Diabetes (Young People)
Paul Burstow Excerpts(14 years, 3 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing the debate and, indeed, on taking part in last week’s debate. He has brought a sharp focus to an issue that is often not debated—even when we discuss diabetes, it gets rather lost in the broader picture.
I have a constituency interest in the matter. Before the general election, a number of children in my constituency who were supported by Diabetes UK wanted to make me aware of what could be done in schools and families to support them better. There are beacons of hope and places that are doing exceptionally good things that make a huge difference. However, as has been well documented in the debate, there is clearly a lot of work to be done. I have a lot to say in response to the very many good points that have been made in the debate.
It is helpful that the debate is not just grounded in the technicalities of the issue, but grounded in the life experiences of individuals. We have heard such points made by the hon. Member for Mitcham and Morden (Siobhain McDonagh), the right hon. Member for Knowsley and, of course, my hon. Friend the Member for Torbay (Mr Sanders), who has direct experience of the matter. That is powerful because when it is done well, it helps to give a real sense of the difference that can be made to a person’s life—they no longer have to be defined by the condition; they can get on with their life. I hope we share that goal as we discuss how to shape services going forward.
I pay tribute to Diabetes UK and the Juvenile Diabetes Research Foundation, which, through the speeches of hon. Members from all parties, has contributed to the debate and does much well beyond that. This is a welcome opportunity to focus on a condition that does not get the same headlines as cancer, cardiovascular disease or, for that matter, type 2 diabetes. It presents a threat not only to children’s health but, as we have heard in the debate, to their well-being and, in turn, that of their families.
The debate has rightly focused on what we can do to improve matters. The right hon. Member for Don Valley (Caroline Flint), who understandably has had to leave to attend to other business, raised a few points with a policy emphasis that were rather churlish, but I understand that they were well meant. I am sure that she and I will have an opportunity to debate those on another occasion.
Mr George Howarth
I am loth to rise to defend my right hon. Friend the Member for Don Valley (Caroline Flint), on the grounds that she is more than capable of defending herself, but the key issue that she raised was not too party political; it was about how young women are viewed and how they respond to the pressures to conform to a particular body shape.
Mr Burstow
I will come shortly to the point, which was absolutely well made, and certainly line up with the right hon. Lady’s comments on that. As has been mentioned, the Minister for Equalities has done a sterling job on behalf of the Government to place the issue at the front and centre. She has not resiled from the issue and will continue to pursue it as she has done so far. I was more anxious about that concern being aligned with the Government’s direction of travel on GP commissioning, which I will return to because it was raised, quite fairly, in the debate.
We have heard today about type 1 diabetes—a complex, lifelong, progressive condition that requires careful long-term management to prevent the severe and sometimes fatal complications that have been described. A 2009 survey of children with diabetes in England revealed that 23,000 children and young people currently have type 1 diabetes. There has also been a national diabetes audit, which included a separate report on paediatric diabetes that gives us a fair picture of the extent of childhood diabetes and how well it is being managed. Although Britain has one of the highest numbers of children diagnosed with diabetes in Europe, we have one of the lowest numbers of children controlling their diabetes well, and we have heard what the implications can be for those children and their families. That is extremely worrying, because poor glucose management increases the chance of the child experiencing complications. I echo the view, expressed by many Members in the debate, that that is an area where we can make significant and sustained improvements. I want to describe what we are trying to do about that.
The first question is: how can we ensure that more children receive an early and accurate diagnosis of diabetes? The challenge for GPs is that type 1 diabetes can be difficult to spot. A child might present with the vague symptoms of extreme tiredness and weight loss, which can be mistaken for other illnesses. Type 1 diabetes is quite rare, so GPs might not come across many cases in their practice. That explains why there have been instances of the sort that have been described today: tragic cases of symptoms being overlooked and children diagnosed only after becoming seriously ill.
The National Patient Safety Agency is currently looking at a number of reports of misdiagnosis and delayed diagnosis and is working with the national clinical director for diabetes to look at what we can do to improve diagnosis rates and reduce emergency admissions. Clearly, we will have to look at protocols and how they might serve as a tool that can be used, but we need to ensure that the work is properly concluded before we decide whether that is an appropriate mechanism.
It is true that building professional awareness is key to improving diagnosis rates. We need GPs and A and E staff, in particular, to consider diabetes as a possibility when they see children with appropriate symptoms, and we must ensure that they are equipped with a range of diagnostic tools to do so. NHS Diabetes, the improvement body for diabetes care, is working with various royal colleges and other bodies to improve professional standards and ensure that best practice is reflected in their training curricula. NHS Diabetes is also working with Diabetes UK to publish best practice guides on how a child with type 1 diabetes should be cared for. Therefore, material is being generated that will help a wide range of professionals not only in the NHS, but in education and social services, to recognise the symptoms and understand what good care looks like. In addition, the Juvenile Diabetes Research Foundation has been placing posters in GPs’ surgeries, highlighting the signs and symptoms to help people recognise the condition.
Once diagnosed, children need a combination of high-quality clinical care and wider support to ensure that they manage their diabetes effectively. I concede that across the NHS we have a mixed picture, as has been well described. That is the picture the Government have inherited, and we are determined to improve it. Children with diabetes often need multiple referrals to different specialist services, so well integrated multidisciplinary care is crucial to service delivery.
The right hon. Member for Knowsley broke the ground for the building of the centre in Aintree that he described, which I understand will bring diabetes clinics closer together and make it much easier to access those services. We want to see more such centres of excellence. I welcome that development but stress, rather as he did, that too often the focus is on how many hospitals, doctors and nurses there are. Beds and buildings are not as important as good services, particularly when it comes to managing long-term conditions such as diabetes, as well co-ordinated and well thought-out services that are closer to the patient and can respond to their personal circumstances and fit around their lives will meet their needs better.
Barbara Keeley
While preparing for the debate, I noted that my right hon. Friend the Member for Knowsley (Mr Howarth) and the hon. Member for Torbay (Mr Sanders) are lucky enough to represent the two parts of the country where integrated health and social care is thought to be working the best. While talking with the King’s Fund the other day, I learned that there are only six places in the country where it is judged to be working that well. On GP commissioning—several Members touched on this point—how can the Minister ensure that that will improve, because our fear is that that major, top-down reorganisation will mean that those five or six places will be the only ones in the country?
Mr Burstow
Had I turned to the next page in my brief, I would have reached an answer to that question, so I will come back to it in a moment. My final point about care is that the latest paediatric diabetes service survey suggests that the picture is improving. It is important to stress that there is movement in the right direction, but there are still deficiencies.
On the question of GP commissioning and how we better integrate the commissioning and joining up of services, a point that the hon. Lady and others have missed in much of the commentary on the White Paper is the clear intention for local authorities to hold a new role in assessing population need. That assessment will be critical to the future of the commissioning of health and social care and to the new role of local authorities in public health, which is key to early prevention of type 2 diabetes. The notion that there is fragmentation and atomisation is far from the truth. The intention is to ensure that we have that alignment of services, which would be much better achieved through the partnership between local authorities and GP consortiums.
Mr George Howarth
I recognise the problem to which the Minister refers, but Knowsley primary care trust and Knowsley council, for example, already have a number of integrated posts; the chief executive of the PCT is also the director of social services. The process that the Minister is seeking to create through the reforms to a large extent already exists in places such as Knowsley, yet it seems that they will undo what has already been created.
Mr Burstow
As the hon. Member for Worsley and Eccles South (Barbara Keeley) has already said from the Front Bench, that is not the norm but the exception. We want that to become the norm. The point is that that has not happened everywhere. We need approaches that ensure that we design services in ways that involve all the key players, including clinicians and local authority social services, where appropriate. That is the ambition of the White Paper.
We want to unleash the potential of GPs by aligning them much more closely as commissioners with the services. I note that the Juvenile Diabetes Research Foundation supports the White Paper and sees it as a key way to lever the changes that Members have argued for in the debate. It sees the reforms as an opportunity to secure things that are not delivered under the current NHS architecture, such as insulin pumps, and I certainly wish to ensure that that happens.
Mr Howarth
I apologise for making so many interventions, but I want to make this simple point. One of the consistent themes in this debate has been that the weakest link in the system for treating young people with diabetes is the service that GPs provide, particularly in diagnosing diabetes in the first place. I cannot see the logic, from a diabetes point of view, in handing all the power and control to people who do not understand the disease.
Mr Burstow
The right hon. Gentleman and the Juvenile Diabetes Research Foundation seem to be in different places. The foundation takes the view that the condition is best managed through primary care. As I said, we must upskill, ensure that the signs and symptoms are better understood, and use the clinical skills of GPs more effectively.
Mr Burstow
I will give way in just a moment—I want to pick up on another point. I am surprised that the hon. Lady keeps going on about GP commissioning, when it was her Government who introduced practice-based commissioning. We are building on those reforms, and see them as an essential way of ensuring that taxpayers’ money is most effectively geared to delivering the best possible health outcomes for people with diabetes and other conditions.
Barbara Keeley
I do not think that Opposition Members are alone now that the Royal College of General Practitioners has expressed major concerns about GP commissioning and is pleading with the Health Secretary to put the reforms back.
I want to raise a point about local authorities and coterminosity with PCTs. We have a better coterminosity situation—and have struggled to get to it—but I know that some local authorities around Greater Manchester will be faced with having not one but two, four or five GP consortiums. As I said, health and social care integration is working in places such as Knowsley and Torbay, where great work has been done to bring things together. The fragmentation is coming out because of the nature of the reorganisation.
Mr Burstow
Again, I do not recognise that characterisation, in that coterminosity does not exist in many parts of the country under the current model. As the hon. Lady has rightly said, integrated models of care, and collaborative approaches and behaviours are not present in many places. The desire and intent behind the White Paper is to make them the norm.
I want to do justice to this debate. We could have a debate about the White Paper, and I am sure that at some point the Opposition will choose to do so. If they do that, we would be only too happy to meet them point by point, but I want to talk about some of the key developments that will bear down on this problem and really help to transform lives.
The coalition Government want to make a significant move in respect of their commitment to introducing a much stronger payment system for children’s diabetes services, which will help to bring them out of the shadow of other NHS services. As a start to the process, a new mandatory tariff, which we plan to introduce in stages from April 2011, will recognise paediatric diabetes care as a clear and discrete specialism within the NHS, and will provide a clear funding stream to support such services over the long term.
At present there is a non-mandatory tariff, which was rushed in for April 2010, but it is wholly inadequate because it fails to take into account the complex nature of paediatric care, which this debate has articulated. As a result, under the current system, many paediatric diabetes services either continue to be under-resourced—we have heard about that today—or are funded through other budgets. Hence, they can sometimes be relegated to a second-class status in the NHS. The new tariff, as part of a more patient-focused funding model, will help to put us on the right track.
Mr Burstow
I will. The hon. Gentleman has listened to the whole debate, and I appreciate the fact that he has done that.
Mr Campbell
We have reached the point about money, and I can assure the Minister that the first concern of a parent of a child diagnosed with type 1 diabetes is the health of the child, not money. My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) discussed support for families. May I ask what representation the Minister has made to the Department for Work and Pensions on disability living allowance, which is available to many families of young people with type 1 diabetes?
Mr Burstow
I obviously have many conversations with colleagues in the DWP, but as that is the first occasion on which that matter has been raised in this debate, and as I want to do justice to other speakers, I shall move on to ensure that I answer their questions.
Let us deal with family support more generally. The hon. Member for Mitcham and Morden took us through some of the statistics; the impacts on families’ lives are truly disturbing. We need to ensure that appropriate and tailored support services are in place, including the right support for carers.
I am concerned that where peer support services are provided, they are not given priority. However, not all peer support services need funding; they need willingness and support to ensure that they carry on. I would certainly commend peer support as one of the ways in which people can cope with self-care and the ongoing management of the conditions that have been discussed in this debate.
Let me deal briefly with emotional support for children in particular, and the children’s charter, which has been mentioned several times. My hon. Friend the Member for Torbay spoke about the impact of a diagnosis at a young age. Part of that comes back to providing proper emotional support in formal settings—schools and other settings. We must ensure better alignment in the way that we develop our thinking around public mental health strategies, and we will be saying more about that in a cross-Government strategy on mental health later this year. I am sure we will want to pick up, at least in thematic terms, on the public health issues in the White Paper that we will publish, also later this year.
I very much welcome Diabetes UK’s children’s charter, which will help to establish the kind of support that children and young people need to help them cope. Also, a guide has been developed to help commissioners ensure that children with diabetes receive the emotional and psychological care that they need.
