Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 17th July 2012 Commons Chamber

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

15. What steps he is taking to bring forward legislative proposals on the funding of social care.

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

The draft Care and Support Bill contains clauses that support our commitment to introduce a universal deferred payments scheme and a national eligibility threshold. We have set out our intention to base a new funding model on the principles of the Dilnot commission model and we will take a decision in the next spending review.

[Mrs Glindon]

Last week the Secretary of State dismissed the concerns of Labour MPs about councils being hard pressed to find funds to implement any of the proposals. The Local Government Association stated that there was no money. Will the Minister now commit to legislation in this Parliament to sort out the funding of social care at local level?

[Paul Burstow]

It does not need legislation to sort out the amount of money that goes into social services; it does need legislation, however, to put in place a universal deferred payments scheme. We have made it clear that we will fully fund the commitment that we have already announced and we will work with the Local Government Association and others on its detailed design and implementation.

[Barbara Keeley]

The verdict of the Care and Support Alliance on the delay in introducing legislation to reform social care funding is this:

“Each day of delay condemns greater numbers of older and disabled people to the risk of isolation and neglect,”

trapping people in hospital and pushing many more carers to “breaking point”. Just when will the Government realise the damage done by delaying the decision to do anything about funding social care?

[Paul Burstow]

In fact, in October 2010 this Government took an important decision about the funding of social care: to invest an extra £7.2 billion. I wish Opposition Members would stop running local authorities down and support the ones that are doing the right thing and ensuring that they spend the money the Government have provided to them on social care, rather than cutting those services. That is what I am doing; I hope that the hon. Lady will as well. I just wish that she had prefaced her comments by apologising for 13 years of Labour failure on social care.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome my hon. Friend’s statement today and the announcements last week about the future structure and the commitment to introduce legislation later in this Parliament in line with the draft Bill. Will he confirm that it is the Government’s intention to pursue the cross-party talks on funding options for the Dilnot package, and that if solutions can be found, they can be included in the legislation that is introduced?

[Paul Burstow]

Notwithstanding some of the perhaps intemperate exchanges we have in this place, my colleagues and I are still determined, if those on the Opposition Front Bench are, to engage in talks on how we reform the funding system. Indeed, the debate we had in the Chamber last night confirmed that both sides of the House wish to support the principles of the Dilnot reforms, so I hope that we can have such talks and that they can be reflected in the Bill.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I welcome the Government’s commitment to support the provision of free and fully integrated end-of-life care. While the palliative care funding pilots are progressing, can lessons be learnt quickly in my borough of Enfield where, sadly, most people are dying in hospital rather than, as is their choice, at home or with the support of local hospices?

[Paul Burstow]

My hon. Friend is absolutely right. Just last week we published the world’s first ever survey of bereaved people’s experiences of the end-of-life care received by loved ones. It revealed quite stark variations from one part of the country to another, and will prove a valuable tool in driving up performance of areas that are not doing well by families in end-of-life care. As for the White Paper, we have said clearly that we are committed to doubling funding for the pilots to ensure that we have the data to take decisions about the introduction of free personal care when it comes to end of life.

[Liz Kendall (Leicester West) (Lab)]

Opposition Members are genuine in our desire to reach cross-party consensus on the funding of social care. Will the Minister demonstrate his Government’s seriousness by agreeing to include Treasury Ministers directly in the cross-party talks, as Labour has offered to do from the start?

[Paul Burstow]

Talks that start with lots of preconditions are not going to be very good talks to start with. The Government always retain the responsibility for making decisions about taxation and spending priorities. We set out our position last week on the Dilnot Commission, and we now have a clear basis for talks, as those on both sides of the House seem to agree on the principles of Dilnot as the basis for reform.

--- Later in debate ---

[Laura Sandys (South Thanet) (Con)]

9. What steps he is taking to improve social care services.

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

The White Paper introduces new measures to help us to deliver better quality services and to improve the care that people experience, including through greater transparency, with new provider quality profiles and new care audits. It also clarifies what quality in care and support means, by setting out principles, standards, roles and responsibilities for driving up the quality of care. The White Paper makes it clear that we will rule out crude commissioning by the minute, which turns care workers into clock-watchers, and that we will work with commissioners, care providers and people who use services and carers in order to bring to an end commissioning practices that undermine people’s dignity and choice.

[Andrew Selous]

I recently visited Ashton Lodge residential home in Dunstable, and I was delighted to hear from the residents how kind the staff were. Occasionally, however, I get letters from constituents detailing simply unacceptable levels of care for their family in residential homes. How can we involve local communities more so they take a role in ensuring that all residential homes have consistently high standards of care?

[Paul Burstow]

I am grateful for that question. Indeed, one of the issues set out in the White Paper is the collaboration by the Department of Health and others with leaders in the care sector to make sure that care homes become much more embedded as part of their local communities and much more genuinely open to their local communities—working with local schools and working with HealthWatch, which will have powers of entry to work with those care homes as well. By turning the spotlight on in a benign way, making sure that all care homes are more open to their public, I think we can significantly improve quality.

[Laura Sandys]

In parallel with the social care budget, do the Government see a strong role for GPs to look at prevention—putting in special monitoring as people get older to ensure that we stay younger and fitter for longer?

[Paul Burstow]

Indeed we do. We identify in the White Paper the fact that there has been a postcode lottery for many years when it comes to access to primary care in our care home sector. The White Paper sets out how to ensure that we begin to eradicate that postcode lottery. By establishing a national commissioning board to commission primary care, we can ensure greater consistency in the future.

[Ms Margaret Ritchie (South Down) (SDLP)]

What conversations has the Minister had with his counterpart in Northern Ireland in respect of protecting the high standards of residential and nursing care that already exist for the people in Northern Ireland?

[Paul Burstow]

I am grateful to the hon. Lady for her question. Indeed, officials in my Department are in close contact with officials in all the devolved Administrations to make sure that we share best practice across the nations so that we drive up the quality of care for all.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Only last week, the Secretary of State said about care:

“The…number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not.”—[Official Report, 11 July 2012; Vol. 548, c. 322.]

Figures published by his own Department show the number of delayed days is up by 18% in the last year and 29% since August 2010. Are Ministers completely out of touch with reality, or would the Minister now like to correct the record?

[Paul Burstow]

Of course what the hon. Gentleman omits to mention in seeking to give an impression is this: the implication is that social services are not coping with delayed discharges and are the principal cause of them, but the figures do not bear that proposition out. [Interruption.] Indeed, the extra investment the Government are making in reablement services means that discharges in this area are being assisted and improving—[Interruption.]

[Mr Speaker]

Order. The question has been asked, and the Minister is giving his answer. Members may like it or dislike it, but they have a duty to listen to it with courtesy. While I am about it, let me emphasise that there is far too much sedentary noise coming from both Front-Bench teams. I think that the Minister has finished his answer; we are grateful to him.

--- Later in debate ---

[Julie Hilling (Bolton West) (Lab)]

12. What assessment he has made of the effect on residential care providers of reductions in local authorities’ budgets.

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

Local authorities choose how best to use their funding; however, the levels of residential care provision are not determined solely by local council social care budgets. The supply of care home places is governed principally by demand from both public commissioners, such as local councils and the NHS, and private purchasers of services.

[Julie Hilling]

Nine out of 10 residential home providers say that low council fees are creating a two-tier system, as new investment is directed at wealthier areas where there are more people who can self-fund, and 82% of those providers say that self-funders are being charged more to cross-subsidise local authority-funded residents. This clearly is not fair, so what is the Minister going to do to rectify the situation?

[Paul Burstow]

We know from the most recent survey published by Laing and Buisson that there has been a 1.4% increase in the fees paid this year, compared with no increase last year. We also know that there is a surplus of places, which accounts for about 10% of the total number of bed places available in care homes up and down the country. So there is actually space, and it is entirely appropriate for local authorities to negotiate appropriate prices to provide good-quality care from one locality to another.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

Following the census announcement yesterday that there are elderly hot spots, including North Yorkshire, will this is be a good opportunity for the Minister and the Government to review health and social care funding to reflect a growing elderly population in sparsely populated, isolated rural areas such as North Yorkshire?

