NHS Commissioning Board

Paul Burstow Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

Absolutely not. The legislation and the regulations will faithfully implement our policy intent, which is to put clinicians at the heart of decision making in the NHS and to make the interests of the patient paramount.

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

I thank the Minister for his statement, and especially for confirming that the regulations will be rewritten to put it beyond doubt that the patient’s interest always trumps competition in these circumstances. Will he also confirm that any tendering arrangements currently operating in the NHS are operating under legislation introduced by the last Labour Government?

[Norman Lamb]

My right hon. Friend is right on all counts. As he says, the patient’s interest must trump everything else. One of the things that we will reinforce in the amended regulations is the paramount importance of integrated care. We legislated for that for the first time through the Health and Social Care Act, which the Care and Support Bill will reinforce and which, indeed, is reinforced by the mandate of the NHS. The Government’s whole intent is to drive a fundamental shift to integrated care for the benefit of the patient.

Health Care (Sutton)

Paul Burstow Excerpts

Thursday 28th February 2013 Commons Chamber

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

I am grateful for this opportunity to address the House and to explain to it and to the Minister the disaster that is playing out in slow motion in the NHS in south-west London. I am talking, of course, about a programme named the “Better Services, Better Value” programme, which was launched by the south-west London primary care trust cluster two years ago. BSBV was set up to address concerns about quality and patient safety. The argument is that London should lead the way to all-consultant rotas to guarantee better care.

Taken at face value, no one could argue with that proposition. We all want great care, and we all want the safest and best care for ourselves, our families and our constituents. BSBV’s answer to this quality challenge, however, is a grandiose reconfiguration of acute care costing over £350 million. It proposes the centralisation of emergency care, maternity and paediatric care on fewer hospital sites in south-west London. The result is the loss of two A and E departments, two maternity units, three paediatric units and other associated services.

Despite quality and safety concerns being the driving force, actual quality today has been discounted. It is assumed that quality will improve, but there is no explanation or evidence to justify the assumption that those things that are not good now will necessarily become better in the future. How that can be made to happen has not been spelled out.

I have to tell the Minister that BSBV is causing huge damage to the NHS in south-west London. It is dividing medical opinion and demoralising staff in hospitals such as my own St Helier hospital. It is also distracting the NHS from the much bigger task of delivering the productivity and quality gains needed to meet the Nicholson challenge. In the wake of the Francis report, it is clear that BSBV has not considered the impact of forced reconfiguration on patient safety. That must be a risk, and it should be properly evaluated and taken into consideration.

I said that BSBV had come up with a grandiose solution. At the top of every list BSBV draws up comes my local hospital, the St Helier hospital. My constituents are being expected to travel for longer and further because of a dogma—that greater specialisation on fewer hospital sites improves outcomes. Last year, however, a paper in the Health Service Management Research journal examined the evidence to support this dogma. Anthony Harrison of the King’s Fund reviewed a large number of studies, some of which were commissioned for the Department, and concluded that there was no evidence of a causal link between volume and outcomes. BSBV, however, relies on that dogma, and tries to shame anyone who argues against it by painting opponents as being “opposed” or in a position of being prepared to support and tolerate poorer outcomes.

As I say, this view is being advanced without evidence. There is some evidence that greater specialisation may well save lives—I do not dispute that—and the reorganisation of hyper-acute stroke care and major trauma across London appears to be a case in point. Those are examples where it certainly makes a difference and they have made a difference across London. It is important, however, that we await the results of studies of how those improvements have been secured before we claim to have a full understanding of all the factors that have played a part in delivering the gains that have been realised.

Although BSBV advances its view of the benefits of centralisation, it fails to examine some of the important downsides. Shockingly, the proponents of BSBV ignore evidence demonstrating a link between mortality and miles travelled to gain access to emergency care. There is as much as a 1% increase in mortality for every extra mile travelled. They ignore evidence showing that St Helier has one of the safest maternity units in London—a unit at which mums want to have their babies. They also fail to consider the benefits of retaining A and E, maternity and paediatric services at St Helier to ensure that the NHS has the capacity to meet rising demand. Demand is rising—birth rates are rising and the number of people needing hospital services is, too.

In pursuit of this dogma, wildly optimistic assumptions are manufactured about the extent to which demand for emergency care can be shifted out of hospital or avoided altogether. Those involved assume, for example, that 10% of A and E attendances can be avoided and that up to 60% of such admissions can be shifted to urgent care, but the evidence for that is weak and is contested by emergency care experts. There is, in fact, a growing body of empirical evidence that calls into question some of the diversion schemes that have been set in place. Even the National Clinical Advisory Team’s evaluation of BSBV last summer questioned the assumptions and urged caution. NCAT says that

“experience elsewhere has shown that on implementation not all of the planned shifts in flow are met.”

It suggests that a more realistic assumption is that about 30% of A and E patients will be shifted to urgent care. More damaging still, its independent assessment warns that the data used to make the assumptions are recognised in emergency care to “lack reliability.”

Yet those flawed assumptions are at the heart of BSBV’s grand design. I think that they pose a significant risk to the safety of patients, a risk made worse because those in charge of the programme have not even worked out how to deliver the step change in out-of-hospital care on which their heroic assumptions rely. Nor have they worked out how much it might cost to deliver the changes in primary and community health care. The reports of both NCAT and the gateway review comment on that glaring gap in the BSBV case. NCAT says:

“At present attention is focused on hospital reconfiguration. There should be at least as much concern shown to the developments in primary and community care which are essential prerequisites of that hospital reorganisation.”

