Whorlton Hall

Debate between Norman Lamb and Caroline Dinenage

Thursday 23rd May 2019 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

(Urgent Question): To ask the Minister if she will make a statement on the treatment of people with learning disabilities and complex needs at Whorlton Hall.

[The Minister for Care (Caroline Dinenage)]

Many of us here today, and many of those listening and watching this urgent question, will have seen the very disturbing footage shown on the “Panorama” TV programme last night. It was footage detailing the incredibly traumatic experiences of vulnerable people with learning disabilities and autism at Whorlton Hall—somewhere they should have been safe, somewhere they should have been cared for. The actions revealed by the programme are simply appalling—there is no other word to describe them—and I condemn any abuse of this kind completely and utterly.

I want to begin by saying that I can only imagine the impact of those experiences on the people themselves, and the lasting damage and trauma that it will have caused to them and their lives. It must also have been incredibly distressing for their families, watching what has been happening to their loved ones, unable to step in and unable to do anything to help them. It is utterly, utterly tragic. On behalf of the health and care system, I am deeply sorry that this has happened.

As hon. Members will be aware, unfortunately, this is not an isolated incident; we have heard reports like this before. That is why there have been a number of reports published even this week on the care of people with learning disabilities and autistic people in in-patient settings. All those reports have been commissioned directly or indirectly by the Government, and all of them have found very clear evidence of care that has fallen way below the standard we expect and the standards that people absolutely deserve.

The allegations of abuse at Whorlton Hall were shared with my Department, NHS England, the Care Quality Commission and the provider ahead of the programme airing yesterday. Immediate steps were taken to ensure the safety of patients, including ensuring that safe staffing levels were maintained following the suspension of a significant number of staff by the provider. A Whorlton Hall incident co-ordination group was established, involving NHS England; NHS Improvement; Cygnet, as the owner; the CQC’s regional head of inspection; the local clinical commissioning group; and the local authority.

Durham constabulary opened a criminal investigation earlier this month, and the CQC and NHS England are supporting its enquiries. While that investigation is ongoing, I cannot comment on the specific incidents or individuals depicted, as Members will understand. The evidence presented, including but not limited to the “Panorama” footage, must be thoroughly examined, and where those investigations find that allegations of abuse are substantiated, action will be taken.

One thing we can all be clear on is that what was shown last night was not care, nor was it in any way caring—suffice it to say that I am clear in my mind the nature of what was occurring at Whorlton Hall.

There are three questions that we need to consider urgently. First, was the activity in Whorlton Hall criminal? The police investigation is looking into that. Secondly, is the regulatory and inspection framework working for these types of services? We want to know why, after whistleblowing concerns had been raised, was the outrageous culture and behaviour at Whorlton Hall not identified? What went wrong? We will be working to understand in detail the timeline of events, the actions taken and where things might have been addressed earlier. Thirdly, was the oversight of commissioners fit for purpose? Where were the CQC and NHS England in this?

More broadly, there is a range of questions about whether these types of institutions and these types of in-patient settings are ever an appropriate place to keep vulnerable people for any extended length of time and why community provision is not sufficient. Work is continuing on all those subjects as well. We know the problems that exist in the system and we are utterly determined address them.

[Norman Lamb]

I thank the Minister for that response. Last night’s “Panorama” was deeply shocking and particularly distressing for any family who have a loved one in an institution and are worried about their safety. We saw people with learning disabilities and autism mocked, intimidated, taunted and provoked, and care workers admitting to deliberately hurting patients—behaviour appropriately described as psychological torture. The individuals responsible must be held to account, but so must the provider that allowed this dreadful culture to persist. Will there now be an investigation by the Health and Safety Executive into the possibility of criminal prosecution against the provider?

The truth is that, seven years on from Winterbourne View, the system continues to sanction a model of care that is outdated and wrong. If people are contained in institutions a long way from home, awful things will happen behind closed doors. Will the Secretary of State now take personal responsibility for closing down institutions that provide the wrong model of care? Why does the CQC continue to register new institutions that offer inappropriate institutional care? Does the CQC need new powers? What lessons must we learn from the fact that the CQC rated this place as good? Is this another case of whistleblowers not being listened to? How much was Cygnet charging the NHS per week for this awful abuse and neglect?

This horror comes in the same week as a damning CQC report on segregation, an equally scathing report by the Children’s Commissioner on children being wrongly placed in institutions where force is routinely used and the LeDeR—learning disabilities mortality review—report confirming the extent to which people with learning disabilities and autism are fatally failed by the system. Does the Minister accept that we are tolerating widespread human rights abuses? Is it true that the Government moved forward the publication of the CQC report to pre-empt the “Panorama” report? What families want is not another review; they want action to protect their loved ones.

Will the Government take action to end the endemic use of restraint—including face-down restraint against adults and children—five years after I issued guidance to that end? When will the Government tell us what will replace the transforming care programme? It ended in March and we are still waiting—there is hardly a sense of urgency. Finally, will there now be substantial investment in the development of community facilities, so that people with learning disabilities and autism have the chance of a good life that the rest of us take for granted?

[Caroline Dinenage]

These exchanges reflect the views that I am certain we all hold, and I thank the right hon. Gentleman for raising all those questions. The culture and behaviour shown on yesterday’s television programme are absolutely abhorrent and we must stamp them out. More broadly, it is clear from the reports published earlier this week, which the right hon. Gentleman refers to, that we need to do much more to improve the quality of care in mental health wards for anyone with a learning disability or autism. I want to reassure the House that we absolutely recognise that, and steps are being taken to address it.