[Paul Burstow]

My hon. Friend is absolutely right to highlight those issues and the emerging findings from the survey. It is important to say that data will be a key consideration in how the next spending review is shaped, along with the priorities that the Government will give to different demographic pressures as a result.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

13. What recent representations he has received on the reconfiguration of children's heart services.

--- Later in debate ---

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

T2. The Minister will be aware of the 500% increase in the use of antidepressants over the past 20 years. I welcome the announcement of the hundreds of millions that will be spent on talking therapies over the next few years, but will the Minister tell us specifically what funding has been allocated for mindfulness, which is the best known treatment for repeat episode depression?

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

I am grateful to the hon. Gentleman for that question. He has been a doughty campaigner and pursuer of this issue and I can tell him that a number of improving access to psychological therapies—IAPT—services are developing and using mindfulness-based approaches. Indeed, as the hon. Gentleman said, NICE recommends them for the treatment of recurrent depression. A number of randomised controlled trials are going on to see how it might be applied to other long-term health conditions. There is baseline allocated funding but there is no specific earmarked funding for this particular project other than in the context of the IAPT programme, in which we have invested £400 million.

[Mark Lancaster (Milton Keynes North) (Con)]

T6. Yesterday’s figures showed a 17% increase in the population of Milton Keynes over the past 10 years, the highest outside London or Manchester, and an unexpected increase of some 4,000 over the estimate in the past 12 months. May I seek the Secretary of State’s reassurance that that will be reflected in future health care budgets for the city?

--- Later in debate ---

[Duncan Hames (Chippenham) (LD)]

T7. Last year’s National Audit Office report highlighted inconsistencies in the care of patients with neurological conditions such as Parkinson’s, which neurology networks could address. When will the Government publish their review, announced last September, of clinical networks in the national health service, and will it offer any hope for Parkinson’s patients?

[Paul Burstow]

I am grateful to my hon. Friend for asking that question. The NHS Commissioning Board is currently conducting a review of the effectiveness of clinical networks, and the scope for expanding them. It includes examining the case for neurological clinical networks, and a report should be published very soon.

[Kerry McCarthy (Bristol East) (Lab)]

T4. In yesterday’s debate, when talking about the south-west consortium, the Minister of State, the right hon. Member for Chelmsford (Mr Burns) emphasised the need for negotiations and agreement with staff. Does the Secretary of State not think it was shocking that staff found out only through a series of freedom of information requests that the consortium existed, and can he tell me when the Department of Health first found out about the consortium?

--- Later in debate ---

[Mary Macleod (Brentford and Isleworth) (Con)]

T10. I commend the Government for their plans to improve the care and support system, especially for an ageing population. How will the changes make a real difference to carers, particularly those supporting people with Alzheimer’s and dementia? Is there more we can do to support them?

[Paul Burstow]

I am grateful to the hon. Lady for her question. She is right: we have to do as much as we possibly can to recognise and support family carers. In the White Paper, we have set out a number of steps, not least investment of £400 million to fund more breaks for carers. We are working with the Royal College of General Practitioners to make sure that they are more aware of carers and can identify more carers. We are doing work to make sure we have earlier, quicker diagnosis in more areas of dementia so that people get the support they need. Most important of all, we are making sure that hospitals, as part of the services they provide for people with dementia, actually deliver on NICE guidance on supporting family members. Finally, the Government are legislating, for the first time ever, on support for the needs of carers.

[Andrew Miller (Ellesmere Port and Neston) (Lab)]

What assessment has the Secretary of State made of the views of clinicians, and scientists from academia, industry and the third sector, on the impact of change on the development of stratified medicines?

--- Later in debate ---

[Mark Durkan (Foyle) (SDLP)]

When the national advisory council of the Thalidomide Trust recently met Government representatives, no funding undertakings were available on the replacement of the health support grant for sufferers. When can we expect a meaningful commitment in that regard, and is the Department liaising with its devolved counterparts?

[Paul Burstow]

Yes, we are liaising with the devolved Administrations. Yes, we had a productive meeting with the trust and the council, which confirmed that they will shortly submit to us the second-year evaluation of the pilot programme. I undertook to look at that carefully and enter into further discussions with a view to reaching a conclusion and making further announcements this autumn.

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

Ministers may recall the concern of patients and carers in the New Forest area about the decision to close a third of acute adult mental health beds in Hampshire. Are Ministers aware of a similar trend in other parts of the country, and if they are, as they should be, what do they think about it?

Adult Social Care

Paul Burstow Excerpts

Monday 16th July 2012 Commons Chamber

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

Let me begin by striking a note of agreement between Government and Opposition, before moving on to the areas where we disagree. I agree with the hon. Member for Leicester West (Liz Kendall) that our debates about our ageing society are too often couched in terms of burdens and impacts on public expenditure, when they should be a cause for celebration as we have more people living longer and living healthier for longer. That stands as a tribute to our national health service, our local authorities and many others besides.

I sat in the House for 13 years in opposition to a Labour Government, and it became very clear to me that, despite the wealth of the nation being much greater at that time than it is now, the Labour party was not willing to tackle the pressing need for serious systemic reform of social care. I shall talk in a moment about the Labour Government’s last-minute moves to address that agenda.

Social care is Bevan’s orphan. It was left over after the NHS was established in the 1940s, and it has suffered ever since. It has been hidden behind its favoured sibling, the national health service, out of sight until life takes a turn and tips people into crisis. Social care’s founding principles date back to the Poor Law; it was a poor relation to the NHS, ripe for reform, but neglected for decades.

Much of last week’s reporting about the Secretary of State’s statement in the House and the publication of the White Paper and draft Bill gave the impression that the only subject that was talked about was who pays for care—where the line is drawn between what an individual personally is responsible for in meeting their care costs and what costs the state would pick up. The Government do not dispute that that is an important issue, and we have made significant progress on that agenda, but it is not enough simply to redraw the boundary between personal responsibility and state support, because the system of social care in England is undoubtedly broken.

Given that there were 13 years of Labour inaction, the hon. Member for Leicester West must face up to some of the challenges in respect of social care. A White Paper finally emerged in the dying days of the last Labour Government; it was published on 30 March, just seven days before a general election was called. That is not good enough; it is too little too late. What did that White Paper say? It talked about national eligibility, but when? It was by 2015, so it was going to take Labour five years to introduce that change. On portability, it did not commit to ensuring that support would be provided immediately in the area to which the person was moving. In other words, there was still a risk of interruptions. In addition, that Labour White Paper said nothing about the rights of carers. The hon. Member for Leicester West was absolutely wrong when she told the House that Labour was responsible for introducing carers legislation. Back-Bench Members in this House, tirelessly arguing the case, were responsible—[Interruption.] Labour, Conservative and Liberal Democrat Members supported those many measures over a number of years, but none came from the Front-Bench and none came from the Labour Government.

[Hugh Bayley (York Central) (Lab)]

I would like to get back to the issue in hand and call a spade a spade. The only substantial asset that most families have to pass on to their children and grandchildren is the home they live in. If the Government want a new inheritance tax, would it not be fairer to levy it at the same percentage rate on rich and poor alike, and not simply target those people who have the misfortune to fall ill at the end of their life?

[Paul Burstow]

I will come in a moment to our response to the Dilnot commission recommendations, so I will deal with the hon. Gentleman’s point at the right time.

[Hugh Bayley]

Now would not be bad.

[Paul Burstow]

No, I am talking about the time at which in the sequence of my speech I will make the point about the Dilnot commission recommendations.

I wish to make one other observation on the national care service White Paper that the Labour Government published seven days before the last general election was called. Our White Paper addresses the end-of-life care issues, but Labour’s failed to address them.

[Mr David Anderson (Blaydon) (Lab)]

The Minister is rightly critical of the failure of the previous Government to bring in care for the people of England. Does he support what was done in Scotland by the previous Government?

--- Later in debate ---

[Paul Burstow]

I am not certain which thing the hon. Gentleman is inviting me to support. Many measures were introduced by the coalition Government in Scotland over a number of years to reform the social services system in Scotland, not least some relating to adult safeguarding which this Government are now making progress on.

[Andy Burnham (Leigh) (Lab)]

I think that the Minister has unfairly misrepresented the process we went through in the last Parliament. We did not just have a White Paper before the general election. We had a Green Paper in the summer of 2009, and the whole process was kicked off in the 2007 spending review. Upon a request from the then shadow Health Secretary, I agreed to cross-party talks. So the Minister is unfair in saying that nothing was done and then a rabbit was produced from the hat. May I say to him that the White Paper that I produced before the election addressed both service reform and funding? I am afraid that the same could not be said of the White Paper that emerged last week.