The same zeal for centralisation runs through the proposals for maternity services. Although St Helier’s maternity unit is performing above the average in south-west London, although more than 3,400 mums are choosing to have their babies at St Helier every year, and despite welfare and health inequality concerns about women giving birth in more remote locations, those in charge of BSBV are proposing the break-up of an excellent maternity and paediatric team. Again, the evidence calls that zeal into doubt.

I said that BSBV was a distraction from the big challenge facing the NHS—the Nicholson £20 billion challenge, which was identified by the Department of Health back in 2008. The NHS in south-west London has drawn up plans to find £394 million for quality and productivity improvements out of a budget of £2.4 billion by 2016. The money that it frees up will be used to meet rising demand and improve quality. No one disputes the fact that it will be a tough programme to deliver, and I must tell the Minister that BSBV is not helping. In fact, it delivers very little for the Nicholson challenge: just £18 million. Is all the pain that BSBV is inflicting worth it? Those involved in BSBV want to spend a projected £350 million in capital in order to realise that £18 million. I calculate that, according to BSBVs figures, it will take more than 20 years to get a payback on that capital investment. BSBV’s purpose is to tackle quality and safety concerns which we all want to be tackled, to fix consultant rotas, and to deal with other related issues. According to its own figures, that will cost between £4 million and £7 million.

Has not a “do the minimum” or “do the least harm” option been drawn up to find ways of delivering the benefits without all the costs of BSBV’s grand design? No such plan has been developed. To date, those in charge of BSBV have spent £5.5 million. They plan to spend £6 million more this year, and to spend a further £2 million every year while the programme continues. Surely there is a saving to be made there.

We have a grand design in search of a justification: a classic old-fashioned, top-down London NHS-inspired reconfiguration. The goal has been to reach decisions before the old NHS structures are abolished at the end of March, tying the hands of the new GP-led clinical commissioning groups. Yet last year, during the passage of the Health and Social Care Act 2012, it was made clear that there would be new ways of designing health care, and that things would be different. The new design was to be based on a detailed analysis of the current and future needs of the local population, an analysis that would underpin the development of local health and wellbeing strategies which, in turn, would be reflected in the commissioning plans of councils and clinical commissioning groups. The last analysis of that kind that was conducted in my area, in 2009, did not support a wholesale change in acute care, but BSBV is trying to drive a coach and horses through that. Rather than designing services that fit its postcode, it is trying to shoehorn south-west London into its template.

Because BSBV has so clearly predetermined the fate of St Helier, it has caused planning blight. It has derailed the de-merger of Epsom and St Helier hospitals by causing huge uncertainty about the future of both. BSBV has jeopardised the hard-won £219 million rebuild and refurbishment of St Helier hospital, despite the former chief executive of NHS South West London repeatedly stating that this was a fixed point. That blight could be lifted today if the Minister made it clear that it was no part of the Government’s design to allow the old institutions of the NHS—primary care trusts and strategic health authorities—to dictate how the new GP-led clinical commissioning groups act. Furthermore, can the Minister confirm that the NHS Commissioning Board is under a duty to secure the autonomy of CCGs, and that she rejects any recreation of the top-down culture and will ensure that CCGs are empowered to arrange local health care that fits and anticipates the needs of their populations?

I do not underestimate the difficulties that CCGs face in resolving how best to arrange health care services in Epsom, Merton and Sutton, but it is clear that BSBV does not offer a credible mechanism for meeting the challenges. As the principal commissioners of services at the Epsom and St Helier University Hospitals NHS Trust, the Sutton, Merton and Surrey Downs CCGs should be able to shape acute health services for the future. They must be able to commission those services in a way that the three local health and wellbeing boards believe to be right, unfettered by any legacies from the outgoing health commissioners.

I hope that, as the new commissioners of acute and community health services, my local CCGs will take the opportunity arising from the current delay in the BSBV programme to bring it to an end. A clean break from this flawed process will be a clear signal from the CCGs that there will be a fresh start, and that they want to engage with the Epsom and St Helier University Hospitals NHS Trust and the local community, local councils and MPs to map out a future for acute health services that has community and clinical support.

In conclusion, I hope that the Minister will be able to confirm the following: first, that the local clinical commissioning groups are free to scrap BSBV; secondly, that a “do minimum” option is a must-do when it comes to reconfigurations; and thirdly that the Department of Health will take a close and critical look at this old-style, top-down reconfiguration from BSBV. BSBV is based on flawed assumptions and poor data, and it is time to stop wasting money on this discredited process. We need a fresh start in south-west London, not tired, old, worn-out NHS reconfiguration of the very worst sort. I hope the Minister can help.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his long service and the great work he did as a Department of Health Minister and for securing this debate. He has made a number of very good and important points—although I do not agree with everything he said—and I assure him that my officials will read his speech, and if I fail to respond to any of his points now, we will write to him. He has asked a number of questions, and I may not be able to answer all of them—and strongly suspect I will not be able to give the sort of answers he would like.

My right hon. Friend is standing up for his constituents’ health services, which is absolutely right. It is right that Members come to the House and speak up on behalf of their constituents. On hospitals and health care services, at the end of the day we all want the same thing: the very best services for our constituents. Everyone is entitled to the very best health services.

As my right hon. Friend will know, it is not my role to defend or to rubbish the “Better Services, Better Value” process. He has made some very good points, but I have no doubt that it was set up for the very best of reasons. There are no proposals at this stage, but there is a huge consultation stage. I am told the underlying reason for setting up the BSBV was to ensure that everyone in south-west London and Surrey Downs has the very best health services seven days a week, 24 hours a day.