Societies are rightly judged on the way we treat our most vulnerable citizens. This is not just about reviewing a few individual cases in which things went wrong; it is about a system across health, education, social care and criminal justice—it all needs to change. Today, people will rightly be very angry about what has happened and what was shown on last night’s television programme, and they will want answers. They will also rightly be very angry that, eight years after Winterbourne View, we have another scandalous case in which vulnerable people with learning disabilities or autism are on the receiving end. They will rightly ask what action has been taken and what more we need to do.

As the right hon. Gentleman will know, six months ago the Secretary of State commissioned the CQC report on segregation, seclusion and restrictive practices. It was published earlier this week simply because the original publication due date of 31 May is during a recess, and he will know that the Department has come in for enormous criticism in the past for publishing reports when Parliament is in recess, post elections or when the House is not sitting and for publishing late. We wanted to avoid all those things. That is why the date was brought forward. The publication was ready and we took the view to publish it. The publication of the LeDeR report was a matter for NHS England, of course, it being an independent document.

The action we announced in response to the CQC report on Tuesday confirms how seriously we take this issue. We are adamant that no stone should be left unturned in identifying problems, poor practice and care that falls short of what we would expect for our own family members. That said, this is not about segregation or seclusion or failings at specific hospitals, but about the need for far better oversight more generally. Where it is essential that somebody be supported at a distance from their home, we will make sure that those arrangements are supervised. We will not tolerate having people out of sight and out of mind. Where someone with a learning disability or an autistic person has to be an in-patient out of area, they will now be visited on site every six weeks if they are a child and every eight weeks if they are an adult.

The host clinical commissioning group will also be given new responsibilities to oversee and monitor the quality of care provided in their area. This is an issue not just for the regulator, but for those who commission the care. We must be clear that improving the quality of specialist in-patient care is critical, but we are committed to preventing people from entering crisis and having to be admitted to in-patient care in the first place, and that is what the transforming care programme is about. This programme has not finished. As was highlighted in the NHS long-term plan, the transforming care programme and the building the right support plan continue, and we are renewing and redoubling efforts to reduce the number of people in an in-patient setting by 35%. So far, it is down 22% from 2015, but that endeavour continues. The right hon. Gentleman highlights the report from the Children’s Commissioner on Monday. We take the issues they spoke about very seriously.

The right hon. Gentleman asked lots of questions, many of which I think were answered in the three questions I highlighted earlier—the questions that we will be addressing over the coming weeks: criminal liability, oversight and commissioning. Where there have been failings, these will be addressed. Autistic children often have a range of needs or supports that must be joined up, which is why we are reviewing our entire autism strategy and will extend it to include children. As part of the NHS long-term plan, there will be a concerted effort to implement arrangements to ensure that those at the highest risk of admission to a specialist hospital get the help they need, and we will ensure that every area has a dynamic support register in place.

We think that staff in these settings must be much better trained in awareness of learning disabilities and autism, which is why we conducted a thorough inquiry and public consultation on training for learning disabilities and autism. In the coming months, we will set out our response to that consultation and proposals to introduce mandatory training for all health and care staff. We will continue to bring those in-patient numbers down and take every step to take the best practice in health and care and make it the norm everywhere. We will root out toxic cultures and behaviours of the type we saw last night so very painfully on our television screens, but I am fully aware that there is no room for complacency.

Learning Disabilities Mortality Review

Debate between Norman Lamb and Caroline Dinenage

Wednesday 15th May 2019 Commons Chamber

[Caroline Dinenage]

This is really important. We have seen an increase in reports of segregation and restraint, but that is partly because we have seen much better recording of the data. That is also very important, because we need to understand where people are being kept in seclusion or restrained inappropriately. The Secretary of State has asked the Care Quality Commission to review the matter and make recommendations about the use of restrictive interventions in settings that provide all sorts of residential care. The first part of that review will be reporting back very shortly.

[Norman Lamb (North Norfolk) (LD)]

I welcome the Minister’s clear statement that it is wholly unacceptable that people with learning disabilities continue to experience much shorter life expectancy. It is wholly unacceptable, but the problem is that we have all been saying this for years and nothing ever changes. We do not appear to be capable of learning the lessons that she says are necessary. One problem is that people with learning disabilities are often under the care of people who do not have the training necessary to understand the interaction between physical health conditions and learning disability. That is often the cause of that premature mortality. I brought together a group of clinicians who make the case for a new specialty in learning disability so that we have people who understand those crucial interactions between physical ill health and learning disability. Will the Minister meet me and those clinicians so that we can really understand how we can start to make a difference here rather than continuing to say that it is unacceptable and doing nothing effective about it?

[Caroline Dinenage]

I start by saying that I am always very happy to meet the right hon. Gentleman because he has great expertise, knowledge and understanding of this field and often makes incredibly valuable suggestions. In response to his question, that is why the commitment to mandatory training for all health and care staff is absolutely vital. We should not forget that this is not just about medical professionals, but about people such as receptionists. The way that adults with learning disabilities and autism are treated by someone at the front desk of a health and care setting can immeasurably affect their interaction with that provider. That is why this training is so important, why we have consulted so widely on how to deliver it, and why we will set out some really coherent plans later on in the year.

Local Government and Social Care Funding

Debate between Norman Lamb and Caroline Dinenage

Wednesday 24th April 2019 Commons Chamber

[Caroline Dinenage]

I want to make some progress, because a number of Members have made a lot of points and I want to try to cover them, but I will come back to those who want to ask questions.

My hon. Friend the Member for Lewes (Maria Caulfield) said, in the words of Bananarama, that “it’s not what you do, it’s the way that you do it”. She highlighted the innovative moves by her local council in East Sussex to look into delayed transfers of care and stepdown beds. She rightly paid tribute to the hard work of the NHS and local authority staff who do so much to stop people being trapped in hospital beds, which we know is no good for them in the long term.