[Paul Burstow]

That is interesting, because the White Paper that was published seven days before the general election was called carried no details on who should pay, what they should pay or when they should pay. It contained no details of that sort, and I urge people to read it and compare it with the White Paper, draft Bill and other details that we published just last week. In 13 years, when the money was available, the Labour Government did not do anything; they left it until the last seven days and even then did not come up with the details.

In the space of two years, this coalition Government have advanced further and faster than any in the previous 20 years on addressing a wide range of issues and challenges and backing that with tangible action. Unlike what happened with Labour’s royal commission, so firmly kicked into the long grass, this Government have accepted all the recommendations of the Dilnot commission as the basis for a reformed system. Many of those recommendations are translated into the legislation that we published last week. Crucially, the Government accept the principles of a capped cost system as the basis for protecting people from catastrophic costs. Labour’s motion seems to suggest that Labour does, too. I want to make it clear that we are keen, still, to engage with the official Opposition and other stakeholders in reaching a final settlement on this question of the boundary between the state’s responsibility and the individual family’s responsibilities for meeting care costs.

[Mark Field (Cities of London and Westminster) (Con)]

Does the Minister not recognise that any cap, be it at £35,000 or £60,000, as was initially proposed by Dilnot, is likely within a very short time to be wholly inadequate, given the funding constraints that we are under? The harsh reality is that people who wish to preserve an inheritance for their children—that is an understandable desire—must recognise, as must their children, that those children will have to take on the burden of looking after aged parents, in both time and financial terms. It sounds like a hard truth, but it needs to be put on the record, because otherwise we are not going to get any further forward in dealing with this matter.

--- Later in debate ---

[Paul Burstow]

The hon. Gentleman expresses an opinion that is held by many people, but the Government’s position is not to take that view. We take the view that a cap on care costs is an important component in a redesigned system for funding in this country. What we have said clearly is that we have to address how that is paid for as part of a spending review. That is why we believe that both a cap and an increase in the means-test threshold provides the necessary assurance for a family to plan and prepare for care, and provides the mechanisms by which the financial services industry can grow and develop to offer appropriate products.

[Mark Field]

Is there not a problem with what the Minister has said? I understand that this is an incredibly difficult issue, which we all have to deal with. I have lost both my parents. One died at the age of 70, only 18 months ago, at a time when we were on the cusp of putting her into full-time care, which would have been ruinously expensive. Is not the problem with all this that if we put in place today any system with a fixed cap, it will almost certainly be superseded by events and will then be seen as unjust for future generations?

[Paul Burstow]

The hon. Gentleman identifies one of the issues associated with the design of the introduction of a cap. It is worth pointing out that the interaction between the cap and the means-test threshold means that every family would have a different level for which they would be liable to meet their care costs. The issues relating to design are real, as are those about how to meter the system from the point someone enters it, and they require detailed work as part of the design of an effective implementation alongside the costings of it.

[Hugh Bayley]

The hon. Member for Cities of London and Westminster (Mark Field) is right to identify that there is a link between inheritance and the high cost of end-of-life care for people. May I put it to the Minister that if there is a cap of £100,000, the entire inheritance could be wiped out for a family who have a modest home in the north of England, whereas somebody living in a home worth 10 times as much in southern England would still maintain a large proportion to pass on?

[Paul Burstow]

That is why we have to explain this clearly. By lifting the means-test threshold to £100,000, the interaction between the absolute cap and the means test means that the amount the individual will ultimately pay as their lifetime contribution towards their care costs is related to their wealth. I urge the hon. Gentleman again to look at both the tables and the graphs in the progress report, as he will see exactly how it protects the assets of a family, even in the scenario he has described.

It is also important to understand that redrawing the boundary between what the individual pays and what the state pays does not—things all too often were conflated in this way last week—add any new spending power to the system. That leads me to the question of getting funding into the system. Before the 2010 spending review, the Dilnot commission urged the Government to protect baseline funding for social care, and we did just that. In October 2010, we confirmed an extra £7.2 billion of support for adult social care, which, together with a programme of efficiency, was sufficient to protect access to support. That included an unprecedented £4.2 billion of NHS resources to support social care, to promote integration and innovation, and to support the expansion of reablement services. The Labour party wants to paint a picture of doom and gloom up and down England on these services, tarring every council with the same brush of being crude cutters of services, when that is not the case.

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

Perhaps I could describe to the Minister what is happening in Trafford, which has a Conservative council and is where my constituency is located. We are seeing a twin squeeze, despite the Minister’s apparent sanguinity about the funding. On the one hand, we are seeing thresholds for access to care being raised as a means of rationing the way in which the money is spent. On the other hand, as care providers are telling me, commissioners are reducing and reducing the price they are prepared to pay providers to the point where they can hardly sustain their business at all or meet minimum wage legislation.

[Paul Burstow]

We know from the surveys that although last year there was a cash freeze in the increases that local authorities paid to provider organisations, this year across the country the average was a 1.4% increase. Again, that does not quite tally with the picture that some hon. Members want to paint.

It is also worth saying that the picture of local authorities grappling with tough budget settlements is complex. Different councils are responding to the pressures on budgets in different ways. Some are acting in a very smart way, as the Demos report, “Coping with the Cuts”, revealed. Such councils are protecting access by focusing on reablement services, helping more people to get back on their feet without the need for long-term support, which is better for the individual and more cost-effective. Indeed, the latest figures from the Association of Directors of Adult Social Services reveal that councils are protecting front-line care.

[Roberta Blackman-Woods (City of Durham) (Lab)]

Would the Minister agree to look closely at the report of the all-party local government group on social care, published today? It makes it very clear that a funding gap still exists and recommends that NHS money should be used to plug that gap. Will the Minister commit to continuing to do that and to considering the other recommendations in the report?

[Paul Burstow]

Obviously, I will happily look at the report and I look forward to meeting the all-party group to discuss its findings and recommendations later.

I want to report to the House the findings of the ADASS survey, which was published recently. Last year’s survey found that for every pound saved by local authorities in social care, 69p came through greater efficiency. This year, it found that that had risen to 77p in every pound. Yes, some councils are cutting services, and last year 23p in every pound that councils saved came from service reductions, but this year that figure is just 13p in every pound. Local authorities are getting smarter in organising their services, so I want to pay tribute to those councils and councillors who have worked hard with service users, carers and providers to protect services to make the best possible use of the extra money the Government have provided. As a result, between last year and this year, council budget spend on social services has gone down by just 1%.

[Sheila Gilmore (Edinburgh East) (Lab)]

On the question of efficiencies, would the Minister include councils that tendered a service and made a saving, but to the detriment of the end user of the service? That is how we got to the 15-minute, short-term care options. Is that an efficiency or a cut in service?

[Paul Burstow]

When there is a crude race to the bottom and contracting is by the minute simply to ration access to the service, resulting in a care home provider or home care provider delivering care on a very time-and-task oriented basis, that is totally unacceptable. We know that in places such as Wiltshire, where home care services are organised on an outcomes basis, that is delivering better results for the service users and releasing resources to reinvest in services.

[Richard Fuller]

When I intervened earlier, Mr Deputy Speaker, I forgot to refer hon. Members to my entry in the Register of Members’ Financial Interests as the director of two care companies.

The Minister is absolutely right to say that there is a patchwork of responses from local authorities. I absolutely welcome the end of per minute billing, which is a tremendous step forward, but I draw the Minister’s attention to the comments made by the hon. Member for Stretford and Urmston (Kate Green). She talked about the pressures of meeting the minimum wage and the pressures that local councils are putting providers through. The Government must consider that issue, because there is exploitation in some areas. As businesses and charities try to meet the requirements local councils are putting on them, workers are finding it difficult to achieve a sustainable wage in providing care services.

[Paul Burstow]

My hon. Friend is absolutely right to highlight that issue, which the Low Pay Commission has commented on over a number of years, including before this Government came into office. In our White Paper, we make it very clear that local authorities, as the commissioners of such services, must be mindful of their responsibilities in ensuring that the resources they provide to providers are sufficient to allow them to fulfil their legal obligations.

