Tobacco Packaging

Paul Burstow Excerpts

Thursday 7th November 2013 Commons Chamber

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

I rise as chair of the all-party parliamentary group on smoking and health. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman), a fellow officer of the all-party group, on securing this important debate, which is an important opportunity for the House to continue to put pressure on the Government to move on this issue. I am a co-sponsor of the debate. It should come as no surprise that the APPG strongly supports effective action to reduce the harm that is caused by tobacco. I welcome the contributions from the hon. Member for Stockton North (Alex Cunningham), my hon. Friend the Member for Harrow, East and the hon. Member for Barnsley Central (Dan Jarvis), all of whom set out compellingly the piles of evidence that show the effectiveness of standardised packaging as a further aid to tobacco control and reduction of the harm that tobacco does. That surely has to be a key goal of public health policy in this country.

Reducing the number of people dying from preventable disease and of people living with chronic disease has to be a key part of what this debate is all about. How do we address that? By tackling risk factors—in this case, the risky behaviour of taking up smoking in the first place. A variety of interventions can make a difference. In this country over the past few years, parliamentary action and parliamentary pressure have persuaded Governments to do something. I congratulate the right hon. Member for Rother Valley (Mr Barron) on his initiative when he was Chair of the Health Select Committee to enable the Labour Government to bring in via a free vote the ban on smoking in enclosed public places.

No Government have a particularly good record of leadership in this area. Most Governments tend to have to be led by this place. That is why we are having this debate today, and I hope the Government will take their lead from this House and the other place, because both Houses have a cross-party unity of purpose in addressing these issues. We have seen that progress over the years.

Over the past 15 years the combination of measures has made a difference. Smoking prevalence has fallen among adults by a quarter and among children by as much as half. More clearly remains to be done, as the debate so far has demonstrated. Smoking is still a major cause of preventable disease and death. It far outweighs the next six major causes. When it comes to public health and to children and young people, we have a special duty, over and above that which we owe to all our fellow citizens. That duty is clear: we should act. Above all, standardised packaging is about protecting children and young people, as has been said in this debate.

Big tobacco must attract children. Why? Because its product kills 100,000 of its customers every year in this country, and it needs to replace those dead customers. The evidence is clear. Smoking is a childhood addiction, not an adult choice. We need to understand that. Some 40% of smokers are addicted by the age of 16, and two thirds are addicted by the age of 18. Two hundred thousand children take up smoking every year and about 530 of them do so in my borough, the London borough of Sutton. Very few people start smoking over the age of 20, as we have heard.

The focus on the recruitment of children has been admitted by big tobacco. The tobacco industry knows how sensitive children and young people are to brands of all sorts. Removing the brightly coloured packaging has been shown to make a difference. It has made those products less attractive to children.

[Mark Durkan (Foyle) (SDLP)]

The right hon. Gentleman rightly emphasises addiction, but have we not heard, even in this debate, that this is addiction marketed as freedom?

[Paul Burstow]

Absolutely, and that is the most pernicious part of it. It is addiction posing as freedom of choice, whereas once they are addicted, people have lost their freedom of choice, and it is very hard to step back from that.

[Jake Berry]

On the subject of free choice, I am interested to hear that three-quarters of smokers take up smoking between the ages of 16 and 18. If people are not capable of exercising free choice at the age of 16, why does the right hon. Gentleman think it right that the Lib Dems have a policy of reducing the voting age to 16?

[Paul Burstow]

To make sure that the record is clear, I said that two thirds of smokers are addicted by the age of 18. It is entirely right that we have the debate on the voting age. The House has voted on the matter and has supported the idea that we should allow people to exercise a democratic choice at the age of 16, but that is not today’s debate. Although I would hope that voting was an addictive behaviour, it is not, and getting people to vote at an earlier age is more likely to get the participation rate up. That is why I support it and why my party does as well.

Let me move on to another point about what the industry has as its agenda. Imperial Tobacco’s global brand director, Geoff Good, has said that package redesign has been worth

“over £60 million in additional turnover and a significant profit improvement. . .the UK had become a dark market, the pack design was the only part of the mix that was changed, and therefore we knew the cause and effect.”

That was in 2006. Tobacco advertising is already banned in the UK. The branding and brightly coloured packaging clearly meet the legal definition already in existence. They are a form of commercial communication with the aim or direct or indirect effect of promoting a tobacco product. In the words of Imperial Tobacco’s global brand director, Geoff Good,

“pack design was the only part of the mix that was changed”.

The cause and effect are clear. Package-based advertising should be banned.

In earlier contributions to the debate, reference was made to some types of packaging. One example was Vogue cigarettes. The packet looks like a lipstick container or a perfume product. It is intended to convey the glamour of smoking, about which the hon. Member for Hornchurch and Upminster (Dame Angela Watkinson) spoke earlier.

I have a question for the Minister, which she might be able to address in her contribution later. It concerns the World Health Organisation’s framework convention on tobacco control. I understand that the UK plans to sign the protocol on the elimination of illicit trade in tobacco products. The protocol makes it clear that arrangements for tracking and tracing tobacco products should be independent of the tobacco industry. In other words, the industry should not be allowed to self-police. Does the Minister agree that the EU draft revision of the EU tobacco products directive should give full effect to the World Health Organisation protocol to ensure independence of action for our enforcement agencies in dealing with the illicit trade?

I welcome the Minister’s remark at Health questions a week ago that she was examining the issue “very carefully”. However, having already considered the evidence, her predecessor made it clear in the House and elsewhere that she supports the measure, as does my hon. Friend the Minister of State, Department of Health. Why do we still have to wait for the Australian scheme to be tested further? We know after the first 11 months that it has been bedding in well. As we have heard already, it is having a material effect on consumer behaviour. Consumers are reporting that they think the same product tastes different. The same product is less attractive. Standardised packaging is affecting behaviour, which is a key element of this drive.

There is clear and sustained public support for standardised packaging. National polls show that two thirds of the public want to see the Government act on this agenda. When my local paper, the Sutton Guardian, ran a poll recently, it found that 80% of those who took part in that poll backed standardised packaging. Other nations in the United Kingdom are choosing to act. Other nations in Europe are choosing to act. The evidence is mounting, as is the death toll and as is the recruitment of children and young people to this pernicious habit. May we now see action? May we have something that children and young people deserve—this Government and this Parliament acting to protect them from the harm of smoking? Standardisation of packaging is the next step in effective tobacco control and I hope the Government will take that step soon.

Changes to Health Services in London

Paul Burstow Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Speaker]

Order. I should just say to the House, almost as a courtesy, that I am prioritising London Members. However, non-London Members should take heart. If they exercise their knee muscles they may have an opportunity in due course.

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

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was absolutely spot on in her question to the Secretary of State, not least with regard to variability and accessibility of GP services. A few months ago, I asked him whether he would make it a requirement for plans to expand out-of-hospital care to be in place before hospital changes occur. Can I take it from his statement that it is his intention that, when recommendations from the Independent Reconfiguration Panel are before him, he will require plans to build capability for community health services and primary care services to be in place before they go ahead?

[Mr Hunt]

The right hon. Gentleman campaigns assiduously for his constituents. I recognise that there are worries about potential changes in his constituency, an issue he often raises. Yes, we must ensure, if there are transitions or changes, that proper plans are in place to ensure they can be made safely. If he reads the report, he will derive a great deal of comfort from the stress the IRP puts on the necessity of having proper alternative provision in place before any changes are made.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

I can only repeat what I have said: I am a new Minister and I am looking at this very carefully. There are interesting new pieces of information coming through all the time to assist us in making public policy in this area. It is under very active consideration.

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

I welcome the Minister to her new role. Will she, when considering the evidence, look at the fact that the tobacco industry, in its marketing and packaging strategies, is aiming at certain markets, particularly children and young people, whom they want to start smoking? Given her desire to ensure that children do not take up the practice, surely she should act on the evidence by ending the existing packaging arrangements and having standardised packaging so that we can deal with this problem.

[Jane Ellison]

At the risk of repeating myself, all I can say to my right hon. Friend is that I am looking at that very carefully. He is right that we all want to stop children and young people smoking. There is a mass of evidence out there, and we are gaining new evidence and information all the time to help us make decisions. I will continue to look at it as one of the absolute priorities within my brief.

Tobacco Products (Plain Packaging)

Paul Burstow Excerpts

Tuesday 3rd September 2013 Westminster Hall

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

I congratulate the hon. Member for Harrow East (Bob Blackman) on securing the debate at this early stage, so that we can put the case for Parliament making the decision and getting the solution, getting on with it in a way that the Government have been reluctant to do.