My hon. Friend the Member for South Suffolk (James Cartlidge) reminded us of the parlous financial situation that we inherited in 2010, and of all the difficult decisions that have had to be made across different councils and central Government as a result. He also gave some great examples of local councils that have achieved efficiencies through innovation, technology and sensible decisions, and spoke of the need for much more honesty and transparency as we try to find a solution to the problem of adult social care.

The hon. Member for St Helens South and Whiston (Ms Rimmer) made a thoughtful and measured speech, focusing mainly on adult social care. She spoke a lot about the workforce issue, about which I myself am particularly passionate. In February we launched an adult social care recruitment campaign called Every Day is Different. The aim is to raise the profile of the sector, and to encourage people with the right values to apply to work in this incredibly important role. The Department of Health and Social Care also funds the Skills for Care campaign to help the sector with recruitment, retention and workforce development. That includes the distribution of £12 million a year for a workforce development fund. Providers can bid for a share of the fund to help their staff to train and gain qualifications at all levels.

My hon. Friend the Member for Redditch (Rachel Maclean) spoke passionately about carers, who have already been described as the unsung heroes of our health and care system. My hon. Friend and neighbour the Member for Fareham (Suella Braverman) made a number of points, but, in particular, raised problems in relation to continuing care. NHS England has launched an improvement programme to help clinical commissioning groups to address variations in the assessment and granting of eligibility.

The hon. Member for Hartlepool (Mike Hill) made a thoughtful and heartfelt contribution. He talked specifically about the challenges facing coastal communities. I empathised with that, as I represent a coastal community myself. He said that Hartlepool was a vibrant and welcoming place. He is a great ambassador for his constituency—as, indeed, is my hon. Friend the Member for Chelmsford (Vicky Ford), who tells us all that her own constituency is the No. 1 place to live in the UK, and also the No. 1 hotspot for night life. I am not sure how she knows that! She spoke about the lottery of long-term care. We will seek to address the catastrophic way in which care costs can affect some individuals in the Green Paper, when it comes forward.

[Norman Lamb]

The Minister has just mentioned the Green Paper. I realise that she cannot say when it will be published, but do the Government intend it to lead to reform in the current Parliament when it is published, or are we likely to have to wait until some time in the middle of the next decade before any reform actually happens?

Mental Capacity (Amendment) Bill [Lords]

Debate between Norman Lamb and Caroline Dinenage

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I am here today to prove my mettle.

I will start by stating the obvious: our liberty is our most fundamental human right. The challenge today is that the current system of deprivation of liberty safeguards no longer provides protection to all the vulnerable people entitled to it. The system has proved to be overly bureaucratic and inefficient to apply, and case law has resulted in article 5 of the European convention on human rights being understood in a very different way, and this has, in effect, widened the definition of deprivation of liberty eighteenfold. The result is a long backlog of applications that has built up over time such that today about 125,000 people may be subject to a deprivation of liberty without formal authorisation.

The Bill introduces a new system—the liberty protection safeguard—based on work of the Law Commission that involved more than three years of consultation and consideration. It is designed to provide robust protections and to be simpler so that protections may be afforded quickly and effectively to those who need them. It is absolutely right that any proposed changes to the protection of some of the most vulnerable people in our society be scrutinised closely, however, and I am grateful for the close examination of the Bill by hon. Members and noble Lords during the Bill’s passage here and in the other place.

I thank the hon. Member for Rhondda (Chris Bryant) for raising the issue of how liberty protection safeguards will work for people who have a brain injury or may need to be deprived of their liberty while receiving care or treatment. I also thank him for his chairmanship of the all-party group on acquired brain injury. He does an outstanding job and is a great advocate for the group.

A leading charity in this area, Headway, reports that every 90 seconds someone is admitted to a UK hospital with an acquired brain injury or related diagnosis, such as trauma, stroke, tumour and neurological illness, and many of these will require some form of rehabilitation. For some people, this can be a lifelong need. Having met the hon. Gentleman yesterday to discuss his concerns, I understand that neurorehabilitation can in some cases help people to regain capacity over time and that his amendments are intended to account for this and to ensure that a deprivation of liberty occurs only when strictly necessary.

I would like to provide some reassurance that the first principle of the Bill is that a deprivation of liberty should occur only where it is considered essential and where authorisation conditions are met. I can assure the hon. Gentleman that we have considered carefully how this model will work for this group of people and are confident that the reformed model will embed consideration of deprivation of liberty into the earliest stages of care and treatment planning so that from the outset these arrangements will work alongside neurorehabilitation therapy and adhere to the less-restrictive principle of the Mental Capacity Act 2005.

[Norman Lamb (North Norfolk) (LD)]

I understand the Minister’s concern not to impinge on the rights of disabled and elderly people, but is she not concerned that more than 100 social care and disability organisations have written to her raising continuing concerns, including about the Bill adversely affecting the rights of people who rely on care and support services. Does she think they are wrong, or does she think they have legitimate concerns that still need to be properly addressed?

[Caroline Dinenage]

Of course, any organisation representing these vulnerable people that raises concerns deserves to have them listened to, and I am sure that the vast majority are legitimate concerns, which is why we have been listening so carefully up until this point. The right hon. Gentleman will know how many amendments we have made in the other place, in Committee and today.

We will continue to listen and collaborate as we deal with the code of practice, about which I shall say more in a moment. A working group of third-sector organisations is helping us to put the document together so that it is not rushed. It is not being prepared for the purposes of Parliament, but it will come before Parliament. Following a wide public consultation, both Houses will vote on it. That collaboration has been and will continue to be important: it is not the end of the conversation, but very much part of it.