A number of hon. Members who represent the area covered by the review have rightly made representations. Some, like my right hon. Friend, have spoken in this House. He has also been to see me, as have others, including my right hon. Friend the Deputy Leader of the House, and the Under-Secretary of State for Transport, my hon. Friend the Member for Wimbledon (Stephen Hammond), is coming to see me next week. My hon. Friend the Member for Croydon Central (Gavin Barwell) and the hon. Member for Mitcham and Morden (Siobhain McDonagh) spoke in the most recent debate on the future of A and E services, which was held only a few weeks ago. I shall refer to some of those speeches.

The area affected by the reconfiguration covers south-west London and the Surrey Downs. South-west London has a population of 1.4 million, the Surrey Downs have a population of 280,000 and between them they enjoy a health service that is funded to the tune of £2.8 billion a year. As my right hon. Friend the Member for Sutton and Cheam has made clear, although much of this is about saving money and meeting the Nicholson challenge —a scheme introduced under the previous Government and supported at the time by both Opposition parties, and one that continues because we recognise that those savings must be carried through—this is not about cuts. If anybody makes that case, as I have said before, they do no service to anybody or to the debate. This is not about brutal cuts but about trying to deliver the best service for people throughout the whole area seven days a week, 24 hours a day.

My right hon. Friend the Prime Minister, when he presented the Francis report to this place and answered various questions on it, gave an answer that we should all remember. I have used it before, but let me repeat it now. He said:

“Let me refer again…to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront”—

which is something on which we all agree—

“we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included”—

and it includes me, too—

“reach for the button that says ‘Oppose the local change”’.—[Official Report, 6 February 2013; Vol. 558, c. 288.]

I agree with those words. We are all beholden, whatever part we play in reconfiguring and reorganising health services, to ensure that we do not have an immediate knee-jerk reaction to oppose change. I am not saying that my right hon. Friend the Member for Sutton and Cheam has done that, but others have. Change is the right vehicle and the right driver to ensure that the people of this country get the best services.

To explain how difficult it is to make a reconfiguration, let me refer to the speech made by the hon. Member for Mitcham and Morden in the recent debate on A and E services. She said:

“My local NHS says it needs to reconfigure services because it has to deliver £370 million of savings each year—a reduction of around 24%, or how much it costs each year to keep St Helier hospital going. A programme has been set up, laughingly called “Better Services, Better Value”, to decide which of four local hospitals—St Helier, St George’s, Kingston or Croydon—should lose its A and E department. That is despite the fact that, across south-west London, the number of people going to A and E is going up by 20%, and that the birth rate in our part of London continues to rise.”—[Official Report, 7 February 2013; Vol. 558, c. 515.]

That is another hon. Member who would join my right hon. Friend in opposing any changes, cuts, closures and so on at St Helier.

[Paul Burstow]

The Minister is responding fully to the points I have made so far, but let me demonstrate the distinction between my point and that made by the hon. Member for Mitcham and Morden (Siobhain McDonagh). She has conflated the BSBV programme, which is a reconfiguration, with the Nicholson challenge. The Nicholson challenge is being taken forward separately in south London and BSBV does not deliver on it.

[Anna Soubry]

I am grateful to my right hon. Friend because I was going to agree with him that the hon. Lady’s analysis was not correct. The point that I am trying to make is that she seeks to defend her hospital, as my right hon. Friend does. She does not want changes that in any way undermine her hospital, and she makes that case with some passion. It is interesting that my hon. Friend the Member for Croydon Central, who also took part in that debate, made a speech that completely contradicted what the hon. Lady had said.

--- Later in debate ---

[Anna Soubry]

That is a peculiar, old-fashioned procedure, but none the less valuable and enjoyable, Mr Deputy Speaker.

My hon. Friend the Member for Croydon Central argued in the same debate in favour of the BSBV review on the basis that, according to one of the many reports that form part of the review, Croydon Health Services NHS Trust—in other words, his hospital—should have 16 whole-time equivalent consultants, but it has 4.9; St Helier should have 12 but has 4.5; Kingston hospital NHS trust should have 16 but has 10; and St George’s should have at least 16 but has 21. That suggests that departments across south-west London, with the exception of the one at St George’s, do not have anything like the recommended level of consultant cover. He went on, as we might imagine because he, too, wants the very best for his hospital and his constituents, to make the case that BSBV would deliver exactly what he wants for his constituency.

[Paul Burstow]

The hon. Member for Croydon Central (Gavin Barwell) made some important points in that debate, but he did not go on to make the key point that when we look at the figures for BSBV, we see that the cost of delivering the improvement that he and I both want is between £4 million and £7 million, yet under BSBV £350 million would be spent to do that.

[Anna Soubry]

All I can say is, a good point well made, and move on towards my concluding remarks.

My right hon. Friend has asked me a number of questions. If I do not reply in full, I assure him that I will in a letter. I am told that a “do minimum” option should exist. I know that he knows this, because he was a Minister in the Department of Health, but I want to remind everyone that, for this scheme or any reconfiguration scheme to go forward to full public consultation, it has to pass four tests that were clearly laid down by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) when he was Secretary of State for Health. The four tests are support from GP commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice.

In conclusion, I shall deal with my right hon. Friend’s three final questions. I am told that a “do minimum” option should exist. In relation to whether CCGs are free to withdraw from the process, I think it is important that I read out what I am told; I do not want ever to be accused of not saying things I have been advised on. I am told that local CCGs are already a key to BSBV. However, and perhaps more important, after 1 April CCGs will be in the driving seat and by definition BSBV would be unable to continue without their support. That would seem extremely obvious.