In the last four minutes, I want to speak about insulin pumps. The right hon. Member for Knowsley rightly raised that key issue in the debate and in an article that he published today. The National Institute for Health and Clinical Excellence has clearly recommended pump therapy for children and young people if daily injections are not working. Frankly, I am disappointed and shamed that many primary care trusts are dragging their feet on making pumps available. That should have been sorted out; I should not have to come to this Chamber to explain why that has not been done, given how long the recommendations have been there. It is a pity that the delay was not challenged more in the past, and that the previous Government did not get around to sorting it out. I expect to see real improvement in this area as a result of the new funding arrangements that have been discussed in the debate.
My hon. Friend the Member for Torbay raised some important points about obstacles, and I want to ensure that, through the all-party group on diabetes, we have further conversations about what we can do to kick down those obstacles, and to ensure that the important research on artificial pancreases that is being done in this country is not undermined by the treatment not being available because there is not a route through the pumps. That point has been powerfully made in the debate, and I want to ensure that we follow through on it.
Research has been touched on in broader terms, and I want to mention a couple of examples of work that is being done at present. We are looking at how to provide better psychological support for children with diabetes, and how we can improve education and training in diabetes for children and families. We are also funding a major trial on the effectiveness of insulin infusion treatments versus standard injections. Alongside that, there is a vibrant third sector investing in research.
We have heard about work at Cambridge university to develop an artificial pancreas to reduce the risk of hypoglycaemia in children and adolescents. The link to telehealth that my hon. Friend the Member for Torbay referred to is important, and I want to ensure that the message is clearly understood and that we build it into some of the work that the Department is doing. I am about to run out of time, so I will have to write to my hon. Friend about international research.
Hon. Members raised points about schools. I shall elaborate in more detail by writing to all those who have taken part in the debate, but it is key that schools understand their responsibilities in respect of well-being and safety, and that they provide appropriate support for children who need to take medication at school.
The Government are determined to improve care for type 1 and type 2 diabetes. This is not something that we will put on the back burner. We have inherited a legacy but intend to build on and really improve those services.
Diabetes
Paul Burstow Excerpts(14 years, 3 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
I am grateful to the right hon. Member for Leicester East (Keith Vaz) for taking the opportunity to apply for this debate, and congratulate him on his good fortune in securing it. It follows on from the questions he asked at Health questions yesterday. I know that he has an enduring, personal interest in pursuing this cause, and I pay tribute to his work, effort and leadership in raising awareness of diabetes among the south Asian communities in his constituency. He rightly paid tribute to the work of the Silver Star organisation.
Let me first address his final point, which was on his discussions with Ministers in the previous Administration and the intentions to create a centre of excellence. I need to be honest with him. I cannot give him an undertaking tonight other than the most important one that any Minister should give at the Dispatch Box, which is that I will go away and properly consider the matter and come back to him as speedily as I can. If that means a further discussion face to face, I would be happy to do that as well.
I also look forward to the debate that I will have with the right hon. Member for Knowsley (Mr Howarth) on type 1 diabetes, and I hope that we will get the opportunity to explore some other issues on that topic. While these are not prime-time debates, they are an opportunity to air issues that affect the lives of our constituents, so I am grateful to the right hon. Member for Leicester East for raising this matter tonight. He is right to highlight the disturbing rises in the rates of diabetes in this country, because it is placing a huge strain on the NHS, and has a profound effect on people’s long-term health, with the most deprived and excluded groups often paying the highest price.
Diabetes could be described as a head-to-toe condition. Complications—many extremely serious if poorly managed—can affect every part of the body. I was particularly shocked, as I prepared for the debate, to discover that 73 lower limb amputations occur every week due to complications from diabetes. More shocking still, 80% of those amputations could have been prevented, some by lifestyle changes and others by changes in the approach of the NHS. Every preventable amputation is an appalling human tragedy, and something we need to improve on, which is why I am so pleased that we are discussing these issues tonight.
There was plenty in the right hon. Gentleman’s speech that I supported and much common ground between us. I wholeheartedly agree that we must do more to prevent diabetes across all age groups and all social backgrounds. The Government’s approach therefore has three levels. The first is the population level, and in diabetes, this is about improving general health across the population at large, recognising—as the right hon. Gentleman rightly said—that diet and lifestyle are key risk factors in diabetes. Then come targeted interventions for people at risk, which recognise that we can reduce and even reverse the worst effects of diabetes if we intervene early enough. Finally, there is the long-term management of established disease, and people with diabetes and clinicians must work together to delay, reduce or prevent complications. We need to get all three aspects right in order to secure the better results in diabetes care that all hon. Members would wish to see.
On the population level, rises in diabetes are closely linked to lifestyle and behaviour, which makes this a considerable public health challenge. Much of this is about individuals taking responsibility for their own health—for example, choosing not to have some of the sweets that the right hon. Gentleman mentioned—by changing what they eat, drink and how much exercise they take. We are clear that the Government and the NHS, while they have their parts to play, cannot and should not do everything. But what we can do is educate people about the risks, and give them the information to lead healthier lives and understand and change the influences that govern their behaviour.
I can confirm that the Change4Life programme will continue to be a focal point, as it has been successful in putting the issue on people’s radar. The Change4Life brand will continue, but we will need to change it, as it can no longer be about glossy, national advertising campaigns directed from the centre. We need Change4Life to become less an old-style, centrally directed campaign, and more a genuinely social movement, owned collectively by communities, families, voluntary organisations and industry, and driven locally. Hand in hand with this, we need a much more targeted and community-led approach to health improvement as a whole. In the White Paper, we said that local councils will be given a central leadership role on public health, and we would expect local authorities to work with the NHS and other services to develop the appropriate strategies and approaches.
Keith Vaz
Some of the key people in this are GPs. I welcome everything that the Minister has said so far, but we need to get guidance out to GPs to tell them that they need to be proactive, as my GP Dr Farouki was. When they have a patient who matches the criteria and is therefore at risk, they should perform the test, which takes only five minutes. Such guidance could be very effective.
Mr Burstow
I am grateful for that point. I will say a little about guidelines in a moment, because good news is on the way in that regard.
I was talking about the public health role of local authorities that we are developing. It will be supported by a dedicated ring-fenced budget and the implementation of a new health premium, which will allow local areas to target reductions in health inequalities, including inequalities associated with diabetes and other cardiovascular diseases. We are also committed to working with industry on a new public health responsibility deal to ensure that business takes action together with others to support the nation’s health.
On early intervention and diagnosis, the right hon. Gentleman is right to emphasise the importance of identifying pre-diabetes. There are two developments that relate to the role of GPs. First, the National Institute for Health and Clinical Excellence is developing guidance on preventing adult pre-diabetes in the first place. This will be published next year and will inform and support local public health strategies and others, as I have already described. Secondly, NICE is also preparing guidance on preventing pre-diabetes from progressing to type 2 diabetes. That will be a valuable tool in our fight against diabetes, and will help GPs and other health professionals to advise and support people at risk, hopefully to stop the disease in its tracks.
The right hon. Gentleman is right that earlier intervention and better diagnosis is crucial. NHS Health Check, which was introduced by the last Government, can prevent more than 4,000 people a year from developing diabetes, and could detect 20,000 cases earlier, so it can be, and should be, a very powerful means of detecting and supporting people at risk.
Mr George Howarth
Before the Minister moves on to the wider issues, I want to make a point about GPs and how they can be helped, which he was talking about. One of the difficulties is that often GPs are ill equipped to diagnose diabetes in the first place, and there is an argument for them to be given a series of protocols on how they should deal with certain symptoms. That would lead them towards a proper diagnosis, so I hope that he will consider something along those lines.
Mr Burstow
I will both consider it and hopefully have the opportunity to come back in next week’s debate and say a little more about it.
Mr Sanders
The right hon. Member for Knowsley (Mr Howarth) makes a very important point. There is also the role of pharmacists, who need to be aware of the symptoms that people might describe to them. There are also the opticians and chiropodists. Any number of health professional could be involved in a preventive campaign.
Mr Burstow
My hon. Friend is right, and I certainly pay tribute to him for his work as chair of the all-party group on diabetes. He has been a powerful advocate on these issues for many years. I applaud what he has done, and he is right—pharmacists and other health care professionals are part of what we need to do in order better to equip the whole service for detecting and intervening.
I was told that the right hon. Member for Leicester East was going to ask about extending the age range. That is an important point that needs to be discussed. At the moment, NHS Health Check starts at 40 and calls people every five years. The best clinical and most cost-effective case was made for doing it at that age. However, there is nothing to prevent primary care trusts from commissioning services that widen the age range. They should be considering that, particularly in areas with more susceptible populations, and clearly Leicester is one of those cases.
Keith Vaz
Last year, I wrote to the chief executive of every PCT asking how much they spent on preventing diabetes and on health checks such as the ones the Minister described. Some thought it was a freedom of information request and became very defensive. Will the Minister go back and get this information from his Department and place it in the Library of the House?
Mr Burstow
I will look into that. My view is that we need far more transparency when it comes to such issues, so that people can make comparisons of the performance of their local organisations and hold them to account over how they spend taxpayers’ money on these services.
I want to move on to long-term management. Once diagnosed, people need personalised support to manage what is a highly complex and changeable condition. A person with diabetes must know how to spot and report changes in their health, and how to get the right services to prevent more serious problems. That issue was raised by my hon. Friend the Member for Torbay (Mr Sanders) in Health questions yesterday. He was right to do so, because it is important to ensure that we have good care planning, embodying the principle of “No decision about me, without me”, which is vital in starting to transform the relationship between GPs and patients. Indeed, the diabetes year of care programme, led by Diabetes UK and the NHS, is already looking at how we can improve care plans for diabetes. Education goes hand in hand with that. I know that many NHS organisations offer patient-structured education programmes, specialist diabetes advice, care planning discussions and annual checks. We need more of that: it needs to be consistently applied and we need to ensure that good practice becomes the norm.
On treatment, it is no surprise to learn that the best results are achieved when there is a fully integrated, multidisciplinary team working across primary and secondary care, which picks up on my hon. Friend’s point. Programmes such as the excellent “Think glucose” campaign and the guidance produced by NHS Diabetes on in-patient management are already helping hospitals to discharge patients sooner and give them a better experience of care. However, there is more to do on that—as well as in other services, such as foot care and eye services—to ensure that problems are dealt with early on, and certainly long before amputations become necessary.
Meanwhile, in primary care the relationship with GPs is crucial, as the right hon. Gentleman rightly said. We need them to be alert to the signs of pre-diabetes in routine consultations and to play a key role in the ongoing management of existing conditions. How we incentivise GPs to do so is a key issue. Clearly the qualities and outcomes framework is one avenue that could be explored, but it is for the National Institute for Health and Clinical Excellence to determine what QOF indicators are ultimately introduced. My hon. Friend referred to pharmacists. I certainly agree that they provide another channel for reaching those at risk, which is precisely why they are one of the ways in which health checks can be used in various settings.
In conclusion, the right hon. Gentleman spoke about his experiences in Leicester and the important lessons that he has drawn. He is right to point to the financial climate, which is undoubtedly a constraint on what any Government can do. However, it is also correct to say that this is not just about beds and buildings; it is actually about services and where they matter most in identifying diabetes early and then providing the appropriate care. The issue is fundamentally about outlooks, attitudes and priorities in the NHS and beyond. The principles that we have set out in the White Paper—pushing power downwards, paying for quality and strengthening the voice of patients—will bring fresh impetus to improving outcomes for diabetes.
It is clear that this issue is not just for the NHS, but for all of us—for the society in which we live. We need to strengthen preventive action on diabetes. Let me conclude by saying that I share the right hon. Gentleman’s commitment and passion. I look forward to maintaining a close dialogue with him, and with my hon. Friend and the all-party group on diabetes, and to participating in next week’s debate on type 1 diabetes.
Question put and agreed to.
Oral Answers to Questions
Paul Burstow Excerpts(14 years, 3 months ago)
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Emma Reynolds (Wolverhampton North East) (Lab)
2. What account he took of arrangements for the provision of mental health services in developing his proposals for GP commissioning.
The Minister of State, Department of Health (Mr Paul Burstow)
GPs play a crucial role in co-ordinating patient care and committing NHS resources through daily clinical decisions. Our new model of commissioning builds on the regular contact that GPs have with patients and their understanding of patients’ wider health care needs. Our proposals will create an effective dialogue across all health and social care, with professionals putting in place the conditions for a more integrated and personalised approach to both physical and mental health.
Emma Reynolds
I thank the Minister for his answer. According to a recent survey by the leading mental health charity Rethink, 58% of GPs questioned said that they did not feel they had the level of expertise required to commission mental health services. Given that, what specific measures will the Government take to ensure that GPs have the skills and expertise needed to commission those highly specialised services?