--- Later in debate ---

[Caroline Dinenage]

I am afraid that I will not take any more interventions because Mr Deputy Speaker might fall out with me entirely. In short, care home managers will be responsible for consultation, which is already part of good care.

Amendment 50 would require an approved mental capacity professional to complete the pre-authorisation review, where care home arrangements are being authorised and where the care home manager provides a statement to the responsible body. The Law Commission recommended the creation of the AMCP role and also recommended that their use should be focused on those cases where their input is needed. The commission recommended that AMCPs should consider cases where an objection is raised and the Bill does that. The Bill also allows other relevant cases to be referred to an AMCP. We expect, for example, cases where there are complex circumstances, or particularly restrictive practices are proposed, to be referred by the responsible body to an AMCP. We have also specified that an AMCP must carry out the pre-authorisation review in independent hospital cases. However, we agree with the Law Commission that not every case should be considered by an AMCP. By having a targeted system, with a greater focus on more complex cases, we can ensure that people receive the protection to which they are entitled.

Turning to amendment 51, I thank hon. Members for raising advocacy, about which we spoke at length in Committee. Advocacy is of the utmost importance for ensuring that the voice of the person is heard. That is why this Bill creates a presumption of advocacy for everyone who is subject to arrangements under liberty protection safeguards. During our engagement with stakeholders, many people and their families told us that the DoLS system was something that was done to them without family involvement. That is why this Bill introduces the appropriate person role described by the Law Commission. Family members and those close to the person will be able to be an appropriate person and provide representation and support. We recognise that that role can be challenging, which is why it will be conducted only by those who are willing to do it. Otherwise, people will be able to request an independent mental capacity advocate to support them in providing that important representation.

Like Opposition Members, we want to ensure that people receive advocacy, but we recognise that we should not impose it on people, nor should it become a formality without real effect. Our Bill already delivers on amendment 51.

[Norman Lamb]

Will the Minister give way?

[Caroline Dinenage]

I am afraid that I cannot take any more interventions at this stage.

Our Bill allows the person themselves to request an IMCA from the responsible body if they have the capacity to do so, and it explicitly states that an appropriate person can request an IMCA or that the responsible body should appoint an IMCA if it believes that the appropriate person having the support of an IMCA would be in the cared-for person’s best interest.

I agree that the appropriate person has a challenging role with vital duties to ensure that the person exercises their rights, and we want to work with others in the sector to establish how best to support them in this role. There is existing provision in the Bill to address the concerns raised by amendment 51. In some areas, the amendment adds uncertainty and over-complication.

This Bill is about protecting vulnerable people and replacing a one-size-fits-all system.

Assessment and Treatment Units: Vulnerable People

Debate between Norman Lamb and Caroline Dinenage

Tuesday 6th November 2018 Commons Chamber

[Caroline Dinenage]

That is a really good question. We are looking carefully at how we can support children much better so that they do not go into these sorts of units at all. As I say, it is about the wraparound services that can identify much earlier somebody who might be at a crisis point, and making sure that the care and support is put in place to prevent people from having to be admitted to units of this kind.

[Norman Lamb (North Norfolk) (LD)]

Does the Minister agree that the Care Quality Commission needs to look into the endemic use of force in these institutions, as well as at the use of exclusion? Does she agree that unless and until we find a mechanism to transfer money from spending in these institutions to support in the community, we will never solve this problem?

[Caroline Dinenage]

The right hon. Gentleman has done so much work on this issue and cares about it intensely. NHS England has transferred more than £50 million, up front, so that clinical commissioning groups that are planning to close beds can start to provide the community provision that is crucial to keeping people well in the community and out of residential settings.

[Norman Lamb]

And use of force?

[Caroline Dinenage]

We are absolutely clear that force should not be used at all.

Transforming Care Programme

Debate between Norman Lamb and Caroline Dinenage

Thursday 5th July 2018 Commons Chamber

[Caroline Dinenage]

That truly is good news, Madam Deputy Speaker. I will try not to go on, as my husband tells me I have a propensity to do. I will answer as many questions as I can. I may have misinterpreted some of them, and I may not be able to read the copious notes I have written, but I will write to Members if I do not get to their points.

We can all agree that people with a learning disability and/or autism have the right to the same opportunities as everyone else to live satisfying and valued lives and to be treated with dignity and respect; that goes for their families, too. As good and as necessary as in-patient care can be—we have heard examples of how it has changed people’s lives—we know that people with a learning disability should have the opportunity to live at home, to develop and maintain relationships and to get the support they need to live healthy, safe and rewarding lives in their own local communities.

The mandate to NHS England—the list of “must dos” for the NHS—set by the Government every year includes the following clear objective:

“We expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and support them to live full, healthy and independent lives.”

The transforming care programme is at the heart of that commitment. It is a partnership across local government and the NHS to transform the care, support and treatment available to enable people with a learning disability, autism or both to lead the lives of their choosing with and in their local community.

Through the national transformation plan, “Building the Right Support”, we have an ambitious and comprehensive plan to bring councils and clinical commissioning groups together in transforming care partnerships to plan and provide services across their areas; to use funding in new ways, including through pooling budgets, which I will talk about in a moment; and to ensure that people and their families have a clear idea of what they should expect from those agencies through the national service model. Key to all that has been building the right support in the community so that people do not need to go to hospital in the first place and those who are already there can move out.