I want to pick up on the phraseology: standardised packaging versus plain packaging. Standardised packaging is what we are talking about. It is clear, and enables public health messages to be delivered powerfully. The way in which the packages are designed has a clear psychological impact in reducing the likelihood of people taking up smoking and increasing the likelihood of their quitting. It is important that we talk about standardised packaging, because it really makes a difference.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

The case has been well made that clever packaging seduces children into smoking, but how will standardised packaging impact on the rational adult person’s choice to smoke?

[Paul Burstow]

I would use the phrase “insidious packaging”. That is what we are talking about. We have seen today examples of the sort of packaging that has been used, and in the evidence submitted as part of the preparations for the debate we have seen how those who lead tobacco companies talk about the value they place on packaging as a tool to solicit more custom and get more people to take up smoking in the first place. Big tobacco needs to recruit more smokers because it has to replace those who quit and, more chillingly, those who die as a consequence of taking up smoking. That is why we must have a bias towards action to protect the health of children and young people from the harm that smoking does.

In its systematic review of evidence, published as part of its consultation, the Department of Health gathered absolutely clear and strong evidence of the impact of standardised packaging on reducing smoking. The evidence is there; what is lacking is the political will. The Minister has that will, but the Government as yet do not. Parliament should take a leaf out of the book of the previous Parliament, when it came to smoking in enclosed public places. It was not the then Government who led on that; they hid behind many of the same arguments that are being used now. Yet again, it took the leadership of the Health Committee—having an inquiry, producing a report and publishing the evidence—to make the case for the ban, and the Government being prepared to allow a free vote.

We should have a debate and a free vote in this House to give effect to the policy change, because it will save lives. It is no longer satisfactory or acceptable to be kicking this can down the road. We should not have been doing that with the ban on smoking in enclosed public spaces and we should not be doing it now with standardised packaging.

I hope that people will be moved by this debate and that the Minister can move her colleagues. I know that both she and the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), are committed to this change, which is an essential public health goal. As one speaker said, controlling tobacco and saving lives requires us over time systematically to improve and strengthen regulation. This is another step on the journey of changing public attitudes and saving lives.

Carers

Paul Burstow Excerpts

Thursday 20th June 2013 Commons Chamber

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

I beg to move,

That this House has considered the matter of carers.

I start by thanking the Backbench Business Committee for choosing this as the first debate of this parliamentary Session since the re-establishment of that Committee. I very much appreciate the fact that within the space of a few days after the celebration of national carers week, the Backbench Business Committee was able to grant us this time to examine how better to support carers in this country and to recognise the extraordinary contribution that each and every carer makes to their families and our society. I am grateful to my hon. Friend the Member for Banbury (Sir Tony Baldry) and the hon. Member for Worsley and Eccles South (Barbara Keeley) for their support for this application and for the contributions that I look forward to hearing from them later in the debate.

As I said, last week was national carers week. With over 10,000 events up and down the country—I am sure that many hon. Members will have had the opportunity to participate in them in their constituency—this was the biggest carers week so far. Here in Westminster, MPs were invited to a variety of events, including a speed dating event with carers with a wide range of life experiences. I had the opportunity to meet, among others, a woman called Karen whose husband has Parkinson’s. She told me about her experience of being a carer for someone with that particular condition and about the isolation she felt, having taken on that caring role. She conveyed a sense of being increasingly excluded from participating in many aspects of society. I met other carers involved with Marie Curie, who told me how, because of the nature of the diagnosis and the rapid progression of the cancers in question, they experienced additional strains and burdens in trying to get the right support at the right time for their loved ones. The week concluded with a lively carers question time event, in which the Minister and a range of experts participated.

This year’s theme was “Prepared to Care?” It highlighted the fact that people who take on caring roles are often not prepared for the physical and emotional impact of caring, nor for its impact on their lives in other ways, not least financially. In that sense, it is worth stressing that this is not a “them and us” issue. It is easy to think about this as something that is going to happen to other people, whereas the figures clearly show that three out of five of us will be a carer at some point in our lives. It will touch all of us, either through personal experience or through our family’s experiences.

I want to pay particular tribute to the carers I have met over the years in my constituency during my time as a Member of Parliament. I want to thank the Sutton Carers Centre for being a lifeline for thousands of carers—young and old alike. The carers centre in Sutton has been my guide and teacher on carer issues over the past 15 years. Whether through shadowing carers to learn directly from them or meeting carers at the centre, I have found that the things they want—the things they tell me they want—are not impossible or unreasonable. They do not want to feel that everything is a constant battle—a battle to get a diagnosis, a battle to get an assessment, a battle to get support, a battle to get a break, or, indeed, a battle to navigate around the system.

Over the years, I have met and listened to many carers in my constituency and I have met carers for whom the lifeline that keeps them sane and keeps them connected is not the formal social care support, nor even the carer centre. It may be, for instance, the local bowling club, as I learned from one of the carers whom I shadowed. The determination of the club’s members to support a friend was the most important thing in that person’s life. Not enough is made of such informal, often fragile networks of support, although they often represent the vital difference between just surviving and having a life.

There is clear evidence that the caring role takes its toll on people, physically, emotionally and financially. Six out of 10 carers report experiencing depression because of their caring role, and, as I have said, caring can be a lonely business: three out of five carers say that they have experienced difficulties in maintaining relationships with friends. Another problem is the desire of many carers to stay in the workplace so that they can remain connected through their work. More than 3 million are trying to balance their caring responsibilities with paid work, often at the expense of working hours or their career prospects.

Last June I hosted a carers summit with the forum Employers for Carers, led by BT. The aim was to explore opportunities to help carers to remain in the workplace. BT and other members of the forum, such as British Gas, have a good track record in that regard. They invest in their staff and want to retain them, so identifying and supporting carers seems logical to them. The cost to the bottom line of a business of replacing a member of staff can be huge, and one of the purposes of the summit was to enable more employers to see the business case for carer-friendly employment practices. The Government subsequently established a “task and finish” group to consider ways of creating an environment in which people could balance their caring responsibilities with their careers. That work is vital.

According to a recent survey conducted by YouGov for Carers UK, an estimated 2.3 million people have given up work at some point to care for an older or disabled loved one. One in four gave up work or reduced their working hours because the cost of replacement care was too high, and a similar number reported that services were not flexible enough to meet their needs. The impact of being forced to give up work to care for a loved one on an individual’s finances alone is clear, but the London School of Economics has estimated that the hidden cost to the economy—in benefits and lost tax revenues—is a staggering £1.3 billion a year, every year. When lost earnings are taken into account, the figure can rise to as much as £5.3 billion. That is not a cost that the United Kingdom can continue to bear as a consequence of a failure to act and provide the safeguards, supports and systems that would enable carers to remain in employment.

There is an urgent need to us to reframe the debate. We must stop focusing on the burden on the economy, and see caring as an asset and an opportunity. We must begin to view it in the way we view child care support and services. Carers must be entitled to more flexibility at work, although the Government have done much in that regard. Given the scale of demographic change—the over-85s are now the fastest-growing section of the population, and their number is set to double by 2030—and the growing proportion of “sandwich workers” who are attempting to juggle paid work with the demands of caring for both children and older relatives, the provision of flexibility is becoming an imperative. The Government must also think about how the market for low-level support services such as cleaning, shopping, gardening and befriending can be increased and, crucially, brought into the formal labour market.

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

I congratulate the right hon. Gentleman on securing the debate, which is timely given some of the things that have been happening in old people’s homes. Does he agree that there is a case for asking employers to help people who have to care for a family member? Such people are often under stress, and if they have to give up their jobs, their standard of living will fall as well.

[Paul Burstow]

That is a key point, and one that I want to put to the Government very strongly. Carers can only be helped to remain in the work force and balance their working lives with their caring responsibilities if the right substitute care and flexibility are available, and if employers have the right attitudes in the first place.

[Kate Green (Stretford and Urmston) (Lab)]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will take one more intervention, but I must not take too many more, because I have only 15 minutes in which to speak.

[Kate Green]

Could not public sector employers be exemplars in this respect? Can the right hon. Gentleman suggest any ways in which such good practice could be spread throughout the public sector?

[Paul Burstow]

The hon. Lady is absolutely right to say public sector employers should be—and could be, and must be—exemplars in this. Indeed, it would be great if the NHS itself was an exemplar in this area, yet as I will come on to say, I think in too many ways institutionally the NHS is rather biased against carers, and certainly blind to their needs in too many cases.

There is an economic reason why we need to do more in this area. It is estimated that as many as 50% of those involved in personal and household services operate in the grey economy. This represents a further missed opportunity in terms of job creation and lost revenue to the Exchequer. Looking across the channel to France where work began almost a decade ago to address a number of these issues, market development for homecare services has led to the creation of an additional 2 million jobs, with the industry becoming one of the biggest growth sectors in that economy.