[Heidi Alexander (Lewisham East) (Lab)]

The Minister talks about the financial pressures faced by local authorities in providing care to elderly and disabled residents, but is he aware that the cost to local authorities of self-funders who have to fall back on the state is in the region of £1 billion a year? Does he agree that that is a very unpredictable thing for local authorities to deal with? What proposals does he have to help local authorities in that regard?

[Paul Burstow]

I am grateful to the hon. Lady for her question, because it allows me to talk about some of the points I think will directly address it. Reform of our care and support system is about more than just who pays for care; it is also about some other very important issues. A central proposition in the White Paper we published last week concerns the move from a service focused on managing crisis, and often not doing so very well, to one focused on supporting people’s well-being by concentrating on early intervention and prevention. That is why, alongside the White Paper, we published a draft Bill that will underpin the reforms we intend to make, consolidating, simplifying and modernising the legislation. The Bill sets out for the first time in statute some very clear governing principles about how decisions are made in social care, focusing on people’s well-being and living by the idea set out by our first White Paper in government of “No decision about me, without me”.

The Bill sets out a number of important changes that go to the heart of people being able to plan, prepare and have proper choice about the care available to them. First, it makes it a requirement for local authorities to ensure that there is a universal offer of information and advice so that people can plan and prepare. Secondly, it requires for the first time local authorities to focus on prevention. Thirdly, it requires a sufficiency of quality care so that choice is available to people locally. Fourthly, it requires integration and co-operation not just between the NHS and social care but between those agencies and housing.

The Bill will not only do that; it will simplify the point of entry into the state system. It will ensure consistent national eligibility and, for the first time in Government legislation, will ensure that there are rights for carers not just to an assessment of their needs but to support for those needs. It will also deal with the often mentioned issue of protection from disruption when people move from one part of the country to another or when a child moves from children’s services to adult services. It will guarantee continuity of services, which is not currently provided for.

Personal budgets, which were started by the Opposition but have not stuck well because of the legal framework, will for the first time be given a clear legal basis. I am delighted to say that whereas when this Government came to office in 2010 we inherited 168,000 people receiving personal budgets, by March of this year 432,000 people were benefiting from them. There will also be clear legal duties on the NHS, police and councils to safeguard people.

At the heart of our White Paper reforms is the notion that we need less variability on quality, to ensure that providers are responsible for driving up quality and accountable for doing just that, and to have more and open information about the quality of provision. That is why our provider quality profiles will provide that information in a way that will allow people to compare and rate providers for the first time and why we are putting an extra £32.5 million in to support those services.

[Andy Burnham]

The Minister is mentioning the things in the White Paper that he will ask councils to do. Can he give us a figure tonight for how much the Government have estimated that the cost to councils will be of providing all those things and tell us how councils will pay for it?

[Paul Burstow]

I will come on to give a specific figure in a moment, so the right hon. Gentleman will have to be patient.

I wanted to pick up again on the point about the White Paper ruling out crude contracting by the minute—a culture of clock-watching which has been allowed to grow up for years in too many places and which is not good for dignity, respect or quality. Under the Labour Government there were years and years of delay and dither when it came to addressing the quality of care workers and health care assistants. This Government are putting in place a code of conduct and national minimum training standards, and will double the number of people able to access apprenticeships in the care sector to 100,000.

[Andrew George (St Ives) (LD)]

I am grateful to my hon. Friend for his remarks. I hope I am not taking him back too far, but given that he is talking about the integration of services, particularly among authorities, and implying the portability of assessments for those with care packages, will he comment on the extent to which the Local Government Association has approved and supported the proposals in the Government’s White Paper?

[Paul Burstow]

On the proposals for portability of assessment and guaranteed continuity of care, the LGA is certainly aware and has been engaged in the consultations that we undertook last year as part of our preparations for the White Paper. It did not, of course, negotiate line by line the text of the White Paper, but it has the opportunity, as does everyone else, to participate now in the scrutiny of the draft Bill that we introduced. I hope the LGA will do so. We wish to engage with the LGA on these issues.

Integration is an important part of these reforms. Too often, people feel bounced around the system. What we do for the first time in the White Paper is set out a number of important steps towards more integration of the two existing systems.

[Jim Shannon (Strangford) (DUP)]

The Minister has used the term “integration” several times. In Northern Ireland we have an integrated health and social care system, which is working extremely well. I am conscious that that is very different from the position on the mainland. Are there lessons from the integrated system in Northern Ireland that could be applied here? We have done it well in Northern Ireland. Perhaps the example could be used here.

[Paul Burstow]

From my own limited study of the system and from visits that I have made over the years, one of the conclusions that I would draw, which is at the heart of our reforms as well, relates to culture and collaborative behaviour across the various parts of the system. That has been essential to delivering genuinely integrated care in some parts of Northern Ireland. I believe it is essential to delivering genuinely integrated care in England as well.

I mentioned earlier that end-of-life care was an omission from the Labour Government’s last White Paper. It has not been omitted from ours. We are doubling the budget of the pilots that we have instituted to test the patient funding mechanisms and to make sure that we have the necessary data to understand the benefits of a free social care system at end of life. We want to make it clear that we see the merits of such a change, and it is why we want to make sure that we have the information on which we can base the final decision.

Our goal is to shift the focus of the system to prevention and early intervention, not to wait for the system to stutter into life when a crisis strikes. We want to make it easier for people to plan and prepare, both to avoid and reduce the need for care and to meet the need for care in the first place. Last week we laid out a reform agenda of universal information and advice, national eligibility, deferred payments, integration of health, housing and social care, better transition for children to adult services, and support for carers. Together those constitute the most comprehensive overhaul of adult social care in 60 years, and they are a contrast to the motion before us, which adds nothing, says nothing about how change will be paid for, and says all that it can to scare people about the current system.

Rather like 13 years of a Labour Government, today’s motion gets us nowhere. That is why we are investing an extra £300 million in the system to support change, and why I urge my right hon. and hon. Friends to vote against the motion.

[Several hon. Members]

rose—

Strategic Needs Assessment and Joint Health and Wellbeing Strategies

Paul Burstow Excerpts

Monday 16th July 2012 Written Statements

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

We will be publishing a consultation document seeking views on draft statutory guidance on the preparation of Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies during the summer recess. “Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies”—draft guidance” will be placed in the Library at the appropriate time. The document will also available electronically at: www.dh.gov.uk/health/category/publications/consultations/.

Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies are about the NHS, local government and communities working together to improve health and wellbeing outcomes and reduce inequalities. The purpose of statutory guidance in relation to this is to:

lay out the statutory duties, which underpin Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies to be undertaken by clinical commissioning groups and local authorities through health and wellbeing boards from April 2013;

explain how Joint Strategic Needs Assessments, Joint Health and Wellbeing Strategies and commissioning plans fit together in the modernised health and care system; and

set out how the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy process will enable the NHS and local government, working with their community and partner organisations, to make real improvements to the health and wellbeing outcomes of local people.

We will be consulting on the draft guidance to ensure that it is clear and fit for purpose in supporting health and wellbeing boards in undertaking Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies from April 2013. It is also an opportunity to seek views on what further supportive materials health and wellbeing boards would find useful in undertaking Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies; which the Department can work with sector-leaders to develop.

This consultation will take place over the shortened period of eight weeks due to the fact that the Department undertook engagement with health and wellbeing boards earlier in the year to inform this guidance. We will be publishing the consultation during summer recess to be able to support emerging health and wellbeing boards as they refresh their Joint Strategic Needs Assessments and develop Joint Health and Wellbeing Strategies in order to underpin their commissioning plans ready for April 2013.

Once underway the consultation period for will be open for eight weeks.

Young Offender Institutions (Speech and Language Therapy)

Paul Burstow Excerpts

Thursday 28th June 2012 Commons Chamber

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

I congratulate the hon. Member for Feltham and Heston (Seema Malhotra) on securing the debate and on setting out the issues so clearly. I note that, curiously, my noble Friend Lord Addington is debating this matter with Ministers in the other place. It is clearly of importance to parliamentarians in both Houses. The work of the all-party parliamentary group on speech and language difficulties underscores that point.

