Personal Health Budgets

Norman Lamb Excerpts

Friday 30th November 2012 Written Statements

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

I am announcing the publication of the final independent evaluation report on personal health budgets, which have been piloted in the national health service since 2009 as a way to give people more choice and control over their care.

In summary, the results show that:

personal health budgets are cost-effective when implemented as the policy intended and patients have genuine control;

they improve people’s quality of life, well-being and feeling of being in control—but do not generally have any statistically significant effect on health status or clinical measures such as blood sugar levels for diabetics;

they may be more effective for people who are higher users of NHS services (such as people receiving NHS continuing health care) and those with mental health needs; and

they may reduce use of NHS services indirectly—particularly by reducing hospital admissions.

These are positive findings, which provide evidence for rolling out personal health budgets beyond the pilot programme. However, there is still much to learn about implementing personal health budgets for large numbers of people. This argues for a measured approach: setting a clear strategic direction of travel and supporting further learning as personal health budgets are scaled up.

In the light of the evidence, I can make a number of commitments.

First, the Government can confirm the ambitious objective set in the mandate to the NHS Commissioning Board, that

“patients who could benefit will have the option to hold their own personal health budget, subject to the evaluation of the pilot programme, as a way to have even more control over their care”.

Secondly, we also reaffirm our commitment to introduce a right, from April 2014, for people receiving NHS continuing health care to ask for a personal health budget; the evaluation clearly suggests that personal budgets have benefits for this group of people.

Thirdly, we want to enable NHS commissioners across the country to offer personal health budgets, including through the option of a direct payment. Direct payments for health care are currently only lawful within pilot schemes, but the Health Act 2009 gave power to extend them nationally by order, with the approval of both Houses of Parliament under the affirmative resolution procedure. We intend to bring forward proposals for this. To help inform the process, we will be launching a public consultation later this year on updating the regulations for direct payments. Meanwhile, existing pilot sites will still be able to offer direct payments, and will be able to act as early leaders in rolling out personal health budgets more widely.

Fourthly, we will be providing additional support to nine areas that are “Going Further, Faster”, pushing ahead with implementation on a larger scale and demonstrating how personal health budgets can be extended beyond NHS continuing health care. The Department will provide £1.5 million of funding to support early roll-out of personal health budgets in the period until April 2013, when responsibility will transfer to the NHS Commissioning Board.

Finally, we have also today launched a toolkit that is available to everyone who has an interest in personal health budgets. It contains a wide range of learning from the pilot programme, including practical advice and information to support the implementation of personal health budgets.

More information on personal health budgets, including the toolkit and stories of people who have budgets can be found on the personal health budgets learning network at: www.personalhealthbudgets.dh.gov.uk.

The evaluation report has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 27th November 2012 Commons Chamber

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

3. What plans he has to improve the quality and quantity of mental health crisis care services.

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

Mental health is a priority for this Government. That is reflected throughout the first mandate to the NHS Commissioning Board. The quality of all services, including crisis mental health, must improve. It is for the Commissioning Board, working with local commissioners and partners, to commission services in response to need.

[Paul Burstow]

I welcome that answer, particularly as regards the strengthening of the NHS constitution. My hon. Friend will accept that a mental health crisis is a very frightening thing to happen to a person and can be life threatening. The charity Mind has shown that there is unacceptable variation across the country in the quality and accessibility of crisis services. Does the Minister agree that just as the Government have rightly shone a light on the variability of physical health services, we need to do the same for mental health services? We need an atlas of variation for mental health services that hon. Members and others can use to challenge local commissioners to improve.

[Norman Lamb]

I am grateful to my right hon. Friend for that question. Atlases of variation are an important way of raising standards and we will be discussing their future use with the new commissioning organisations. He is also right to highlight the absolute importance of having parity of esteem between physical and mental health. The Government’s mandate makes it absolutely clear that there must be parity between mental and physical health services.

[Hazel Blears (Salford and Eccles) (Lab)]

There are 800,000 people in this country who are living with the effects of Alzheimer’s and dementia. For some of those people, challenging behaviour is a serious issue. Will the Minister ensure that every clinical commissioning group has a lead for dementia in the mental health field so that that can be taken seriously in every community in the country?

[Norman Lamb]

That is absolutely a priority for the Government and the right hon. Lady is right to highlight its importance. The NHS Commissioning Board will work with local clinical commissioning groups to ensure that we raise the standards of health and care services, but she is absolutely right to highlight the importance of substantially improving access to dementia services.

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

Can the Minister clarify how often mental health centres and hospitals are inspected and how often patients are spoken to to help improve the service?

[Norman Lamb]

The Care Quality Commission inspects all services. Of course, there is now a registration system for such services. The hon. Gentleman is absolutely right to highlight the importance of ensuring that mental health services are regarded as just as important as physical health services, which has not always been the case.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

Does the Minister agree that when people are experiencing a mental health crisis, the initial response that they receive when seeking help is vital? What steps are he and his Department taking to make sure that staff in accident and emergency departments are able to respond appropriately?

[Norman Lamb]

I am grateful to the hon. Lady for raising that important point. A fortnight ago I visited Heartlands hospital in Birmingham, where the RAID—rapid assessment, interface and discharge—team provides brilliant access for people arriving in accident and emergency who have a mental health problem, and ensures that they get immediate access to mental health services. That sort of best practice not only improves health and well-being for those individuals, but saves the system money. We need to spread that best practice across the country. I am very grateful to the hon. Lady for raising it.

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

13. What recent representations he has received on strategies to support patients with osteoporosis.

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

The Department of Health has received no recent representations on strategies to support patients with osteoporosis. From April this year, osteoporosis was included in the quality and outcomes framework, giving GP practices financial incentives for diagnosing and treating osteoporosis in their patients.

[Mr Amess]

Does the Minister welcome the new Falls and Fractures Alliance that will hold its first board meeting next month? It has been set up specifically to reduce admissions to hospitals resulting from falls, fall-related injuries or hip fractures in the over 65s.

[Norman Lamb]

I very much welcome the establishment of the alliance, and I applaud the work of the National Osteoporosis Society, Age UK, and the all-party group of which I think the hon. Gentleman is a member. We know that if we follow the evidence, we can substantially reduce the number of falls and fractures, thereby increasing health and well-being and reducing the cost to the system.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

14. What the process is for deciding the future of health care provision in south-east London; and if he will make a statement.

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[Chris Ruane (Vale of Clwyd) (Lab)]

15. What recent assessment he has made of the treatment of repeat episode depression by (a) drugs and (b) mindfulness-based intervention.

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

The National Institute for Health and Clinical Excellence has evaluated and recommended the use of mindfulness-based therapies as a psychological intervention for the prevention of relapse, within its guideline, “Depression: the treatment and management of depression in adults”. Drug treatment is also useful in the management of enduring depression.

[Chris Ruane]

The number of prescriptions issued for anti-depressants has gone from 9 million to 46 million in the past 10 years. NICE has recommended mindfulness as a better treatment than drug therapy for repeat episode depression, but it has not been taken up by the NHS. Will the Minister meet a delegation of MPs and mindfulness experts from across the UK to discuss how mindfulness can play its full role in helping the NHS and people with mental health problems?

[Norman Lamb]

I acknowledge the hon. Gentleman’s work on promoting the case for psychological therapies, including mindfulness, and would be happy to meet him and a delegation of experts. The Government have massively increased psychological therapies—nearly 1 million people in the past two years accessed psychological therapies through the improving access to psychological therapies programme. We are totally committed to improving access to psychological therapies to cure the imbalance in access to services for people with mental health problems that has existed for a very long time.

[Lisa Nandy (Wigan) (Lab)]

16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets.

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[Sir Tony Baldry (Banbury) (Con)]

T2. The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so?

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

I thank my hon. Friend for that question. The NHS outcomes framework includes an indicator on the quality of end-of-life care as it is experienced by patients and carers, which is based on the VOICES survey of bereaved relatives. The proposals for reform to the NHS constitution include a right for patients and families to be involved fully in discussions, including at the end of life.

[Graham Stringer (Blackley and Broughton) (Lab)]

T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?

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[Lilian Greenwood (Nottingham South) (Lab)]

T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?

[Norman Lamb]

Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.

[Tessa Munt (Wells) (LD)]

T7. Since the Prime Minister made his radiotherapy promise to current and future cancer patients last month, cancer centres all over the country have been telling me that it cannot be delivered, because there is not enough investment in new radiotherapy machines and in the recruitment and training of staff to operate them. Will the Secretary of State give the same financial commitment to the annual radiotherapy fund as he is giving to the cancer drug fund, and will he meet me to discuss the matter?