There are clearly lessons to be learnt in how to support and strengthen carers’ ability to care in a way that supports the wider UK economy. I hope the Minister will be able to tell us when the “task and finish group” recommendations will be published.

Moving on, one of the most practical ways to support carers is to provide them with breaks from caring. That can help reduce the stress and the often constant demands that caring involves, and allow them to have the time to improve their own physical and mental health.

In recognition of the value of carers breaks, the Government committed in the 2010 spending review to spend £400 million over four years on breaks for carers living in England. As the Minister at the time, I was convinced of the importance of giving carers a break and knew that it would make a huge difference to their lives. I therefore regret that the evidence suggests that that has not happened. Monitoring by the Carers Trust for the year 2011-12 found that action on the ground had often been slow or non-existent. Despite clear reporting requirements, in many areas it was impossible to track how money had been spent, and in a small minority of cases nothing at all had been spent on services for carers. Some fantastic work has been done, but progress has remained appallingly slow. To be fair, this problem has dogged not just the coalition Government, but successive Governments.

I ask this question: what is the common factor? The common factor is the institution we are using to direct the money, which is the NHS. It does not see carers as significantly important contributors to it, and therefore it does not see this money as worth spending on them. That has to change.

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

I acknowledge the right hon. Gentleman’s efforts when in government, and I agree that this issue has dogged successive Governments. I wonder whether we have reached the stage where we have to give some clear statutory rights to carers in respect of respite care, because whatever organisation has the budget, it does not seem able to recognise that this is an essential need if a person is going to continue to be a carer. Would the right hon. Gentleman entertain that approach?

[Paul Burstow]

To be honest, in this area the NHS is probably drinking in the last-chance saloon. If we do not see progress, legislation may be necessary. There is another way in which the money could, and should in future, be earmarked for this purpose. There have been transfers from the NHS to local authorities for the support of social care more generally, and in some local authority areas that has happened with the carers break money as well; it has been transferred. It has not happened everywhere, however, and I think it should now become mandatory, so this money gets spent for the purpose the Government said in their spending review it was for. That is a perfectly reasonable thing to expect, and the Government need to reflect on three years of this money not getting where it needed to be, after a number of years of that under the last Government as well.

A survey by Carers UK found that in one in five cases where a person who was receiving care from family or friends was admitted to hospital as an emergency, that could have been prevented if the carer had received more respite care and support. This makes big differences financially to the NHS. It uses resources better, and that is why it beggars belief that the NHS has not yet made sufficient progress, with its partners in local government, to improve access to breaks for carers.

Under the health service reforms, with clinical commissioning groups taking the lead, there have been some examples of improvement, such as in Huntingdon, where there is an interesting carers breaks project led by GPs. Partnered with Crossroads Care, they identify carers by meeting them socially, and prescribe breaks. Carers who are met in that way tell me they have for the first time had the experience of having raised their needs as carers and seen that translated into tangible action that made a difference for them. We need to see more of that. It is a vital lifeline.

As has already been said, there are huge issues to do with identification of carers. Research by Macmillan has found that while over 70% of carers came into contact with GPs, doctors and nursing staff, only 11% of all carers reported that they had been identified as a carer by a health professional. We as a Government talk about making every contact count, and we should do so when it comes to identifying carers. I hope the Minister can look afresh at what we can do to challenge NHS England to fulfil its obligations. I hope the National Audit Office will take a look at how successive Governments have attempted to engage the NHS with the carers agenda.

I want to finish by talking briefly about the Care Bill. It is no small thing that this is the first ever Government Bill to provide for carers’ rights. Until now, the cause of carers has been advanced by private Members’ Bills. Let me place on the record my appreciation for the work of the late Malcolm Wicks, whose Carers (Recognition and Services) Act 1995 was a landmark in the rights of carers and a fitting legacy for such a thoughtful and generous Member of this House. For the first time, the Care Bill enshrines in legislation carers’ rights to an assessment of their needs and, importantly, establishes a duty to meet those needs which are eligible. It also establishes clearly the need to consult and involve carers in decisions about the care of those they care for.

Although the Care Bill is hugely welcome, inevitably there are gaps and unintended consequences that must be addressed if all carers are to get the support they are entitled to. Following the Government’s welcome announcement last week of their intention to amend the Children and Families Bill to ensure that the rights of young carers are as strong as those proposed for adult carers, we must see the necessary changes to it and the Care Bill, and ensure that the rights of parent carers of disabled children, which have so far been neglected in both Bills, are not allowed to fall through the cracks.

I look forward to colleagues’ contributions and hearing them draw on their experience of engaging with carers in their constituencies. I know from talking and listening to carers, and from tweeting about carers’ issues, the genuine and palpable outrage they feel because all too often they are overlooked and under-supported. We need to change that. The Government are making good progress, but more still needs to be done.

--- Later in debate ---

[Barbara Keeley]

I thank the Minister for that point, but I have to tell him that he and the children’s Minister have to start to accept that making reassuring noises and having meetings is not enough.

[Paul Burstow]

The hon. Lady is absolutely right to be pushing this issue forcefully. We were given a commitment by the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson) last week that amendments would be drafted, and presumably they will be tabled in the House of Lords. It would helpful for us to know, and to hear from this Minister, that the Government will shortly be publishing the amendments that will be made to the Care Bill as well as those that will be made to the Children and Families Bill.

[Barbara Keeley]

I thank the right hon. Gentleman for that point. I am, however, going to push the matter with the Minister because there was an opportunity in this regard. New clauses were moved during the remaining stages on the Children and Families Bill last week that were copies of clauses from my Bill, and they would have required those bodies that I talked about to have policies in place. We are not talking about a large financial commitment; we are talking about bodies having policies in place. Our schools, our colleges and our higher and further education institutions should have policies in place to recognise young carers, but up and down the country they do not have those. The disappointment that organisations outside here that support young carers will have felt results from the fact that the debate was managed last week so that those new clauses were not reached. That does not show good faith, and if I were a member of the coalition of organisations that support young carers, I would look at that and say, “I don’t know what the Government are going to do.” The Minister will have to accept that they are still disappointing people who have not been protected sufficiently by the law.

I conclude by touching quickly on the financial context of social care and how it affects carers. Giving carers rights in the Care Bill is indeed a positive step, but the Local Government Association reminds us that the Government’s austerity programme and the need for further savings do not fit well with the aspirations of the Bill. Councils have had to reduce their adult social care budgets by 20% over the past three years. At least a quarter of those cuts are from reductions in services and increases in charges. Almost 90% of councils only meet needs that are at the substantial or critical threshold.

Staff at our local carers centre told me that carers are being affected by the bedroom tax, the increase in the value of non-dependent deductions, fewer sources of grant funding, and reductions to care packages that appear to be driven by cutting costs, not by changes in need. That is particularly true where they are caring for somebody with a learning or physical disability. Worries continue into the future when the change from disability living allowance to the personal independence payment starts to affect carers. The Government’s own impact assessment published in February indicated that almost 10,000 fewer carers will be entitled to carers allowance by 2015 as a knock-on consequence of the loss of disability benefits following the introduction of PIP. Carers UK has calculated that this represents a £31 million cut in support to carers. We should bear in mind that if those carers were left unable to care as a result of not having access to those carers benefits, replacing the care that they provide would cost at least £300 million in replacement adult social care services. That is a serious point.

This morning I asked a question about the loss of £28.3 billion of income for disabled people over the next five years through the combination of the welfare changes being made. We must take on board the fact that that loss of income will hit the carers of those disabled people. Carers, as we learned during carers week, are prepared to care. We must do better in supporting them.

--- Later in debate ---

[Sarah Newton]

I absolutely agree that local authorities should be remorselessly focused on the best possible outcomes for the people they have a duty to provide care for. They should also understand that while the vast majority of people are not eligible for local authority care, local authorities have a responsibility as market shapers in their localities to ensure that private, third and voluntary sector organisations are able to provide the care services that most people pay for themselves. By constantly engaging in a race to the bottom, they are undermining the ability of those organisations to provide services to the community. Most private or third sector domiciliary care providers need a certain amount of contracts or business from the local authority.

[Paul Burstow]

My hon. Friend is making an important point about the patchy quality of domiciliary care. There are good examples, such as in Wiltshire, where the service has been remodelled to focus on outcomes. However, there is an issue about whether the Government have the necessary powers to ensure that where poor commissioning practice is allowing contracting by the minute, which is resulting in sub-standard care to an individual, they can ensure good quality commissioning practice in the future. The Joint Committee on the draft Care and Support Bill has recommended a change in the law and the Government are doubtful of its need. Does she agree that the Government need to keep thinking about that and perhaps come back with an amendment?