Mr Burstow
I do not accept that that is the case, and from the consultation and engagement that the Department and I have already had with GPs and others, it is quite clear that there is huge enthusiasm for the reforms that we propose in the White Paper and a real desire both to see patients put at the heart of the NHS and for GPs to have real control over commissioning again, to ensure that services really meet patients’ needs. When it comes to specialist commissioning, we have said in the White Paper that there will be opportunities for charities, other providers and local authorities to access support to harness those skills.
Mr Stewart Jackson (Peterborough) (Con)
Parnwell, in the east of Peterborough, which has specific health needs, faces the loss of its current single general practitioner upon his retirement at the end of October. Can the Minister confirm that there is no necessity to remove single practitioner GP facilities, and that they can be incorporated into the new GP commissioning system as we go forward?
Barbara Keeley (Worsley and Eccles South) (Lab)
It is of great concern that medical charities such as Rethink tell us that most GPs that they have surveyed feel that they lack the expertise needed to commission mental health services, and also that campaigning groups such as the Muscular Dystrophy Campaign feel that GPs have too little knowledge of muscle wasting conditions to commission services for their patients. Given Government plans to hand commissioning over to GPs, to abolish primary care trusts and, according to the White Paper, to reduce the role of the Department of Health in training, can the Minister say more to the House about how the considerable shortfall in expertise in commissioning services will be tackled over the next year or two?
Mr Burstow
It is perhaps worth noting that the Select Committee on Health, when there was a Labour majority on it before the election, back in March, identified significant weaknesses in PCT commissioning. In particular, it identified the lack of clinical input. Our White Paper puts that clinical input back into commissioning. When one considers that one in four of all consultations involve mental health problems and that 90% of all mental health care is delivered in primary care settings, one sees that putting the GP right at the centre is critical to better outcomes.
Dr John Pugh (Southport) (LD)
On the subject of consultation, what consultations have taken place with the mental health charities, either prior or subsequent to the proposals?
Mr Burstow
In July, I and the Secretary of State had a successful and long engagement with all the mental health charities, and we are continuing to have a dialogue with them.
Mr Jim Cunningham (Coventry South) (Lab)
3. What estimate he has made of the number of redundancies which would result from the abolition of strategic health authorities and primary care trusts?
Keith Vaz (Leicester East) (Lab)
9. What steps his Department is taking to inform young people about diabetes prevention.
The Minister of State, Department of Health (Mr Paul Burstow)
I thank the right hon. Gentleman for his question, and for his tireless campaigning to raise awareness of diabetes. We know that being physically active and maintaining a healthy weight can reduce an individual’s risk of developing type 2 diabetes and cardiovascular disease. Our approach is to support families and young people to eat healthily and be physically active.
Keith Vaz
I thank the Minister for his comments. I declare an interest as one who has type 2 diabetes. As he knows, we spend £1 million an hour treating diabetes-related illnesses, and more and more people are now being diagnosed at a much younger age. What steps are the Government taking to alert parents and young people to the perils of diabetes?
Mr Burstow
The right hon. Gentleman is absolutely right to draw our attention to the rising rate of diabetes in our country. When it comes to diabetes in children, we have to bear in mind that the diagnosis for type 1 diabetes—which affects about 23,000 children in this country—is a genetically predisposed condition that cannot easily be prevented. We need to do more about type 2 diabetes, however, by tackling the obesity problems in this country. We need to deliver physical and healthy eating programmes through schools and other partners, and those things are much better done in the context of the local authorities, which will now have a new responsibility for public health that the last Government never gave them.
Mr Adrian Sanders (Torbay) (LD)
Information and education are also important for people with the condition of diabetes, to help them to get the maximum benefit from their prescribed course of treatment. May I urge the Minister to make an assessment of the improvements to health that education and information can contribute?
Mr Burstow
My hon. Friend makes a good point about the value of information in empowering patients, and about the value of education. That is why we want to do more with NHS information prescriptions, which is an important tool, and to ensure that the care planning process that delivers tailored care plans also includes structured education. There is no doubt that providing education really does make a difference to the outcomes for people with diabetes.
Jim Shannon (Strangford) (DUP)
I thank the Minister for his response to the question. I also wish to declare an interest as a type 2 diabetic. The junk food culture of the moment is a serious problem, so what steps is the Minister taking to address that in his effort to reduce the number of people being diagnosed as diabetic over the next year?
Mr Burstow
The best way of responding to the hon. Gentleman’s very appropriate question is to say that we are taking a four-pronged approach to diabetes. First, we need to tackle the causes of the condition through a renewed impetus on public health. We shall announce more of our plans in our White Paper later this autumn. Secondly, we need earlier identification and diagnosis so that we can help people to manage their condition at an earlier stage so that it does not progress. Thirdly, we need effective management and self-directed care. Finally, we need world-class research so that we can better understand the condition and deliver better treatments.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
10. What steps he is taking to ensure the adequacy of resources allocated to hospital accident and emergency departments.
Mr John Baron (Basildon and Billericay) (Con)
13. What recent representations he has received on the proposed one-year cancer survival measure.
The Minister of State, Department of Health (Mr Paul Burstow)
I have received many helpful representations on the proposed one-year survival measure, including his own when I met him along with a number of leading cancer charities in July. We have launched a full public consultation to shape the first ever outcomes framework for the NHS, and I urge all interested parties to contribute. The consultation document has put forward a range of possible outcome measures, including a one-year cancer survival rate that could be included in the framework. A full response to the consultation will be provided when it closes on 11 October.
Mr Baron
The one-year cancer survival measure is welcome, because it will encourage earlier diagnosis. As the Minister will know, however, under-treatment of the elderly in the NHS remains a pressing problem, which was highlighted in a recent report on cancer inequalities by the all-party parliamentary group on cancer. Can he assure us that the over-75s will not be excluded from the one-year or the five-year cancer survival measures once they are constructed?
Mr Burstow
The hon. Gentleman makes an important point. It is essential for us to ensure that the NHS delivers treatments that are both based on evidence and age-appropriate, which means ensuring that older people receive treatments that will enable them to survive cancers. His representations will need to be taken fully into account as we consider the results of the consultation on the outcomes framework.
Chris Leslie (Nottingham East) (Lab/Co-op)
Has the Minister seen today’s report from Cancer Research UK? It suggests that many primary care trusts and hospitals focus on drug therapy, and that radiotherapy—particularly targeted and image-guided radiotherapy—is often not given enough priority. Can the Minister assure us that, when considering cancer drugs expenditure, he will give equal priority to radiotherapy treatment?
Mr Burstow
The hon. Gentleman’s question is also relevant to surgery, but Cancer Research UK was right to produce this snapshot of the lamentable record of the last Government on access to radiotherapy. Spending on the NHS has now reached European levels, but we have not seen an equivalent achievement in terms of outcomes. That is why the present Government have been consulting on outcomes, and why we have asked Mike Richards, clinical director for cancer services, to examine these very issues in his review of the cancer reform strategy.
Gordon Birtwistle (Burnley) (LD)
14. What steps his Department takes to ensure that local NHS trusts observe its guidelines on reconfigurations involving transfer of facilities from one hospital to another.
Anna Soubry (Broxtowe) (Con)
15. What mechanisms are in place to assess the effectiveness of assertive outreach teams in providing support for people with severe mental illness; and if he will make a statement.
The Minister of State, Department of Health (Mr Paul Burstow)
The Department of Health has issued guidance on the key components of an effective assertive outreach team. It is for each local trust to put in place robust quality assurance arrangements to ensure that it delivers the high-quality and effective service that the public expect. That is further underpinned by the work of the Care Quality Commission.
Anna Soubry
I am grateful to the Minister for his response. One of my constituents, William Barnard, who was profoundly mentally ill, went on to kill his grandfather as a result of the poor system that was operating in relation to his care. What progress has been made in ensuring that other teams do not suffer from the same failings in their systems?
Mr Burstow
The hon. Lady and I debated this issue in the Chamber back in July. One of the most concerning aspects of the case of William Barnard was a singular failure to listen to the concerns expressed by family members and carers on the part of those who could have taken the necessary action to improve matters. I continue to take a close interest in the investigations being undertaken by the local NHS. We want to ensure that when lessons can be learned nationally, they are reflected in the Government’s forthcoming mental health policies.
Miss Anne Begg (Aberdeen South) (Lab)
Have the Minister or others in his Department had any discussions with the Department for Work and Pensions, because in the coming months a large number of people with mental health problems will be called in for interview to be reassessed from incapacity benefit on to employment and support allowance? This is already causing a great deal of anxiety among my constituents because Aberdeen is one of the trial areas. I wonder whether any of the mental health professionals have been informed and are ready for the influx that might result from that change in policy.
Mr Burstow
There are several parts to that question. First, we have already made commitments to invest in talking therapies, which are improving hugely the quality of lives of many people with mental health conditions. Secondly, I and departmental officials have had meetings with colleagues in the DWP, and I will have further meetings shortly, particularly to discuss the DWP input into a cross-Government mental health strategy.
Andrea Leadsom (South Northamptonshire) (Con)
16. What recent representations he has received on requirements for doctors to record the primary cause of death on a death certificate.
Adult Autism Strategy (Statutory Guidance)
Paul Burstow Excerpts(14 years, 3 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
A national public consultation on statutory guidance for health and social care bodies to support the delivery of “Rewarding and fulfilling lives: The strategy for adults with autism in England (2010)”, under section 7 of the Local Authority Social Services Act 1970 was launched on 29 July 2010. A copy has been placed in the Library and copies are available to hon. Members in the Vote Office.
The landmark Autism Act 2009 (introduced as a Private Members Bill by the now Secretary of State for Wales) marks a milestone in the drive to transform support and services for adults with autism in England. This Government have already made clear the commitment to drive forward work to tackle the disadvantage which people with autism and their families sadly so often face and to deliver the autism strategy published earlier this year by the previous Government.
This consultation on draft guidance for health and social services bodies to support the implementation of the autism strategy is a marker of that commitment. The draft guidance focuses on the seven areas highlighted in the Autism Act 2009 and is focused on achieving two key outcomes:
improving the way health and social care services identify the needs of adults with autism; and
ensuring identified needs are met more effectively to improve the health and well-being of adults with autism and their families.
Throughout, the draft guidance underlines the importance of using existing processes and resources to achieve these outcomes.
The aims of the consultation are to:
hear the views of service commissioners and providers, people with autism and family carers and use those views to inform the development of the statutory guidance;
further understand the expectations of adults with autism and their family carers in relation to health and social care services;
seek views on the issues around the provision of health and social care services for adults with autism; and
gather more information about health and care services currently provided for adults with autism and family carers.
The consultation will run to 18 October 2010, and we will publish final guidance, informed by the responses we receive, in December.
This consultation on statutory guidance for health and social care bodies is part of an ongoing programme of activity to ensure adults with autism will be able to enjoy the same rights and freedoms as the rest of society. This Government are committed to supporting people with autism to live independently as equal and included citizens. This means ensuring that programmes across the voluntary and public sectors that are aimed at improving care and transforming services address the needs of people with autism; and that mainstream public services especially become more inclusive of people with autism.
Trigeminal Neuralgia
Paul Burstow Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing the opportunity to debate this important issue on the last day before the summer recess. To have the privilege to be the Minister replying to a debate at this Dispatch Box is not something I necessarily expected when we all departed from this House in April, so it is a double pleasure to be concluding business in the House before we leave for a busy summer recess.
I congratulate the hon. Gentleman on highlighting this important topic, on bringing it to the attention of the House and on raising it with me as the Minister and, through me, with officials. He is right to raise both his personal experience and, in doing so, the experiences of many others who suffer from this condition and who often live with long-term chronic pain. He has spoken movingly and powerfully about the misery and discomfort that the condition can bring. I have heard that in some cases a strong wind just brushing a person’s cheek can be enough to trigger or ignite that intense pain through the nerve endings firing up. That is almost impossible to imagine unless one has personally experienced it, as he has described.
The hon. Gentleman asked about professional awareness. I have to confess that ministerial awareness of this condition was extremely low until quite recently. I had not heard about it—I will be honest—and I have spent the past few days learning as much as possible about it. From what I have learned, I agree that the condition deserves to be much better understood by policy makers, the general public and front-line clinical staff. The hon. Gentleman gave an excellent account of what clinical experts believe causes trigeminal neuralgia and of how the condition can be managed, and he rightly talked about how understanding of its prevalence is developing.
As the hon. Gentleman has explained, there are various treatments available. I understand that in about three-quarters of cases, patients respond well to anti-convulsant drugs, which have the effect of settling the nerve endings. However, although those drugs can be effective in reducing the frequency of attacks, they might not remove the pain entirely. Pain management techniques are then important for helping patients to manage their condition when attacks occur. As he has described, some patients might find that drug treatments become less effective over time or that they cause undesirable side effects. That is when surgery might become necessary to interrupt or block electrical activity in the nerve. There are several options, as he has described, but in the most severe cases, surgery is often the option taken up; it can be invasive and delicate, and it might not always bring the long-term relief that is desired.