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[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

The Minister will be aware that the process of making Kalydeco available to people with cystic fibrosis in England is much further advanced than in Scotland, where the G551D gene is two to three times more prevalent—a point highlighted by the Daily Record yesterday in respect of seven-year-old Maisie Black from Burnside in my constituency. Will the Minister clarify that the roll-out in England will not be restricted, so that young children, who have the least accumulated lung damage and therefore most to benefit, do not lose out on the chance of benefiting from this transformational drug?

[Norman Lamb]

The specialised commissioning groups will receive advice at their December board meetings and are expected to finalise their advice on the clinical and cost-effectiveness of Kalydeco early in the new year. The aim is to provide consistent national advice on the use of the drug for a sub-group of patients with cystic fibrosis.

[Steve Baker (Wycombe) (Con)]

Aylesbury constituent Mrs Evans-Woodward is a young woman who has had five heart attacks. One evening her husband drove her to Wycombe’s heart attack unit with a racing pulse, but she was turned away to the minor injuries unit, which again turned her away to the accident and emergency unit in Stoke Mandeville, before suggesting that she sit outside and call an ambulance, which she duly did—all of this with a racing pulse of 180. This is not good enough. It is an appalling prioritisation of bureaucracy over simple human care and compassion. Does it not show that the NHS needs to become much more accountable to patients?

NHS Consultation

Norman Lamb Excerpts

Tuesday 6th November 2012 Written Statements

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

I have launched a public consultation on proposals to strengthen the NHS constitution. These changes include:

strengthening patient involvement and shared decision making;

making clear the importance of patient and staff feedback;

setting out a new duty of candour;

emphasising the importance of integrated care;

clarifying patients’ rights for making complaints;

making clear how patient data is protected and used;

emphasising the importance of valued, empowered and supported staff to the delivery of high quality patient care; and

strengthening commitments to dignity, respect and compassion.

In addition, the Department of Health proposes some minor technical changes to the NHS constitution that are necessary to ensure it reflects legislative changes introduced since its launch in January 2009. This includes making clear that the constitution extends to local authorities in the exercise of their public health functions as set out in the Health and Social Care Act 2012.

The changes proposed in the consultation respond to the recent recommendations of the NHS Future Forum working group on the NHS constitution, which was tasked in March 2012 with advising the Secretary of State for Health on whether there was scope for strengthening and reinforcing the constitution. The Government accepts the forum’s recommendations in full.

Following the forum’s conclusion that awareness of the NHS constitution remains too low and should be increased, the consultation document sets out the Department’s commitment to work collaboratively with the NHS Commissioning Board, clinical commissioning groups, and Health Education England to promote and raise awareness of the constitution.

The consultation seeks views on how the NHS constitution can be given greater traction, so that patients, staff and the public know what to do if their expectations are not met. The Department will establish an expert group, which I will chair, to develop proposals to do this. We will consult on these separately in the spring following the report of the public inquiry into the events at Mid Staffordshire NHS foundation trust.

The consultation will run until 28 January 2013. The Government intend to publish the revised NHS constitution, together with updated supporting documents—the Handbook to the Constitution and Statement of NHS Accountability—by 1 April 2013.

“A consultation on strengthening the NHS constitution” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Winterbourne View

Norman Lamb Excerpts

Tuesday 30th October 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

(Urgent Question): To ask the Secretary of State for Health to make a statement on the steps the Government have taken to ensure the safeguarding of former Winterbourne View residents.

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

The review into the abuse at Winterbourne View hospital, established by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), set out 14 actions to transform care and support. Central to the review is ensuring the safety and well-being of these very vulnerable people. I shall publish the final report before the end of November.

When Winterbourne View closed, NHS commissioners put in place independent clinical and managerial supervision and commissioned an independent assessment of every patient. The Care Quality Commission worked with commissioners to relocate Winterbourne View patients to suitable alternative placements.

In March, the Department of Health review team commissioned NHS South of England to follow up the 48 patients who had been in Winterbourne View, and there was a further review in September. The first review in March revealed that 19 former patients were the subject of safeguarding alerts. In response to this, officials asked commissioners to take appropriate action and confirmed that a follow-up would take place in six months’ time. I was extremely concerned to be informed that this follow-up had revealed that there are current safeguarding alerts for six former patients. I am assured that these are all being followed up to ensure the safety and well-being of the individuals concerned. That is extremely important. Furthermore, the September follow-up exercise revealed that 32 Winterbourne patients were now living in the community in their own family homes, in supported living or in a residential care home, with 16 still living in hospital settings.

The priority is to improve commissioning to develop the good local services that will prevent people from being sent to hospital inappropriately. We are working closely with the NHS Commissioning Board, the Local Government Association and directors of social services on what support local services need. Although a small number of people will need hospital treatment, we expect to see—and, indeed, must see—a substantial reduction in the number of in-patients.

We intend to strengthen safeguarding arrangements to prevent and reduce the risk of abuse and neglect of adults in vulnerable situations. Where there are safeguarding concerns, the local safeguarding adults boards need to be closely involved. The boards will be placed on a statutory footing for the first time, ensuring a co-ordinated approach to local adult safeguarding work.

The Government will put in place the necessary legislation for safeguarding adults boards, and local councils should bring clarity to their roles and responsibilities, but it is the responsibility of the care provider—we must remember this—to ensure a culture of safety, dignity and respect for those in their care, including stopping abuse before it happens. Those providers must be held to account for the care that they provide.

[Liz Kendall]

I thank the Minister for his statement, but there remain serious concerns about whether the Government have taken all necessary steps to ensure that the former patients of Winterbourne View are now receiving safe and effective care. Last night’s “Panorama” programme revealed that 19 patients have been subject to safeguarding alerts since leaving Winterbourne View. Not all those alerts mean that someone has been harmed, but “Panorama” said that one was due to an incident of assault and another had resulted in a criminal investigation. Is that an accurate reflection of the picture?

Have the families of all patients with a safeguarding alert been given the full details? What specific action has been taken as a result of the alerts, and can the Minister guarantee that the patients in question are all no longer at risk? Can he also guarantee that all local commissioners responsible for all the former Winterbourne View residents now have a proper plan in place to ensure that they receive good-quality care?

Has the Care Quality Commission recently inspected all the providers that former Winterbourne View patients were moved to, and are the Government confident of the CQC’s findings? Last night’s programme raised particular concerns about Postern House, which the CQC inspected in January this year following the Winterbourne View scandal. The CQC said that it met all the essential standards of quality and safety, and that suitable arrangements were in place to ensure that people were safeguarded against the risk of abuse, yet “Panorama” revealed a number of problems at Postern House over several years and the fact that a former Winterbourne View patient had a safeguarding incident there in June this year. Is the Minister confident that all patients currently in Postern House are safe from the risk of abuse?

The Minister rightly said that responsibility for the care of people with learning disabilities lies with providers, commissioners and the CQC, but it is Ministers who set policy and have responsibility for ensuring that it is implemented. The Government have a particular responsibility to ensure that former Winterbourne View patients never have to suffer from such appalling abuse again. Organisations such as Mencap are also very concerned that the Government are not moving quickly or strongly enough to end the practice of sending patients with learning disabilities to long-stay institutions far away from their family and friends.

The Minister must answer our questions about whether former Winterbourne View residents are all now guaranteed safe care, and he must urgently bring forward proposals to reform learning disability services properly for the future.

[Norman Lamb]

I thank the shadow Minister for asking the urgent question. The view is shared on both sides of the House that what “Panorama” exposed is utterly intolerable and has to come to an end. I am absolutely determined that when I make the Government’s final response by the end of November, it will be robust and clear so that everybody understands what has to happen.

When I came into my job, I heard briefings about the whole saga and how long it has gone on. For years and years, public money has been spent on putting people into inappropriate settings, often putting them at risk of abuse. That is a national scandal, and it has to end. I will be very clear about ensuring that we take robust and effective action.

The hon. Lady is absolutely right that Ministers are here to set policy, and that is what I intend to do. Since my appointment, I have been working to ensure that we set the right policy to protect vulnerable individuals. She is right that they must never suffer from abuse. Of course, there is always the risk of rogue individuals who behave very badly, and they must be dealt with through the criminal law, as has been seen with Winterbourne View staff. I have also made the point that the corporate owners of such organisations must be held to account for things that go on in their homes if those homes have been neglected. I want to meet the parents of those who were at Winterbourne View to hear from them directly, and I will seek to make arrangements for that.