[Sarah Newton]

I back what my hon. Friend says. The Joint Committee’s report was excellent and showed Parliament at its best. People with tremendous experience from the House of Lords and this place worked together to scrutinise and improve that excellent Bill. The Government should be commended for introducing it at a time of economic restraint, especially as it has financial consequences: spending more money on supporting carers is a bold thing to do at the moment and it underlines the great value we put on carers. I back my hon. Friend in his call for an amendment, because if local authorities are tempted to avoid doing what we would all regard as the right thing—to look after the most vulnerable people in our society—we need to tighten up the law to remove that temptation from them.

I would like to share another issue that was raised in carers week. The strong message from carers was that they do not always feel involved in the decisions made by professionals about the people they are caring for. The Government have, rightly, enshrined in their health and social care reforms the principle that “No decision should be taken about me without me.” I would like to extend that so that “No decision is taken about the person I am caring for without me.” I have heard far too many cases, in my own case work and during carers week—particularly from parents caring for children with disabilities—where substantial decisions, on whether their children should be cared for away from their home many hundreds of miles away, were considered without proper discussion with the parents. That is absolutely wrong. There is a prevalent attitude among some professionals that they know best: “Trust me, we know what is best for your child. Trust me, we know what is best for your wife or your husband.” While I would like to be able to trust all professionals—we think that by and large they do have the best interests of people at heart—there should be openness and transparency. Carers should be involved in decisions, so that there is a joint agreement and an understanding about what is in the best interests of the person being looked after.

On a more positive note, I would like to share some of the good practice I saw during carers week. I saw great examples of innovation involving the voluntary sector, in particular. We have talked about statutory provision and what employers can do, but broader civil society and the voluntary sector have an enormous role to play too. I would like to share two examples from Cornwall, one of which is from my own constituency.

A group of people in Falmouth in my constituency responded to the Prime Minister’s dementia challenge by wanting to ensure that everybody in the community supported people with dementia. More than 200 organisations in Falmouth got together to make it a dementia-friendly community. I was proud, in my hometown, to be at the launch a couple of weeks ago, and I was proud that it was the first town in Cornwall, and probably one of the first in the country, to be a dementia-friendly community.

What does it mean to be a dementia-friendly community? It means that the shopkeepers in the high street have gone through awareness training. It means that we have dementia cafes and that the people in the youth centre are aware of people with dementia. Overall, it means that people who suffer from dementia, or are caring for someone who suffers from dementia, can go into Falmouth with confidence, knowing that they will receive a warm welcome in the shops, libraries, public spaces and the youth centre. The people there will understand more about dementia and some of the behaviour that comes with it. Some people might find that behaviour a little bit challenging and scary, which often makes the people who care for someone with dementia want to stay at home. They can be fearful of the response they will receive in a public space and end up becoming isolated. I can honestly say that people with dementia will receive a very warm welcome in Falmouth, thanks to the huge amount of work done by a small group of volunteers ably led by the Bridges, who are Rotarians in Falmouth.

The whole community has got behind this exciting project—indeed, so much so that another group of people in Falmouth, led by a former nurse, Lisa Dann, has been working with Dementia UK over the last year to raise enough money for two admiral nurses. For those who do not know, admiral nurses, who are similar to Macmillan nurses, are specialist nurses who work alongside those with dementia and their carers, providing a lifeline for people coping with what can be a very difficult condition. Lisa was motivated to set up the charity and raise funds because of the poor support that her mum and her family received when her dad was suffering, before sadly dying from dementia.

Lisa has created a fantastic legacy in recognition of her father by raising enough funds—£60,000 in one year, which is a great credit to her, her team and the community—for the whole of Cornwall to have two admiral nurses. Her group is working innovatively in a partnership with a large social enterprise in Cornwall—Cornwall Care, which is the largest independent care provider in the county—to make the scheme sustainable. The group will be raising more money for more admiral nurses, which will provide a huge amount of support for carers, as well as people suffering from dementia. That is a good example of how the voluntary sector and volunteers can create a caring environment for carers.

--- Later in debate ---

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

I congratulate the Members who helped to secure today’s debate.

During the debate on the Queen’s Speech, I referred to the experiences of two carers in my constituency. One was Lynne Hanslow, who cares for her 96-year-old father, keeping him out of residential care. All that she asks for is a fortnight’s respite break each year, but this year, despite having given the council four months’ notice, she was denied that break and was abused by a local authority employee when she complained about her treatment. Not surprisingly, Ms Hanslow ended up having to go to her GP. A carer had been made ill by neglect and worry.

I have spoken to the council’s director of adult services, but so far Ms Hanslow has not received the full apology that she deserves, along with a promise that that will not happen again. I believe that the council’s chief executive should make the apology, thus sending the signal that he means to take the needs of carers seriously and will not stand for his staff treating them with contempt. Ms Hanslow’s experience is one of the reasons for my conclusion that statutory respite care should become a legal, enforceable right for carers. We have tried the other approaches for too long.

I also mentioned the case of Margaret McGarry. She cares for her frail elderly mother, who suffers from dementia. Her direct payments have been suspended, apparently in retaliation for her having had the temerity to go to a solicitor because she felt that the local authority was being unreasonable in terms of the flawed level of support that it was prepared to provide. There should be a much simpler independent review process for carers like Margaret McGarry who are treated in such an appalling way. The current system seems almost to be weighted in favour of officials and bureaucrats, at the expense of carers. I wonder whether the time has come for local authorities to create carers champions to look out for carers’ interests. I have come to the conclusion that local authority complaints procedures in much of the NHS these days are not about problem solving at all. They are about process. They are almost a game to create an illusion of accountability. I think we need a champion who will listen to carers’ concerns.

[Paul Burstow]

I think it is worse than that. The balance of power is entirely wrong. It is too much on the side of the local authority to which the individual is complaining. That is why we need advocacy, but it is also why we need to look at the case made in the Joint Committee report on the draft Care and Support Bill for the need for a tribunal service, to start to address these matters in a more impartial way, detached from the local authority. How can a local authority investigate itself?

[Steve McCabe]

I certainly agree with that, although I would be reluctant for us to have a complex system that the carer has more difficulty accessing. I take on board the right hon. Gentleman’s point, however.

In arguing for a champion, I am looking for someone like a councillor, with sufficient clout to intervene and right wrongs and cut through the madness and bureaucracy that all too often ends up punishing, rather than protecting, the carer. That does not mean we should not also have further review and appeal processes, but I want us to have something simple that people can make use of and that will make a difference.

A champion might also do more to make sure the voices of ordinary carers are heard. I am thinking about the hidden carers that so many Members have mentioned—the people who are too busy caring to have time to attend the consultation sessions, which are organised to suit the convenience and working hours of the NHS and local authority officials, so these people are never heard.

[Steve McCabe]

I welcome what the Minister says. I am able to identify these people in my constituency, and I do not understand why it is so hard for the caring organisations to identify them.

I wonder why we do not say that at the point when an individual qualifies for attendance allowance the local authority should be notified and instructed to commence consultations with the person and their carer, with a view to establishing a long-term care plan and review strategy. That could reduce the occurrence of crisis care episodes, and the authority could simultaneously start to develop a support plan for the carer, so the needs of the carer are at the centre of the care plan.

[Paul Burstow]

The hon. Gentleman’s point about attendance allowance is interesting and important. He may know that this week the Strategic Society Centre think-tank published an interesting report setting out how this area might be reformed in a way that provides just what he has described: a front door into the social care system. Does he share my surprise that we have a system that does not talk to social care at least in part because it is entirely paper-based? It is not electronic, and perhaps the Department for Work and Pensions needs to consider putting it on that basis, so the information can be shared more freely.

[Steve McCabe]

I think I probably would agree with that, although the right hon. Gentleman must recognise that the Government are moving increasingly towards systems that do not allow for face-to-face exchange. I understand that that is one of the major disputes about what is happening in the DWP. I think it would make classic sense, however. All of us hear enough about joined-up government, and this is one area where a bit of joined-up government could save money and provide a much better service.

--- Later in debate ---

[Paul Burstow]

Will my hon. Friend confirm that the Government will be publishing amendments to give effect to this within the next week or two? Will he set out the timetable? Will the Government also address the other gap, which is the one regarding parents who are caring for disabled children? We need to make sure that none of those who have caring responsibilities get left behind.

[Norman Lamb]

I cannot give my right hon. Friend a specific time scale for what might happen—he needs to watch this space, and I am sure he will. On the question of parent carers, the view of my hon. Friend the children’s Minister is that there is sufficient provision under section 17 of the Children Act 1989 to provide for the assessment and support of disabled children and their parents. In addition, special educational needs reforms in the Children and Families Bill will give parents more choice in and control over the support they and their children receive.