Members have raised concerns today about the progress made under the transforming care programme. I can reassure them that progress continues to be made, but I will commit to take forward most seriously all the concerns raised today. The number of in-patients continues to decrease, and it is down to 2,400. NHS England has been clear that it is fully committed to meeting the ambition to reduce the number of in-patients by at least 35% by next March. It has talked about the intention to close around 900 learning disability beds. I entirely take the point made by the hon. Member for Dulwich and West Norwood (Helen Hayes) that focusing on the number of beds misses the point, and that it must be about ensuring that community provision and support are available to enable people to make that move, rather than the fact that beds are closing.

[Norman Lamb]

I appreciate the Minister being willing to write to us after the debate with anything she is not able to cover. Does she understand the concern that a headlong rush to meet the target because we are getting close to the deadline without proper arrangements in place could be disastrous for individuals? If the target is not achieved, that is better than a complete failure, with readmissions after failed discharges. The focus on detail in every case is critical.

[Caroline Dinenage]

I completely agree with the right hon. Gentleman. I do not want to have concerns about safe discharge, and that is why we look at that in care and treatment reviews. More than 7,000 of those reviews have been carried out, to reduce the time that people stay in hospital and improve the quality of care they receive while in hospital. Essentially, they are a step towards ensuring that community provision is available before people are allowed to leave hospital. The latest data show that the proportion of in-patients reported as never having had a care and treatment review was 8%, down from 47% in January 2016.

[Norman Lamb]

It should be 0%.

[Caroline Dinenage]

Absolutely, it should be 0%. As the right hon. Gentleman knows, that is what we are working towards.

--- Later in debate ---

[Caroline Dinenage]

I agree with my right hon. Friend that there is absolutely no point in having arbitrary targets that do not actually deliver the quality we are aiming for. As we all know from political history, targets for the sake of it have not always necessarily worked out in the way intended.

It is worth emphasising that this is a really special programme for people with very complex needs who require a very particular type of support. They also need to have their care reviewed and to have a bespoke package put in place, tailored to their needs, to allow them to live in the community. There is no one single intervention and no template for what care is needed because every person is different.

[Norman Lamb]

Will the Minister give way?

[Caroline Dinenage]

If I may make a little progress, I will definitely answer the right hon. Gentleman’s questions a bit later.

Care must be personalised, and it must be enduring. This can never be a case of rolling out a particular model of care across the country or seen as kicking off some kind of universal service.

To further accelerate discharge and the community service necessary to provide it, NHS England has transferred £50 million to clinical commissioning groups that are closing hospital beds so that they can invest in community alternatives. In addition, between 2015 and the end of the programme, NHS England will have invested over £50 million in transformation funding to support transforming care partnerships in putting in place the critical components of community support. This support includes community forensic teams, crisis prevention teams and teams focused on supporting children in the community.

Additionally, the Department of Health and Social Care has provided capital grants of over £23 million, which has been spent on housing to support people to return to live in the community or to prevent an admission to hospital. NHS England has a pipeline of further investments that it plans to deliver over the next year to support housing projects, to accelerate bed decommissioning and discharges and, most specifically and importantly, to develop community teams.

Members have expressed concern that once the transforming care programme ends in March 2019, action to support those with a learning disability and the most complex needs will also end, but I stress emphatically that that is not the case. NHS organisations and local authorities have come together to build on existing practice, and they have engaged with families and organisations to develop innovative plans to suit their areas. That must not stop. We are closing those beds permanently, and ensuring good-quality community provision is more important than ever. We should be crystal clear that the principles of building the right support will endure beyond March 2019. The philosophy is to change the way that we support people with learning disabilities for good.

[Norman Lamb]

rose—

[Caroline Dinenage]

Perhaps I can make a bit of progress and then I will come back to the right hon. Gentleman. We are not moving people from a hospital, where their outcomes are poor, into the community, just for them to be replaced in hospital by others. The transformation must be permanent, and we must consider what central support local areas need to ensure that that happens.

Hon. Members have been tempting me to talk about what will happen beyond March 2019, and to give a commitment on how the future of transforming care will look beyond that point. All delivery partners share a commitment to support the progress made by local partnerships to transform the choices available for local people, and to ensure that they are supported to lead fuller and more independent lives in their local communities. Plans are currently under way, and we will provide hon. Members with further updates once they have been finalised.

Transforming care is not the only area in which we seek to support those with a learning disability, and we are driving work to improve health and care outcomes across the board. It is an uncomfortable truth that mortality rates for people with a learning disability can be a measure of how well their care needs are being met. Following the publication of the report “Confidential Inquiry into premature deaths of people with learning disabilities” in 2013, we know that those with a learning disability die much earlier than those without, and too often for completely avoidable reasons. That is unforgivable.

In order to tackle that issue, in 2015 we established the learning disabilities mortality review programme, which requires consistent, local scrutiny across England into the deaths of anyone with a learning disability, so that action can be taken based on those findings. Like me, hon. Members will have been deeply concerned by the recent report from the University of Bristol, which leads that programme. The report highlights the persistence of inequalities faced by people with learning disabilities in their health and care. People with learning disabilities are still dying prematurely, and I was particularly alarmed and distressed to note that neglect, abuse, delays in treatment, and gaps in service provision played a part in one in eight of the deaths reviewed, which is unacceptable. The situation described in the report must change, and the Government will soon respond to its national recommendations in full. I am pleased, however, that we are not waiting for that publication to ensure that action is taken, and significant remedial actions are already under way.

I agree with the right hon. Gentleman that as well as implementation we must embed change and ensure that we never revert back—that is key and something I am determined to focus on. We need a relentless focus on improvement, and I am convinced that training is a key part of that. Local commissioners must use that learning and take appropriate remedial action in their own areas.

The NHS improvement learning disability standards published in June specify that an NHS trust should measure the service it provides against clearly defined standards, so as to identify improvements. We will collect information on every trust centrally, to monitor how well the needs of people with learning disabilities are being met.