Radiosurgery is another option, which may successfully interrupt the nerve impulses. There is exciting work under way using Gamma Knife technology, which is less invasive and can be more effective. The hon. Gentleman might be interested to know that the National Institute for Health and Clinical Excellence recently issued updated guidance on treating trigeminal neuralgia using Gamma Knife.
I have been told by my policy officials that one of the big challenges in treating this condition is diagnosis, which involves a GP or dentist having to rule out a whole host of other possibilities, including tumours, dental problems, the after-effects of shingles and dysfunction of the jaw. I can tell the hon. Gentleman that the Royal College of General Practitioners has developed a curriculum statement for neurological problems, which includes the need to consider trigeminal neuralgia in patients with headaches and neuropathies—I think that last word will read better in Hansard than I pronounced it—so it should be something that GPs cover as part of their initial training.
I add that the condition is also referenced in undergraduate dentistry training. Of course, because of its rarity, many GPs and dentists will see it only very infrequently in their practice, so I join the hon. Gentleman in welcoming the work that the British Dental Association is doing to promote the condition and to keep these possibilities in the front of dentists’ minds. By way of supporting these efforts, I have asked my officials to contact the dental deans to make sure that the condition also features in the continuing education and training of dentists.
The hon. Gentleman’s description of trigeminal neuralgia shows the need to join up national and local approaches to pain management and long-term conditions. As an action arising from this debate, I have asked my officials to look carefully at pain management in the context of the framework for long-term neurological conditions. I want to help the NHS to make the right connections between local services and to align national and local policies more closely to be helpful in that regard. We will have to make sure that all that feeds into commissioning and clinical practice at local level, and there are several areas in which we are looking to build knowledge and awareness at all levels of the NHS.
First, as the hon. Gentleman might be aware, NICE has recently issued new clinical guidelines on managing neuropathic pain. The guidelines specifically mention trigeminal neuralgia and describe the circumstances in which patients should be referred to a specialist pain service. On the back of that, NICE is working with the National Institute for Health Research to explore additional avenues of research that could help patients with the condition.
The NICE guidelines on neuropathic pain recommended four areas for future research, one of which is specific to trigeminal neuralgia and would give us evidence of the effectiveness of one of the most commonly used treatments. The other three topics cover the use of combination drug therapies, factors influencing quality of life, and the question of how much treatment should be influenced by the underlying cause of pain. They will be relevant to all forms of neuropathic pain, including trigeminal neuralgia. I can tell the hon. Gentleman that the topics are being considered for research as part the health technology assessment programme, and that a decision will be made in due course.
A second area of interest concerns the future planning of local services. The Government have agreed to press ahead with a national pain audit, to which 200 pain clinics are already signed up. Data collection will begin later this year. The audit will assess not only the organisation of local services to ensure that they meet local needs, but quality of care through the measurement of patient outcomes. The audit will help us to build a picture of patient need, which will help the NHS to build local strategies to improve pain management services. Again, such information will enable us to ensure that the right services are available for people with trigeminal neuralgia.
Thirdly, as the hon. Gentleman might also be aware, a consultation will take place during the summer on the NHS transparency in outcomes framework set out in the recent NHS White Paper. We want to hear the views of health care professionals, patients, carers, hon. Members and the public on what measures we should seek with regard to best outcomes and ensuring that patients have the right experiences in the NHS. I would certainly like TNA UK to contribute its thoughts on that, because that would help the shaping of the kind of outcome agenda that we want to see.
Fourthly, I will meet the Neurological Alliance, an umbrella group representing more than 50 neurological charities and organisations, to discuss the way forward on long-term conditions more generally. I understand that TNA UK is part of this group, so I hope that it will make its views known in the alliance so that they can form part of our discussions.
I join the hon. Gentleman in thanking third sector organisations such as TNA UK, which he rightly praised, for their work in raising patient awareness. On average, someone with chronic pain will have direct contact with a health professional for only about three hours a year; they care for themselves for the rest of the time. It is therefore extremely important for patients to know about their condition and receive the support that they need to manage their pain. That will become ever more important as we broaden control through personal health budgets and offer patients greater choice and say over their treatment. Good information for patients is the key to unlocking those benefits. I should add that there is also useful information on the NHS Choices website, which discusses the diagnosis and treatment of the condition and puts patients directly in touch with TNA UK.
The hon. Gentleman asked what else TNA UK could do to raise awareness of the condition or to improve the position of sufferers. I have already described a number of initiatives on which we would warmly welcome input from TNA UK. If I may make a final suggestion, the Chronic Pain Policy Coalition is doing excellent work nationally and regionally to inform and shape policy. TNA UK has common cause with such groups, so they could helpfully join forces to make the case for better pain management throughout the country.
I congratulate the hon. Gentleman on securing the debate, and I am now aware of the pain and agony that the condition can bring. Although I am afraid that the Department of Health is not resourced to give equal attention to every individual condition, it is gratifying to know that organisations such as TNA UK are supporting patients and promoting greater awareness. I am keen for us to work with them, and with the hon. Gentleman, to continue improving the quality and effectiveness of treatment for those who suffer pain, and I believe that the White Paper provides useful impetus in that regard.
On a personal note, I wish the hon. Gentleman the very best. I am delighted to hear that his treatment was to his satisfaction, and I hope that it provides him with lasting relief from this distressing condition.
Question put and agreed to.
Right to Request Social Enterprise Scheme
Paul Burstow Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
I will be announcing shortly the second wave of National Health Service organisations that will join the Department’s “Right to Request” social enterprise scheme. Details will be placed in the Library of the House when available.
The “Right to Request” gives all primary and community care staff employed by primary care trusts (PCTs) the right to put a request to their PCT board to set up a social enterprise to deliver health and social care services. Each of these organisations has received the approval of their PCT and strategic health authority (SHA) to pursue plans to set up a social enterprise. With appropriate support, these projects should go on to become successful and financially viable social enterprises that strengthen the delivery of tailored health and social care services in the NHS.
The projects include a wide range of health and social care services, including those for children, young people and adults, and end of life, mental health and disability services. They range from single service lines to whole provider arms.
This announcement is part of the ambition set out in “Equity and Excellence: liberating the NHS”:
“to create the largest and most vibrant social enterprise sector in the world”.
The initiative to encourage and support social enterprises to deliver public services is the first of its kind in the world. The scheme empowers staff to harness their entrepreneurial skills and exercise leadership to improve services for local communities through social enterprise.
I am committed to supporting the creation and expansion of mutuals, co-operatives, charities and social enterprises and want to enable these groups to have much greater involvement in the running of health and social care services.
John McGrath
Paul Burstow Excerpts(14 years, 5 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
I congratulate my hon. Friend the Member for Broxtowe (Anna Soubry) on securing what I think is her first Adjournment debate. Adjournment debates provide an opportunity for issues such as this to be debated in the House, and for the Government to account for what they are responsible for and ensure that others do the same. It is entirely appropriate for such a tragic and distressing case to be raised in an Adjournment debate.
Our thoughts must go first to the family whose lives have been turned upside down by this devastating incident. I offer them my deepest sympathies. As my hon. Friend said, members of the family are in the Gallery listening to the debate, and I look forward to meeting them afterwards and discussing the case with them directly. I fully understand their desire to ensure that something positive comes out of this terrible tragedy. As my hon. Friend said, our priority now is to ensure that the NHS learns from the incident, at a local and also, where appropriate, at a national level. I have asked my officials to look carefully at the issues raised by the case as they consider the future direction of mental health policy.
I shall say a little more about the national context later, but let me begin by focusing on the local issues. As my hon. Friend explained, Nottinghamshire Healthcare NHS Trust launched an internal investigation, which reported in April. It is a frank and honest account of what went wrong, and it gives the local NHS a good basis on which to improve the safety and effectiveness of its mental health teams. All that precedes the full external and independent investigation that the strategic health authority will commission in the near future. The trust has assured me that since the internal report came out it has taken active steps to address the weaknesses identified. It tells me that it is improving records management, strengthening communication between teams and reviewing its policy and procedures for assertive outreach. It is also addressing the way that mental health teams assess and manage risk, as well as looking at leadership issues and how they manage a patient's condition over the long term.
In addition, the trust has reviewed the cases of every patient using assertive outreach services to ensure that their care is not being compromised by the same failings. It has commissioned an external review of its assertive outreach teams, which is due to report in a fortnight. I have been reassured that the trust's board will examine the findings and respond swiftly and diligently to them. My hon. Friend and I would agree that all that work must feed directly through into better and safer practice on the ground. Crafting objectives and principles is one thing; achieving tangible improvements to practice is quite another.
My hon. Friend is absolutely right to emphasise the issues of strong leadership and clear lines of responsibility in assertive outreach teams. I can tell her that what should happen is that every assertive outreach patient has a named care co-ordinator. The co-ordinator takes overall responsibility for the appropriate assessment, care and review of the patient. There is no nationally prescribed model for who must take on that responsibility. I do not think that it is sensible to start prescribing how local teams are structured or run through a mandatory code. After all, patients’ needs will differ, and so will local circumstances.
However, there must be clarity. Everyone should know who is responsible for what, and people should be properly qualified, skilled and supported to discharge their responsibilities. The trust accepts that point. It tells me that it has set out a clear process for responding to service users who have not adhered to the agreed level of contact. Team managers are now responsible for monitoring that. I also understand that a risk assessment expert has spent a week with the assertive outreach team and is now developing a risk training programme for all staff. That training will be delivered in October.
Building on that point, I have also asked the trust about its quality assurance procedures. Assertive outreach obviously depends on strong relationships across different teams. That can be hampered if people change jobs, or if the continuity is broken in some other way, so the right quality assurance process is vital. Change has to be embedded within the organisation through regular and robust assessment of the competency of assertive outreach teams. In this regard, the trust tells me that it has improved clinical and managerial supervision as well as its performance management arrangements. For instance, attendance at multidisciplinary team meetings is now compulsory for anyone involved in a patient's care. Team managers now carefully monitor attendance at these meetings, and ensure that all actions coming out of the meetings are properly followed up.
I am keen that lessons from this tragedy are shared and absorbed by the rest of the NHS. In our White Paper, we talk about an NHS freed from the endless succession of top-down mandates and departmental circulars. That is the right approach. We want to replace command and control with much stronger local accountability, with councils in particular taking a much stronger role in working with the NHS and holding it to account. We have also said that the NHS will focus much more on achieving better outcomes; there is a debate to be had about what those outcome measures will be. A consultation is happening over the summer, and outcomes for mental health patients will form part of those discussions.
However, cutting the Whitehall apron strings does not mean abandoning our duties to look at local incidents and consider national repercussions. I will not pre-judge the external investigation. My hon. Friend would not expect me to do that, but I can tell her that the external investigation will be sent to the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness as a matter of course. The inquiry team will consider the findings as part of its regular reviews of homicide investigations. The National Patient Safety Authority would respond to any points of national concern raised by the independent investigation.
In addition, my hon. Friend may be aware that the NHS already flags patient safety incidents via the NPSA’s national reporting and learning service, and if a trend or pattern emerges the NRLS can issue an alert to all relevant providers. Those alerts would give advice to the NHS on how to prevent such events from occurring.
My officials have contacted the NPSA about the specifics of this incident and it says no similar problems affecting other assertive outreach teams have been reported to it. Therefore, I will be particularly interested to see the dossier of evidence and I will follow that through.
Mary Macleod (Brentford and Isleworth) (Con)
This incident was very movingly described by my hon. Friend the Member for Broxtowe (Anna Soubry), and I do not think it is an isolated incident—I think it has happened elsewhere around the country. Can the Minister give an assurance that the lessons from this case will be learned across the country and that it will change the way things are done in the future?
Mr Burstow
In terms of the systems as they work now, we will do all we can to make sure that that learning is embedded, but I am concerned that my inquiries today have shown that the NPSA was not aware of this dossier and I will therefore look into that, and look at the dossier itself in order to see what it can teach us.
However, I want to reassure both hon. Ladies—and other Members—that if the independent investigation were to make recommendations with national implications, we would look at them very closely and make sure they were translated into action and learning around the country.
Let me end by saying that mental health professionals have an extremely difficult and challenging role; the hon. Member for Broxtowe was right to acknowledge that. The judgments they make are often finely balanced, and the risks they shoulder are considerable. Most professionals are doing an excellent job, and we ought to acknowledge that while also being concerned where practice falls short, but sometimes there are failures in care that could and should have been avoided. Tragedies like the case of John McGrath demonstrate the need for constant vigilance, scrutiny and self-improvement.