--- Later in debate ---

[Paul Burstow]

In that case, I shall be very brief indeed, Mr Deputy Speaker, and simply thank all those who contributed to this debate, ask the Minister to write to all Members who have taken part in the debate about the issues that he did not have time to address, and underscore the fact that this debate recognises the invaluable work of carers and the fact that they are the backbone of our care system. Without them we would not have a health and social care system worth its name. We owe them a great debt, and as a result of that debt we must strive to do more.

Question put and agreed to.

Resolved,

That this House has considered the matter of carers.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 11th June 2013 Commons Chamber

[Mr Hunt]

We do have a strategic approach, but we also have some very important safeguards that any big change in approach has to go through before it is implemented. That is why I asked for a report from the Independent Reconfiguration Panel on the plans for north-west London, and I will consider that report very carefully before I make any decision.

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

When considering issues relating to A and E closures, particularly the proposed closure of the A and E department at St Helier hospital, which serves my constituents, will the Secretary of State ensure that those who propose such plans make sure that there is also a costed plan for developing out-of-hospital care, which is an essential prerequisite for any changes to acute services?

[Mr Hunt]

I agree with my right hon. Friend on this issue. It is extremely important that all these plans take a holistic view both locally and nationally. That is why, in looking at how to resolve the A and E issues we have faced and the severe pressures last winter, we are looking not just at what happens inside A and E departments, but at primary care alternatives and the integration of social care services, which are all equally important.

Mental Health

Paul Burstow Excerpts

Thursday 16th May 2013 Commons Chamber

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

I beg to move,

That this House has considered the matter of mental health.

There can be no health without mental health, and, above all else, I hope that today’s debate communicates that clearly and powerfully in the country and in this House. I start by thanking the Backbench Business Committee for recommending this most important of subjects for a debate, and the Government for finding the time to make it possible. Undoubtedly, there is a lot to debate on mental health, and I am grateful to my two colleagues—one on either side of the House—who have joined me in seeking this debate. I refer to the hon. Members for Bridgend (Mrs Moon) and for Broxbourne (Mr Walker), who hope to catch your eye, Mr Speaker, and contribute as we proceed.

Last year the House had a remarkable, moving debate on mental health, which was very personal for some hon. Members. It demonstrated that mental health is not an issue of “them and us”, but affects all of us. One in four of us may experience a mental health problem at some point.

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate the right hon. Gentleman on securing the debate. Recent World Health Organisation figures predict that by 2030, depression will be the leading cause of diseases around the world, physical and mental. People can lose years of their life, as mental illness undermines their physical health too. Would the right hon. Gentleman agree, therefore, that mental health must be at the top of the Government’s agenda?

[Paul Burstow]

I certainly would. The fact that a large number of hon. Members are present, hoping to contribute to the debate, that the Backbench Business Committee advocated the debate, and that the Government have given the time suggests there is cross-party consensus that mental health has for far too long been hidden in the shadows and not awarded sufficient priority. The cost to our society of mental ill health across England, Scotland and Wales amounts to over £116 billion a year, but that does not adequately capture the human cost—the misery—that arises from it. Given that the burden of mental ill health is about 23% of the burden of all disease in our country, it is surprising that for so many years it has not been tackled with the necessary vigour. So I agree absolutely with the hon. Lady.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Does the right hon. Gentleman accept that, in addition to the need for continued investment in the so-called medical facilities and services that are part of treating mental health, there is a need for continued investment in the so-called talking therapies, and the opportunity to invest and grow the social services’ response to mental health services as well?

[Paul Burstow]

I am grateful to the hon. Gentleman for that question. He is absolutely right that access to talking therapies—begun as a result of Lord Layard’s initiatives before the general election, which the coalition Government continued to support and which is being rolled out—is very important in enabling people to recover socially, get back into work and get on with their life. At the best performance rates, as many as half the people that go through talking therapy services recover, and that can make a huge difference to them, their families and the figures I was talking about earlier. I shall return to the subject of talking therapies in a moment.

Last year I took part in the debate from a slightly different position—I spoke from the Dispatch Box. I was able to report some important progress. We had a new mental health strategy. We had the continued roll-out of talking therapies, which the hon. Member for Harrow West (Mr Thomas) just asked about. Groundbreaking work was being done to reinvent child and adolescent mental health services from the inside out, to offer access to talking therapies for children and young people. We had the flowering of a new movement to establish social recovery as a goal for mental health, with the establishment of recovery colleges channelling the lived experience of mental illness into practical learning and skills, and resilience to enable people to get on with their lives.

There was the good news that the Government had backed financially the task of Time to Change, the charity sponsored by Rethink and Mind, really motoring to tackle issues of social stigma in our country. Reports since then show that the first phase of that programme has materially altered public views about mental health in this country, but the programme needs to be sustained.

[Jeremy Corbyn (Islington North) (Lab)]

The right hon. Gentleman makes a good case for supporting Mind and other mental health charities, which do a very good job in changing attitudes to mental health. Is he not concerned, however, that many health authorities throughout the country are cutting funding to non-governmental organisations—voluntary organisations that do very good mental health therapy work, often on a contract basis? They are being cut, and therefore the opportunities for support for people going through crisis are reducing, not increasing.

[Paul Burstow]

Yes, I am concerned. The picture is complex. The figures show that spending on adult mental health services over the past couple of years overall has reduced by about 1%, which is not good, but deeper analysis of those figures shows that about half of commissioners have increased their investment and the other half have reduced their investment, so the picture is more complex than it first appears. None the less, it is concerning that services are being withdrawn where they involve providing peer support or reaching into harder-to-reach communities, particularly black and minority ethnic communities, which often get left behind and often are most prone to being subject to the most coercive parts of our mental health system. So I agree with what the hon. Gentleman said.

In the debate last year I was delighted to be able to signal the Government’s support for the Mental Health (Discrimination) (No. 2) Bill, which was introduced by my hon. Friend the Member for Croydon Central (Gavin Barwell). It is a rare thing—as we heard earlier in the business statement, only about 10 Bills last year which were introduced as private Members’ Bills made it on to the statute book. It was great that that Bill made it on to the statute book, and I congratulate my hon. Friend and all those involved in taking it forward.

I have referred to the mental health strategy for which I had some responsibility. At its heart is the radical—I might even say revolutionary—idea that there should be parity of esteem between physical and mental health. That idea is gathering momentum. We have seen the Government place that notion in the mandate for NHS England as a driving force for the way the Commissioning Board takes its responsibilities forward. It is increasingly on the lips of policy makers and service commissioners. But the recognition that there are critical interdependencies between physical and mental health still has a long way to go.

There are more than 4.6 million people in this country living with long-term physical and mental health problems, and far too often their experience of the NHS is that they are broken down into their constituent diseases, rather than being treated as a whole person. As a result, their physical health needs are treated in one place—in many cases, in many places—and their mental health needs, if they are identified at all, are dealt with in another.

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

I pay tribute to my right hon. Friend for introducing this welcome debate, which I hope will become an annual debate. He is making a very important point about the experience of service users and the lack of integration in dealing with their needs. Does he agree that we should be aiming for a well-being-based approach with a single point of entry, which will allow people to be signposted to appropriate services? That means local authorities, the health service and the third sector genuinely coming together in an integrated way.

[Paul Burstow]

The hon. Gentleman makes an important point about the need for a greater focus on well-being. It is one of the reasons why I am so pleased that the Care Bill which was introduced in the House of Lords last week has as its first and clear mission for our social care system the promotion of well-being, and it goes on to stipulate what that means in practice. It is about control and people’s ability to lead ordinary lives—the lives they want to lead in their communities. That must be at the heart of an approach to mental health that sees the whole person, rather than trying to treat them in constituent parts of the presenting conditions.

The point about failure to join up services is key. All too often, long-term physical health problems overshadow mental health problems. The results of that are all too clear—slow, and in some cases no, recovery and people living with long-term physical health problems that could have been better treated in the first place. The cost in wasted resources in our national health service is about £10 billion a year and up to a further £3 billion on medically unexplained symptoms.

[Mike Crockart (Edinburgh West) (LD)]

My right hon. Friend talks about the need for all services to be involved, starting with social care and local authorities. Does he agree that the process needs to start even earlier and move into education and training, enabling teachers to recognise when illnesses start to show themselves? One in 10 children aged between five and 16 now suffer from mental health problems, including eating disorders and self-harm—the types of problems that will blight their lives for decades afterwards.