It is important to recognise that speech, language and communication difficulties are part of a complex and multi-layered range of needs that young people between the ages of 15 and 21 may have, particularly those within our criminal justice system. I understand the concerns about speech and language therapy that the hon. Lady has raised and will try to address them.

There have been a number of studies, mostly small-scale studies, on the prevalence of speech, language and communication needs. They place the prevalence of such needs in custodial settings at anything between 60% and 90%. One recent study found the 60% of young offenders screened on entry to custody had speech, language or communication needs. As has been said, among the general population the figure stands at 1%, although there are regional and local variations.

Much attention has been given to these issues over recent years. The hon. Lady made reference to Mr Speaker’s work on behalf of the last Government. The coalition Government are taking forward a number of the actions in the Bercow review. First, we had the Green Paper on special educational needs and disability, and the follow-up report that was published recently. Secondly, there have been pathfinder pilots to develop unified plans covering health, education and care needs, supported by the use of personal budgets. Thirdly, we have had the review of the early years foundation stage. The Department of Health is working closely with the Department for Education to join up health and care, sorting out one of the oft-stated criticisms of SEN provision for so many years.

I assure the House that speech and language therapy is available to young people, and in particular to those in the custodial estate. Currently, it is commissioned in the custodial estate through primary care trusts. It is meant to be commissioned according to local need. That means that in-house services are provided in some larger young offender institutions—not just in Feltham, but in Wetherby and Hindley. I urge the hon. Lady to look at the provision in those two other institutions.

From next April, the responsibility for commissioning prisoner health will move from primary care trusts, as they are abolished, to the new NHS Commissioning Board. That will help to ensure that people with health needs in custodial settings receive care comparable with that received by those in the wider NHS. Offender health lead commissioners will act for the board and determine the right level of service to be provided to meet the identified needs within the prisoner population. They will work at local level with health and wellbeing boards, children’s services, and police and crime commissioners.

[Nick Smith]

May I press the Minister? How many young people’s custodial settings have speech and language therapists working at them? Do some or all settings have them?

[Paul Burstow]

The hon. Gentleman will have heard me say that there is specific in-house provision at three settings, but there will also be referrals through NHS pathways for speech and language services, meaning that any young person in need of speech and language therapy should have access to it. That is one of the requirements of the commission—its responsibility is commissioning appropriate services to meet identified needs. I shall come to the identification of needs in a moment.

Speech, language and communications needs are just one part of an often complex picture. It is important that we acknowledge that there are complex interactions with, for example, mental health problems, learning disabilities, substance misuse and alcohol problems. Therefore, psychiatry, psychology, community psychiatric nursing, psychotherapy, and occupational and creative therapy can all play a valuable part—a bigger part in some cases—in treating and meeting the needs of young offenders.

The hon. Lady was right to highlight the contribution that speech and language therapies make not just in direct services, but in supporting colleagues in a multi-disciplinary team to ensure they have the necessary skills to provide the right communications support and so on.

Adopting a personalised approach is at the core of that. The hon. Member for Blackpool North and Cleveleys (Paul Maynard) rightly said that we need to ensure that people have the communications skills and understanding both when they are in prison or youth offending services and when they are released. That was an important point.

The hon. Lady spoke powerfully of her visit to Feltham and the conversations she had with the 15-year-old lad about his experience of speech and language therapy—he said it gave him more confidence. That is another reason why such therapy is an important component of the right health interventions to meet identified needs.

The hon. Member for Blaenau Gwent (Nick Smith) said in an intervention that early intervention is relevant as well as the change in commissioning responsibilities. Early intervention is a key part of the Government’s approach. Continuity of care and treatment is key. The average period of detention for a young offender is very short—80 days, often including remand. Custody therefore provides opportunities for health assessment and for identifying problems and needs, after which referrals can be made. It is therefore important that we have systems that allow those follow-ups to take place. It was right that the previous Government decided that the commissioning of prison health services should be an NHS responsibility, enabling those systems to be properly joined up, and this Government have maintained that.

We need to look right across the whole criminal justice pathway to provide health interventions that are appropriate to the individual presenting needs. In 2010-11 there were 2,040 10 to 17-year-olds in the secure estate at any one time on average. Sometimes, four times as many were on remand or awaiting sentence to custody, and 85,300 were being supervised by youth offending teams. There is a similar pattern in the 18 to 20 age group.

[Seema Malhotra]

It is important to talk about action across the justice system and recording and assessing, but where will that information be held, so that the records are kept and maintained as a person passes through the justice system?

--- Later in debate ---

[Paul Burstow]

That allows me to talk about Asset and what we are dong. Asset is a tool used by the criminal justice system to risk-assess reoffending, whereas we are introducing a comprehensive health assessment tool that incorporates questions on speech, language and communication needs and is designed better to meet the complex range of needs of children and young people in the secure estate. I will send further details about that to the hon. Lady, but in a way the role of the NHS in our prison service is better supported through the second tool and the information systems that support an individual on their journey through the criminal justice system.

We also need to go further back up the criminal justice pathway. The Department is expanding the liaison and diversion services for all ages, and that includes tailored support for children and young people and appropriate referrals for those with speech, language and communications needs. Even further back up the criminal justice pathway is our programme to support troubled families, which tries to break the very cycles that the hon. Lady talked about—of school absenteeism, crime and antisocial behaviour—and which can exacerbate other presenting problems and lead to greater communications difficulties.

In conclusion, this has been an important debate. Speech and language therapy is a highly valued intervention, and the Government recognise the contribution it can make to the quality of life of young people and the potential for reduced reoffending as a consequence. It is clearly necessary that people in the custodial service and in contact with the criminal justice system can be referred and have access to those services. However, speech, language and communications difficulties are just one part of a complex picture of needs, which is why we are ensuring that a more holistic approach is taken that assesses the range of needs that an individual presents when they enter the custodial estate.

As a consequence, we have threaded right through the criminal justice pathway a more personalised mix of treatment and therapy that meets those individual needs. That is our goal. These changes build on the important reform of commissioning, using the strength of a national commissioning board leading on commissioning prisoner health services and working with local partners to make the necessary connections with local services. That is how we will improve the quality of life, care and treatment for young people in our custodial estate. I shall write to the hon. Lady with the details she requested.

Question put and agreed to.

Winterbourne View Hospital

Paul Burstow Excerpts

Monday 25th June 2012 Written Statements

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

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

I am today publishing an interim report of the review which I set up to establish the facts and bring forward actions to improve care and outcomes of people with learning disability or autism and behaviours that challenge. The interim report has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

This interim report does not cover what happened at Winterbourne View itself. I will be able to report on that once current criminal proceedings against former staff at the hospital are completed and all the evidence is published in the serious case review being conducted by South Gloucestershire council.

But there is already good evidence that the health and care system is not meeting the needs of people with learning disability or autism and behaviour which challenges, and there is an unacceptable gap between best practice and actual practice.

This interim report looks at the quality of the health and care support provided to the approximately 15,000 people in England with learning disabilities or autism who have mental health conditions or behaviour which challenges, and the quality of health and care services they receive. It draws on the reports of the Care Quality Commission’s focused inspection of 150 hospitals and care homes for people with learning disabilities, widespread engagement with people with learning disabilities, people with autism, family carers, voluntary groups, health and care commissioners, providers and professionals, as well as the regulators, and other evidence submitted to the review team.

The main findings set out in the interim report are that there are too many people in in-patient services for assessment and treatment and they are staying there for too long. This model of care has no place in the 21st century. Best practice is for people to have access to the support and services they need locally to enable them to live fulfilling lives integrated within the community. In too many services there is robust evidence of poor quality of care, poor care planning, lack of meaningful activities to do in the day, and too much reliance on restraining people.



All parts of the system—commissioners, providers, workforce, regulators and Government—must play their part in driving up standards of care and demonstrating zero tolerance of abuse. This includes acting immediately where poor practice or substandard care is suspected.

Our key objectives are to:

improve commissioning across health and care services for people with behaviour which challenges with the aim of reducing the number of people using in-patient assessment and treatment services;

clarify roles and responsibilities across the system and support better integration between health and care;

improve the quality of services to give people with learning disabilities and their families choice and control;

promote innovation and positive behavioural support and reduce the use of restraint; and

establish the right information to enable local commissioners to benchmark progress in commissioning services that meet individuals’ needs, improve the quality of care, and reduce the numbers of people in in-patient services for assessment and treatment.