Hon. Members mentioned workforce and training, and on 9 May we announced a £10 million fund for incentives for postgraduate students to go on to work in the fields of mental health and learning disabilities, as well as for those who go on to work in community nursing roles. We are considering the most effective way to implement an incentive scheme. Our response to the LeDeR report will address its clear recommendations on workforce training.

The right hon. Gentleman spoke about how we improve data. Clearly, with monthly data published on progress we are aiming for transparency. NHS Digital is working with the transforming care partnerships to make sure that we have high-quality data. The aim is for the mental health services dataset to be the main dataset in the future.

I was pleased that Members spoke with positivity about some of the outcomes for their constituents, albeit in some cases way too late. I am very grateful to my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) for talking about some of the transformational results of the work so far. We clearly need to see more of it. The right hon. Member for North Norfolk talked about what an incredible difference the Shared Lives scheme can make. My self-appointed best friend, an adult from my constituency with learning disabilities who sadly passed away last year, lived in a Shared Lives home. I saw what an incredible relationship she had with the family she lived with.

[Norman Lamb]

I am very grateful to the Minister for giving way. On that specific point, she will probably be aware that the development of Shared Lives is quite variable around the country. There are some regions where it has developed quite well and other regions where there is virtually nothing. The Government could give more resource to expand the programme, because that is the way that we really change lives, getting people out of institutions and giving them a fulfilling life.

[Caroline Dinenage]

I am very glad the right hon. Gentleman said that because as part of the Department of Health and Social Care legacy scheme we are providing £70,000 in this year for that sort of intermediate and reablement provision which Share Lives would come under. We should definitely be investing more in that.

I take very seriously the right hon. Gentleman’s point on conflicts of interest. We have to look at that very carefully, because it might imply that any clinician would be conflicted in making a clinical decision because they are employed by a trust. Providers are monitored by the CQC and doctors are of course subject to extremely rigorous professional registration, but I take what he says very seriously and I will look more closely at his concerns. I am very happy to meet him to discuss this issue further if he would like me to do so.

The right hon. Gentleman spoke about pooling resources. There are now formal mechanisms for that to take place, such as section 75 and the ways in which CCGs and local authorities can work together. That is the point of having transforming care partnerships’ commissioners working together.

The right hon. Gentleman spoke about the exclusion of families from decisions. That really upsets me and it really should not happen. There are legal duties, under the Mental Capacity Act 2005 and the Mental Health Act 2007, to have independent mental health advocates. I would be very keen to speak to him further about what more we can do to make sure that the legislation is having the desired effect.

My right hon. Friend the Member for Chesham and Amersham knows I am a massive fan of hers. She has probably done more to further the cause of individuals with autism and their families than anybody else in the history of this building. She spoke with great knowledge about autism and was absolutely right to point out that transforming care is not only about learning disabilities but people with autism. In Think Autism, the adult autism strategy, we set a programme of action across Government to support autistic people to lead fulfilling and independent lives where possible. We have recently refreshed the governance arrangements that will achieve greater traction and delivery of the required outcomes, better supporting autistic people to live healthy independent lives and participate in their local communities.

My right hon. Friend spoke about autism care pathways. NHS England is developing a framework of adult community mental health services which will include care for adults with comorbid neurodevelopmental disorders and/or learning disabilities, rather than the pathways planned and set out in the “Five Year Forward View” implementation plan. NHS England’s care pathway programme has evolved to take account of the current operational context and expert service user advice. The pathway is linear about discrete episodes of care, so is more appropriate for specific interventions undertaken by specialist teams.

My right hon. Friend spoke about the barriers that autistic people face in accessing mental health services. Trusts should already be ensuring that services are accessible to people with autism and that they have made reasonable adjustments to care pathways to ensure that people with learning disabilities and autism can access the highly personalised care and achieve the equality of outcome that we all want.

The hon. Member for Dulwich and West Norwood spoke about her constituent, Matthew Garnett. It was a great pleasure to meet the hon. Lady and Matthew’s mum, Isabelle, recently. I was very shocked to hear of Matthew’s experience and deeply upset to see the pictures of him at his lowest ebb, when he was suffering from the neglect that she spoke of. It was very distressing. I am pleased that the NHS is learning from this. The Marsh review into Matthew’s care has helped to shape a much more focused approach to the needs of children and young people who are at risk of slipping into the sort of crisis that she mentioned. The operational delivery group allows stakeholders, including young people, to shape policy.

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[Norman Lamb]

I think I can safely say that the debate this afternoon has reflected quality rather than quantity. I am not referring to my own contribution, of course. We have focused on an important issue, and I am grateful that the Minister has treated it with the seriousness it deserves. I want quickly to highlight the key things that I think she needs to focus on, and I would be delighted to meet her to discuss them, perhaps together with the key organisations that I referred to at the start.

The Minister did not particularly focus on children in her response. If we are to have a system that works in a sustainable way in the long term, keeping children out of institutions will be key to solving the problem, particularly given that the numbers have doubled in the past few years and that we are going in the wrong direction. I particularly commend to her the brilliantly led Starfish programme in Norfolk as an exemplar of what can be done to keep people out of institutions.

On workforce training, I was pleased to hear about the money—£10 million, I think—for postgrads, but we also need training for the frontline staff in community settings who make the return to the community possible. A really important point was made about Alderwood and the experience of the constituents of the hon. Member for Dulwich and West Norwood (Helen Hayes). I also talked about Fauzia in this context. Training is needed in how autism affects individuals. It is not just about training in autism generally. Understanding the impact on an individual is what is so important, as is wider community training.