[Paul Burstow]

I entirely agree. That is one reason why the Government have committed to the talking therapies service for children and young people that has so far been rolled out. I am meeting head teachers in my constituency tomorrow to discuss how we can ensure that they commission the right mix of services to support children and young people, not least because conduct disorders, for example, cost society hugely and hold young people back from realising their potential, academic or otherwise. That is undoubtedly the case with integration, which is a key theme of tackling these issues more effectively. That is why I welcome the fulfilment of the commitments made in last year’s care and support White Paper, which my hon. Friend the Minister announced earlier this week, regarding integration pioneers and the new integration framework.

Work on mental health must be embedded in physical health services, which must be embedded in mental health services. When we consider that people with severe mental illness die, on average, 20 years younger than the rest of the population, and that that is due mostly to physical health problems, we begin to understand just how profound that diagnostic overshadowing of mortality can be. It is a scandal and it needs to be addressed. I am delighted that the Government are taking many steps to tackle it.

[Dame Anne Begg (Aberdeen South) (Lab)]

The right hon. Gentleman is rightly concentrating on health services and how they can help mental health and well-being, but does he share my concern that other parts of Government, such as the Department for Work and Pensions, are exacerbating many people’s mental health problems through the way work capability assessments are being carried out, and that those people are having new mental ill health episodes as a result of the trauma of having to go through an Atos assessment?

[Paul Burstow]

Yes, and that issue, which I know is of concern to Members on both sides of the House through their constituency casework, for example, was raised in last year’s debate. Although some steps have been taken to try to improve those processes, they still do not seem to me to capture fully the important differences in dealing with mental health and, as a result, can exacerbate mental health problems. There is more to do in that area and I look forward to the Minister picking up on that issue. Given that the Cabinet committee that had co-ordinating responsibility for the mental health strategy, which is a cross-government strategy, is no longer in place, I wonder how tackling those sorts of issues will be co-ordinated in future.

It is worth noting that there are a considerable number of working-age people with a history of schizophrenia, for example, who are able and—I stress this point—willing to work. Indeed, Rethink’s schizophrenia commission identified employment rates in that group as being about 8%, with a range of 5% to 15% across the country, compared with the obviously much higher rates for the general population. Individual placement and support schemes, which are some of the most effective forms of employment support for people using mental health services, really can achieve remarkable transformations in people’s ability to take up employment. I hope that the Minister can say something on how such issues are being addressed with DWP colleagues, because that is where a cross-government strategy really should be making a difference, rather than simply addressing direct NHS provision.

[Mr Thomas]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will give way one last time, but then I really must conclude.

[Mr Thomas]

I am grateful to the right hon. Gentleman for giving way a second time. Will he underline the importance of mental health trusts such as Central and North West London NHS Foundation Trust, which serves my constituents, working with the local voluntary sector such as the Mind groups in Harrow and Brent? Will he therefore encourage his Front-Bench colleague to look with particular interest at the letter I am about to write to him, raising the concerns of Mind in Harrow and in Brent about the trust’s failure to work properly with the services it is providing?

[Paul Burstow]

I note that the Minister paid close attention to that intervention and I am sure the hon. Gentleman will enjoy the exchange of correspondence on the matter.

I want to discuss the health care aspects of parity of esteem. Curiously, not all general hospitals have 24/7 access to a mental health liaison service offering immediate support, yet we know that when that works well it can make a big difference to the quality of care, help to reduce the length of stay in hospital, especially for older people, and generate savings four times greater than the cost of running the service. There are good examples of where this has been done, particularly in Birmingham, and it is odd, given such obviously compelling evidence, that it has not yet been taken up more widely.

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

I completely agree with my right hon. Friend. There is some very good practice, including RAID—rapid assessment interface and discharge—at Heartlands hospital in Birmingham, but there are too many places where there is a complete absence of such services. The starkest aspect of the lack of parity of esteem is that there is a good emergency service—it may be under pressure but it is there—for people with physical health problems but not for those with mental health problems. That has to be addressed.

[Paul Burstow]

I am grateful to the Minister. Perhaps in his own speech he can say a little more about how we might better incentivise this change. Despite the compelling economic and medical benefits, these services are still not being provided widely enough.

[James Morris (Halesowen and Rowley Regis) (Con)]

The more fundamental point is that a significant proportion of the money that is spent on mental health services in the national health service—about £14 billion—is focused on acute services. If we were to shift, say, 4% of that budget into community-based solutions and early intervention, that might have a much more dramatic impact on our ability to tackle the underlying problem.

[Paul Burstow]

The hon. Gentleman makes a good point. Indeed, that has been part of the approach taken in the talking therapies strategy, which is about moving the resource to where it will make the most difference at an earlier stage, and helping to promote recovery in the first place.

The Minister said that the emergency service is a stark example of where parity of esteem has not been achieved, and I want to give another example. The Royal College of Psychiatrists and its president, Sue Bailey, have been looking, on behalf of the Department of Health, at the whole issue of parity of esteem and what practical steps could be taken to address it, and it has recently published work on that. How can it be right, for example, that a recommendation by the National Institute for Health and Clinical Excellence on the availability of a drug is a must-do for the NHS but a NICE recommendation on the availability of therapies is not? This means that evidence-based non-pharmacological treatments that are clinically effective and cost-effective are often left unimplemented. I hope that that bias will soon be brought to an end.

The same can be said for access standards. There has rightly been uproar when even small changes occur in the amount of time people wait to attend accident and emergency departments. NICE has said that a person experiencing a mental health crisis should be assessed within four hours, yet only one in three people is so assessed. I am puzzled by the decision not to set a 28-day access standard for therapy, because the NHS constitution should embody parity of esteem, and that is a tangible way it could do so. Having said that, I take heart from the revised NHS constitution handbook, which said albeit it in a footnote:

“The Mandate indicates that we will consider new access standards, including waiting times, for mental health, once we have a better understanding of the current position. We need to do this work and consider carefully the implications of introducing any new standards, before we can make any firm commitments in this area.”

Why on earth is this problem still not being understood? Why do we need yet more reviews? Will the Minister give an indication of the time scale?

[Norman Lamb]

We clearly need to understand the scale of the problem of access. It is a bit shocking that we do not know the figures across the country for the number of people waiting and how long they are waiting. The mandate of the commissioning board requires that it must establish that and then set access standards. That is really important work, because there is a legal obligation to seek to meet the requirements of the mandate.

[Paul Burstow]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Can I help the right hon. Gentleman? We said that he would have 15 minutes, but we are now on 20 minutes and other people are waiting to speak.

--- Later in debate ---

[Paul Burstow]

Thank you, Mr Deputy Speaker. I was looking at the time and at my notes and thinking that I should conclude so that other hon. Members can contribute fully to the debate.

My final point concerns the power of data and the difference they can make. Will the psychiatric morbidity survey, which is due to be repeated in 2014, be repeated? I draw attention to the value of the cancer intelligence network, which has demonstrated the power and effectiveness of nationally co-ordinated data. Given that, as I have said, mental health accounts for 23% of the total disease burden in this country, it really would make sense to have a mental health intelligence network to bring together all the relevant data. I hope the Minister will address how that might be achieved.

In conclusion, estimates put the cost of poor mental health in England, Scotland and Wales at £116 billion, but the right combination of public health, sustained effort to tackle stigma, easy access to psychological therapies for all ages, and good community and crisis care could make a huge difference to that figure. More importantly, it could deal with and reduce the suffering experienced by people with mental problems as a result of our past failures. I hope the Minister will respond positively to this debate, and I am grateful to the other Members who wish to take part in it.

--- Later in debate ---

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

I thank the shadow Minister for her contribution. I feel that this subject brings out the best in this place—we have had a well-informed, civilised and rational debate. There has been no political point scoring, just thoughtful concentration on an important subject, and I am grateful to all hon. Members.

Before I come on to the contribution of my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I will say that I completely agree with the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that the arrival of public health in local authorities presents us with an opportunity. The establishment of Public Health England brings its expertise to bear on its relationships with local practitioners in public health, working alongside other services. The potential for public mental health, which has been largely disregarded or ignored in too many places in the past, is real. At the conference for the directors of children and adult services in Eastbourne last October, I attended a presentation by an academic from the London School of Economics on the economic case for interventions in public mental health. There is a powerful return on investment, which means that people are benefiting from it. We have a great opportunity, and I am grateful for the hon. Lady’s comments.

The hon. Lady made important comments about black and minority ethnic communities and the mental health system, and I will come back to that. I appreciated the comments made by the hon. Member for Croydon North (Mr Reed), and I will refer to them later.

The hon. Lady raised the issue of suicide and young people. There are too many cases in too many hospitals where people who have self-harmed turn up and do not get a psycho-social assessment. We know that having that assessment, with the therapy that can follow, massively reduces the risk of suicide, yet only about 50% of A and E departments ensure that that happens. That has to change, because lives are literally at stake. We have to take this issue very seriously.