The hon. Lady mentioned the 19 safeguarding alerts. In fact, that intolerable figure was in March but by September, the number was down to six. She is right, of course, that not every safeguarding alert means that something awful is happening. It means that concerns have been raised, and it is important that people raise their concerns. I assure her that I will do everything I can to end this scandal and ensure that we have proper safeguarding arrangements in place.

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

Will my hon. Friend assure the House that the alerts are being actioned and dealt with? We know that on previous occasions, South Gloucestershire council and Avon and Somerset police received countless alerts, but if it had not been for the BBC and “Panorama”, we would never have found out about this issue. When I saw the programme last night, I was appalled that patients can be moved hundreds of miles without their families—and their parents in particular—being told. I thought that was an outrage.

[Norman Lamb]

My hon. Friend raises extremely important points. First, we must ensure that the alerting system works effectively. We are putting safeguarding boards on a statutory basis. That is important and means that all key players will have a part in ensuring that adults in vulnerable situations are kept safe. We must ensure that alerts always work effectively in the future.

My hon. Friend’s point about individuals being placed a long distance away from home is of absolute concern. It strikes me that if someone is placed far away from their community, in what is effectively a closed setting, conditions are created for potential abuse to take place. That has to stop.

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

Does the Minister agree that there can be no excuse for abuse in any setting at any time? Is there not a profound problem that many of our most vulnerable citizens up and down the country are looked after by people who are poorly trained, poorly qualified and paid the minimum wage for 12-hour shifts? Is that the underlying root of this problem?

[Norman Lamb]

First, it is important to make it clear that many highly dedicated care workers provide fantastic quality care for elderly people and other adults in vulnerable situations. However, the hon. Gentleman is right to address the fact that we need to raise standards across the board. We are working with Skills for Care to ensure there is a code of practice to implement proper standards, and that minimum training standards apply across the sector. We must also ensure that we keep people in good health and well-being in their own homes as much as possible, reducing the number of people who go into care and nursing homes. That will make it possible to spend more on those people who do need to go into a home, and ensure that standards are maintained at the right level.

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

As we learnt from Winterbourne View, the absence of safeguarding alerts is not necessarily a sign that everything is okay. Winterbourne View was receiving £3,500 a week for some of its residents, yet it was delivering very poor care and allowing its staff to abuse. In future, can we ensure that the contracts let by social service departments and the NHS are written not by the provider, but by those who are buying the service in the first place to get the right quality of care?

[Norman Lamb]

I pay tribute to my right hon. Friend for his work in this area. He draws attention to the fact that there is a serious issue about the quality of commissioning and the work done by primary care trusts and, in some cases, local authorities. Too often, people seem to be placed in those settings and then to all intents are purposes forgotten about, which is not acceptable. Standards of commissioning and ensuring that contracts contain the right terms are extremely important.

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

Does the Minister agree that this whole dreadful saga—which he rightly describes as a national scandal—underlines the importance of self-advocacy for vulnerable people? In his legislation and any guidance that may follow from it, will he take steps to ensure that the voices of these most vulnerable people will be heard directly wherever possible?

[Norman Lamb]

The right hon. Gentleman makes an extremely valuable point, and I would be happy to discuss that with him further. Too often in the past there has been a paternalist approach in which others have decided what is best for individuals. Hearing the voice of people with learning disabilities is absolutely central to getting this matter right.

[Claire Perry (Devizes) (Con)]

People who watched “Panorama” will know that a tall, flame-haired young man named Simon Tovey was one of the patients who suffered horrific abuse. His mother, Ann Earley, is my constituent, as is Simon, who has now returned to a lovely community care home in West Lavington. Mrs Earley believes that the views of parents in particular were not heard under the system—they knew for years the problems pertaining to Simon’s care. What reassurance can the Minister give to Mrs Earley, and the House, that the views of parents and other responsible adults will be included when seeking to avoid these tragedies in the future?

[Norman Lamb]

It struck me when I listened to the story of that family that I would like to meet them if they are interested in having that discussion. Just as it is essential that people with learning disabilities have their say, it is critical that the family is involved in the discussions before the commissioning takes place, so that they are partners in the decisions that are taken in respect of those individuals.

[Mr Dave Watts (St Helens North) (Lab)]

Can the Minister reassure the House that there are sufficient inspectors to go around those establishments during the day, during the evening and at night to ensure that standards are maintained?

[Norman Lamb]

Inspections are essential to ensure that we identify where problems exist. The role of the Care Quality Commission is critical in that respect. We need to do more to open up those establishments to public view. One role that the new local HealthWatch can take is to go into care homes, nursing homes and so on to see for itself. The more there is a culture of openness, the less likely it is that abuse will take place.

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

I commend to my hon. Friend the work of organisations such as the Swindon Advocacy Movement, which does so much work not only to advocate for service users, but to train volunteers, so that more adults with learning difficulties can stay in the communities in which they live, work and thrive. In that way, the nightmare scenario of Winterbourne View can be avoided in future.

[Norman Lamb]

I absolutely commend the work of the organisation to which the hon. Gentleman refers and would be interested to hear more about it. The scandal is that so many people over so many years have been put into institutions and ended up there for years when their care would be much more appropriate for their needs if it took place in their communities through supported living or in a care home. As my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) mentioned, the extraordinary thing is that we were spending public money—on average, £3,500 per patient in Winterbourne View—to put people at risk of abuse. Often, an appropriate care package costs less than that, and gives the individual the care they need in their own community.

[Fiona Mactaggart (Slough) (Lab)]

I have raised with the Minister and his predecessor the problem that, often, the responsible authority does not know where people are placed. Families might have died since the placement, and yet there is no national audit of placements of people with learning disabilities, who are often placed a long way from their home. When the Minister returns to the House in November, will he ensure that there is an audit of where people are placed so that we can track them properly?

[Norman Lamb]

I shall certainly consider the hon. Lady’s point and am happy to discuss it further with her. At the end of the day, we must ensure that people in highly vulnerable situations are adequately protected. I want to ensure that all the steps we take are aimed at that goal.

[Chris Skidmore (Kingswood) (Con)]

The Minister has mentioned raising the standard and quality of care providers. Will he consider the introduction of a starred grading system for care providers, so that we have absolute transparency on how well they are performing, and so that we know the most excellent care providers and the worst?

[Norman Lamb]

My hon. Friend raises an important point. One thing we are doing on the NHS Choices website is having quality indicators for every care home, nursing home and so on. That means that any individual looking for a care home for a loved one will be able to find out much more about the quality of the care that an organisation provides. In due course, the website will include user reviews, so that people who have experienced care in those homes will have their voices heard. That openness of information could have a transformational effect in driving up standards.

[Emma Reynolds (Wolverhampton North East) (Lab)]

It beggars belief that some of the vulnerable adults who were subjected to the most appalling and horrific abuse at Winterbourne View were moved to other providers where they were either abused—according to the “Panorama” allegations—or at risk of further abuse. Will the Minister reassure me that all local commissioners responsible for each of the former Winterbourne View residents have a proper plan in place to guarantee that they are now receiving safe and effective care?

[Norman Lamb]

I share the hon. Lady’s view on what has happened. We must make absolutely certain that every commissioner is held to account. My understanding is that proper arrangements are in place for all those individuals, but I will continue to monitor the situation to ensure that that remains the case. We must be alert to the interests of the 48 residents who were in Winterbourne View, but we must also focus our minds on the 1,500 people who are in settings of that sort—assessment to treatment centres—often for years. The interests of all those individuals are important.

[John Pugh (Southport) (LD)]

To put it bluntly, after all this, is the Minister still confident in the CQC and does he believe that it is fit for purpose?

[Norman Lamb]

I tend to the view that we have had too many changes of regulator over a number of years, and that continuity would be a good thing. An assessment of the CQC earlier this year indicated that it was on the right track. I have met the new chief executive and am reassured by the plans he has in place. It is seductive to believe always that it is an attractive proposition to abolish an organisation and set up a new one, but is there any more chance that a new organisation will be better? Let us therefore make the CQC work properly.

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

I welcome the Minister’s response—he is sincere in his desire to address these issues. Does he recognise the important role of whistleblowers? Does he have any information on concerns raised by whistleblowers in respect of the alternative provision before Winterbourne View patients were transferred?

[Norman Lamb]

The role of whistleblowers is central. Importantly, the Government have funded a whistleblowing helpline, which is available to any worker in the care sector—it covers all care homes. It is important that any worker at any stage feels they can raise their concerns with the relevant authorities so that they are properly investigated. What happened with the whistleblower at Winterbourne View was not acceptable, because their concerns were not taken up effectively.