The report sets out clear actions at a national level to support local improvement and ensure that we are able to deliver these key objectives.

I will continue to update the House and will publish the final report of the Winterbourne View review in the autumn.

Cancer Treatments

Paul Burstow Excerpts

Tuesday 19th June 2012 Westminster Hall

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

I congratulate my hon. Friend the Member for Southport (John Pugh) on securing the debate and on setting out—as he always does so admirably—the terrain that he wished us to traverse. Other hon. Members have done just that, and it is helpful to have this opportunity to mention the progress that has been made since the publication of the Government’s cancer outcome strategy in 2011. The annual report that we published last December set out that strategy in greater detail than I fear I will be able to provide in the time available today, and I commend it to Members.

Interestingly, one common theme in this debate has been touched on, quite rightly, by most of those who have contributed. Health inequality has been raised in the context of patient experience surveys—with which the Government will continue—and of age. The Government take health inequality so seriously that we have placed for the first time clear duties on commissioners and other parts of the NHS to act to reduce it, and we will say more about that soon when we publish the draft mandate for the NHS Commissioning Board.

The hon. Member for Leicester West (Liz Kendall) referred to age and the differences in outcomes from cancer services for older people. I approved funding for a joint piece of work by Macmillan Cancer Support and Age UK to explore some of the obstacles and barriers that may prevent people from taking up cancer treatment or accessing it in the first place. We recently visited Barts Health NHS trust, which is taking part in that pilot programme, and we are looking at issues such as comorbidity and services in the community. We will report accordingly and take action to ensure that lessons are learned. The hon. Lady was right to raise the issue, and the Government have decided to implement provisions on age with regard to goods and services in the NHS and social services. On taking office, one of my first responsibilities was to take the necessary decisions to ensure that no part of the NHS would be exempt from those provisions, and key decisions needed to be taken to make it clear that age can be used only on an objective basis in health care and social care decision making.

I will say something about the NHS outcomes framework, and then respond to as many of the points that have been raised as I can in the time remaining. Recognising that many people have more than one medical condition, we have deliberately taken a generic approach to the NHS outcomes framework, rather than focusing on specific diseases. We recognise, however, that cancer is a big killer, and we have said repeatedly that improving health outcomes for cancer patients is a priority for the Government. We have aimed to reflect that in the framework by including seven specific indicators on cancer. Those include the under-75 mortality rate from cancer, and the one and five-year survival rates for the three major cancers, to which other hon. Members have referred: colorectal, breast, and lung. In addition, two overarching indicators include data on cancer: potential years of life lost from causes considered amenable to health care; and life expectancy at 75.

The indicator “under 75 mortality rate from cancer” is shared with the public health outcomes framework. By having that shared indicator, with joint accountability for delivery, Public Health England and the NHS Commissioning Board will have the incentive to work together to improve cancer mortality and survival. That relates to the question about the commissioning of public awareness campaigns. I can confirm to the hon. Member for Leicester West that Public Health England and the NHS Commissioning Board will have a joint responsibility, and a clear obligation, to commission in that regard.

[John Pugh]

On the point about indicators, a clear theme throughout the debate has been late diagnosis. Late diagnosis is not the same as late treatment. With GPs probably under more pressure than ever before not to make unnecessary referrals to secondary health settings of one kind or another, do the Government keep or have they any intention of keeping statistics on whether, where people are diagnosed late, the cause of the late diagnosis was that they presented far too late or that the GP and whoever they saw figured out what was wrong with them far too late?

[Paul Burstow]

I am coming to that. It relates to the point raised by my hon. Friend the Member for Basildon and Billericay (Mr Baron), who chairs the all-party group, about staging data. I will say more about that in a minute.

Outcomes for cancer patients and survivors will also be covered by other areas of the NHS outcomes framework. For example, we will measure patients’ experience of the NHS by looking at different patient surveys. We have been talking about that in this debate.

In addition to the indicators in the outcomes frameworks, the cancer outcomes strategy sets out a commitment to improve cancer survival rates generally and—we have heard the figure—to save an additional 5,000 lives a year by 2014-15. The strategy is supported by more than £750 million of investment for implementation during this spending review period.

Our aspiration is to have cancer survival rates as good as the best in Europe, but we have to stage progress to that goal. Our ambition during this spending review period is to halve the gap between England’s survival rates and those of the best in Europe. The estimate, based on the latest figures available, is that that would save an extra 5,000 lives. To deliver on that ambition, we must tackle survival rates for all cancers. To realise our goal, we are taking action to achieve earlier diagnosis of cancer, to extend existing screening programmes for breast and bowel cancer and to improve access to radiotherapy.

Let me deal specifically with early diagnosis. My hon. Friend the Member for Southport referred to the recent lung cancer awareness campaign—the “coughing” campaign as I think he described it. Obviously that campaign has not just dropped out of thin air into the broadcasts of our media around the country. It is the product of a detailed process of testing, trialling and evaluation. Indeed, the original idea came from a local campaign in Doncaster. Then there was a series of regional pilots to see how it would affect behaviour and what benefits would arise from that. I will be more than happy to send my hon. Friend the details of that and, as we evaluate the national programme, how that is going as well.

Early diagnosis is central to our strategy. It is one of the areas to which our international benchmarking has pointed us. By diagnosing cancer earlier, we will improve patients’ chances of being successfully treated, as other hon. Members have said. Through the national awareness and early diagnosis initiative, we have worked with the NHS and other stakeholders to run a number of campaigns to raise awareness. That is about getting people to talk about things that they would not necessarily normally want to discuss—getting them to overcome embarrassment, because embarrassment never killed anyone, but not turning up at the GP’s and asking key questions about particular cancers certainly does.

The hon. Member for Leicester West asked about support for GPs. A range of support is available to help GPs assess when it is appropriate to refer patients for investigation of suspected cancer. Obviously, there are the National Institute for Health and Clinical Excellence referral guidelines. However, we need to do more and we are investing in better GP access to diagnostic tests. I will say a little more about that in a moment. The national cancer action team, Cancer Research UK and Macmillan Cancer Support are working together to develop a broader GP support programme for the coming years. That includes working with the Royal College of General Practitioners.

The hon. Member for Strangford (Jim Shannon) raised the issue of pancreatic cancer. We are working closely with Pancreatic Cancer UK. In fact, we will be working through many of the issues of early diagnosis in a workshop specifically on pancreatic cancer next week. I will be speaking at that event.

We know from the latest diagnostic waiting times and activity figures that despite increasing demand, the proportion of people waiting more than six weeks for an endoscopy has decreased during 2011-12. I hope that hon. Members will join me in congratulating the NHS on the way in which it went about preparing for and dealing with the increased work load that arose from the bowel cancer symptoms awareness campaign that ran between January and March this year.

The Department is working with partners to support the NHS to improve the management of diagnostic demand. There are a couple of things that we are doing in particular. We are promoting the uptake and spread of efficient and productive service models. Some places have no problem in utilising the capacity that they have. Other trusts have struggled, and we are using NHS Improvement to target the trusts where the highest waits have occurred. We are also providing a variety of tools and information to support commissioners. Data are a key component in driving improvements, and we have a new data set for diagnostics, which is providing a wealth of new information.

In our cancer outcomes strategy, we said that access to appropriate treatment, delivered to a high standard, was critical to improving outcomes. That is why we have made available £150 million more over the spending review period. In April 2012, we confirmed plans to develop proton beam therapy services in Manchester and London by the end of 2017. Those services will have the capacity to treat up to 1,500 people a year. Much has been achieved with regard to access to radiotherapy in recent years. Radiotherapy waiting times are now within the 31-day operational standard for both first definitive and subsequent radiotherapy. Modelling shows that that improvement saves 2,500 lives annually in comparison with waiting times in 2007. Data are playing their part, and there are other issues around that.

I want to touch on investment. In answer to a question last week, I said that the first and foremost responsibility for maintaining equipment and identifying when it needs to be replaced does, of course, sit with the provider that uses that equipment. However, in March 2012, we announced the establishment of a £300 million fund, to be operated by NHS Supply Chain, to bulk-purchase medical equipment to achieve better prices for the NHS and to encourage trusts to keep their equipment up to date. It is therefore a combination of responsibilities, but we certainly see the foremost responsibility sitting clearly with providers in that regard.