[Paul Burstow]

That is very helpful. Given that CCGs will be in the driving seat from 1 April, does that mean they can hit the ejector button and get BSBV out?

[Anna Soubry]

I do not know the answer to that, and of course I would not put it in those terms, but I shall make further inquiries and certainly write to my right hon. Friend so that he has a proper and full answer to that very important question, which I have no doubt many other right hon. and hon. Members would like to ask in relation to other reconfigurations, notably in the south of England.

My right hon. Friend’s other question, in effect, was: would someone at the Department of Health look at BSBV? As he knows, from 1 April the NHS Commissioning Board will have responsibility for determining whether the four tests have been met, prior to a public consultation on BSBV. The Secretary of State only becomes involved quite some way down the line. I will not—I nearly said I was going to bore you, Mr Deputy Speaker; I would not dream of doing such a thing. However, the intervention of the Secretary of State can only occur much later down the line, when the matter has been referred to him by the overview and scrutiny committee of any local authority, by way of an independent reconfiguration panel, and so on.

As I said, my right hon. Friend has raised some important points. If they have not been addressed by me, they will be by way of a letter. I congratulate him again on having secured the debate.

Question put and agreed to.

Social Care Funding

Paul Burstow Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I am making the announcement today, so we have to give the financial services industry some time to respond to the proposal. However, the indications are encouraging, and I think that we will all see, in plenty of time for the 2017 start of this plan, what products are available. There may be separate products, but it may also be something that becomes part of people’s pension planning. In the same way that people decide what arrangements they want in their pension for an annuity and for a lump sum payment, payment towards these costs up to the level of the cap may become another part of the pension plan. We need to let the pension and insurance industries have the time to respond and to come up with these plans.

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

Does my right hon. Friend agree that, in evaluating these proposals, the public need to understand the nasty little secret at the heart of social care in this country, which is that we have among the harshest of means tests and that that leads to people facing catastrophic costs? Will he also ensure, in making these reforms, that he provides the Joint Committee examining the draft Care and Support Bill with all the necessary details of how this will be implemented?

[Mr Hunt]

I would be happy to do that and I am grateful to the right hon. Gentleman’s Committee for its work to date on pre-legislative scrutiny. He will understand why I was not able to go into details when we met to discuss the Bill last week. He is absolutely right: dealing with that threshold is one of the most important things and I am sure we will benefit from good scrutiny, as we have done to date.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

I think that the hon. Lady might perhaps read Lord Leveson’s conclusions before she starts hurling about allegations, many of which came from her side of the House, that were later shown to be totally false. With respect to the decision on Lewisham hospital, I thought that we had a very useful meeting last night with the south London MPs who are directly affected. She understands that the process put into law by her party and her Government means that I cannot reopen the entire consultation and start seeing some groups without seeing all groups that are affected. That is why I am limiting the discussions I have with colleagues, but I think that that is the right thing to do.

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

The evidence is compelling that improved access to talking therapies for children and adults makes a huge difference to their mental health. Will the Minister therefore assure me and the House that the NHS Commissioning Board will have the necessary dedicated teams to ensure that the adult improving access to psychological therapies—IAPT—programme is delivered and that the new children’s programme is, too?

Dementia

Paul Burstow Excerpts

Thursday 10th January 2013 Commons Chamber

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

I thank the Backbench Business Committee for the timely opportunity to debate on the Floor of the House this most important of issues. I also thank my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for her commitment to, and interest in, these issues and her determination to ensure this debate took place today, and the right hon. Member for Salford and Eccles (Hazel Blears), who chairs the all-party group on dementia. Together, the three of us argued the case for this debate to come to the House, and I look forward to their contributions. They are both passionate about this issue.

Earlier this week, I was at an event at which the daughter of an 86-year-old woman with dementia said some things that spoke to what this debate is all about. She talked about being a full-time carer for her mother and about the agonising decision to move her mother into a care home. She said that although death and moving house were probably the two most traumatic events in our lives, dementia was a never-ending bereavement and that the daily trauma had robbed her and her mother of life. Such true-life experiences, many more of which I hope will come out in today’s debate, make it plain why dementia is now the disease most feared by the over-55s.

My interest in the issue goes back well over a decade and was started by a report that I read into the inappropriate and, in some cases almost abusive, use of anti-psychotic medication. Even then, the side effects were beginning to be well documented and understood, so it is no wonder that at the time these anti-psychotics were labelled as a chemical cosh. As the evidence has mounted over the last decade or so of the increased risk of stroke as a result of these drugs and of the fact that they can shorten lives, I was prompted to ask endless parliamentary questions to Ministers about the matter and to produce a series of reports. At times, it felt a bit like banging my head against a brick wall.

I am pleased to say that the wall has started to tumble and that things have begun to change, and, in the last two and a half years, we have seen a 52% reduction in the prescription of these drugs to individuals receiving them for inappropriate reasons. As a result, lives have been saved and lives have been changed. But—and it is an important but—the Prime Minister’s progress report on his dementia challenge made it clear that there is no room for complacency and that there is still too much regional variation in the use of these drugs to manage people with dementia and too much prescribing. I hope that the Minister will tell us what the next steps will be, when the next audit, which has been committed to, will take place and be published and what other steps he thinks will be necessary to ensure that we achieve the goal of a two-thirds reduction in prescribing.

I pay tribute to Clare Gerada, president of the Royal College of General Practitioners, who was instrumental in getting the co-operation of GPs for the necessary surveys to understand prescribing practice and who has led some of the change in culture and behaviour in this area. I also pay tribute to the last Labour Government—not something I always do—for producing the first national dementia strategy. It was one of the first in the world, in fact, and should be recognised as an important contribution.