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

I welcome the Minister’s statement. On inspection, can he clarify what provision exists for inspectors to speak to patients? How will that be further enhanced?

[Norman Lamb]

I am sure that inspectors can speak to patients, and that they routinely do so, but I will check on the important point the hon. Gentleman makes. We mentioned earlier the views of those with learning disabilities and their families, but it is essential that the regulator hears directly from them of their potential concerns.

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

I am not sure that the Minister has made his position clear. Is it his intention to end the appalling practice whereby vulnerable people can be transported to establishments hundreds of miles away from their home town at the whim of the authorities and without the knowledge and consent of their families?

[Norman Lamb]

I have tried to be clear on my views on what has been happening—it has been going on for years. As I have said, the fact that someone is sent 200 miles away from home creates the conditions in which abuse is more likely than if they are in their own community. I want that to end—I want to be as clear as I can that that is a national scandal that needs to be brought to an end.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his comments. I also watched the “Panorama” programme last night and was horrified. According to the local council and the Minister, changes have been made. Will he confirm that the lessons learned will be conveyed to the devolved Administrations in Scotland, Wales and Northern Ireland to ensure that this terrible abuse never happens again anywhere in the UK?

[Norman Lamb]

The hon. Gentleman makes an essential point. Wherever people are, they must be protected from potential abuse and benefit from high standards of care. I will give him my absolute assurance that we will work closely with the devolved Administrations to ensure that people receive that benefit, wherever they are in the UK.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

I heard the Minister’s earlier answer on the importance of whistleblowing, but will he set out what further steps he will take to encourage staff to whistleblow and to ensure that, when they come forward with concerns, they do not suffer retribution as a result?

[Norman Lamb]

The legal framework is satisfactorily in place to protect whistleblowers who raise their concerns with the relevant authorities, but this is about culture. We must do everything we can to ensure that providers encourage their staff to raise concerns—internally first, if possible, but with other authorities, if necessary—whenever they see abuse or neglect taking place. We must also encourage individuals to feel safe about raising concerns. The framework of protection is there for individuals to do that.

[Chris Bryant (Rhondda) (Lab)]

There are two problems. First, the “out of sight, out of mind” mentality has meant that thugs have been able to get away with terrible behaviour in care homes. Secondly, despite the enormous advances in ischaemic heart disease, cancer and diabetes, for example, the amount of money invested every year to find solutions and treatments for mental health conditions remains very poor.

[Norman Lamb]

On the first point, I agree with the hon. Gentleman that these closed settings and institutions too often create the conditions for abuse to take place. It is all the more important, then, to get the regulation right for the sake of those individuals who have to be in such institutions—a minority have to be there for their own safety or that of the public. On the second point, he raised the general issue that for a long time—probably, it has always been the case—mental health has been a poor relation to physical health in terms of the amount of money spent on research and how the money flows within the NHS. I seek to address that.

[Kerry McCarthy (Bristol East) (Lab)]

In Bristol, we face the closure of care homes, while south Gloucestershire is outsourcing the in-house home care teams. Following the case of Winterbourne View, which is just outside my constituency, there is a lack of confidence in the area in the private sector. What can the Minister do to reassure people that it is safe to place vulnerable relatives in private sector care homes?

[Norman Lamb]

First, abuse is unacceptable and horrifying wherever it takes place, whether in the public sector or the private sector. The review that followed Winterbourne View being exposed revealed poor standards of care in too many places in both the public and private sectors. We need to be clear on that. Secondly, I have questioned whether there is adequate corporate accountability and whether adequate rules and regulations are in place to ensure that accountability. If people are making a profit out of providing care, they have to be held to account for the standards of that care.

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

May I raise with the Minister my concerns about the relaxation of checks on people who work with vulnerable adults and children, as set out in the Protection of Freedoms Act 2012? As a new Minister, will he undertake to look at the specific provisions in that Act and see whether he is satisfied that our most vulnerable people are protected?

[Norman Lamb]

I am happy to discuss the matter further with the hon. Lady. It is clear, though, that when a care home provider seeks to recruit a member of staff to work with people in a care home setting, they have to—[Interruption.] They are obliged in law to carry out criminal records checks on people who work within that setting. I repeat, however, that I am happy to discuss the matter with the hon. Lady and to look again at the issues.

[Ian Lucas (Wrexham) (Lab)]

As the Minister has made clear—his commitment is coming through—the care provider is key. As he moves forward, will he look at whether there is any disparity between private and public sector provision? In cases that I am aware of, there has been a qualitative difference: vulnerable individuals are not being looked after as well as they ought to be by some private sector providers.

[Norman Lamb]

We probably all know from our constituencies of fantastic private sector care providers that provide a fantastic quality of care to older or younger adults with disabilities and so on, so we must be careful not to condemn the whole sector. My clear view is that wherever there are low standards of care it is unacceptable. But let us remember Mid Staffordshire hospital, where hundreds of people lost their lives unnecessarily owing to poor standards of care. It can happen in both public and private sectors. We must find it intolerable in both.

Mental Health (Approval Functions) Bill

Norman Lamb Excerpts

Tuesday 30th October 2012 Commons Chamber

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

I beg to move, That the Bill be now read a Second time.

The purpose of the Bill is simple, but urgent. The Secretary of State described to the House yesterday how the need for it arose and came to light, and I hope that hon. Members will bear with me if some of what I say today repeats what he said then. May I begin by reiterating my gratitude to Opposition Members for the highly constructive approach that they are taking to the issue, without which we would not be able to respond with the necessary speed?

Detaining a mentally ill person in hospital and treating them against their will is clearly a matter of the utmost seriousness, and it is treated as such by the law and by health and social care practitioners. The statutory framework is contained in the Mental Health Act 1983, which sets out that, for assessments and decisions under certain sections of the Act, including detention decisions under sections 2 and 3, three professionals are required to be involved: two doctors and an approved mental health professional, usually a social worker. One of the two doctors must be approved under section 12 of the Act. When strategic health authorities came into being in 2002, the Secretary of State at the time quite properly and lawfully delegated to them his function under the 1983 Act of approving the doctors able to be involved in making these decisions.

Early last week, the Department of Health learned that, in four out of the 10 SHAs—North East, Yorkshire and the Humber, West Midlands and East Midlands—the authorisation of doctors’ approval was further delegated by the SHAs to NHS mental health trusts over a period extending, in some cases, from 2002 to the present day. The issue was identified as a result of a single doctor querying an approval panel’s processes. I was informed later in the week, as soon as the extent of the issue became clear, and since then, the Secretary of State and I have been kept informed of, and involved in, the action being taken.

[Emma Reynolds (Wolverhampton North East) (Lab)]

This is an issue of great concern. Can the Minister reassure the House that the four areas that he has identified are the only areas in which this has happened, and that it has not taken place in other regions?

[Norman Lamb]

I can assure the hon. Lady on that point. All SHAs have undertaken an assessment of the position, and the position has been regularised for future cases in those four SHAs. Of course, individual patients may be moved to different parts of the country, but the problem relates to those four SHA areas.

[Hywel Williams (Arfon) (PC)]

Rampton and Ashworth are involved, and patients from Wales travel to those hospitals. Have there been any discussions between the Minister’s Department and the Wales Office or the Welsh Government on the implications of this for patients from Wales?

--- Later in debate ---

[Norman Lamb]

Yes, I can confirm that that is the case. The Secretary of State spoke to the relevant Health Ministers this morning. I hope that that gives the hon. Gentleman reassurance.

[Jim Shannon (Strangford) (DUP)]

Following on from what the hon. Member for Arfon (Hywel Williams) has asked, may I ask the Minister, in relation to Northern Ireland, what investigations have taken place to ensure that no one was detained illegally, and whether there are likely to be challenges from people who have been sectioned? I am afraid that they might have reason to claim against the Government for that purpose, given that no legislation was in place. Please excuse the condition of my voice, by the way.

[Norman Lamb]

I am grateful to the hon. Gentleman for that intervention, but I am afraid that I struggled slightly to hear all the points that he was making. Perhaps the best way of dealing with all this is to ensure that I respond in writing to all his questions. I can also assure him that the Secretary of State spoke to the Northern Irish Minister yesterday and briefed them fully on the situation. There is good liaison there.

Our current assessment is that about 2,000 doctors were not approved properly in line with the provisions of the 1983 Act, and that those doctors have participated in the detention of between 4,000 and 5,000 of the patients currently detained in NHS or independent sector hospitals. There are two important points that I would like to make clear now. First, the decision to detain a patient under the Mental Health Act is primarily a clinical one. There is no suggestion, and no reason to believe, that the irregularity of the approval process for these doctors has resulted in any clinically inappropriate decision being made, whether the decision was to detain or not to detain. Nor is there any suggestion that the doctors approved by mental health trusts are anything other than entirely properly qualified to make these recommendations.