I am tremendously grateful to the Backbench Business Committee for giving us another chance to talk about mental health. I again pay tribute to my right hon. Friend the Member for Sutton and Cheam for leading the debate and for the great work he did in office to lay the foundations for the progress we are now tangibly making. The previous Government invested heavily in mental health, as well as the rest of the health service, and it is right to acknowledge that progress was made in that period. The focus on parity of esteem, and making it a reality, is potentially exciting. I was struck by an interview with Angela McNab, the chief executive of the Kent and Medway mental health trust, which is one of the larger mental health trusts. She said that the Government were

“prioritising mental health like never before, making sure that it fits on a par with physical health”—

and that this had come as a welcome step change to mental health professionals. That is an encouraging view from the front line.

My right hon. Friend raised several important points, including about recovery colleges. I am very interested in the whole recovery model and the role of recovery colleges. He also talked about the importance of the inspiring Time to Change campaign, which is part- funded by the Government. I mentioned earlier that I am encouraging all Departments to sign up to that campaign, so that we can lead from the front. We cannot expect private sector and other public sector employers to act properly if the Government do not lead, so it is important to demonstrate parity of esteem in the way that the Government treat employees.

My right hon. Friend also referred to the adult psychiatric morbidity survey. I can confirm that discussions are taking place between the Department and the Health and Social Care Information Centre and that it should take place in 2014. He also referred to the intelligence network. NHS England and Public Health England are developing plans and using the cancer intelligence network as a model, not necessarily to replicate, but to learn from. I am grateful to him for raising those issues.

The impassioned words that we have heard today show that within these walls lies the ambition, across all parties, to make the necessary changes, and I thank all hon. Members who have spoken about their experiences, views and, yes, even their criticisms. This sort of open debate can help to challenge stigma, scrutinise services and scrutinise commissioning decisions, which are critical in terms of how much money is allocated to mental health as against physical health and to ensuring that mental health remains a core priority not just for the Government, the House and the NHS and care system, but for the whole of society.

We have heard many good contributions. I shall write to hon. Members to respond to the substantive challenges and questions they have raised, but let me touch now on several quick points made today. The hon. Member for Bridgend (Mrs Moon) mentioned the importance of recognising the link between alcohol abuse and mental health. She talked about people who have left the armed forces with problems of post-traumatic stress disorder, which has become prevalent with the conflicts in Iraq, Afghanistan and so forth. Simon Wessely and his colleagues are doing some fantastic work on that.

The hon. Lady also mentioned the role of the police, particularly the Metropolitan police, and made the valid point that they are not trained well enough or systematically enough. Lord Adebowale, whom I met this week to talk about his report, makes the point that the police will always have to deal with mental health. It is not a question of it being wrong that they are dealing with it; the critical point is that there should be close working between the police and mental health services so that there is an immediate referral, not an inappropriate placing of someone in a police cell. Just imagine suffering from a mental health crisis and ending up in a police cell. It is the worst possible thing that could happen. Even children sometimes end up in police stations. It is totally inappropriate and avoidable—that is the important point.

The hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones), who have done so much to challenge stigma, have performed a valuable service in speaking out about their own experiences of mental illness. They have demonstrated, very visibly, that someone can be successful and make an enormous contribution to society, yet also have mental health problems. That is an incredibly important point. The hon. Member for Broxbourne talked about the role of employers and mentioned some really good employers, such as BT. This is about enlightened self-interest, not just about being kind to people. It is in companies’ and employers’ interests, including the Government’s, to treat mental health issues seriously. The cost to employers when those suffering from mental health problems lose their jobs—the loss of all the training and experience or just the sickness absence—is enormous, but it can be significantly reduced with a smarter approach. The hon. Member for North Durham talked about a number of individuals who have had mental health issues, but also been very successful. He talked a lot about the importance of tackling stigma.

The hon. Member for Croydon North (Mr Reed) made an important contribution about the treatment of black people by mental health services—the shadow Minister talked about that as well. There is something wrong that has to be challenged. The hon. Gentleman raised the case of Seni Lewis, which I am happy to talk to him about—I have surgeries on Monday night and we can discuss this. I have agreed to attend the Black Mental Health conference on police and mental health in June, because I felt it was important that I should engage in this whole issue and take it as seriously as it deserves to be.

The hon. Member for Totnes (Dr Wollaston)—I apologise for missing her contribution and a number of others—raised a number of issues. I will ensure that she receives proper responses to them. She talked about liaison psychiatry. While we are talking about emergency services, one thing that has become more and more apparent to me is the complete disparity between what happens to people with mental health problems and what happens to those with physical health problems. I was utterly shocked—but sadly not surprised—by a letter that a Member of Parliament in the south-west wrote on behalf of a constituent. The constituent had rung the crisis number for mental health services in his area and had not got a reply. No one was answering the crisis helpline. On another occasion they rang and were asked to ring back in half an hour. In the meantime that person could have committed suicide.

Then we come to what happens in A and E and the fact that in too many hospitals there is no mental health specialism available. Last Saturday I met a constituent who had found her son at home with ligature marks round his neck. She took him to A and E, where there was a half-hour conversation with a junior doctor before he was discharged home. The next day she found him hanging in her home. She is determined to pursue the complete failure of the system when something so dreadful can happen.

Whether we are talking about what happens when someone is picked up in the middle of a mental health crisis by the police and taken to a police station inappropriately, what happens when someone tries to get in touch with crisis services or what happens at A and E, we have to have an effective emergency mental health response system in place. This is a matter of real urgency, so I have asked all the relevant organisations—the Home Office, the Association of Chief Police Officers, the Department of Health, the Royal College of Psychiatrists and so on—to come together and draw up an agreed plan to tackle the most stark differences between the treatment received by people with physical health needs and that received by those with mental health needs.

[Paul Burstow]

That is a welcome announcement from the Minister about achieving parity of esteem in emergency and crisis care. However, in the wake of the Francis inquiry, which rightly drew our attention to serious patient safety and dignity issues in our physical health care system, I suspect that we will need to ensure that we are not distracted or led into not addressing the same issues—which clearly exist—in our mental health systems.

[Norman Lamb]

My right hon. Friend makes a very good point and I completely agree.

The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke again about eating disorders—I took part in a debate that she secured in Westminster Hall. She talked about the role of parents, the nightmare of a child—I will call them a child—over the age of 16 deciding to refuse treatment and the horror that parents sometimes go through when they are not listened to sufficiently by clinicians dealing with their loved one’s condition. She also mentioned type 1 diabetes sufferers, and I would be interested to hear more about that.

My hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) is no longer here. Oh, yes he is! He has moved to a different place, just to confuse me. He talked about the low diagnosis rate for Alzheimer’s and dementia in his area. He also stressed the importance of the recognition of mental health by the Government, which I think he welcomed.

The hon. Member for Bolton South East (Yasmin Qureshi) talked about the importance of accessing appropriate and culturally sensitive care and treatment. That is incredibly important, as is getting the approach right for each individual and giving them the power to determine their priorities. She made those points well. She also stressed that the picture round the country was very variable. That is more the case in mental health than in physical health. Some areas have great services, some of which I have witnessed, but in others they are simply not good enough.

--- Later in debate ---

[Paul Burstow]

I thank the Backbench Business Committee again for enabling us to have the debate. I also thank those on both Front Benches, my hon. Friend the Member for Broxbourne (Mr Walker) and the hon. Member for Bridgend (Mrs Moon), and every other Member who has either intervened in the debate or contributed directly.

Today’s debate on mental health, like last year’s, has created and elevated a sense of hope. It has made it clear that there is a real commitment across parties in the House to do better and to do more: to enable people to gain access to the right care, at the right time, in the right place. That means starting early. It means starting in our schools. It means ensuring that when there is a crisis, we have an emergency service that is as good as our physical emergency services. I welcome what the Minister has said about that today.

A number of Members have suggested that this should become an annual debate. Clearly Parliament needs to hold the Government and the NHS Commissioning Board to account on these issues, and it would be good if we could find time every year to see just how much progress has been made.

It has been very interesting for those of us who follow Twitter to see just how many people have been tweeting about the debate. It has already extended well beyond the confines of this place, and that is to the good. I am pleased that so many Members have taken part, and I am very grateful to them. I hope we will eventually reach a place where there is no health without good mental health.

Question put and agreed to.

Resolved,

That this House has considered the matter of mental health.

Health and Social Care

Paul Burstow Excerpts

Monday 13th May 2013 Commons Chamber

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

I want to concentrate my remarks on social care, because all too often in debates entitled “Health and Social Care” we tend to spend most of our time debating health, and yet our social care system is absolutely vital in regulating health care costs and delivering a better-quality health service. The Bill announced in the Queen’s Speech—it was indeed published on Friday—goes a long way towards laying some important foundations for a better social care system.