The Minister said that mechanisms were now in place to shift money across. What I do not understand is why that does not appear to be working effectively enough. If it is there, why is it not happening routinely? Why cannot the money just shift to a local authority to facilitate a much-needed community place? I am reassured that the work will continue after March next year, but it needs a national programme. I am afraid that it cannot just be left to localities. We know that there are some great places around the country doing amazing work, but others are falling well behind. There needs to be an inspiring national drive and the sense of an imperative that things have to change, wherever people live.

On the cross-departmental work and the taskforce to which the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) referred, we must recognise the importance of employment opportunities. So many people can work and can be paid in work, and that of course relieves the burden on the statutory services. Understanding that, and recognising that housing plays a vital part in this—

[Caroline Dinenage]

Will the right hon. Gentleman give way?

[Norman Lamb]

Am I allowed to give way, Madam Deputy Speaker? I am coming to the end of my response very soon—

Social Care

Debate between Norman Lamb and Caroline Dinenage

Wednesday 25th April 2018 Commons Chamber

[Caroline Dinenage]

What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.

[Norman Lamb]

The hon. Lady is right to pay tribute to informal carers, and indeed to paid carers, but does she not feel uncomfortable with the fact that she and all her colleagues on the Conservative side legislated with us to introduce a cap, committed in 2015 to implement the cap, then abandoned it, thus abandoning the very informal carers she says she cares so much about?

[Caroline Dinenage]

We have not abandoned the cap. The Prime Minister said very clearly that we would continue to consult on the cap, and that will come forward as part of our plans for the Green Paper later in the year. We in this Chamber often hear about Labour’s recession and how it led to some hard decisions about public spending to get the country back on track, but we often forget—

--- Later in debate ---

[Caroline Dinenage]

I hope my hon. Friend will not mind, but I want to make a little progress. The fund has helped to join up health and care services so that people can manage their own health and wellbeing, and live independently in their communities for as long as possible.

Another area where we have made significant progress is quality and safeguarding. The Care Act 2014 placed adult safeguarding on a statutory footing for the first time and established a national threshold that defines the care needs that local authorities must meet. This eliminates the postcode lottery of eligibility across England. Last year, local authorities in England advised more than 500,000 people how to access services to meet their care needs—this includes services provided by leisure, housing, transport and care providers, as well as voluntary groups.

Everyone is entitled to, and deserves, quality care, and we are working to improve the terms and conditions for people accessing care, to ensure that their rights are protected.

[Norman Lamb]

On the sleep-in allowance, is it reasonable to expect providers to fund these back-pay claims, given that at the time the liability was incurred commissioners and providers entered contracts on the basis of what the Government said was right in terms of the minimum wage? When the Government change the position, surely it is not fair on organisations, private or third sector, retrospectively to expect them to pay.

[Caroline Dinenage]

I understand and share the right hon. Gentleman’s concerns on sleep-ins, and will be addressing this a little later in my comments.

We have established adult safeguarding boards to help to protect vulnerable adults in our society from abuse or exploitation. They can also act as an important source of advice and assistance for those using the adult safeguarding system. This Government also introduced the toughest system of care home inspection in the world. Eighty-one per cent. of adult social care providers are good or outstanding according to the CQC, which is a testament to the many hard-working and committed professionals working in care, to whom we owe a huge debt of gratitude. The CQC regime is already having a positive impact and 82% of providers who are rated as inadequate go on to improve.

Regardless of that, there is too much variation in the quality of care. Neighbouring local authorities can have radically different success rates on care quality and we are taking steps to address that. We are working with the adult social care sector to implement Quality Matters, a shared commitment to take action to achieve high-quality adult social care for service users, families, carers and everyone working in the sector.

We welcome the Competition and Market Authority’s recent market study on care homes. It makes difficult reading, but we have welcomed it and as part of developing the Green Paper the Government are carefully looking at all the issues identified. What is more, we have published a package of measures to improve consumer protections in the social care sector after the CMA raised concerns about unfair consumer practices in homes, including the charging of unfair fees to residents and the lack of contractual and pricing transparency.

Those measures, which include working alongside industry to develop model contracts and supporting the CQC to better hold providers to account, aim to put the power back into the hands of residents and their families. We are clear, however, that if improvements are not seen we will look to change the law to strengthen protections so that people can be treated with the dignity and respect they deserve.

That leads me to the third aspect on which I want to focus. Ultimately, the social care workforce are the backbone of the care sector. We know that there are challenges and that is why we need to ensure that they are supported to deliver the best-quality care now and in the future. Part of that endeavour involves respecting not only the compassion and dedication of care workers but the vast range of skills they have. Alongside social workers, occupational therapists and nurses, we have many care workers who could benefit from or be inspired by new career progression ladders. We need to ensure that we have enough people within all those skilled roles to support individuals and families in living their best possible lives. That means ensuring that new routes into social care professions have as much variety and value as those developed by the NHS. Apprenticeships are part of that story. I am proud that in 2016-17 more than 90,000 social care apprentices began their training. That is up more than 40,000 compared with in 2010.

Of course, pay remains a constant and often emotive issue. Care workers deserve a wage that reflects the true value of their work. The national living wage is, in part, a reaction to that and the average salary for a care worker in the independent sector has gone up by 4%, with those full-time staff on the minimum wage seeing a pay rise of up to £2,000 since 2015. We are not complacent about the economic pressures faced by many in the system, but that is a good place to start.