When such tragedies do happen, it is vital that all responsible authorities, both local and national, are honest about the weaknesses and diligent about putting things right for the future. Like the hon. Lady, I will take a close personal interest in the independent investigation and the coroner’s report. I want to ensure that this incident leads to improvements, because that is probably the only consolation that can come from such a tragedy.
That is my message to the McGrath family and the hon. Lady who has secured the debate tonight. I look forward to meeting the family shortly to discuss these matters further and to working with colleagues across the House to make sure our mental health services protect and give good quality care for people with mental health needs.
Question put and agreed to.
People with Learning Disabilities (NHS Treatment)
Paul Burstow Excerpts(14 years, 5 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
I thank the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) for securing this debate, because it is a timely opportunity for the new coalition Government to set out their intentions and approach to the issue. I also pay tribute to him because I know from my time in the House, over the past 13 years, that he has been a true and consistent campaigner on behalf of people with learning disabilities and their families. He has brought many issues to the attention of the House and regularly challenged Ministers of the previous Government—I am sure that he will continue to do so with this Government—to strive to achieve better outcomes for people with learning disabilities.
I made it my business to attend the first meeting of the all-party group on learning disability after the general election to signal my intention and commitment as a new Minister. Despite the fact that I could not make yesterday’s meeting, I hope that my good faith and my desire to collaborate with the all-party group will be recognised. I also pay my respect to Lord Brian Rix who, along with the right hon. Gentleman, provides exceptional leadership in that area.
I also thank the hon. Member for Kingswood (Chris Skidmore) and the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, for their contributions to this debate. I will clearly have ample time to respond to their many points and questions. If I miss anything out, I will write to right hon. and hon. Members later. It is right that such issues should arouse strong feelings and that they should be kept at the top of the agenda. The right hon. Member for Coatbridge, Chryston and Bellshill drew attention to the Disability Rights Commission report “Closing the gap” and the impact that it had when it came out. No one should be in any doubt of the extent to which the Mencap report “Death by indifference” provided a wake-up call to the NHS and the Government of the day. The health ombudsman’s report has also been very important in alerting us to the failings in the system.
Four years on, a great deal has been written and said about this subject. None the less, despite the “Valuing People Now” strategy and the many worthy efforts to improve services, there are still some parts of the NHS that are not delivering well enough for people with learning disabilities. We have inherited that legacy and we are determined to take action on it. I welcome and support the principles set out in Mencap’s “Getting it right” charter, and we will try to collaborate with the charity to ensure that we address and take forward the additional challenges. I want to work very closely with Mencap to ensure that we translate the words on the page into real change in hearts, minds and practice across the country.
The right hon. Gentleman and the hon. Member for Kingswood were right to pay tribute to the work of many dedicated NHS staff around the country. Constructive feedback also needs to be part of any good process of continuous improvement, and is certainly essential when it comes to the NHS. My hon. Friend the Member for Kingswood put his finger on the pulse when he said that one of the key things that the Government White Paper on the NHS will do is provide a far better focus on early intervention, early diagnosis and prevention. Prevention will be an important part of this Government’s agenda in the delivery and improvement of health care.
I want to make it clear that this Government support “Valuing People Now” as a strategy. Our approach to it is one of continuity and change. I will not be reinventing the wheel, but I will be doing everything I can to make the wheel spin faster—if I can put it that way—because we need continuity but we also need to accelerate the pace of change on the ground.
I have listened very carefully to the points that have been made by right hon. and hon. Members during this debate and I will try to respond to those points. I will start with the point about evidence and information. Gathering evidence and information must be a key part of informing the development of practice on the ground. The right hon. Gentleman and the hon. Member for Worsley and Eccles South, the shadow Minister, were right to say that this is an area where we must do more. Gathering better information and evidence is vital. We need better information and evidence to subject the NHS to proper scrutiny and so that the NHS can conduct proper self-appraisal; consequently, any shortcomings in care can be identified and acted on quickly, both at a local and a national level.
I can confirm that we are pressing ahead with the confidential inquiry and the public health observatory that were recommended by Sir Jonathan Michael’s inquiry. The confidential inquiry will ensure that premature and avoidable deaths of people with learning disabilities are investigated and that lessons are properly learned and applied at a national level. The public health observatory will give us a much stronger evidence base about the needs of people with learning disabilities and the difficulties that they face, which in turn will inform better practice. I am particularly pleased that we will have representatives from Mencap, the National Forum for People with Learning Difficulties and the National Valuing Families Forum on the group that will scrutinise the progress of both the confidential inquiry and the public health observatory.
In addition, all areas of the country have completed, or are in the process of completing, the new health self-assessment framework. That framework brings together strategic health authorities, primary care trusts, hospital trusts and people with learning disabilities and their families. Those organisations and individuals are coming together to assess local NHS progress and to ensure that health services continue to improve for people with learning disabilities. Their work will be shared with the public health observatory to inform its work. The framework offers a strong means of ensuring accountability and it can help us to ensure that NHS services are making the right adjustments in line with their duties under the Disability Discrimination Act 2005 and other legislation, which is a point that has quite rightly been made by all right hon. and hon. Members who have contributed to this debate.
Barbara Keeley
As I think all of us who have been involved in today’s debate understand, there will be a great deal of churn in the organisations that the Minister has referred to, such as the SHAs, the PCTs and the hospital trusts. Greater accountability for, and greater scrutiny of their work is clearly important, but those organisations are now threatened with closure. People will be leaving their jobs, so I want to ask the Minister if there is a follow-on plan for when those organisations expire, as it were?
Mr Burstow
The hon. Lady must have a copy of my speech in front of her, because the answer to that question is in the next paragraph. She is absolutely right. In executing the change that the White Paper sets out, which means removing the sense of central dictation and direction that we have seen in the NHS for the last 13 years, ending that sense of command and control and making the system one that is about delivering outcomes and one that is facing the patient and working alongside them to deliver those outcomes is an important transformation. Therefore we need to ensure that, in the transition planning that is now well under way for the change that will take place during the next two to three years, the institutional knowledge and learning in the existing system properly migrate to the new system, and that best practice is firmly embedded in the front-line services. Those services will remain as they are now, but they will receive more support and investment to do even better.
Mr Tom Clarke
I welcome both the Minister’s tone and his approach to the all-party group. When he considers a number of these issues, I wonder if he feels, as I do, that the importance of advocacy is underlined? Furthermore, does he believe that advocacy will become a central part of the Government’s approach to these matters?
Mr Burstow
I am very grateful to the right hon. Gentleman for his intervention and his question. He raises a point that I will move on to shortly, but I certainly see advocacy as being very important in this area. Looking forward, we will need to ensure that we reflect what we are learning from the work that is going on at the moment in the new commissioning landscape and in the new frameworks for accountability at a local level.
Both the right hon. Gentleman and the shadow Minister have referred to annual health checks, so let us look at that issue. It is quite encouraging that many more people with learning disabilities are now receiving an annual health check from their GP. Last year, just over one in five people with learning disabilities received an annual health check and the latest figures show that two in five people with learning disabilities have received their annual health check within the last 12 months. However, that is clearly not good enough, as it means that three in five people with learning disabilities still do not receive an annual check. As a Government, we are determined to push that process forward to ensure that the training and development that has taken place delivers in that regard.
I have heard many stories about how those health checks have identified, for example, cataracts or cases of diabetes. Furthermore, as has already been said in this debate, if we put ourselves in the position of a person having such a health condition but being unable to communicate the symptoms, we can begin to understand the difference that these health checks can make. I am therefore certainly keen to see annual health checks continue for people with learning disabilities, and we are looking at the most cost-effective way of ensuring that.
Reference was also made to the training of staff in relation to carrying out health checks. Undertaking training is certainly part of the requirement for all the GP practices that are delivering the annual health checks for people with learning disabilities. That training is about raising awareness of people with learning disabilities and their families, and particularly about ensuring that communication issues are understood, that advocacy is provided and that there is also liaison with staff in the acute sector. So there are a number of aspects about training and I will say more about that shortly.
The right hon. Gentleman referred to the training, as did the hon. Member for Kingswood. Reference was made to the recent Mencap poll, which makes disturbing reading as it shows the number of staff who have not had training to help people to make reasonable adjustments to different situations.
The shadow Minister talked about the need to look at people in the round, so that we do not only look at either their learning disability or their physical needs but at both elements. In that way, we will not allow diagnostic overshadowing to take place. That issue must be properly addressed in training. Therefore I wanted to ensure that right hon. and hon. Members were aware that the Council for Health Regulatory Excellence is working with professional bodies to support better training and to improve professional standards. That relates to a point that the hon. Member for Kingswood made about the need for professional ownership of that training, so that it is not just something that is imposed from the top but is seen by professionals as an essential way of learning to do their job better.
As a Government, we are working with the council to reach not only doctors and nurses but the full range of health care professionals. That is clearly important when it comes to meeting the often complex needs of people with learning disabilities. For example, speech and language therapists have a key role in tackling feeding issues of the type that the right hon. Member for Coatbridge, Chryston and Bellshill talked about. However, he referred to a case that I fear I cannot talk about any further, because it is before the courts. Occupational therapists are also important in helping people to develop the skills that they need to live independently, so I am pleased that all the regulatory bodies are reporting progress on that work and I will certainly keep in touch with them to ensure that that progress is maintained. I also want to ensure that that learning is embedded as we move towards delivering the vision that is set out in the Government’s health White Paper published on Monday.
Meanwhile, at a primary care level staff in all GP practices that are delivering annual health checks now have the appropriate training. The Royal College of General Practitioners is due to publish additional training materials for all GPs this summer, which are about getting health checks right for people with learning disabilities. I hope that that reassures right hon. and hon. Members that the Government are not about to shelve the issue of training but are determined to see training programmes develop.
Barbara Keeley
I think that the point about annual health checks has been emphasised. Does the Minister see those checks continuing? Will there be funding for them to continue? He has helpfully quoted some figures that show that we have moved from a situation in which one in five people with learning disabilities receive an annual health check to a situation in which two in five receive such a check. Does he know whether that gap—a gap that means that three in five people with learning disabilities do not receive an annual health check—exists because those people are not known to services or because GPs are just not carrying out those checks? In other words, is there an information gap or is there a practice or provision gap? If he does not know now, perhaps he can tell me in writing later.
Mr Burstow
Regarding the hon. Lady’s point about funding, given the tone and the substantive nature of what I have said about annual health checks it would be surprising if the Government were not determined to see those checks being continued. However, we are obviously in the middle of a spending review and therefore we must ensure that we achieve value for money in those checks. I think that this debate underscores that point only too well. I will write to the hon. Lady on the other point, because I want to get the answer absolutely right, and I will ensure that other hon. Members involved in this debate are copied in.
The hon. Lady also mentioned the value that we all rightly attach to the contribution made by family carers. I hope that she and others, while perusing the White Paper during the past two days, will have seen that one thread running through it from principles to practicalities is the value that this Government attach to the role of carers. For the first time in a Government White Paper, we have stated clearly that we see carers as partners in recovery and the provision of good care, which we want to ensure is provided appropriately in different circumstances. It is an important signal that we hope will be taken on board.
On annual health checks, the hon. Lady will know that the Government are in the midst of a series of pilots to evaluate the best way to implement health checks for carers. We will await the outcomes of the pilots before making further decisions about their wider roll-out.
On engagement, which all hon. Members have mentioned, it is crucial that patients and families are at the heart of all health care services at all levels. The White Paper makes that clear by borrowing from an important past report. We want the aspiration “No decision about me, without me” to inform how the health service develops. We need people with learning disabilities to be fully involved in the planning and design of services at a local level. If we can create an NHS that genuinely listens and responds to patients, in line with the White Paper, we will ensure that people with learning disabilities get the support and advocacy that they need to make their voices heard. That is clearly important, just as it is important to ensure that the values and principles behind the Mental Capacity Act 2005, which I supported during its passage through the House, are understood and translated into practice.
Some parts of the country are already doing great work in that area by, for example, bringing in user-led organisations to advise staff and help them offer patients the right advocacy. We want to see more of that. We will also work through the new body proposed by the White Paper, HealthWatch, which will not only handle patient complaints but be responsible for providing advocacy and support in pursuing them. HealthWatch will have a key role in ensuring that the voices of those whom we are discussing are heard fully across the NHS. It will be a powerful champion for people who are not always heard.
Hospital passports have not been mentioned, but they none the less address some issues raised in this debate. The hon. Member for Kingswood discussed, among other things, the role of liaison nurses. Hospital passports are another helpful development and were one of the top suggestions in Mencap’s charter. The passports are short, accessible booklets that can be carried by people with learning disabilities to give NHS staff information about their medical history, any drugs that they are taking and their likes and dislikes. They are a low-cost but effective idea and are offered by many hospitals throughout the country. I want to see them spread to every hospital. I suspect that the case mentioned by the hon. Gentleman involving poor communications in hospitals might have been avoided if such a passport had been available.