All the proper clinical processes were gone through when these patients were detained. There is no reason why the irregular approval process should have led to anyone being in hospital who should not be—or vice versa—and no patients have suffered because of this. The doctors had no reason to think that they had not been properly approved; they acted in total good faith and in the interests of the patients throughout this period. As of Friday last week, the SHAs concerned had corrected their procedures and all the doctors involved had been properly approved. I hope that that addresses the question raised by the hon. Member for Wolverhampton North East (Emma Reynolds).

[Hywel Williams]

This may be a naïve question, but will the Minister tell us whether doctors approved in one SHA area are then approved automatically for other parts of England or possibly parts of Wales, or is the approval confined to the particular SHA area?

[Norman Lamb]

My understanding is that people are approved for the SHA in which they work, but it is an important question and I will happily confirm the position to the hon. Gentleman in writing.

In the light of our legal advice, we do not believe that any decisions made about patients’ care and detention require review because of this irregularity. Doctors should continue to treat patients who are currently detained under the Mental Health Act in the usual way.

My second point is that we have been advised by First Treasury Counsel that there are good arguments to show that the detentions involving these particular approval processes were, and are, lawful. Given the seriousness of the issues, counsel also argues the need for absolute legal clarity and advises that this is most safely resolved through emergency retrospective legislation. We are taking that advice. As soon as the irregularity was identified, the Department moved swiftly to identify the best course of action and to put the necessary preparatory work in place. Officials immediately sought initial legal and clinical advice, and then swiftly analysed the options, including the reassessment of all the potentially affected patients, working with the health leads in the regions involved and clinical experts from the Royal College of Psychiatrists.

When I was briefed on the situation, I asked for detailed information on the time it would take—the Secretary of State has also sought and obtained this advice—and the clinical risks involved in reassessing all potentially affected patients. Last Friday, the Secretary of State asked for an emergency Bill to be drafted over the weekend as a matter of contingency, and he briefed the Prime Minister personally the following day. Following further discussions and analysis over the weekend, the decision to introduce emergency legislation was taken on Sunday.

At all times, the Secretary of State’s priority—and, indeed, mine too—has been to resolve this in a way that follows clinical advice. That is the most important thing. In the interests of a group of highly vulnerable individuals, it is important to do this in the most sensitive way. It would not have been feasible quickly to reassess all the patients and it may well have caused great distress to them and their families.

We have worked to remedy the problem as it relates to current and future detentions. The accountable officers for the four SHAs in question have written to Sir David Nicholson, chief executive of the NHS, to confirm that they have made the necessary changes to their governance arrangements. Furthermore, the accountable officers in the other six SHA areas have written to Sir David to confirm, in the light of this issue, that they have reviewed their own arrangements and are in full compliance with the Mental Health Act. That directly addresses the question asked by the hon. Member for Wolverhampton North East. I can confirm, incidentally, that approval in one SHA applies elsewhere in England. The Bill will put right those doctors’ approvals wherever they are now practising. That again gives complete clarity to that particular point.

Although we believe that there are good arguments that past detentions under the Mental Health Act were and are lawful, it is vital that doctors, other mental health professionals and, most importantly, patients and their families have absolute confidence in the decisions made. That is why, in relation to past detentions, we have decided that the irregularity should be corrected by the Bill.

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

On this serious matter, will the Minister give a fuller explanation of why, given that the proper procedure was not followed, making it irregular, it is none the less his advice that it remained lawful?

--- Later in debate ---

[Norman Lamb]

I cannot provide full detail, but I can repeat that the legal advice received by the Department was that there are good reasons to believe that the detentions are, and remain, lawful. Absolute certainty is essential in the interests of the patients concerned, whose care is paramount, and indeed of their families. That is why it is so important to proceed straight away with this retrospective legislation.

Although we are only aware of the problem in the four areas going back to 2002, the Bill applies in principle to the approval of all doctors under the Mental Health Act since its introduction in 1983. It retrospectively validates the approval of clinicians by those organisations to which responsibility was delegated, up to the point when all the relevant doctors were fully re-approved and their status put beyond doubt. The Bill will not deprive anyone—this is a really important point—of any of their normal rights of redress if they have been detained for any reason other than the narrow issue of the delegation of authority to approve by the SHAs. All the other rights remain exactly as they are. The provision addresses only the narrow issue of the nature of the authorisation. Nor will it affect any future detentions or legitimise any similar failures in the future—again, an incredibly important issue.

Necessary as it is to address the issue in that way, it is also important that we get to the bottom of how this happened. The Secretary of State has asked Dr Geoffrey Harris, chair of NHS South and former chair of the Buckinghamshire mental health trust, to undertake an independent review to look at how the responsibility was delegated by the four SHAs and, more broadly, the governance and assurance processes that all SHAs use for delegating any responsibilities. The Secretary of State will ask him to look at that in the context of the new NHS structures that come into force from next April to see whether any lessons need to be learned.

It is imperative that that review is swift. The Secretary of State has asked Dr Harris to report to him by the end of the year with recommendations to ensure that every part of the system employs the highest standards of assurance and oversight in the delegation of any functions.

In conclusion, I stress that both the Secretary of State and I have reviewed thoroughly with lawyers, clinicians and NHS managers all possible alternatives to introducing this retrospective legislation. The Secretary of State has been advised that all alternatives would be highly disruptive to the welfare of many of the most vulnerable patients in the mental health system, and would also deprive many other patients—another critical point—of the care they need while any action is undertaken. That is why, in such exceptional circumstances, we are proposing this retrospective legislation.

Mental Health (Approval Functions) Bill

Norman Lamb Excerpts

Tuesday 30th October 2012 Commons Chamber

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

I want to raise two specific points. Opposition Members are concerned that the concept of “Any person” in clause 1 is too broad, because it appears to legalise approvals by anybody. Why does the clause not refer specifically to North-East, Yorkshire and the Humber, West Midlands and East Midlands?

Secondly, where is the provision for the doctors who have been approved by a trust according to what we now understand was a defective process to be re-approved by the correct process? As the clause stands, it seems—I am happy to be put right on this—that doctors approved previously by the trust will be able to continue to section patients without re-approval under the correct process.

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

I will first set out what the clause seeks to do and then respond to the shadow Minister’s questions.

The clause directly addresses the issue that the Bill intends to resolve. Between 2002 and 2012, four strategic health authorities delegated to mental health trusts the function of approving doctors with responsibilities under the Mental Health Act 1983. The legal advice that we have obtained is that there are good arguments, as we have already discussed, that decisions to detain made by doctors who were approved in that irregular way are nevertheless lawful. The clause removes any doubt—that is its purpose. It clearly spells out that when mental health trusts gave approval in the past they are to be treated as having had the power to do so.

The clause has the effect of eliminating any irregularity from decisions made in complete good faith, and in the best interests of the patient, by doctors fully qualified to make them. It does so in a way that is fully consistent with the legal and clinical advice that we have received on the issue, and means that patients and their families do not have to undergo the process of assessment for detention under the Act again solely for the purpose of correcting a technical error made by a strategic health authority.

The hon. Lady asked why the clause was so broad as to refer to “Any person”. I understand her concern, but the point is that we do not yet know whether there were other issues before the establishment of the SHAs. Obviously, that is part of the work that the review will undertake, but to ensure that we resolve the problem absolutely and that all those patients have clarity the decision was made for the clause to refer to “Any person” in order to avoid any risk of our uncovering another problem that might need a separate resolution. This deals with the whole problem of the approval process for the doctors who made those decisions.

The hon. Lady then asked, correctly, whether decisions will be taken properly as we progress. I can confirm that all the doctors have already been re-approved according to a proper process, so every decision that is taken from hereon in cannot be challenged. As we have said, any patient who wants to question the clinical judgement can do so and their rights remain the same as they have always been. This simply addresses the technical issue that we have been debating today.

[Andy Burnham (Leigh) (Lab)]

The clause refers not only to “Any person” but one who

“has done anything in the purported exercise of an approval function”.

On both counts, it is incredibly widely drawn and could take us into the territory of other elements of the approval process that may have been defective. Will the Minister assure the Committee that the clause is as narrow as it needs to be? It seems to be uncomfortably wide and may well restrict somebody’s ability to challenge an element of their section other than the fact that the doctor was not approved by the SHA. It is very loose in its current form.