A couple of hon. Members have spoken about sleep-ins and they are absolutely right to raise that. The Government are committed to creating an economy that works for everyone, ensuring that workers are paid fairly according to the law, including through the national minimum wage, but we recognise the pressure that has been placed on the sleep-in sector by historic liabilities for back pay. We are carefully exploring options to minimise any impact on the sector caused by this and have been engaging with the European Commission to ensure that any response would be legal. The Government will continue to work with representatives of the social care sector to strengthen the evidence base, building on the work we began over the summer. I will, of course, keep the House informed when we have made progress.

There are thousands of care workers in England, and we need many more, but it is true that we already have hundreds of thousands of carers out there—the unpaid hidden army of family, friends and community volunteers without whom the system would simply grind to a halt. We know that about 60% of us are likely to become carers at some stage in our lives. As it is today, one in eight of the adult population is a carer. That is why carers will be a fundamental part of the Green Paper. A sustainable settlement for social care will simply not be possible without focusing on the support we provide to them. Ahead of the Green Paper’s publication, we will shortly publish an action plan on carers, setting out a cross-Government programme of targeted work to support carers over the next couple of years.

Another principle that the Secretary of State has spoken about in the context of the Green Paper is control. We know that the greater control people have over their care, the better the outcomes. The only people who have a specific right to have a personal health budget are adults in receipt of NHS continuing healthcare or children receiving continuing care, which is why earlier this month we launched a consultation on extending the right to personal health budgets and integrated personal budgets to achieve better outcomes for those with the greatest ongoing social care needs as well as health needs. Those are some of the principles that are guiding the Green Paper. The goal is that, whatever a person’s age, they can be confident in our care and support system, not just for their own health and care needs but for those of the people close to them.

Support for Care Leavers

Debate between Norman Lamb and Caroline Dinenage

Thursday 16th November 2017 Westminster Hall

[Caroline Dinenage]

The hon. Lady tempts me to make spending commitments on behalf of the Department for Communities and Local Government. While I would, of course, be absolutely delighted to do so, it is a little bit beyond my job description. I am sure the Department will read with great interest her comments in Hansard.

[Norman Lamb]

I am grateful to the Minister for giving way; she is being very generous. The former Minister Edward Timpson introduced a very good reform to enable payments to continue to children in foster care beyond their 18th birthday, which was widely welcomed. However, if the rate paid for the most complex children being looked after by very experienced foster carers goes down at their 18th birthday, it creates an incentive for the foster carer to encourage them to leave, which is the very last thing we should be doing. Does she agree that we should seek to find ways of ensuring we provide incentives for them to stay at home, as happens in every other family?

[Caroline Dinenage]

I am grateful to the right hon. Gentleman for drawing attention to my former colleague, Edward Timpson, who was a most fantastic Minister in the Department for Education and a great advocate for care leavers. We are supporting the Staying Put arrangements that the right hon. Gentleman alluded to, which mean that care leavers who remain with their ex-foster carer can claim means-tested benefit from their 18th birthday up to the age of 21, but I will look at everything he has said.

In addition, we have exempted care leavers from the shared accommodation rate until they are 22. The shared accommodation rate is normally paid to single people aged under 35. That means that care leavers can claim the higher local housing allowance one-bedroom rate of housing benefit until their 22nd birthday.

I have listened to the arguments made by hon. Members about the issue today. I particularly welcome the comments of my hon. Friend the Member for Colchester (Will Quince); he gave an eloquent description. I also thank him for the significant contribution he has made as chair of the all-party parliamentary group on homelessness, where he does a sterling and very valuable job.

We have always said that this is something we would like to achieve, but at the moment we do not have plans to extend the exemption for care leavers from the shared accommodation rate to age 25. I assure my hon. Friend and other Members who have raised the issue today that we will continue to keep it under review and will consider evidence from stakeholders on the impact that the shared accommodation rate has on care leavers.

We have given care leavers priority access to personal budgeting support in universal credit. That includes benefit advances, rent paid direct to landlords, payments more frequent than monthly and budgeting advice, including debt advice, which was raised by the hon. Member for Stockton North.

We have a fantastic “See Potential” campaign—I say fantastic as it falls under my ministerial portfolio. It encourages employers to recognise the benefits of recruiting people from all kinds of backgrounds, including care leavers. I was so pleased to celebrate the inspiring workplace and training achievements of young people, including care leavers and others, at the Land Securities Community Employment Awards recently—we saw the incredible growth, development and achievement of some very inspiring young people.

I am pleased that the Government are leading by example by setting up a cross-Government scheme to provide employment to care leavers. My Department’s own care leaver team includes a quite brilliant care leaver intern, who I have had the pleasure of meeting, and who is providing us with very valuable insights into issues that care leavers face and helping us improve our services for care leavers. She is very cool as well—she is in the room, which is why I am saying that!

In developing our support for care leavers, we have worked closely with stakeholders. I am particularly grateful for the input from the Children’s Society, representatives of which I met shortly after being appointed to the Department. When I met with them, I was made aware of the fact that in some cases care leavers have difficulty taking up apprenticeships and a number of hon. Members have raised that today. We know that without the support of a family, they struggle economically. Having had that meeting, I hotfooted it straight over to the Department for Education and met the Minister for Apprenticeships and Skills to discuss the idea of an apprenticeship bursary, which would ensure that apprenticeships were an affordable option for care leavers, who do not have the family support that most apprentices can rely on.

The Department for Education are reviewing how the new apprenticeship funding approach is supporting all those who are disadvantaged, including care leavers, with the intention of improving how the system supports those individuals from 18 to 19, so that apprenticeships offer a more attractive opportunity to them and a greater chance of success. It has agreed to explore the proposal for an apprenticeship bursary.

The debate has raised some really important issues, and I am grateful to all right hon. and hon. Members for the points they have made, which will continue to inform our work to support care leavers, alongside our discussions with our valuable stakeholders.