Clearly, acute liaison nurses also have a role to play. All strategic health authorities recently reported on the issue to the Department of Health, and all referred to the value of acute liaison nurses. The number of posts is increasing as such nurses demonstrate their value. They play a part in building capacity, training colleagues, raising awareness across the work force, improving the patient experience and, importantly, reducing length of stay and getting people back into the community appropriately.
I have mentioned commissioning structures. As we migrate from the old system to the new, we must ensure that the learning is carried over. That creates opportunities and possibilities for organisations such as Mencap and others to play their part in ensuring that they work alongside commissioners at a local level to deliver it.
Barbara Keeley
While the Minister is on that point, will he enlarge on how the commissioning of the services that we have been discussing will take place? Will they be locally commissioned, or will the NHS independent board commission them from GPs?
Mr Burstow
The NHS commissioning board will commission the family practice services that GPs provide, but the GP commissioning consortiums will be responsible for a wide range of commissioning services, some of which they may do collectively at a sub-regional or regional level, while others will be discharged by the NHS commissioning board. The important thing is the expertise available, and we say in the White Paper that GP consortiums will have access to that expertise in a number of ways. They might choose to bring it in-house, use their local authority’s commissioning expertise—some local authorities have exceptional expertise—or work with third sector organisations. There are already examples of that happening, such as with Turning Point. I suggest that opportunities exist for organisations to offer commissioning expertise in order to develop services that are much more in tune with the needs of particular patient groups.
The right hon. Member for Coatbridge, Chryston and Bellshill was absolutely right to flag up the wider societal challenges of discrimination, particularly the discrimination faced by people with learning disabilities. He was therefore right to identify, as the Government do, that we must not approach the issue in a narrow, health-focused way. We need a wider social perspective in taking forward strategies on the matter, and that will be part of our thinking throughout.
The right hon. Gentleman also asked me about the Mansell report, which I know was the subject of discussion last night at the meeting of the all-party parliamentary group on learning disability. I thank Professor Mansell for his important work, not least because I understand that the work reported yesterday was commissioned by the Department of Health. It demonstrates the vital importance of improving services and outcomes for people with learning disabilities and provides important examples of good service and good practice that we must ensure sit firmly in the strategy going forward. My officials will work further to ensure that we see how the findings fold into the ongoing work on the strategy.
The right hon. Gentleman asked about the DVD. We are happy to ensure that it can be accessed on the website and to discuss other ways we can collaborate to maximise awareness of it and the Mansell report. We are keen to ensure that people have access to it and will do what we can to achieve that.
I am told that financial matters, to which the right hon. Gentleman referred, were discussed last night at the all-party group meeting. How can we maintain and accelerate progress in the straitened financial circumstances that the Government have inherited? Part of the answer is that the NHS has benefited from this Government’s commitment to real-terms growth. However, we have inherited a debt legacy that must be tackled, and we have made it clear that the sick should not have to pay the price for that, nor should people with learning disabilities. The NHS will have to be even more creative and willing to work in new ways with the third sector and other organisations to maintain and quicken the pace of reform. I am confident that we can do things differently and achieve with less, and that we can do more for people with learning disabilities.
Ultimately, we need to achieve real change to make an impact on the ground. Yes, we need better training, evidence and engagement but, ultimately, we need better services driving better outcomes for patients. We need services that are integrated—the White Paper provides a way forward on that—as well as more responsive. They must be built around the individual needs of patients and families, meet their expectations and give them a say in their treatment and ongoing care.
In conclusion, the NHS White Paper can be the catalyst that we need to drive change. The message is simple. We want an NHS that is focused on outcomes and judged by what really matters to people: the extent to which it helps them live longer and healthier lives. We will need to consider how we measure those outcomes in the right way for people with learning disabilities, and I look forward to working with the all-party group, Mencap and many other organisations on that. Reducing preventable mortality might, for example, be a helpful starting point, and we want to consult on that.
The shift away from process-led measures towards outcomes will bring a cultural shift in care and help the NHS to shake itself free of any of the lingering discrimination that has been talked about in this debate—any sense of looking at the disability rather than the individual as a whole in terms of how treatments are decided. That is the opportunity the Government’s White Paper presents and I am determined to work with the right hon. Member for Coatbridge, Chryston and Bellshill, the all-party group, Mencap, families and others to ensure that we grasp that opportunity and deliver the best outcomes possible.
Child Health (Nottingham)
Paul Burstow Excerpts(14 years, 5 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
It is a delight to serve under your chairmanship today, Mr Amess; I know you have taken an interest in health debates over the years. I congratulate the hon. Member for Nottingham East (Chris Leslie) on securing this debate. He is right to say that he has brought a serious range of issues to the attention of the House. I applaud him for ensuring that the concern that he and his hon. Friends share about improving children’s health in Nottingham is kept on the agenda both here in the House and in Nottingham.
I am delighted to have the opportunity to respond to this debate and to acknowledge some of the work that has already been done by hon. Members in Nottingham. In particular, the hon. Member for Nottingham North (Mr Allen) has been a staunch advocate on the subject, and has a good track record both in the House and in the local area. The hon. Member for Nottingham East should pay tribute to his leadership, particularly in respect of the teenage pregnancy taskforce, which has done important pioneering work on early intervention that has started to make a significant difference. The Government are determined to do everything they can to ensure that the lessons learned from the taskforce are embedded and sustained as we go forward.
I also want to thank the hon. Member for Nottingham East for his positive remarks about the work of local NHS staff. They are keen to build on the equally strong relationship they have with him and other hon. Members in the area by extending to me an invitation to have discussions with them. A lot of what the hon. Gentleman has said today was concerned with how we ensure that local services are better aligned with each other and collaborating effectively, and that the culture is right to promote effective joint working. Members have a key part to play in that process as local community leaders, and we already have an exemplar in that regard: the hon. Member for Nottingham North.
The hon. Member for Nottingham East cited a lot of statistics on this subject that are compelling and in some ways quite depressing. He pointed out that there is a significant concentration of deprivation and poverty indicators in parts of his constituency, and across the city of Nottingham more generally. Sadly, the map of poor child health aligns all too readily with the wider issues of social and economic deprivation. Clearly, there are challenges to be faced in that regard.
The local NHS should be congratulated on the progress it has made, because significant improvements have been made in some areas during the last decade. Those areas show that strong, well integrated, well resourced and well targeted mainstream services can indeed make all the difference.
We know that there is much more to do in Nottingham—a point that the primary care trust emphasised when I spoke to its representatives yesterday, ahead of this debate. For example, it reassured me that children’s health, particularly in the poorest communities, will remain a strong priority for the future and that it will continue to invest in local health services as well as contributing strongly to the children and young people’s plan, which is important. I understand that that plan, which is very important in driving delivery on the ground, will go to the city council in a few weeks’ time.
That culture of strong partnership working is particularly important: we need much more in the way of joined-up planning, commissioning and delivery in the future. The PCT has reassured me that its priority is continuity, and I hope that that reassures the hon. Members for Nottingham North and for Nottingham East. We want to ensure that we are pushing ahead in areas where progress has been made—there has been progress—and quickening the pace of improvement elsewhere. The Government intend to support such efforts and to ensure that the work that has been started on early intervention and prevention is not lost or thrown aside, but is seen as an essential investment. In truth, that work is not a waste of resources but unlocks resources; to stop it would indeed be a false economy. Therefore, we want to ensure that the poorest communities can get the well targeted services, run by confident and assertive staff, that they need.
Reference has been made to spending pressures. Those pressures existed before this Government came into office; indeed, the last Government acknowledged that the deficit presented a significant challenge to the public sector, including the health service. Indeed, they mapped out the challenge that would have to be faced. Through our first, emergency Budget, the new Government have recognised that not to act promptly would be to fail to deal with the difficulties and the legacy we inherited. In failing to reduce the deficit, we would not only endanger the whole economy but some of the most vulnerable people in our communities, through an inability to secure sustainable public investment in key services. So the decisions we have made, some of which have undoubtedly been painful, are absolutely essential if we are to deliver the sustainable economy and growth that we all need, and the support that is essential to ensure that services continue to develop.
However, as part of making those tough choices, the Government took the decision to protect the NHS and to secure real-terms increases each year for the duration of this Parliament. The hon. Member for Nottingham East was right to say that that does not mean it will all be plain sailing from now on; there will be difficulties and challenges ahead, and there are real pressures on the NHS budget. However, we do not believe that the sick should pay the price for the debt crisis, and this funding will enable the NHS in Nottingham to continue improving services.
That does not necessarily mean “more of the same”. One of the lessons that I took from last week’s National Audit Office report on health inequalities is that success is not all about spending more money. In many cases, it is about spending money more wisely, and the type of schemes the hon. Member for Nottingham North has led in Nottingham are a case in point. In that way, big differences can be made with relatively small amounts of investment.
We need a fresh approach, with a health service that is more preventive, more integrated, more answerable to local communities and more responsive to local needs. We will say more about that approach in the health service White Paper that will be published in the near future, and which will clearly have an impact on the way that health and social care services are delivered in the Nottingham area.
Mr Allen
My hon. Friend the Member for Nottingham East pointed out that one way we can make small amounts of money go a long way is through inventive use of the working neighbourhoods fund or its predecessor, the neighbourhood renewal fund, for example. Sadly, however, as my hon. Friend pointed out, those funds are the first things to go when an organisation starts looking at its core operation and contracting inside its own silo, rather than reaching out in partnership with others. That is a problem and the Minister really must address it.
Mr Burstow
It is a challenge, and one that both the Government and local organisations understand. When we publish the White Paper, I hope the hon. Gentleman will see that we are addressing that challenge in a very direct way, to ensure that every pound the taxpayer invests in our health service really delivers the maximum possible benefit for the communities it is meant to serve.
The hon. Member for Nottingham East raised a number of specific points and I want to address as many as possible in the time remaining. On child and adolescent mental health services, he said that up to one in 10 young people in Nottingham are diagnosed with mental health problems. Clearly, deprivation, isolation and exclusion are often the harbingers of poor mental health, and children living in poverty are frequently the worst hit. That carries a cost of the sort the hon. Gentleman talked about—one borne not only by those children personally but by the wider community. The hon. Gentleman was therefore right to talk about the vital role that children’s mental health services play. The children and young people’s plan is focused, rightly, on greater prevention and earlier intervention. I can therefore assure him that this Government attach a very high priority to early intervention, preventive mental health services and public mental health services; they are very important to us.
The children and young people’s plan also aims to stop young people experiencing behavioural problems, mental illness, substance misuse and low educational achievement. Again, that requires a confident and well equipped work force who bring together skills across the statutory and third sectors. I understand that the local NHS and the local council plan to improve the training and development of staff in dealing with such behavioural problems.
The hon. Gentleman asked about smoking, which I acknowledge is an important issue that we need to keep a clear focus on. I understand that work is progressing in that field that is targeted at reducing smoking during pregnancy. He also talked about the work that has been done on teenage pregnancy in Nottingham. He is right to say that we should applaud the fact that the teenage pregnancy rate in Nottingham has fallen for eight consecutive quarters. The rate in Nottingham was among the highest not only in the UK but in Europe. Clearly, the rate is now going in a different direction—one secured by the integration of services and effective leadership on the ground. However, the figures remain stubbornly high, and we need to ensure that there is more effort and focus on reducing them. The local PCT has reassured me that a number of schemes it is taking forward, such as the C-card scheme and various other initiatives involving sexual health services, are being maintained. By way of reinforcement, reducing teenage pregnancy will be a feature of the joined-up working produced by the children and young people’s plan.
The hon. Gentleman cited statistics on dental health that were even more stark than those I was presented with by my officials, including on schools that reported having pupils with six teeth that were either missing, decayed or filled. In fact, the latest figures show a slightly different and hopefully better picture. They suggest that five-year-olds in the Nottingham city area have, on average, 1.73 decayed, missing or filled teeth. That places the city’s PCT as the 31st worst performer on that indicator, whereas it was the second worst the last time such figures were published. That figure of 1.73 compares with an average figure of 1.11 for five-year-olds for the whole country. The hon. Gentleman is therefore right to say that more needs to be done about oral health and hygiene in Nottingham. The City Smiles programme will certainly continue to play an important part in that work. On the direct provision of dental health services in Nottingham, the hon. Gentleman will be pleased to know that two new dental practices will open in October, in Bulwell and Bilborough, which will obviously improve access to such services. He also talked about fluoridation. Clearly, such matters are to be decided upon locally, but I will pass his comments on to my ministerial colleagues.