About 1.8 million people living in England have had a diagnosis of cancer, and the number is growing. We know that we can do more to improve their quality of life, which is why we have been working in partnership with Macmillan Cancer Support on the national cancer survivorship initiative. The use of patient surveys has been a key aspect of that. We will publish a full analysis of the detailed work that we have undertaken jointly this autumn.

We have committed to the next cancer patient experience survey in 2012. We find those data invaluable. The shock to the system when a provider finds itself at the bottom of the tables is very powerful indeed and is leading to significant improvements.

The hon. Member for Ealing, Southall (Mr Sharma) talked about the limited scope of existing indicators. I can tell him and other hon. Members that we are considering how we can make progress on bringing a number of indicators together. My officials are working with the information centre to consider the resource implications of substituting existing indicators and whether it would be appropriate for a composite indicator to replace some of the individual survival rate indicators. Ensuring that we cover more cancers was a concern that several hon. Members raised in the debate.

On funding cancer networks, my right hon. Friend the Secretary of State has made the position clear. We have provided funding for the remaining year for which the Department is responsible. Indicative figures have been set out. A review is going on of clinical networks and how they are governed. That will ultimately determine precisely how much resource is allocated. There is no final figure at this stage.

Regretfully, I shall conclude now, as I am about to run out of time. There is much going on in respect of cancer. I will write to the hon. Members who took part in the debate so that they can see what I would have said if I had more time. However, the cancer outcomes strategy remains the guiding light for the Government to deliver the world-class cancer care that people deserve in this country.

Mental Health

Paul Burstow Excerpts

Thursday 14th June 2012 Commons Chamber

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

There is no health without mental health. In that simple statement I sum up the coalition Government’s approach to mental health.

In contributing to this important debate, I start by congratulating my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker), among others, on tirelessly pursuing the case for having this debate on the Floor of the House. It is one of the rare debates that we have on this subject, and it clearly airs the issues that are so important to so many of our fellow citizens.

The hon. Member for North Durham (Mr Jones) said that it was a privilege to have the job—the vocation—of being a Member of Parliament, and I could not agree with him more. Sometimes, that privilege involves the surprise that we can still experience in the Chamber when debates are genuinely authentic and when people speak from the heart. I thank him for his candour and honesty; we need more of that. The chair of the all-party parliamentary group on mental health, my hon. Friend the Member for Broxbourne, talked, with humour and much else besides, about his experience with obsessive compulsive disorder. Anyone living and struggling with such conditions, who has not perhaps reached the point of wanting to talk about it, will feel huge respect for both Members for bringing the attention of the House to these matters. They have made us all wake up to something that we ought to know, but that we too often forget. That is that mental health is not a “them and us” game; it is about us—all of us. It touches us all in one way or another.

I am probably not going to be able to do justice to every contribution in the debate, not least those that I have not yet heard, but I assure hon. Members that I will continue to listen throughout the remainder of the debate, and that if any issues arise that I have not covered in this speech, I will write to the Members concerned to address those points.

The hon. Member for Strangford (Jim Shannon) made some important points about the support for our veterans, and for our armed forces more generally. This Government have done a lot in that regard—not least the commissioning by the Prime Minister of my hon. Friend the Member for South West Wiltshire (Dr Murrison) to produce his report, “Fighting Fit: a mental health plan for servicemen and veterans”. The report deals with many of these issues, and the Government take them, and the action that they require, very seriously.

[Mr Kevan Jones]

I congratulate the hon. Member for South West Wiltshire (Dr Murrison) on the report, but would the Minister acknowledge that it built on a lot of the work done by the previous Government, which I was responsible for?

[Paul Burstow]

I hope that there will be cross-party consensus on these issues today, and I shall take the hon. Gentleman’s question in that spirit. He makes a fair point. This is about building on what is working, and ensuring that it can work even better. The work done by my hon. Friend the Member for South West Wiltshire has certainly accelerated the pace.

When the Deputy Prime Minister and I launched the mental health strategy last year, we recognised the need to tackle the root causes of mental illness as well as ensuring that community and acute services provide timely treatment and care. We placed a strong emphasis on recovery from a human, rather than just a medical, perspective. We also made it clear that delivering significant improvements in people’s health and well-being requires parity of esteem between physical and mental health.

I know that some hon. Members are concerned that not enough emphasis has been placed on acute and in-patient care. Let me be clear. Our plans to provide a safe, modern, effective mental health service give equal emphasis to the full range of services, from public mental health and prevention through to forensic mental health services. This is about people receiving high quality, appropriate care when they need it. If services can intervene early—the case for that has already been powerfully made—so that mental health problems can be managed in the community before more serious problems develop, that should result in acute in-patient care being made available more quickly for those who need it.

My hon. Friend the Member for Loughborough mentioned the concerns raised by the Association of Chief Police Officers about places of safety. In partnership with the Home Office and the police, we are examining how to ensure that health services are properly commissioned in custodial situations. I would be only too happy to meet her and the ACPO mental health lead to discuss those issues further.

[Jeremy Corbyn]

Will the Minister look carefully into the circumstances of people who die either in police custody or in a mental health institution as a result of a mental health issue, to determine whether adequate forms of inquest and inquiry exist, and whether adequate lessons are being learned from the experiences? In view of what is going on in one or two inquests at the moment, I feel that there are some quite serious deficiencies in that area.

[Paul Burstow]

I thank the hon. Gentleman for his question. May I undertake to write to him about that matter in more detail? It has come up in our work on our suicide prevention strategy in relation to the nature of suicide verdicts, and narrative verdicts in particular, in coroners’ courts. I would be happy to come back to him on that issue.

In the past year, we have made progress across a broad front. We have committed £400 million to make psychological therapies available for adults of all ages, as well as for people with long-term health conditions and with severe and enduring mental illness. When it comes to our focus on recovery, the latest figures show that 44.4% of those who complete programmes recover and that more achieve lasting improvement. That puts us on track to achieve our target rate of recovery of over 50%.

Given that we know that the first signs of more than half of all lifelong mental illnesses can be detected in adolescence, we have to go further. That is why the Government are breaking new ground by investing in a new training-led approach to re-equip children and young people’s mental health services to offer a range of psychological therapies. I pay tribute to the leadership shown by YoungMinds. Without its support, we would not have come as far in this area as fast as we have.

I want to say something about the necessity of achieving the best possible outcomes for people in mental health crisis. Secondary mental health services across the country have made significant changes, both in community and hospital settings, including the provision of alternatives to psychiatric hospital admission. For example, more than 10,000 people with an early diagnosis of psychosis were engaged with early intervention services last year. That is the highest figure ever recorded. The improvements in community-based early intervention services are driving up standards of care, as well as reducing the demand for hospital admissions. I freely acknowledge that there is more to do and I take on board the point that my hon. Friend the Member for Broxbourne made about the need to look at the variability in the accessibility of mental health advocacy.

The development of recovery-focused services is a critical part of the Government’s strategy. That work is being led by the NHS Confederation’s mental health network and the Centre for Mental Health. They are supporting pilot sites that cover almost half of England and are making the kind of changes that service users have sought for years. The programme has identified 10 key changes to the way in which staff work, the types of services that are provided and the culture of organisations to embed recovery principles into routine practice.

When I visited the South West London recovery college, I heard powerful personal testimonies from people who were living purposeful and fulfilling lives, and who were living with their illness rather than having to be cured of symptoms or illnesses. It is important that recovery is not just seen in medical terms, but is self-defined. Students at the college learn not only how to manage their condition, but skills to help them back to work and to form new relationships. Some become lecturers at the college themselves. I was told that being called a student, rather than a patient, helped people take control of their recovery, gave them more confidence and, crucially, made them feel normal, as opposed to being treated as a helpless, passive recipient of care.

Part of a good recovery is the ability to exercise more control over one’s life. In health care, that means that there must be more shared decision making and choice. In opening the debate, my hon. Friend the Member for Loughborough mentioned the principle of “no decision about me without me”. Undoubtedly, the any qualified provider policy and tariff reform have a part to play in that.