When I became care services Minister in May 2010, I had to make a judgment: did we carry on the road laid out in that strategy, or did we start again? I took the view that we should use the strategy as the foundation for future action, and I am pleased to say that, as a result, the Government have done a lot to deliver on the strategy and go beyond it, through the creation of a dementia action alliance, bringing many different organisations together in a common cause, through clearer commissioning guidance, through collaboration with the Design Council and through funding the Life Story Network to run training courses. The latter is a small thing, but it makes a big, big difference: by telling our stories and understanding who we are, we start to look beyond the diagnosis of dementia, and, as a result, we start to treat the person, not just the disease.

Furthermore, the audit of dementia services has given us a handle on where different parts of the country have reached in developing their services and has led to new incentives in hospitals to support best practice and the much-valued—I hope—analytical tools that will help to drive up diagnosis rates, which are still far too low. Following the research call made just over a year ago, I was delighted to see just last week that £20 million of funding has now gone to new dementia research projects. That far exceeds what I expected at the time as a Minister and certainly what many officials in the Department expected. It really is fantastic news.

The Prime Minister’s dementia challenge has put dementia centre stage, promoting dementia-friendly communities and raising the bar for early diagnosis and quality of care, along with ensuring vital dementia research too. There is a lot happening and it can happen back in our constituencies as well. All of us have an opportunity—and, I believe, a responsibility—to challenge our local services to do more to become more dementia-friendly and ensure that they learn the lessons from best practice. However, there are some questions that the Minister needs to answer about what comes next. The current dementia strategy runs its course in 2014. What comes next? In my view, there has to be a successor strategy—one that is perhaps different from the current strategy in a number of ways, building on the work being done as a result of the Prime Minister’s dementia challenge.

That challenge is a challenge to the whole of Whitehall, not just the Department of Health. Every Department should be a catalyst for action on dementia within its sphere of responsibilities. Indeed, just before Christmas I tabled a series of parliamentary questions to try to establish what each Department was doing to support the dementia challenge. The answers I received were highly variable. Not all Departments seem to have clocked the fact that they could materially do something to make a difference in their sphere of responsibilities. I hope we can pick up on what the Prime Minister said about this being a challenge that cuts right across society, as well as ensuring that it is picked up and understood right across government. Any new strategy needs to embed dementia-friendly thinking right across Whitehall.

We cannot have a debate such as this and not talk about carers. It is important to stress and value the role that family carers play. That is why I was pleased to see recently that the National Institute for Health and Clinical Excellence has launched a consultation on new indicators in the quality and outcomes framework for identifying carers of people with dementia. That is fantastic, but what about all the carers who do not happen to be caring for someone with dementia? On this occasion I think it is wrong to single out one disease. I hope that others will make that comment in the consultation too. The most recent research by the Carers Trust into the NHS and carers’ breaks continues to make depressing reading, however. Too much of the NHS is still ignoring carers and not doing enough to passport the money that this Government have committed to carers’ breaks and make them a reality. As the NHS increasingly wakes up to the big challenge of supporting people with dementia and other long-term health conditions, it needs to wake up to its role in supporting carers too.

I have already mentioned that I was pleased to see the increased research funding that is coming through. I was delighted in 2010 when the coalition programme included a commitment to dementia research. That is a commitment that I lobbied the then Liberal Democrat health spokesman—now the Minister on the Front Bench—to include in our manifesto. Although there has been progress—with a road map now setting the direction of travel, a challenge group bringing various players together and a commitment to double research spending—I found myself becoming increasingly frustrated as a Minister by what I felt to be a poverty of ambition when measured against the burden of disease that dementia represents. We are not yet doing enough—we do not yet have the critical mass—to reach the scale and pace necessary to gain the understanding and insights that we need to make the breakthroughs. The £20 million from the research call is fantastic and I hope it will make a difference, but we still have lessons to learn from the journey made by the cancer research movement. I believe the dementia research challenge group itself needs to be challenged more. We need a long-term plan for dementia research and a sustained increase in funding for at least the next decade. This is about a common endeavour—a collaboration, as it were—between the research funders and the research community, so that we make a concerted effort to expand our knowledge of this disease, to diagnose and treat it and, ultimately, to understand and defeat it.

[John Pugh (Southport) (LD)]

I am listening carefully to my right hon. Friend, but dementia is clearly not an English disease; rather, it is an international threat. Is there not scope for massive international collaboration on what is an issue confronting all nations?

[Paul Burstow]

My hon. Friend makes an important point. Yes, there is scope for that; indeed, many research organisations in this field are already collaborating internationally. However, as a country with a very reputable research tradition, it is important that we should be in the vanguard of that research and put in place the necessary infrastructure to drive it forward.

[Huw Irranca-Davies (Ogmore) (Lab)]

I thank the right hon. Gentleman for giving way and welcome his very good introduction to this debate. I would make the same point about research within the UK. Post devolution, we often tend to look at it in terms of the different nations and regions in the UK. We should be sharing the best expertise and best practice right across the nations, because 800 of my constituents have been diagnosed—I suspect that there are many more who have not and they, too, need the very best assistance and support.

[Paul Burstow]

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

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

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

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

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

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

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

--- Later in debate ---

[Paul Burstow]

I am grateful to my hon. Friend and look forward to that collaborative approach to the Committee’s work.