The Care Bill attempts to address a number of long-standing flaws in the system that have developed over the past 60 years through a series of piecemeal measures enacted by successive Governments. It is essential that in considering this over the next few months we make sure that we get it right, because legislation in the social care sphere comes to the House very infrequently. Our care and support system is of key importance because the rapid age shift that is taking place in our population is profoundly changing the nature of the demands on the system. It is important to note that this is not just about ageing; it is about the complex co-morbidities of long-term health conditions, both physical and mental, that are at the heart of the serious pressures on our whole system.

Our social care system has a number of features that need to change. It is too oriented around crisis and stutters into life when things have already gone wrong. It does not enable people to plan successfully for future care needs or, indeed, to prevent and postpone them. It does not provide adequate signposting, information, advice and advocacy for people to secure what they need from it, making it feel too much like a fight to get what is necessary. There is a lack of recognition of, and support for, family carers. Quality is variable around the country. We have heard announcements today about co-ordination of care and continuity, which is clearly a problem too. The costs of care are a lottery, and that needs to be addressed.

The Bill is taking all this forward. It focuses on early intervention and prevention, with a new responsibility for that to be up front in the way that local authorities plan their services. There are new duties on information and advice. I welcome the fact that the Government have agreed that the Bill should specifically refer to financial advice as being part of the legal obligations. There are new rights for adult carers—I will talk about young carers in a moment—with a lower threshold of eligibility for services. That is very welcome. A new rating system is being established to assist with quality of care and to help providers themselves to benchmark their performance.

[Andy Burnham]

I know that the right hon. Gentleman is very knowledgeable on this subject, but does he believe that councils have sufficient resources to consider new rights, given that we hear that care is collapsing all over the country and the Local Government Association says that if nothing else happens councils will be overwhelmed by the costs of care in less than 10 years?

[Paul Burstow]

I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.

The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.

I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill, which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.

The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

[Mrs Madeleine Moon (Bridgend) (Lab)]

In a previous life I was a contracting officer for a local authority, and I contracted and commissioned care from the private sector. We always faced the same problem: the local authority tried to get more care for less money. That meant that contractors were paid less for their care workers, who were constantly not paid for travel time. How do we break this vicious cycle if we do not accept that we have to fund local authorities properly to make possible the provision of quality care?

[Paul Burstow]

I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

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

I agree that the quality of commissioning needs to be addressed as well as the quality of provision if we are to get better care for the people who need it.

[Paul Burstow]

I welcome that comment from the Minister and look forward to seeing more detail.

My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

[Mr David Ward (Bradford East) (LD)]

Can I tempt my right hon. Friend to comment on his proposals on the use of universal benefits for wealthy pensioners? I know that he has produced a pamphlet.

[Paul Burstow]

I will try to do that in the one minute and 14 seconds left to me.

The ADASS survey paints a quite disturbing picture of the next two years. More providers will face financial difficulties and there will be increasing pressures on the NHS as social services shunt people into health care services.

The spending review that is under way is for just 12 months. It needs to fund the successful implementation of this legislation, and not least the introduction of the Dilnot proposals. More than 450,000 people will need assessments to get into the new system. The spending review also needs to sustain the transfers of money from the NHS to social care. Beyond that, the spade work needs to be done now to make the case for the critical interdependencies between social care and health that will sustain our social care system and make our health system deliverable and affordable.

The Queen’s Speech, with its specific commitment to this legislation, contains a landmark reform that will do a great deal to improve the quality of life of our constituents.

--- Later in debate ---

[Barbara Keeley]

I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

[Paul Burstow]

The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

--- Later in debate ---

[Mr Barron]

No, I have given way twice and I am not going to give way any more.

What is not in the Queen’s Speech? Public health has been mentioned by several people. I served on the Bill Committee for what became the Health and Social Care Act 2012. I will leave the reorganisation of the NHS for another day, but at the time the Bill was going through, the defence given by Ministers was, “What we will start doing is putting real measures down, and for the first time ever we will put in statute a responsibility to reduce health inequalities in this country.”

Two policies that most people involved in and concerned about public health thought would be in the Queen’s Speech are absent. One is the minimum pricing of alcohol, which was talked up by the Prime Minister over many months. There is evidence that it will stop some people drinking excessively. I served on the Health Committee in the previous Parliament, and just before the general election we published a report on alcohol. People ought to read it to see exactly what is happening. One of the worst statistics was on the people who are likely to die from alcohol-related diseases—certainly cirrhosis of the liver. Thirty years ago, they were people like me—men in their 60s—but now, men and women in their 20s are dying of that disease. This House has a responsibility to do something about that.

The other area that I wish to discuss briefly is the absence of legislation to bring in standardised packaging of cigarettes. That has also been talked up, not only by the Prime Minister but by others. The consultation on standardised packaging started on 16 April last year and ended on 20 August; now, nine months later, nothing is going to happen. I am deeply concerned, and I will tell Members why, although there can be no surprises about me and tobacco, because I have been on an anti-tobacco crusade in the House for nearly two decades. In my borough—I represent a third of it—there are still some 48,000 smokers, and although the number is declining, it is likely that more than 950 young people between the ages of 11 and 15 will take up smoking this year, and half of them will die a premature death. This year, more than 100,000 of our fellow citizens will die a premature death from using tobacco as instructed to by the tobacco companies. If half that many people were dying of anything else in this country, this House would be up in arms about such a massive number of deaths. In the past few months, what we have had is Ministers talking up the idea of legislation further to protect young children from starting smoking, but none of that has come about.

[Paul Burstow]

When the right hon. Gentleman chaired the Health Committee, it published the report that led to the banning of smoking in enclosed public places. That ban was only secured by a free vote in this House. Does he agree that, if we cannot get the Government to act, we need a free vote so that we can make the change in that way?

[Mr Barron]

I shall be putting my name in the ballot for a private Member’s Bill in a few days. If I am successful as I was in 1993, the right hon. Gentleman will have a Bill on standardised packaging on which to vote.

The Government have ducked the issue. There has been some influence—many people say that Lynton Crosby, who has come along to advise the Government, has had that influence, but I will not make that accusation. I wrote to the Prime Minister last week to ask several questions about whether Lynton Crosby has been involved in giving any advice in political circles in this country. Lynton Crosby is advising the Conservative party about re-election, but I want to know whether he has been involved in this area, given his record both politically with the party that he ran, and with his company’s work with and the money it has taken from tobacco companies.

The right hon. Member for Sutton and Cheam (Paul Burstow) is quite right to say that in 2006, when this House took a decision on smoking in public places, Members of this House had a free vote. I was effectively the architect of that free vote, because I tabled an amendment signed by 10 members of the Health Committee and I negotiated a free vote with my own party, as one was being offered by the then Opposition. On that major public health measure, this House was trusted to take the decision itself. Yes, we were lobbied by our constituents. There is nothing wrong with that—after all, it is what we are here for, although we cannot represent them all, as some people seem to think we can. The House was trusted to make that decision and the then Government, to their credit—they should have been awarded that credit—allowed it to do so. Many people were against that, including the Prime Minister, who has said since that he thinks it is the best piece of legislation that ever went through this House.

I say to Ministers that, whether it is because of strings being pulled by people close to the tobacco lobby or because of anything else, we cannot tolerate their not taking further action against tobacco when it is killing 100,000 of our fellow citizens each year. It is about time that someone showed some courage, stood up for ordinary people and for good public health measures—not nonsense measures—and did something to stop the dreadful premature deaths in this country.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 16th April 2013 Commons Chamber

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

When it comes to early intervention with the one in 10 children in this country who have a diagnosable mental health problem, will the Minister confirm that it is the Government’s intention to ensure that those children all have access to talking therapies so that they get the right treatment at the right time, which will make a big difference for them?

[Dr Poulter]

In his time in office, my right hon. Friend did a tremendous amount to promote the cause of mental health and to get parity of treatment between mental and physical health. That is exactly what we propose to do with the money going into the talking therapies—to get in place those early interventions, not just for adults, but for children, too. We shall be taking that work forward in earnest in the years ahead.

Mid Staffordshire NHS Foundation Trust

Paul Burstow Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

Yes, it will be, as it will to providers in the social care sector.

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

Can the Secretary of State confirm that it is his intention that the statutory duty of candour—and the introduction of a ratings system—will apply to home care and care homes, not just NHS providers?

[Mr Hunt]

Yes, I can confirm that. My hon. Friend is right, because part of the big change that we need is to see a big increase in provision of domiciliary care, and an increase in the standard of that care.