The hon. Gentleman also spoke about funding for speech and language therapy. When I talked to representatives of the local PCT yesterday, they certainly gave no indication of any intention or plan to cut those services. I can assure him that I asked the PCT a lot of questions in preparation for this debate. However, if I am misinformed on this subject, I will certainly write to him to give him further details.
You, Mr Amess, will know about the importance of the issue of obesity, as we both served on the Health Committee when it produced a report on obesity some years ago. Again, the local PCT has told me that it will continue its work on the active schools programme, which encourages more children to take up sporting activities.
I am afraid I will probably run out of time shortly, but the hon. Gentleman has certainly given us a run-around the important issues that this Government will continue to maintain a clear focus on. We see delivery on those issues being provided by effective local leadership, effective integration of commissioning and provision, and good leadership from politicians nationally and locally. By doing that, we believe we can improve the nation’s health.
Supporting Carers
Paul Burstow Excerpts(14 years, 5 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
It is a great pleasure to open the debate and to do so as a Minister. I look forward to working with the hon. Member for Worsley and Eccles South (Barbara Keeley) in her new role as an Opposition spokesperson on health. I forgot to welcome her to her role at Question Time the other day, so I put that right now.
We are here to debate a very important issue for our society: how we offer proper support for the nearly 5 million adults in England who spend a significant proportion of their life providing unpaid support to family members or friends. Among those 5 million adults, there is real diversity with respect to the amount of care they provide, how long they provide it for, and when they provide it during their lives.
For instance, the biggest group of carers is made up of older people in their 60s or 70s, or even their 80s. Typically, they are looking after a husband or wife who is in declining health, although they themselves might be in poor or frail health. They are often devoted to their husband or wife, yet they are deeply concerned about what the future holds. The existence of that group reinforces the need for better identification of carers, for better ongoing support to ensure that they stay healthy and well, and for better integration of services across health and social care to ensure that those carers are fully involved in the treatment and ongoing care of their spouse.
Next, there are carers of my generation—people in their 40s or 50s—who find themselves caring for a parent or partner for several years, or perhaps longer. Those people need real flexibility and control to ensure that they can balance their caring duties with their work responsibilities and bringing up their own families. They are the “sandwich generation” that is often talked about.
There are also significant numbers of lifelong carers, who might have a son or daughter with a physical disability or a learning disability. They can become carers in their 20s. They have a lifelong commitment to support a loved one, which means that we are looking for support that can help them to lead a life outside caring, and to have a career, a marriage, friendship and hobbies—all the things that the recent carers week survey told us that so many of them do without.
Let us not forget about young carers. Officially, there are 175,000 of them, but I think that we all know that that figure is just the tip of the iceberg and that there are significantly more. Young carers are children who do not have a recognisable childhood because of their caring responsibilities. They do amazing things to support parents, brothers or sisters, but they need considerable support themselves. They need tailored and integrated support, with schools, social services and community groups working together to ensure that they have the same opportunities as other young people: a good education; good health; training opportunities; a social life; and, yes, the ability just to be children and have fun, which is what childhood should be about.
I am making the point that the policies that we introduce and the support that we offer must reflect that kaleidoscope of carers’ backgrounds, experiences and needs. Although many carers enjoy their caring responsibilities, I have no doubt that hon. Members in the Chamber have met carers in their constituencies who are at the end of their tether. Those carers feel undervalued and overlooked, and frustrated that the care and support available is not tailored to fit their families’ needs. Sometimes they feel a whole host of emotions: anger that such a thing could have happened to their family; grief at a life forgone out of love and duty; and guilt for feeling that they need a break, a breather and a bit of time to themselves.
That is why mainstream statutory services can make a massive difference. A comparison of the findings of the personal social services survey by the Department of Health, which was published yesterday, with the findings of the recent Carers UK survey entitled “No life of my own” reflects that point. The Department of Health survey of 35,000 carers, all of whom were in contact with statutory services, found that only 13% reported having no time to do anything that they valued or enjoyed. In contrast, the Carers UK survey of more than 3,000 carers who may have had little contact with the NHS or social services reported that 76% of respondents did not have a life outside their caring role.
What does that tell us? I think that it suggests that when carers have contact with services—whether in the voluntary sector, the local authority sector or the private sector—they are more likely to have a positive experience. That makes it all the more important that such services work harder for carers.
There are four points that I want to emphasise today. First, we must identify more carers so that we can put them in contact with the services that can help them. Many people simply do not identify themselves as a carer and hence do not come forward to get the help to which they are entitled. This is an area in which GPs can play a role, which was reinforced to me recently when I visited an excellent GP centre in Lambeth.
Just a few days ago, I attended a round-table event organised by the Afiya Trust at which a number of speakers told me about the specific challenges faced by certain ethnic groups. On that point, I intend to look at how we can break down some of the barriers that exist and ensure that we get culturally sensitive support to those who need it.
Secondly, we must ensure that there is effective integration across the whole system. We need joined-up planning, joined-up commissioning and joined-up delivery for carers and the people for whom they care. Public services need to talk to each other, but not just to each other—they also need to talk to the voluntary sector. They must respond to the whole picture of a family’s circumstances, rather than just considering their own specific area of expertise. We need one system pulling together, rather than different systems pulling apart.
Better integration across health and social care is particularly vital. Such integration has been talked about for years—I have attended debate after debate about it. If we want to make progress for carers, councils and health authorities will have to make such integration happen on the ground, along with their partners in the third and independent sectors.
Thirdly, we must make personalisation a reality for everyone and ensure that packages of support genuinely fit around a family’s needs and the way in which they want to live their lives. We plan to do that by encouraging the far wider use of direct payments, which is already a very popular way of giving carers more flexibility and control. The Government have made a clear commitment in the coalition programme that we will encourage more local authorities to offer direct payments. We will also challenge local authorities to provide those payments, and we will encourage others to hold local authorities to account so that they provide them.
One thing that we will not do, however, is to make promises that we cannot keep, which was what the previous Government did when they promised £150 million for breaks for carers. Thanks to the Princess Royal Trust for Carers, it is now well documented that primary care trusts siphoned off that money to spend on other things. Speaking from my personal experience, I can say that getting information from PCTs about how they were spending that money was like pulling teeth. Despite the fact that inquiries and freedom of information requests were made, some PCTs conspicuously failed to answer the local population that they exist to serve.
Let me be clear that local NHS commissioners should have full autonomy and control over how they spend the money that is allocated to them. Therefore, if we are putting money into the baseline, a Minister cannot claim credit by saying that they are going to spend the money on x when they know perfectly well that they cannot guarantee that.
I stress, however, that if we agree to loosen Whitehall’s grip, it is important that there is much greater local accountability. As part of a series of far-reaching reforms, we will set out shortly a programme for much greater transparency and accountability for the NHS at local level. Hon. Members and their constituents will be able to hold their local health services to account for how they spend taxpayers’ money. As a starting point, strategic health authorities have already reviewed how PCTs actually go about prioritising support for carers. We will publish the results of that audit and they will be put in the House of Commons Library in the near future.
I am afraid that I have to inject a dose of realism into this debate, as we also have to deal with the repercussions of the financial legacy that the Government inherited. As the recent Budget made clear, the Government will need to make significant cost savings to help the country to reduce the deficit. There will be a premium on efficiency and on ensuring that every penny of taxpayers’ money counts, reaches the front line and makes a difference to carers’ lives.
That may involve difficult judgment calls. For example, I have just made the decision to terminate the caring with confidence training programme on the grounds that it was not delivering value for money or giving carers training where it mattered. We will be providing the training materials from that programme free of charge to carers’ centres and others so they can carry on, with local partners, delivering training for the benefit of carers who need it. Having cancelled that programme, we can now ensure that the money does much more to benefit carers on the ground. We will shortly roll out a training programme to raise GPs’ awareness of their role in, and contribution to, supporting carers.
Better support is not necessarily about spending more money; it is about spending more wisely, which is what we intend to do. At the same time, the state should not over-reach itself. There are limits to what the Government and statutory services can do on carers’ behalf. As demography and patterns of disease remould our society, the wider community has a responsibility to adapt to those changes. That involves a big role for charities and voluntary groups, which can do much to stimulate grassroots response to many of the day-to-day issues that carers face. As a Member of Parliament for 13 years, I come to this debate not because of my personal experience in a caring role but because I have been taught and shown the issues confronting carers by my own carers’ centre in the London borough of Sutton.
Whether we call it active communities, social capital or the big society, we need to reignite the latent sense of collective responsibility that leads people to look out for each other and make the small gestures that can help in a big way. Employers also have a big role to play in making it easier for carers to stay in work. We pledge to extend the right to request flexible working to all employees, but a right to request is not a right to have. I am conscious that change depends on whether organisations across the private and public sectors grasp the economic arguments about what making such a commitment will deliver. We will be making those arguments strongly in the coming weeks and months, and I hope that all hon. Members in the Chamber will make the case when talking to employers and employers’ organisations in their constituencies. We must also make staff much more aware of the opportunity to ask for a break. The right to request was introduced four years ago, yet recent research indicates that half of those entitled to it did not even know that they had that right.
In conclusion, carers are and will remain a vital thread holding our society together. We pick at that thread at our peril. We will use this summer to develop a fresh, new carers strategy. We will build on what went before and acknowledge what the last Government did, but ensure that what we have is deliverable and affordable, and that it addresses carers’ concerns. I hope that today’s debate will play its part in shaping that refreshed strategy, and I look forward to hearing hon. Members’ contributions.
Mr Burstow
I absolutely agree with that point, and that is why we will not promise to pay cash sums into the NHS baseline that therefore cannot be delivered to where Ministers claim that they will be delivered, and it is why we will ensure that we, as a Government, will provide both leadership and, when appropriate, direction to deliver the sorts of things that hon. Members on both sides of the Chamber have outlined today.
This helpful and useful debate will help to take our thinking forward as we begin our work on refreshing the carers strategy. Hon. Members cited many examples of good practice on the ground, and they offer beacons of hope for how services might look across the country. Challenging those who commission services locally to ensure that they learn from such examples of good practice is a task for not just the Government, but everyone. Examples of best practice do not come from the statutory sector alone, even though the most innovative parts of that sector are themselves beacons. As many hon. Members have said, we also have to applaud and encourage the social enterprises and social entrepreneurs who have spotted opportunities to do something for their communities and found the resources to do so.
I have identified a number of key issues from this debate: what we can do better to identify carers, whether they are young, old or from ethnic minority communities; what we can do to provide information and support for carers so that they can navigate their own way through the system; and what we can do to make the system simpler so that it is not the maze of benefits and complex rules about which we have heard so much in the debate. We realise that people who wear the label “carer” are not all the same. Carers are unique individuals confronting unique circumstances that require individualised and personalised responses. I agree entirely with hon. Members’ points about the need to empower carers as well as the people being cared for.
I will try my best to answer the questions that have been put today, but if I miss anything out, I guarantee that I will write to hon. Members with a fuller response than I can give today. I will also ensure that the points that have been made, particularly in respect of benefits, are raised in cross-ministerial and cross-departmental discussions on the carers strategy at the right place and at the right time. I want them to be taken into account as the work around simplifying and modernising the benefit system is taken forward.
The hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke for the Opposition, made a number of points, many of which we can work on together. Many hon. Members will be aware of her track record inside and outside the House. Elements of her speech made me feel that she expected me to take full responsibility for the things that the previous Government did not quite get right, such as the times when their implementation of a measure was flawed or when they failed to take note of representations. Although it is entirely fair for her to rehearse the points that I made in opposition—I certainly take those to heart—she will understand if I say to her that the last Government’s record left a lot to be desired, by which I mean that the improvements for which carers were hoping were not actually delivered.
Reference has been made to the huge financial pressures in many of our public services at the moment. I was struck quite strongly by the way in which the cuts that have been in train in local authorities for many months are somehow being laid at the door of this Government. In reality, those cuts were initiated and conceived under the last Government, and I just wish that there was a bit more humility and understanding of that. We have a shared challenge when it comes to dealing with the huge public sector deficit in this country. It is all well and good challenging this Government about what they will do in terms of the spending review over the next few months, but it would also be appropriate for a responsible Opposition to offer up suggestions that they believe would be painless that we could do instead.
Barbara Keeley
I do not know whether the Minister has experienced this during his parliamentary career, but the constituency that I represented between 2005 and 2010 covered two local authorities, and it was interesting to see the different priorities that those authorities gave to their work in social care and for carers. We heard a very good example of that in the debate, as Hammersmith and Fulham is adopting a swingeing policy that could take away a vital resource from carers, which I hope that something can be done about. I have heard the leader of Salford council hotly defend the fact that he would rather spend money on adult social care than on potholes, yet quite a lot of people in the city want money spent on potholes. Transparency and localism is one thing but, as with other aspects of health and support services, we could end up with a situation whereby a council such as Hammersmith and Fulham could remove a service, leaving its carers with nothing, while another area, such as Salford, would have excellent voluntary organisations and a council that prioritised social care.