I want to end by quoting from an e-mail I received recently. Hon. Members might be aware that I made some comments last week about one way in which I thought this policy change might be paid for. That generated quite a lot of responses; this is one of the ones I think I can quote in the House. It says:

“Tonight I am sitting on my own in the kitchen of our family home surrounded by a lifetime of mum’s possessions, all full of memories from certain times of our lives, while mum is in a care home blissfully (and thankfully) ignorant of my turmoil.

This has to be the lowest point in my life.

Not only coming to terms with the complexities both mentally and physically of dementia, realising I’ve lost my mum even though she’s still here, but stumbling through the bureaucratic minefield of trying to obtain funding and the emotional pressure of raising money by selling off, in effect, mum’s ‘life’.”

That is really what this debate is about. It is about people’s lives and how we can make them better. It is about how we can make the terrible journey through dementia as good as it possibly can be, and how we can secure the common good of having the right services at the right time. I look forward to hearing other hon. Members’ contributions to the debate.

[Several hon. Members]

rose—

--- Later in debate ---

[Paul Burstow]

On behalf of my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Salford and Eccles (Hazel Blears), I would like to thank each and every one of the Members who have contributed to the debate. Some of the speeches were personal; they were all powerful and moving, and they speak to why this debate cuts across party divides. It is not about party dispute; it is about party consensus across the House. On behalf of my colleagues, I also want to thank the Backbench Business Committee for scheduling the debate.

I want to highlight a number of areas; the first is early diagnosis. Many Members have said that it is absolutely critical and makes a big difference. However, a diagnosis that just hangs a label around a person’s neck does not make a difference. What makes a difference is understanding the person, the journey they have been on and the journey they are about to embark on when they receive that diagnosis.

That brings me to the second area, which relates to care and treatment. In order to understand a person, we need to know them. If we know them, we can ensure that they have a sustained, adaptable and joined-up package of care and support that moves with them and their needs as their condition progresses, and that must apply not only to them but to their friends and family. We have heard some harrowing accounts today of how compassion has been absent from our national health service and our care services, but we have also heard stories of hope, where things are going better. They are the beacons that we need to look to, and we need to light more of them around the country.

A third area is research, which is also about hope. We need to ensure that we invest in understanding so that we can defeat the disease and, in the meantime, treat people much better. If the debate delivers no other message to the Government today, I hope that it will deliver this one: this Government really need to lead and deliver when it comes to research and reform; they need to get on with it. It is long overdue, and it is time for the coalition to deliver it.

Question put and agreed to.

Resolved,

That this House has considered the matter of dementia.

Winterbourne View

Paul Burstow Excerpts

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

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

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

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

[Norman Lamb]

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

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 27th November 2012 Commons Chamber

[Anna Soubry]

It is important that we consider all aspects of how we can treat cancers. We also need to bear in mind the people who care for those with cancer, as we sometimes forget them. Any organisation—especially in the charitable sector—that offers treatments that help people and their families and carers is to be welcomed.

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

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

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

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

[Paul Burstow]

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

[Norman Lamb]

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

NHS Commissioning Board (Mandate)

Paul Burstow Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

The approach the reforms take is this: when there are inequalities in treatment, and when one hospital is particularly good at certain operations and another hospital is not as good, the best way to drive up performance is to make that information available in a way that has never happened before. More than anything, peer review drives the NHS. A very important part of the programme will be to roll out plans similar to those we have rolled out for cardiothoracic surgery, for which a performance comparison by consultant team, not just by hospital, has led to a dramatic improvement in survival rates from heart operations. We need to roll that out across many other disciplines. We also need to be able to compare local GP-led group with local GP-led group, and local authority with local authority. That will be a far more effective way of driving change than the old top-down way. That was tried under different Governments many times and in many ways, but it was never as successful as it was meant to be.

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

I welcome the statement, and particularly the actions that are being taken to deliver parity of esteem between physical and mental health, and to drive improvements on dementia. Those two things are linked by the common frustration of family carers, who feel that their voices are not always heard or understood within the NHS, and that there is too much variation in this country when it comes to identifying carers and ensuring that they get access to the breaks they so often need. Can the Secretary of State assure us that the mandate will ensure that people who need breaks get them before they have a breakdown?

[Mr Hunt]

I thank my right hon. Friend for the work he did at the Department, which is widely recognised on both sides of the House. He is right to talk about the critical role of carers. We have spoken a lot today about dementia. Dementia puts huge pressure on partners of the people affected. Very often, because we do not give the support we need to give at an early stage, people with dementia end up having to go to residential homes, whereas with that support, they would be able to stay at home happily for much longer. It is a critical issue. I hope he will be pleased to see in the section on long-term conditions explicit mention of the role of carers. We will follow the matter closely as the NHS Board implements at a local level the support he mentions.

Winterbourne View

Paul Burstow Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

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

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

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

[Norman Lamb]

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

People with Learning Disabilities (Abuse)

Paul Burstow Excerpts

Monday 3rd September 2012 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) on securing this important debate and thank him for setting out so powerfully the case for action, not just by the Government but by all those in the system. He acknowledged that the responsibility for safeguarding the vulnerable in our society sits with us all. We should all be vigilant and we must be willing to blow the whistle and to stand up and be counted.

The Government agree with the right hon. Gentleman that, like anyone else, people with learning disabilities have the right to lead their lives free from fear, harassment, harm and abuse. People with learning disabilities should be treated with dignity and respect.

