fully supported, how integration of services can change lives, and, of course, how people’s mental and physical health must be treated equally. Too often in the past, mental health has been seen as the poor relation. The Government have established the principle of parity of esteem, and we now have to make it a reality. This debate is an important moment at which to consider that.

The Government have published a mandate for the NHS Commissioning Board which sets out our key priorities for the service. The mandate goes further than ever before in setting out the priority that the Government give to mental health, and it makes it very clear that mental and physical health problems should be treated in a co-ordinated way with equal priority. We expect the NHS to demonstrate real progress on this by March 2015. We have also tasked the NHS with making progress in specific areas. Accessing care and treatment should be as easy for people with mental health conditions as for those with physical conditions, so we have asked the NHS Commissioning Board to consider new access standards, including waiting times, for mental health services. It is remarkable that in the past decade we have introduced waiting time standards for physical health—the 18-week wait—and yet in mental health there is no comparable standard. That has to change.

The NHS outcomes framework includes four measures that relate specifically to mental health. Three of those focus particularly on patients with severe mental illness: premature mortality in people with serious mental illness; the employment of people with mental illness, which my hon. Friend spoke about very movingly; and patient experience of community mental health services. Many other outcomes that we are measuring will be as relevant to people with mental health problems as to people with physical health problems. There is no magic bullet, but I think that this will help to kick off the drive towards real parity of esteem, just as it says in “The Abandoned Illness”.

On top of that, a lot more needs to be done to improve access to psychological therapies for people with severe mental illness. Much of the consideration of the improving access to psychological therapies project has focused on anxiety and depression, but we know that psychological therapies can also be very effective for those with a severe mental illness.

Six local projects, backed by £1.2 million of Government funding, are working on demonstrating the benefits of IAPT in treating people with a severe mental illness or personality disorder. Over the next five months, these organisations will share what they have learned about how best to deliver evidence-based treatments. The work will include demonstrating how this group can get better access to psychological therapies, spreading good practice to other services, and providing good quality data—this has so often been missing in the past on mental health—on how services can be improved for patients.

One of the report’s main findings was that there are far too many people with a mental illness in in-patient wards—my hon. Friend made this exact point—who do not need to be there. Furthermore, many wards are not the calm therapeutic environments that are conducive to improving patients’ well-being. Everyone in the House knows how much of a problem this is. It is not good for patients, families or the staff who work there.

The mandate of the NHS Commissioning Board sets out plans to introduce the friends and family test for all NHS services, including those for mental health in-patients. This will allow people to feed back their experience by saying whether they would recommend a particular service to their loved ones. I should also say that I am looking into the issue of the Care Quality Commission survey. I understand that it was terminated because of concerns about its accuracy and value, but the fact is that it applies in other parts of the health service and I am concerned that mental health services lack such a survey.

Our cross-Government mental health strategy, “No health without mental health”, also recognises the problem. Among its core objectives it lays out, first, that people who are acutely ill need to get safe, high-quality care in an appropriate environment when they need it and, secondly, that following acute illness people should be helped and supported to recover. This will mean different things to different people, but for many it will mean services working together to help people live independently, to find work and to play an active role in society. That means people moving from in-patient wards into the community, with support. This same service is integrated with early intervention, which my hon. Friend has also mentioned, and crisis teams can also support people early in their illness or during an episode of illness, so that they do not progress to needing in-patient care.

Our implementation framework sets out specific actions that local organisations can take to make that a reality. The framework was co-produced by five leading mental health organisations, including Mind and Rethink. In addition, we are already measuring employment for this group as part of the NHS outcomes frameworks for public health and for adult social care.

[Mr Newmark]

On the subject of Rethink, which does a tremendous job, will my hon. Friend join me in congratulating my constituent, Trina Whittaker, and Braintree Rethink on doing a tremendous job for those with schizophrenia and other mental illnesses?

[Norman Lamb]

I absolutely join my hon. Friend in applauding Trina Whittaker and the work of the local Rethink group. I met the national group last week to discuss this very subject. It does tremendous work around the country and I applaud it.