[Norman Lamb]

I am grateful to the shadow Secretary of State for that intervention. We have gone through a very careful process and have followed legal advice on what is necessary to regularise the position. This relates specifically to the approval function, which is defined in clause 1(2). As I have said, the legal advice is that this is the best way to regularise the issue that has been uncovered.

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

Before the Minister responded to the intervention by my right hon. Friend the Member for Leigh (Andy Burnham), he told my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) that if mistakes had been made before the establishment of the SHAs, some of the doctors who had not been properly approved previously may not have been approved by the executive action that the Secretary of Sate referred to earlier. Will the Minister assure the Committee that, should such instances come to light, those doctors will also be subject to a re-approval process?

[Norman Lamb]

The first thing I want to clarify, again, is that the clause ensures that if any previous authorisations were not done in accordance with the statutory provisions, the clause regularises that process, full stop. Of course, if we go back a long way, that may apply to people who have long since been discharged from their section. This regularises the situation for all. It also ensures that the detention of anyone who continues to be sectioned is regularised, because the original authorisation is deemed to be acceptable under the Bill and in accordance with parliamentary intent, as the Secretary of State said earlier.

[Mr Smith]

I am grateful to the Minister, but he has not fully answered my question. The Secretary of State has now properly given approval to those who were previously improperly approved. The Minister is right that many of the people in question may have retired or left, but some may still be practising. If further instances come to light, will they too be subject to a new scrutiny process?

--- Later in debate ---

[Norman Lamb]

I absolutely take the right hon. Gentleman’s point, and I am grateful to him. We must be absolutely certain that everybody is now properly authorised to make decisions. We know that everybody outside the four affected SHAs has been properly authorised—that has been checked and confirmed by SHAs, which have undertaken a proper check of their procedures. We also know that the four affected SHAs have already regularised the position of all their authorised practising doctors. We therefore know that across the whole system, doctors who undertake sectioning from now onwards will be properly authorised in accordance with the Mental Health Act 1983. The Bill addresses the previous problems with the authorisation process, and we have addressed the problem for the future by ensuring that everybody is properly authorised. I hope that deals with that point.

[Andy Burnham]

rose—

[Norman Lamb]

It does not entirely seem to deal with it, so I give way to the shadow Secretary of State.

[Andy Burnham]

I am grateful. It is important to get clarity before we leave this clause.

I know that the Government have not yet undertaken a full case-by-case review of the up to 5,000 cases involved. That prompts the question how the Government can be sure that the whole team involved in each case was qualified to a suitable level, and that there were not some instances of under-qualified people making decisions. That gives rise to concern that we may be retrospectively approving processes that were defective.

[Norman Lamb]

I do not think there is any suggestion that any of the people who undertook sectioning were not medically qualified to do so. The issue is simply with the body that undertook the authorisation and the fact that SHAs delegated that responsibility to mental health trusts, which was not in accordance with the law. The Bill is intended to regularise the position of every clinician who was not properly authorised because of that flaw.

[Andy Burnham]

I do not want to detain the Committee unnecessarily, but because the clause is drawn so widely it will possibly take away some people’s right to challenge whether there was a deficiency in the process or whether someone involved in the sectioning decision was under-qualified. Given that the Government have not undertaken a case-by-case review, I wonder how we can have absolute confidence that the power in the Bill is not too widely drawn.

[Norman Lamb]

I am told that we have dealt, doctor by doctor, with all the doctors in question who are currently practising. The problem relates to the doctor, not the patient, because it is about their authorisation to undertake the duties in the 1983 Act. The only people who undertake the actions referred to in the clause are doctors, who were authorised but unfortunately by the wrong body. That is what we are seeking to regularise.

[Andy Burnham]

We must have absolute clarity about this. In that case, why does the Bill mention “Any person” rather than “any doctor”? Our understanding is that a broader team of people can be involved in a sectioning decision, such as a social worker. If it is only doctors, the Bill should just say “any doctor”, but it does not.

[Norman Lamb]

We are talking about the approval function. Subsection (2) mentions

“practitioners approved to give medical recommendations”,

so it clearly deals with practitioners who have already been authorised, but by the wrong body.

[John Pugh (Southport) (LD)]

I am genuinely trying to understand this point and ensure that the Bill is as foolproof as possible. As I understand the Government’s case, the clinical need of people with mental health problems—the Bill clearly would not apply to people who did not have mental health problems—is trumping the absence of proper process, so the Bill is not an abuse of human rights.

The difficulty that I have with that argument—perhaps I ought not to have it, and maybe I am being particularly thick—is that the clinical need in question was established through a process that is acknowledged as formerly having been flawed. The clinical need is apparent only when a case has been heard and processed. The concept of clinical need here is certainly—

--- Later in debate ---

[John Pugh]

My point is that the definition of clinical need ought to be good enough for a psychiatrist, but I am not convinced that in this context it is good enough for a lawyer.

[Norman Lamb]

All that is being regularised is the power to approve a doctor, not whether a doctor is clinically sound. Any patient who challenges a judgment to section them either now or in the past will retain all their rights in law. We have acted on the advice of both lawyers and clinicians to ensure that we deal with the problem that has emerged in a way that respects patients’ clinical interests and considers them with the utmost seriousness. To go through a full reauthorisation process in every case could be incredibly damaging to individuals in potentially vulnerable situations. The Bill is based on the best clinical and legal advice that we have received on how to deal with the problem.

[Ms Abbott]

The Opposition have listened with great care to what the Minister has said. He has made a point of saying that his advice suggests that the Bill is the best way to deal with the situation. We argue that it is perhaps the most convenient way, but we know that the parliamentary draftsman has been under huge pressure to produce the Bill, and this would not be the first time that parliamentary draftsmen have come up with a form of words that is in some way defective. I repeat our concern about the broad nature of the clause, which states that “any person” who “has done anything” is to be “treated for all purposes”.

Winterbourne View

Norman Lamb Excerpts

Monday 29th October 2012 Written Statements

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

I wish to update the House about ongoing activity in relation to Winterbourne View private hospital.

The House will wish to be aware of two developments relating to Winterbourne View since the last written ministerial statement, issued on 25 June 2012, Official Report, column 2WS. First, the South Gloucestershire safeguarding adults board serious case review into Winterbourne View hospital was published on 7 August 2012 and can be found at:

http://www.southglos.gov.uk/Pages/Article%20Pages/Community%20Care%20-%20Housing/Older%20and%20disabled%20people/Winterbourne-View-11204.aspx.

Secondly, the House will wish to be aware that 11 former members of staff at Winterbourne View who were convicted of offences under the Mental Health Act 1983 and Mental Capacity Act 2005 received sentences on Friday 26 October. Six have been jailed, and five others given suspended sentences. I hope that these sentences will send a clear message that such criminal behaviour will not be tolerated and that there will be real consequences for the perpetrators.



This terrible case has revealed the criminal and inhuman acts some care workers and nurses are capable of. I want this case to reinforce to everyone, from front-line workers, to regulators, service commissioners, managers and board members, that they have a responsibility in preventing abuse of vulnerable people.

The abuse of patients at Winterbourne View hospital was horrifying. This was criminal behaviour—unacceptable in any part of our society, but particularly distressing given that these were people in vulnerable situations.

The BBC “Panorama” programme to be broadcast tonight continues to highlight inappropriate and poor quality care. There is no excuse for this.



The Department of Health review, set up by the former Minister of State, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), has found clear evidence that there are far too many people in specialist in-patient learning disability services (including assessment and treatment units) and many are staying there for too long. This must not carry on and must come to an end. People often end up in these facilities due to crisis which are preventable or could be managed if people are given the right support in their homes or in community settings.

Best practice and Department of Health guidance on this matter are clear—people with learning disabilities or autism and behaviour which challenges should benefit from local personalised services and should be supported to live in the community wherever possible. Only in very limited cases should in-patient services be used. This means that:

no one should be sent unnecessarily into in-patient services for assessment and treatment;

for the small number of people for whom in-patient services may be needed for a short period, the focus must be on providing good-quality care which is safe, caring and open to the community; and

people should move on from these services quickly—planning starts from day one to enable people to move on as quickly as possible to more appropriate care.

The key priorities are to address unacceptable failures of commissioning and to improve the capacity and capability of commissioning across health and care for people with behaviour which challenges with the aim of driving up the quality of care they receive, improving their lives and significantly reducing the number of people using inpatient services. This is best done through effective joint commissioning across health and social care and proper local planning.



I will publish the final report of the Winterbourne View review shortly. Alongside that final report, I will publish an agreement or concordat setting out the responsibilities of Government, commissioners, providers, professional bodies and regulators and the timetabled actions that each body commits to deliver.