This is the first parliamentary opportunity to refer to a sentiment shared across the House tonight. I should like to pay brief tribute to the work of Lord Morris of Manchester, Alf Morris. Opposition Members will know him from his service as a member of the Labour parliamentary party for many years. He was an undoubted, doughty challenger and campaigner for the rights of disabled people, regardless of their disability. He will be missed, having departed this world during the recess. He was the first Minister with responsibility for disabled people and the pioneer of disability legislation in this country, along with Lord Jack Ashley, who is also sadly missed. I suspect that they are both looking down on this debate and regretting the fact that we are still debating abuse of this sort. I want to put on record my tribute to both of them.

[Mr Tom Clarke]

I am very respectful of what the Minister has said about two great men, Lord Ashley and Alf Morris. The last discussion I had with Alf Morris was about this very issue.

--- Later in debate ---

[Mr Clarke]

The House and the Minister will not be surprised to hear that Lord Morris’s final words to me were about the battle of haemophilia and making sure that those who were treated with inappropriate blood should have their rights met. I thank the Minister for his comments.

[Paul Burstow]

I am sure that Lord Morris would have been following these matters very closely and with great interest, and I am grateful to the right hon. Gentleman for raising them.

The events at Winterbourne View that the right hon. Gentleman so clearly described were horrifying and depressing. They were horrifying because they so sharply defined everything that is rotten and can go wrong in closed institutions where people are out of sight. What took place at Winterbourne View was criminal. A culture of abuse was allowed to fester and grow undetected and unchecked. The serious case review by Margaret Flynn sets out in great detail the failings of Castlebeck Care Ltd, and it makes grim reading. The right hon. Gentleman reported many of its findings to the House. The events at Winterbourne View were depressing because, as the report by Mencap and the Challenging Behaviour Foundation, “Out of Sight”, reminds us, it is not the first time that closed institutions have let down people with learning disabilities. The right hon. Gentleman highlighted the personal stories that are contained in that important report, and those stories are very telling, with families feeling let down by the system and the sense that the best interests of the individual are not being served and that their views, wishes and feelings were not sought, and if they were sought were not understood.

In October this year, the court will hand down sentences to the 11 members of staff who have pleaded guilty to maltreatment of patients at Winterbourne View hospital. There are no excuses and no mitigating circumstances. What happened was degrading, dehumanising and despicable. I understand that the Crown Prosecution Service will ask the judge to take into account the fact that these are disability hate crimes when determining the sentence of the defendants.

[Dr Julian Lewis (New Forest East) (Con)]

Can the Minister inform the House whether the people who behaved in such a sadistic way had, prior to recruitment, shown any evidence of tendencies of this sort? We would usually expect people who go into the caring professions to be empathetic, sympathetic and caring. How come people who gloried in sadism found themselves in such positions?

[Paul Burstow]

That goes to the heart of a number of the points made in the serious case review about the nature of the recruitment processes that were used by Castlebeck and the way in which it then carried on inadequately to train, supervise and monitor the conduct of those staff. I will come back to some of the actions that the Government are taking in that regard to make it much more difficult for that to occur again in future.

Of course, what happened at Winterbourne View came to light only as the result of the actions of the whistleblower, Terry Bryan, and the Panorama programme broadcast by the BBC. I personally thanked Terry for his actions when I spoke to him some months ago about the interim report that we published in June, and I do so again tonight. Thanks to Terry, the Care Quality Commission has changed its systems and set up a dedicated whistleblowing team. An even greater emphasis is being placed on the importance attached to the role of whistleblowers. That is why the Government have introduced a free whistleblowing helpline, not only for NHS staff but, for the first time, for social care staff, so that they can get advice on how to report concerns that they have. There has also been a strengthening of the NHS constitution to make these matters clear to their employers as well.

Terry Bryan blew the whistle on the worst excesses of a wider systemic failure. As I acknowledged in the Department of Health’s interim report in June, the problems revealed at Winterbourne View are more systemic. There has been a tendency when reporting on Winterbourne View to heap much, if not all, of the blame on the CQC. Indeed, the CQC seems to stand as the barrier to everyone else who should be in the dock being criticised, scrutinised and challenged for what went wrong. Although the CQC, rightly and properly, acknowledged its failings and apologised at the time, the issue of staffing and the freeze that this Government introduced on coming into office in May 2010 was specifically lifted for the CQC in October 2010, and there were no restrictions on staff recruitment. If there were failings of recruitment, the CQC would need to answer for them—indeed, it has—before the Health Committee.

Every part of the system—NHS and social care commissioners, providers, regulators and health and care professionals—has a part to play and, indeed, has questions to ask itself about what has passed.

[Roger Williams (Brecon and Radnorshire) (LD)]

The Minister rightly pays tribute to the whistleblower, but does he agree that when vulnerable people are moved away from their communities and, indeed, their families to care homes that may be many miles away, complaints are less likely to be made and, therefore, inspections less likely to be triggered?

[Paul Burstow]

My hon. Friend makes an important point and anticipates what I am about to say. The Department’s guidance is clear. People should be supported to live in the community, wherever possible, and only in strictly limited cases should assessment and treatment centres be used. Nowhere in policy or guidance is there justification for long-stay assessment and treatment hospitals. Indeed, the CQC found length of stay ranging from anything between six weeks and 17 years, with five to seven years not uncommon.

The hon. Member for Slough (Fiona Mactaggart) raised the issue of data during her intervention on the right hon. Member for Coatbridge, Chryston and Bellshill. I agree that we need to improve data collection so that we have a clearer picture of what is going on. The painstaking work of the serious case review, Department of Health officials and others to create a clear picture of the system begs questions about the adequacy of data collection for many years.