On personal budgets, we know that people want more control over their own care. For instance, patients often do not like the drugs that they are being prescribed—they might make them overweight or have other detrimental effects. It would be far better to move away, if possible, from that paternalistic, disempowering model towards a system in which patients have much more say.

We are already taking steps to help make that happen. The draft Care and Support Bill, published in July, places personal budgets on a legislative footing for the first time. It specifies that everyone eligible for ongoing social care, including those who are mentally ill, will get a personal budget as part of their personalised care and support plan by April 2013. On NHS services, the mandate sets out that patients with mental health conditions will be able to have an agreed personalised care plan, which they must be involved in preparing; it will not be imposed on them. Those plans will lead directly to people with mental illnesses getting the help that they want, and not being directed to a one-size-fits-all service.

Listening to people with mental illnesses is particularly important because of the huge stigma—my hon. Friend the Member for Broxbourne talked about this—that they endure throughout almost every sphere of their lives. Stigma features heavily in the report and I welcome the clear message that it gives us: we will not tackle stigma by burying our heads in the sand. It goes without saying that schizophrenia is an immensely complex condition, and it is made even more difficult when people characterise it as simply a split personality.

We are listening to service users who tell us of the appalling discrimination that they suffer. Many people tell us that the discrimination they face is often worse than the condition itself. That is why the Government are joining forces with Comic Relief to tackle mental health stigma. We are giving up to £16 million, alongside the £4 million that Comic Relief is providing, to Time to Change, the brilliant anti-discrimination campaign run by Mind and Rethink Mental Illness, so that it can continue its work through to March 2015. My hon. Friend and others who have spoken out about their own mental health problems are helping to address the stigma and make mental conditions more acceptable.

I should also say a word about black and minority ethnic service users, because they are over-represented in in-patient care and often stay longer than people from other ethnic groups. We are discussing those long-standing issues with a range of leaders and organisations from BME communities with a view to tackling them.

There is a clear need for organisations outside Whitehall to work much better together. The NHS, social care and other services need to work hand in hand to ensure that patients with mental health problems get effective, safe and streamlined treatment. Together, they need to identify the risks and manage them appropriately. The NHS Commissioning Board will directly commission specialised services, including secure mental health services. That is a great opportunity to ensure that there is high-standard, recovery-oriented and consistent practice across the country, with clear transitions for patients between different parts of the mental health system.

The Department of Health funds a wide range of research on schizophrenia and other psychoses. We have awarded nearly £49 million over five years to the biomedical research centre for mental health, based at the South London and Maudsley NHS Foundation Trust. It collaborates with the Institute of Psychiatry to translate promising research into effective practice. Psychoses are a major focus of its work. The National Institute for Health Research funds a clinical research network, which allows patients across England to take part in trials and other types of clinical study. The network is currently setting up and recruiting patients to about 90 projects to study schizophrenia and psychoses. Through the “Strategy for UK Life Sciences” the Government will provide an environment and infrastructure that supports pioneering researchers and clinicians to bring innovations to market earlier and more easily, making the UK the location of choice for investment.

The Government believe that people with schizophrenia, and indeed any severe mental illness, have a right to the care and support they need in a safe and comfortable environment where they are treated with the dignity and respect they deserve. They have as much right as anyone else to a fulfilled and productive life, free from discrimination and stigma. The coalition is making valuable changes from the centre, but this cannot be the Government’s responsibility alone. We need everyone everywhere to take what responsibility they can, including the commissioners who must purchase the care that meets people’s needs, the providers who have a duty of care to each and every individual for whom they are responsible, and the regulators who are responsible for ensuring the quality of that care. I have set out some of the recent developments at government level that will improve services for people with schizophrenia. However, I acknowledge that we are still some way from where we want to be. We must not relent in our pursuit of that.

To that end, I am convening a round-table meeting on schizophrenia next week with leading charities, members of the Schizophrenia Commission, the Royal College of Psychiatrists and others. My hon. Friend the Member for Broxbourne is welcome to attend if he is available. The aim of the meeting is to identify the further practical actions that key players can take to improve the quality of life of people with schizophrenia and other severe mental illnesses.

Question put and agreed to.