We will continue to work with voluntary organisations, people with learning disabilities and their families so that they can hold health and social care bodies to account in making sure we deliver real change.

I will continue to update the House on this issue.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

4. What his policy is on making available all information about the results of clinical trials to patients, doctors and medicine approval bodies.

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

The Government support transparency in publishing results of clinical trials, and they recognise that more can, and should, be done. In future, greater transparency and the disclosure of trial results will be achieved via the development of the European Union clinical trials register, which will make the summary results of trials conducted in the EU publicly available. Greater transparency can only serve to further public confidence in the safety of medicines, which is already robustly assured in the UK by the Medicines and Healthcare products Regulatory Agency. By law, the outcomes of clinical trials undertaken by companies must be reported to that regulator, including negative results.

[Mr Speaker]

Order. We are grateful to the Minister but some of these answers are simply too long. If they are drafted by officials, Ministers are responsible—[Interruption.] Order. I require no assistance at all from the Under-Secretary of State for Health (Anna Soubry). She should stick to her own duties, which I am sure she will discharge with great effect.

[Dr Wollaston]

I thank the Minister for his answer and for recognising that missing data from clinical trials distorts the evidence and prevents patients and their doctors from making informed decisions about treatment. Will the Minister meet a delegation of leading academics and doctors who remain concerned that not enough is being done to see how we can ensure that all historic and future data are released into the public domain?

[Norman Lamb]

My hon. Friend raises absolutely legitimate concerns, which have been raised by others, including Ben Goldacre. I am happy for my noble Friend Lord Howe or me to meet her and experts to discuss this important issue further.

[Mr Speaker]

I call Catherine McKinnell.

--- Later in debate ---

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

7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.

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

Providers of services are responsible for the safety and quality of the care they provide. All staff must be properly qualified and vetted, and the Care Quality Commission can and must take action against providers who fail in that regard. Action can range from a warning notice to, ultimately, cancelling a provider’s registration. The commission must be willing to take that action if necessary.

[Barbara Keeley]

But the Minister knows that a recent BBC programme showed that 217 providers of care at home use staff who are not properly qualified, and that dozens of people with criminal records have not been vetted and are working unsupervised in people’s homes. The Care Quality Commission has reached only just over one in four of its target inspections, with 40% of care at home providers never having been inspected by it. What will the Minister do to ensure that we can have more confidence in care provided at home to vulnerable people and that it is up to a better and safer standard?

[Norman Lamb]

I absolutely share the hon. Lady’s concern about this. It is intolerable that people receiving domiciliary care do not get high-quality care and that in some cases people are inappropriately employed. The Care Quality Commission must take action where there is evidence of employers not taking sufficient action to guarantee the quality of their staff. It is essential that the people who run those services are held to account if they fail in that regard.

[Mark Pawsey (Rugby) (Con)]

Will the Minister also consider the matter of the uniforms worn by staff in this sector? I understand that on occasions there has been confusion in members of the general public between such staff and qualified nurses.

[Norman Lamb]

It is absolutely essential that users of services know exactly who the staff are who are caring for them, and the issue of uniform is something that I would be happy to discuss further with the hon. Gentleman.

[David Mowat (Warrington South) (Con)]

8. What plans he has to review the health allocation formula.

--- Later in debate ---

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

11. What steps he is taking to deliver better access to mental health services for school-age children.

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

The children and young people’s improving access to psychological therapies project, which we introduced in 2011, is about transforming mental health services for children and young people with mental health conditions. The Government’s mental health strategy implementation framework, published in July, suggests actions that schools, colleges and children’s services can take to provide better support.

[Tim Loughton]

The Government should be congratulated on tackling the stigma of mental health by their “No health without mental health” policy, but the growing problem of mental illness among school-age children is a concern and with the demise of the early intervention grant, which included the targeted mental health in schools funding, there is a worry that too many schoolchildren will be neglected. Will the Minister liaise with the Department for Education and with school nurses to make sure that appropriate and timely access to talking therapies and others are available for school age children rather than having to rely on the belated chemical cosh of powerful drugs?

[Norman Lamb]

May I first pay tribute to my hon. Friend’s work in this area? He has been really impressive and dedicated in his work. I absolutely agree with him about the importance of ensuring access to mental health services for children and adolescents. In fact, the Government are investing over £50 million over a four-year period through the children and young people’s improving access to psychological therapies programme and, critically, involving schools and colleges in that work. I would be very happy to work with my hon. Friend to improve access for children and young people.

[Phil Wilson (Sedgefield) (Lab)]

Will the Minister confirm that funding for children’s mental health services has actually been cut?

[Norman Lamb]

I repeat the point that we are actually investing more in a transformation of children’s and adolescents’ mental health services—and it is making a real difference. People within the service can see the benefits that it is bringing.

[Mr William Bain (Glasgow North East) (Lab)]

12. What recent representations he has received on regional pay in the NHS.

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

Will my right hon. Friend extend the scope of personal budgets? They help not only patients, giving them wider choice, but carers, allowing them to leave their post.

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

My hon. Friend makes an extremely good point. This is all about giving power to patients. Personal budgets have already been very successful in social care, and there are pilots under way in health care; the indications are that they are proving very successful.

[Jim Shannon (Strangford) (DUP)]

The NHS has a responsibility for all patients in ill health, especially those who are elderly. Is the Minister aware of the information released last week that 3,000 general practitioners have drawn up a list of 7,000 patients who have less than a year to live—in other words, whose level of care is in question? Will the Minister condemn that list and take every possible step to ensure that every patient gets NHS care, irrespective of age?

[Norman Lamb]

The whole purpose of that approach is to ensure that patients get appropriate care at the end of their life. There is very strong consensus supporting that approach, including on the part of Marie Curie Cancer Care and Age UK. It is really important that all GPs and others involved in the care of people at the end of their life engage fully with the patient and the patient’s loved ones. That is the right approach.

[Mel Stride (Central Devon) (Con)]

My right hon. Friend will know that in this country, over 1,000 people a year die as a consequence of asthma. We have one of the highest prevalences of asthma in the world. Will he outline to the House what action we will take to get those mortality rates down?

--- Later in debate ---

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

Further to the answer that the Minister of State gave to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), why do the Government not make it a criminal offence for those who recruit staff on the cheap not to bother checking employees’ employment records, qualifications or criminal records? Surely they are putting people’s lives at risk.

[Norman Lamb]

I absolutely share the hon. Gentleman’s concern. I am looking at the whole issue very closely. It seems to me that the fundamental point is to ensure that the people in charge at the corporate level are held to account for failures of care. We are very serious about ensuring that that happens.

[Several hon. Members]

rose—

Pseudoxanthoma Elasticum

Norman Lamb Excerpts

Thursday 18th October 2012 Commons Chamber

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

I congratulate my hon. Friend the Member for Enfield North (Nick de Bois) on securing the debate. He told the House that his wife had been diagnosed with PXE, and I am sure that this is a matter of great personal concern to him. I am grateful to him for engaging with me and the Department before the debate. I am keen to ensure that we maintain a continuing discussion on this matter. We cannot answer all the questions in the debate today, and we cannot change the whole system or the way in which the NHS operates, but let us discuss the genuine problem that has been highlighted today.

I should also like to acknowledge the contribution from my hon. Friend the Member for Burton (Andrew Griffiths), who spoke movingly about his constituent’s situation. He drew our attention to the fact that, while losing one’s sight is a critical matter for an individual, the cost to society and to the Government demonstrates powerfully the case for treatment in those circumstances. I also want to pay tribute to Elspeth Lax for her tireless work. We owe people like her, and the support groups that offer support to hundreds of patients with many different conditions, an enormous debt of gratitude.

I completely take on board the importance of fast access to treatment. It is critical. Indeed, the NHS constitution makes the point that citizens have a right to a speedy decision, without delay. People need to exercise their rights under the constitution in cases such as these.

[Nick de Bois]

It is worth highlighting that, because of the shortcomings, many people suffering from this condition have resorted to paying for their drugs themselves privately, such is the urgency of their situation.

[Norman Lamb]

I completely understand that. The debate has focused on the effects of the condition on the eye, and these matters are of considerable concern to people with PXE.

There are no licensed eye treatments for PXE. People with PXE should be advised on healthy lifestyle measures, such as stopping smoking, adopting a healthy diet and taking physical exercise, to reduce the risk of complications. They should also be monitored regularly by a health care professional. As it is a genetic condition, patients who are considering having children should receive genetic counselling, and first-degree relatives should be screened. Because of the similarities between age-related macular degeneration and PXE in the eye, some clinicians may consider using treatments that are effective in AMD, including laser treatment and the drugs Avastin and Lucentis, which have already been mentioned. My understanding, however, is that PXE has a different cause and a different process, and patients with PXE might not respond to those treatments in exactly the same way.