[Fiona Mactaggart]

I wrote to the hon. Gentleman last week—although, having been a Minister, I suspect that he has not seen my letter—asking him to conduct an audit of out-of-area placements of vulnerable people and to publish the figures on people who are placed a long way away from home. Will he commit tonight to do that?

[Paul Burstow]

What I will rightly do—having been a Minister, the hon. Lady will understand this—is give her the justice of reading her letter and considering properly what she has asked. There is merit in what she has said. There is certainly merit in ensuring that those who commission such services are collecting that information so that they have a clear picture of those who are being placed out of area.

I am more interested in the more fundamental question of the appropriateness of something that is outside of policy becoming a practice and being established as an ongoing practice. My point is that we need to look critically at the system that has allowed out-of-area placement to grow to the extent that it has, which has allowed such abuse to go unnoticed in some places for too long. There is no place for such long-stay institutions detaining vulnerable people far away from home.

Providers, commissioners, regulators and individual professionals all have a responsibility—a duty of care to those on whose behalf they commission services. Last year, in the wake of Winterbourne View, the CQC conducted 150 inspections of other services for people with learning disabilities. It adopted new ways of working involving experts both by profession and experience. Although the CQC found no other cases of abuse like those exposed at Winterbourne View, it is disturbing that half of the services that the CQC inspected revealed evidence of poor quality care that was failing to meet essential care and safeguarding standards. Everyone who is involved across the NHS and social care has a vital part to play in driving up standards.

As I have said, the Department’s guidance has been and remains clear. The interim report sets out clearly the elements of the model of care that we expect to see commissioned. However, that is not always happening on the ground. Those commissioning, or in too many cases, spot purchasing, long-stay assessment and treatment services need to look carefully at what they are doing. Indeed, I can tell the right hon. Member for Coatbridge, Chryston and Bellshill that the chief executive of the NHS Commissioning Board and the Department’s director-general of social care wrote to chief executives and chairs of all NHS bodies and local authorities to highlight the interim report and reinforce their responsibility to improve commissioning.

When I published the interim report in June, I set out five objectives for improving services for people with learning disabilities and behaviour that challenges. Those objectives underpin the 14 national actions set out in the report to improve care and support for people with learning disabilities or autism and behaviours that challenge. Those actions include promoting open access for families and visitors and ensuring that people are involved in reviewing the care that they receive; encouraging the CQC to carry out unannounced inspections at any time of the day and week; working with the CQC and the Department for Education to promote best practice and positive behavioural support and ensure that physical restraint is only ever a last resort, and certainly not a tool of choice as it clearly was at Winterbourne View; improving integration between the NHS and social care by setting up health and wellbeing boards to agree joined-up ways of improving services; and getting a range of national organisations, including the Association of Directors of Adult Social Services, the Royal College of General Practitioners and other royal colleges, the NHS Confederation and the NHS Commissioning Board, to sign up to a concordant setting out the actions that each will be committed to taking forward to deliver the right care for people with learning disabilities and challenging behaviour.

One final action that I commend to the House is our work with the NHS Commissioning Board to improve the use of NHS contracts. When we read the serious case review, it is shocking to see how few NHS organisations used NHS contracts to contract their services. They used Castlebeck’s own contract, which was a poor document. The serious case review is just part of what we need to examine. There is also the NHS review of commissioning that was conducted by the South West strategic health authority, which sets out a number of other actions that are being taken to address failings.

I made it clear when we published the interim report that I would very much welcome feedback on it to ensure that the final report, and the action plan that we will publish alongside it, would be as robust as possible and deliver what Members of all parties wanted. I therefore welcome the report by Mencap and the Challenging Behaviour Foundation. As part of our response, we will consider the role of commissioners and how we can support them in the new health and care system.

In addition to the work that my Department is doing directly in response to Winterbourne View, we are taking a number of other steps to improve the care and support system. For example, we are introducing the first ever code of conduct and national minimum training standards for health care and adult social care support workers. That goes to a point that was made in interventions. That work is being taken forward by Skills for Care and Skills for Health and will ensure, for the first time, that employers and people who provide care understand their responsibilities and roles in delivering high-quality and acceptable care to people who need it.

In July, when we published the White Paper on care and support, we set out plans for measures to increase the availability of appropriately skilled care workers, including by expanding the number of care apprenticeships. The White Paper also made the case for strengthening safeguarding, which is what this debate is fundamentally all about. That is a key priority for the Government.

We are committed to preventing, and reducing the risk of, significant harm to adults in vulnerable situations, while supporting individuals to maintain control over their own lives and to make informed choices without coercion. That is why the draft Care and Support Bill sets out a new statutory framework for adult safeguarding to address some of the defects that have been identified, and key responsibilities for local authorities and their partners in the NHS and the police. It will ensure that safeguarding adults boards exist everywhere in England. The Bill will place all that on a statutory footing for the first time.

I am grateful to the right hon. Member for Coatbridge, Chryston and Bellshill for securing the debate. In learning the lessons from Winterbourne View, I am determined to ensure that the voices of people with learning disabilities and of families are right at the heart of what we do.

The National Forum of People with Learning Disabilities and the National Valuing Families Forum sit on the programme board that I chair, which will oversee progress on the action plan. Both have key roles to play locally and nationally in driving change.

Let me end by making it clear that the Government’s approach to people with learning disabilities is grounded in fundamental principles of human rights, independence, inclusion and choice. There can be no excuses. There is no tolerance of those who abuse disabled people.

The right hon. Gentleman has done the House a service by bringing these matters to it tonight. I look forward to coming back to the House later this year with the final report setting out the actions that the Government will take to stamp out abuse.

Question put and agreed to.