Mr Burstow
The hon. Member for Hammersmith (Mr Slaughter) made some important points about the situation in his constituency and what his local authority was doing. The hon. Member for Banbury (Tony Baldry) also made references to the impact of tendering. Those are issues to consider, but I am not going to become a Minister responsible for micro-managing every single local authority and the decisions that they take on the allocation of resources—that is not a Minister’s job. However, we do need to ensure that there are not unintended consequences with respect to the rules and procedures followed by local authorities that fall under the Government’s responsibility. I will be very happy to hear further from both hon. Members, either in this debate or afterwards, to ensure that we have the correct rules. We want to support local services that are appropriate to a local community and that the community actually values.
Mr Slaughter
For the avoidance of doubt, I just want to say that it is not so much the financial situation in my area that I am concerned about, because my local authority says that it will, in due course, provide a service for carers. I am more concerned about the impropriety and mismanagement that has led to a long-standing service being simply dissolved overnight although there is no provision in place for the best part of a year to come. I would have thought that that was something in which a Minister and the Government would be interested. It is not to do with involvement in individual cuts; it is to do with the fact that a local authority is unable to manage its own affairs.
Mr Burstow
The hon. Gentleman has been a Member for some time, so he will know that there are regulatory systems in place that would deal with local authorities that were performing in the way that he describes. I am not aware that the authority’s activity has been reported in such a way. However, I stand by the offer that I have made, and I will be happy to receive further representations about the impact of tendering arrangements.
I want to pick up on the references that were made to the operating framework because the hon. Member for Worsley and Eccles South was right to point out that, in the operating framework that the Government issued just last week, we identified a requirement in the local priorities for the publication of dementia strategies. We think that that is an important signal. It was a signal to local PCTs that we wanted them to be more public facing and accountable to their local communities, and that they should account for why they have chosen not to spend money on dementia strategies. The signal was not specifically about dementia, but that we expected more of that sort of transparency in general. People should not need freedom of information requests to get information from PCTs about how public money is being spent, and I hope that that message will be understood by our local organisations that deliver such services.
The hon. Lady also talked about ring-fencing more broadly. The Government are determined to ensure that there is as much flexibility as possible for local authorities to make choices about how they prioritise their resources to deliver what is necessary to meet the needs of their local communities. We have made it clear that because we see the social care transformation grant as such a priority for investment in changes to services, so that they are genuinely personalised in the future, the budget for the final year in which it is available to local authorities will continue to be ring-fenced. We wanted to send the signal that we considered that grant to be important, and we want to ensure that local authorities deliver that grant during the course of this year.
The hon. Lady made a number of very useful points about good practice and the way in which GPs, schools and others play a part in delivering early identification of carers, whether those carers are young, old or otherwise. That should certainly inform the thinking of any Government when it comes to delivering a good carers strategy.
The hallmark of this important debate has been the great consensus about what needs to be done and the value that Members from all parties place on carers. I shall now try to address some of the other points that have been made.
The hon. Member for Stretford and Urmston (Kate Green) talked about financial issues and benefit changes, and such concerns were echoed by others. The carers cross-government programme board, which is charged with providing cohesion around the carers strategy, will look at those issues and hold cross-government discussions about them to ensure that the way in which we go about simplifying the benefit system actually delivers the right results at the end of the day.
The hon. Lady also expressed concern about the impact of public service cuts, which was also referred to by several hon. Members. Again, it is important to remember that some of the measures that are already in place were not initiated by this Government. Nevertheless, we have to be mindful about the impact of any budget decisions that we make through the spending review process. That will certainly be at the forefront of Ministers’ thinking in the coming weeks and months as we consider all the options that will have to be considered as part of the review.
The hon. Lady also talked about the difficulties faced by carers coming back into the workplace—the cliff edge, as she described it. The coalition Government’s programme sets out very clearly a desire to improve this country’s tax system significantly so that we raise the amount at which someone starts to pay income tax to £10,000. We believe that as we move towards implementing that change, we will begin to smooth out some of that cliff edge and start to have a significant impact on easing people’s return to work.
The hon. Member for Kingswood (Chris Skidmore) made a very good speech in which he set out a number of the challenges that we face. In particular, he rightly discussed the current complexity in the benefit system and the way in which it can be an obstacle to take-up of benefits.
The hon. Member for Hartlepool (Mr Wright) made a very good speech. He set out a range of issues relating to young carers in particular, but he also raised other points. He made a very important point about the Hartlepool carers centre, which he mentioned a lot in his speech, and it clearly provides an important service in his area. He also cited the £150 million a year that it saves taxpayers by reducing pressures on NHS resources. We need to ensure that such examples of social enterprises playing a part in easing pressure on public services and helping carers are considered. Such mutual operations can really make a difference.
The hon. Gentleman, like several hon. Members, talked about the role of GPs. He also made some comments about benefits. I refer him to what I have said about how we intend to move forward on benefits.
The hon. Gentleman also asked specifically about young carers. The key point I would make is that the Department of Health is piloting personal health budgets. In my written ministerial statement on Monday, I announced how we intend to evaluate those schemes. The schemes should give us yet another way of smoothing and removing some of the cliff edge that we have heard about by providing access to resources for care and health in a way that allows people to exercise real control over them and therefore much more control over their lives. That is particularly important for managing and smoothing the transition from childhood into adulthood, and we all want to ensure that that transition is made smoother.
The hon. Member for Chatham and Aylesford (Tracey Crouch) spoke about the key issue of the identification of carers. She said that only 5% of carers in her area had been identified by the local carers centre. A large number of people are hidden at the moment and do not necessarily identify themselves as carers. The identification of carers is a key challenge as part of the process of refreshing the carers strategy.
We have heard about the importance of flexible support for carers. Again, that is why personalisation will remain an absolutely central part of how the Government take forward the development of services. Such services should be tailored to fit around people’s lives, rather than requiring people constantly to navigate around them, often for the convenience of the service provider rather than the convenience of the person or family themselves. We want to accelerate towards achieving that vital aim, and we also need increased use of more user-led organisations that are much closer to the circumstances of the family, meaning that they can play an important part in advocacy, brokerage and helping families to navigate around the system.
I think that I have already addressed the main point made by the hon. Member for Hammersmith, who clearly put on record a number of powerful testimonies from his constituents about the value that they place on the centre to which he referred. However, as I have said, I will not attempt to micro-manage the decisions of local government colleagues of any particular party persuasion, as it is for them to account to their electorate for the way in which they spend public money.
The hon. Member for Totnes (Dr Wollaston) discussed young carers and talked about the devastating impact that alcohol can have on people’s lives. She offered advice about some of the ways in which the Government might tackle that issue, such as a pricing policy, and cited advice that the NICE has given. I can tell her that we will be publishing a White Paper on public health later this year setting out the Government’s approach on such challenging issues. I hope that my right hon. Friend the Secretary of State for Health will say more about that White Paper in the not-too-distant future.
The hon. Lady also talked about safeguarding, and we have announced a review of the vetting and barring system. I am one of the Health Ministers with responsibility for safeguarding, so I will receive the recommendations from that review. We need to ensure that the system is proportionate to the risk and that it delivers the appropriate safeguards, but it must not be so bureaucratic and difficult that it actually becomes a barrier to people participating as volunteers, so that is one of the tests that we will apply to the system.
The hon. Member for Liverpool, Wavertree (Luciana Berger) talked about the USDAW campaign, as well as the importance that she attaches to the role of carers in her constituency, some of whom she has already visited. She also discussed the plight of working carers, their interaction with the benefits system and the need for an examination of tapering as a way in which people could retain an element of carer’s allowance. All I can say at this stage is that the Government are committed to reviewing the system with a view to simplifying it.
The hon. Lady also asked how we could ensure that there is greater awareness of the right to seek flexible working. Again, that is not just a challenge for the Department of Health. We will need a cross-government approach on the issue involving my colleagues in the Department for Business, Innovation and Skills and the Department for Work and Pensions. Together, we have a part to play in ensuring that people are genuinely aware of that right.
The hon. Member for Blackpool North and Cleveleys (Paul Maynard) spoke very effectively. I was in the House when he made his maiden speech and it was one of the most impressive that I have heard. I know that his speech was excellent compared with mine 13 years ago.
Mr Burstow
I wish that I had not put it that way, but there we go. That is the trouble with putting things on record.
We heard about the National Audit Office report on Jobcentre Plus, and it is important that the Government pay close attention to the work of the NAO. I was a member of the Public Accounts Committee during the last Parliament, and when the NAO identifies opportunities to obtain value for money and get more out of existing resources, it is important that we take them. If the report is not already required reading for DWP Ministers and officials, it should be.
The hon. Member for Blackpool North and Cleveleys also discussed the care to share forum that was set up to consider respite. We see peer support as a powerful part of what the big society is all about. It enables people to step up and support each other, rather than seeing local authority services as the solution to everything. The right to respite has been discussed a lot in this debate. It is often not the case that a carer wants a week off; a matter of hours can make a huge difference. When I was visiting some services in Newham recently, I met the people who run a telecare project and several carers who had benefited from it. It was clear that what was important to them was the knowledge that the person for whom they cared was safe so they could have a cup of coffee with a friend, a chat and a bit of real life, as that refreshed them. We need more such opportunities for many others.
The hon. Member for Llanelli (Nia Griffith) discussed how we can ensure that carers can both stay in work and return to work. She also mentioned Alzheimer’s and dementia, and research into those diseases. I am sure that she will know that, in the coalition programme for government, we indicated a clear commitment to prioritise dementia research. I am the Minister who chairs the board with responsibility for considering the issue, and we will be making announcements about how we will take it forward in due course.
The hon. Member for Banbury said some kind things, as a result of which I now feel immense pressure—thank you very much! He also made a good point about carers week that I read in this way: carers week is not an annual event; it is every week. We need to find ways to make that not just a platitude but a reality for carers throughout our country. He spoke a lot about the role of GPs as commissioners and the difference that they can make. They are one of the universal services and they see many carers. We must ensure that all GPs understand that when someone comes to see them because of a sickness or disability, the person with them is often the carer, who needs to be identified and offered the signposting and support that will make a difference for them.
The hon. Member for Banbury mentioned the caring with confidence programme, as did several other hon. Members. I purposely included it in my opening remarks because I wanted to be up front about what I had decided to do. My view, having considered the evidence about the programme, was not that the training materials were not excellent—they are well regarded by the carers who have been through the programme—but simply that we were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly. Now the money will be reinvested into delivering more training—including GP training, which has been mentioned—and more support for carers. We will make further announcements in due course.
Barbara Keeley
As with other developments, I did not hear about this in the House; I heard about it from carers organisations. Does the Minister realise the extent to which carers support groups and organisations are concerned? They were geared up and trained to deliver the programme. Having useful materials will be a good thing, but materials are not enough to run a course. They need somewhere to run it, a trained person—probably paid—and resources during the day. It would be useful if some of the money could be diverted to training GPs, but that is a mainstream NHS matter. I emphasise that there is a great deal of concern among carers organisations about the programme, so anything that the Minister can do will be a help.
Mr Burstow
I am grateful to the hon. Lady for that point. I spent time earlier this week on the phone with all the carers organisations that have a direct interest in the matter. We are discussing actively with them the best way to reinvest the money to deliver good outcomes for carers. As and when that becomes clearer, I will certainly make further announcements to the House.
Tony Baldry
Will my hon. Friend tell us when the general issue of funding for carers will be addressed, and whether it will be addressed in the carers strategy?
Mr Burstow
I am looking at my notes on the points about benefits that the hon. Gentleman made and the precise time scales. Obviously, I am not the Minister responsible for the review of welfare benefits, which several hon. Members have mentioned, but it is clear that the timetable is quick and that reports back will be made during the spending review. Hon. Members who have representations to make about how we ensure that carers’ interests are served within those changes should therefore make them now. This debate is a good part of that process, and I will ensure that the matter is kept in the minds of Ministers and officials.
There will be tough decisions, one of which has been my decision about caring with confidence. We will need to ensure that every penny we spend has an impact on the lives of carers, but we must make no false economies. One of the themes of this debate is that we must ensure that the investments that we make deliver good outcomes, and that when we must reduce public expenditure, we do not just shunt costs around the system. We understand that point.
I hold to the view that carers are an important thread that holds communities together. We need to do more to support them. Their value will grow as our society ages and people with disabilities live longer. We must ensure, both across parties and within the coalition, that the refreshed strategy delivers tangible results, rather than being just a statement of intent. It must be clear about delivering change for carers. That is this Government’s commitment, and I look forward to making the difference, along with colleagues, as we go forward.
Question put and agreed to.