Lucentis is considered by some clinicians to be effective in treating people whose eyes have been affected by PXE. I have also mentioned Avastin, but neither Lucentis nor Avastin are licensed by their manufacturer for use in the treatment of patients with PXE. The National Institute for Health and Clinical Excellence has appraised or is currently appraising the use of Lucentis in the treatment of other eye conditions such as wet age-related macular degeneration and other conditions—diabetic macular oedema and retinal vein occlusion, for example—but Lucentis is currently recommended in NICE technology appraisal guidance only as a treatment for wet AMD, subject to certain criteria.

Clinicians may prescribe any treatment, including an unlicensed treatment or a product not licensed for a particular condition, where they consider it to be the best available medicine to meet the clinical needs of their patients—it is for the judgment of the clinician—subject to their primary care organisation agreeing to fund the treatment. Primary care organisations, too, are legally obliged to provide funding so that treatments that have been positively appraised by NICE are available on the NHS. In the absence of relevant NICE guidance, these primary care organisations are responsible for making funding decisions based on an assessment of available evidence and on the basis of an individual patient’s circumstances.

Where a decision is taken not to fund a treatment, primary care organisations must have a process to allow for the possibility that an individual may have exceptional circumstances—I absolutely take the point that loss of sight needs to be taken very seriously into consideration—which justify access to treatment that is not available to the rest of the population. If doctors feel that there are exceptional clinical circumstances, they can request treatments that are not usually funded on behalf of their patients through an individual funding request. I recognise, as I have said, that time can be of the essence in these cases. In this situation, a special panel that includes clinicians would carefully consider individual cases against the latest medical evidence and decide whether the treatment could be approved.

Under the NHS constitution, patients have the right to expect local decisions about the funding of medicines and treatments to be made rationally and without delay following a proper consideration of the evidence. If new evidence arises to support the use of a treatment or if an individual’s clinical circumstances change, a new individual funding request can be made. To help organisations make these difficult decisions, the Department has issued a set of core principles, and primary care organisations are required to have in place clear and transparent arrangements for local decision making on funding of drugs and for considering exceptional funding requests.

I shall deal now with the general issue of the commissioning of services for people with rare conditions. This Government are committed to providing the best quality of care for people with rare conditions. When we took office in 2010, we endorsed the right in the NHS constitution that says no one should be left behind just because of the rarity of their condition. Lack of awareness is, of course, often a real problem. The importance we attach to services for people with rare conditions has been clearly demonstrated in the reforms set out in the Health and Social Care Act 2012, which my hon. Friend the Member for Enfield North was active in supporting during its passage through Parliament. As a result, specialised and highly specialised services, which are currently commissioned at both a national and regional level through a range of NHS organisations, will be brought together under one roof. From April 2013, the new NHS Commissioning Board will directly commission services for people with rare diseases on a national basis. The board will have a clear focus on specialised services organised around programmes of care. These new arrangements for the commissioning of specialised services provide a unique opportunity to do things more effectively and smarter than in the past, and will bring real benefits to patients with rare conditions, including to patients with PXE.

Moving to a national standard system of commissioning while maintaining a local focus managed through the board’s four regions and the local area teams will provide the geographic and speciality oversight that is needed for these services. The commissioning board will set out a detailed service specification for each of the services that it will commission directly. That will link national service knowledge and expertise with local contract knowledge of providers and pathways of care, cementing the new system together in the interests of patients. The benefits to patients with rare conditions are clear: a single national commissioning policy and better planning and co-ordination will result in improved consistency around the country.

The Government are also committed to increasing awareness—which I mentioned earlier—of very rare conditions such as PXE. That commitment has been demonstrated through the UK’s involvement in the development of the UK plan for rare diseases. We shared our views on the proposed plan earlier this year, launching our consultation on 29 February, rare disease day. The consultation document was produced jointly by the four nations of the United Kingdom, and the consultation closed on 25 May.

The consultation responses will inform the UK plan, which is being developed in response to the 2009 European Council recommendation on rare diseases. That recommendation, which was supported by the UK, asked every member state to develop a national plan or strategy for rare diseases by the end of 2013. My officials are currently working through all the consultation responses—there were more than 350, which demonstrates the level of interest—and are writing a summary of the responses. They expect to publish it later in the autumn, with the final plan being published next year.

This is the first time that the UK has developed a plan to tackle 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 PXE. However, a plan in isolation is clearly not enough. This plan will need buy-in from everyone in the system. With that in mind, my officials have been working closely with the newly formed NHS Commissioning Board to ensure that the plan has traction within the system, so that people know about it and understand its power.

In comparison with some other member states, the UK already has good systems for supporting and treating people with rare diseases through the provision of specialised services, but that does not mean that we cannot do better. For example, more co-ordinated care saves patients time, money and stress by avoiding the need for multiple visits to various clinics and hospitals, which has too often been people’s experience in the past. We are also considering how rare diseases can be better represented in training curricula. That is critical to raising the level of knowledge and capacity in the system.

People with rare diseases are likely to come into contact with professionals from a range of disciplines: from GPs through geneticists and researchers to nurses, surgeons, mental health teams and social care workers. It is for that reason that the UK plan for rare diseases will be targeted at the whole of the health and social care sectors. The final plan will set out a coherent and joined-up approach to tackling rare diseases. It will acknowledge existing developments, such as the contribution that expert centres can make to better diagnosis and treatment of rare diseases, while proposing a number of further developments, such as better information for patients so that they can be fully engaged and helped to understand and manage their conditions.

The plan will include recommendations, actions and examples of best practice for commissioners of specialised services, royal colleges, providers of information, and staff on the ground who deliver care to people with rare diseases. It will recognise that each nation of the UK has different health care systems, and it will be for each nation to implement it in accordance with its own priorities and patterns of service. In England, much of the implementation of the final plan will be for the new commissioning board in its role as a single national commissioner of specialised and highly specialised services.

I am grateful to my hon. Friends for raising this important issue. The value of a debate such as this is that it forces Ministers to focus on rare diseases to which we might not have devoted time otherwise. I shall be happy to continue to engage with the issue to ensure that patients with PXE are given the treatment and care that they deserve.

Question put and agreed to.

Suicide Prevention Strategy

Norman Lamb Excerpts

Monday 10th September 2012 Written Statements

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

Today I am publishing a new suicide prevention strategy for England.

“Preventing suicide in England: a cross-Government outcomes strategy to save lives”, has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The document is also available at: www.dh.gov.uk/health/tag/suicide-prevention/.

Over the last 10 years, good progress has been made in reducing the suicide rate in England. However, there were over 4,200 suicides in 2010. That is one person dying from suicide every two hours. When someone takes their own life, the effect on their family and friends is devastating. Many others involved in providing support and care will feel the impact.

There is no single approach to preventing suicide. Effective prevention needs a broad, co-ordinated, system-wide approach, with input from a wide range of organisations. An inclusive society that avoids marginalising individuals, and which supports people at times of crisis, will help to prevent suicides. Government and statutory services also have a role to play—through building individual and community resilience, ensuring that vulnerable people in the care of health and social services and at risk of suicide are supported and kept safe, and ensuring that we intervene quickly when someone is in distress or crisis.

This strategy recognises the contributions that all sectors of our society can make in preventing suicide. In particular, it sets out to:

reduce the suicide rate in the general population; and

provide better support and information to those bereaved or otherwise affected by a suicide.

We have identified six key areas for action to support delivery of these objectives:

reduce the risk of suicide in high risk groups;

tailor approaches to improve mental health in specific groups;

reduce access to the means of suicide;

provide better information and support to those bereaved or affected by suicide;

support the media in delivering sensitive approaches to suicide and suicidal behaviour; and

support research, data collection and monitoring.

The strategy supports action by bringing together knowledge about groups at risk of suicide, applying evidence of what interventions are effective in preventing suicide, and highlighting available resources to support action at local level. It therefore supports local decision-making, while recognising the autonomy of local organisations to decide what works in their area.

One of the main aspects of the strategy, and one of the most significant changes from the previous strategy, is the greater prominence of measures to support families—those who are worried that a loved one is at risk and those who are having to cope with the aftermath of a suicide.

In developing the strategy, the Government have built on the successes of the previous strategy, published in 2002. It has also been revised and strengthened following consultation on a draft strategy which ended in October 2011. I am grateful to the wide range of individuals and organisations who provided input to this work.

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