[Adam Afriyie (Windsor) (Con)]

Many of us recognise that many people who come to our constituency surgeries, perhaps with a housing benefit inquiry or other benefit inquiry, are actually struggling with mental health challenges. It seems to me that the lack of control that results from the way in which Government services are designed can be a great contributing factor to stress and, therefore, to depression. The Minister is speaking about control. Can the design of public services, such as housing benefit and other benefits, be taken into account as a way of relieving the stress on a great number of our constituents?

[Paul Burstow]

That intervention rather helpfully moves me on to the point that has been made by several hon. Members about Atos. Although it is not my ministerial responsibility, a number of important points have been made about how it operates in particular cases. I will ensure that those points are taken into account by my ministerial colleagues at the Department for Work and Pensions. I will gladly pass them on.

[Stephen Timms (East Ham) (Lab)]

The Minister will know that mental health charities have proposed changes to the mental health descriptors in the work capability assessment for employment and support allowance. There seems to be some delay in implementing those. Will he pick that up in his discussions with his colleagues?

[Paul Burstow]

I will certainly act as the messenger and pass that point on, as the right hon. Gentleman has requested.

Stigma has been referred to in this debate. It is undoubtedly one of the biggest barriers to access to mental health services in this country. The Government are determined to reduce the prejudice and discrimination that surround mental health, but we recognise that we cannot do that on our own. That is why Mind and Rethink Mental Illness have developed a major anti-stigma programme called “Time to Change”. That campaign is working and is delivering significant behavioural change across society. That is why the Government are contributing the substantial amount of £16 million up to April 2015.

[Mr Matthew Offord (Hendon) (Con)]

The Minister says that the Government wish to reduce the stigma surrounding mental illness, and I accept that. Does he agree that the decision of the Department of Health in 1994 to hold an independent inquiry into every death involving someone who has suffered mental illness or been part of the mental health system continues to perpetuate that stigma?

[Paul Burstow]

That is an important and challenging point, and I will want to go away and think about what we do. For patient safety, we still need to learn lessons when things go wrong in our system, acknowledge when things have not been done properly and put them right. In that sense, confidential inquiries are an important part of the learning mechanism. One point of frustration that I hear in debates in the House and see in correspondence from hon. Members is the sense that lessons are not learned. As part of our reforms, with the NHS Commissioning Board taking on responsibility for patient safety, we need to ensure that that is not the case in future.

We are investing £16 million in “Time to Change”, and we were delighted when Comic Relief decided to put in an additional £4 million, one of the biggest grants that it has ever made.

I wish to make another point that touches on the contributions of my hon. Friend the Member for Broxbourne and the hon. Member for North Durham. One in five people still think that anyone who has a history of mental health problems should not be allowed to hold public office. How many former Presidents, Prime Ministers or Ministers would have been excluded if that view had been applied? [Hon. Members: “Churchill.”] Precisely. Such a law is as outdated as asylums and as outdated as many of the attitudes that sit behind it. It has to be consigned to the history books just like asylums have been, and under the coalition Government’s watch, it will be. I congratulate the hon. Member for Croydon Central (Gavin Barwell) on securing a slot for a private Member’s Bill on the subject.

Looking ahead, although we have made progress there are still big challenges to tackle. Reference has been made to the implementation framework that will be published to support the roll-out of the “No health without mental health” strategy. That framework has been produced in conjunction with five national mental health organisations—Rethink Mental Illness, the NHS Confederation, the Centre for Mental Health, Turning Point and Mind—and many others have been involved.

We have previously had a very good debate about “Listening to Experience”, Mind’s excellent report on acute and crisis care, and Mind’s policy team have been directly involved in ensuring that the framework delivers on those issues. It will provide a route map for every organisation with contributions to make to improve the nation’s mental health. It will spell out how progress will be made, measured and reported.

What does success look like? To me, it means more people having access to evidence-based psychological therapists; services intervening earlier, particularly for children and young people; services focusing on recovery and people’s needs and aspirations above all; and service users and carers being at the heart of all aspects of planning and service delivery.

Today, economists tell us that mental ill health in this country costs £105 billion a year, and that is just in England. If we succeed and put in place the right combination of public health, anti-stigma policies, accessible psychological therapies and excellent community and acute services, we can dramatically reduce that figure. Put another way, if we can deliver the right evidence-based treatment to children and young people so that their conditions do not persist into adulthood, we can prevent as many as two in five of all adult mental health disorders. As a society, we have made huge progress in how we recognise people’s mental illness, but despite that we have not fully accepted that mental health is equal to physical health and that parity of esteem is needed between the problems of the body and the problems of the mind. That is the challenge—

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

Will the Minister give way?

[Paul Burstow]

I will.

[Dr Lewis]

I have waited many years to intervene on a Minister in his final sentence, and I have achieved that today.

Does the Minister accept, having made a convincing case for people being able to live with their illnesses by being at home, that part of the reassurance that they need to do that is to know that in periods of acute crisis, there will be a bed available for them should it be needed? That should be not only for detained patients but for voluntary patients.

[Paul Burstow]

One thing I did not say—I was trying to cut down my remarks—was that there is an essential need to give more people the ability to control their health care through crisis plans. Crisis plans are an opportunity for people to make a statement in advance on how they wish to be treated in the event of a mental health episode that requires an intervention from mental health services. We know that when the plans are in place, they make a huge difference to the need for admission, and that they can reduce the length of stay. We need to ensure that there is a sufficiency of beds so that people can get appropriate treatment, but we also need to ensure that there is much more focus on good, community-based intervention at an early stage. Getting that balance right is always difficult for health commissioners to achieve—I know my hon. Friend is struggling with that in his patch at the moment.

Those are the challenges the NHS faces. They are challenges not just for our health commissioners and providers but, as this debate has clearly demonstrated, for our whole society. We can transform mental health in this country only if we transform our attitudes. This debate plays an important part in that.

--- Later in debate ---

[Andy Burnham]

We must. Perhaps I am about to make more of a political point, but as has been mentioned so eloquently today by my hon. Friend the Member for North Durham, as well as the hon. Member for Strangford (Jim Shannon), although the trend is upwards—that is happening come what may: I mentioned the financial crisis, during which the rate has jumped up, including in our time in government—the cumulative effect of some of the benefits changes on some of the most vulnerable members of society, coupled with the withdrawal of social care support by councils, means that, right now, some people out there are suffering very badly indeed. That is part of the explanation for the worrying figures that my hon. Friend has just given the House. The Government need to have a look at what is happening out there and whether or not some people are struggling with mental health problems because of the extra stress that other factors, particularly financial, are putting upon them.

I welcome the Minister’s commitment to the improving access to psychological therapies programme, but I hear that waiting times for it are increasing in parts of the country where GPs face much longer referral times. Indeed, a Mind survey of 2011 said that 30% of GPs were unaware of services to which they could refer patients, beyond medication. That tells us that we still have quite a long way to go. IAPT needs protecting and nurturing; it needs to come with a national direction in the operating framework. In the new and changing NHS world, we cannot allow it to be simply whittled away. More broadly, we need to look carefully at commissioning and find out whether GPs have the right skills to commission properly for mental health. We need to consider what the precise commissioning arrangements for mental health are, as there is still some confusion out there about them.

[Paul Burstow]

One of the key aspects of the NHS Commissioning Board’s work in authorising clinical commissioning groups will be to assess their capacity to commission in mental health. As I am sure the right hon. Gentleman knows, the Royal College of General Practitioners is currently exploring what the extra year of education and training will involve, as we move forward to ensuring that mental health is part of it. I think it is a very important innovation.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate my hon. Friend the Member for Loughborough (Nicky Morgan) on securing this important debate, and I pay tribute to my hon. Friend the Member for Broxbourne (Mr Walker), whose speech has immediately entered the list of my top 10 favourite speeches. I thank and commend him for the work he has done over many years as chair of the all-party parliamentary group on mental health.

I state from the outset that I am married to an NHS consultant psychiatrist and that my husband is involved in providing briefings to all Members on behalf of the Royal College of Psychiatrists. For that reason, I think it best for me to confine myself mostly to some personal reflections and some concerns that have been raised in my constituency, and in particular to address the issue of stigma.

As we have been told today, one in four people will experience mental illness at some point in their lives. We have heard powerful speeches about that from a number of Members. Like the hon. Member for North Durham (Mr Jones), I have experienced severe depression: at the happiest time of my life I experienced an episode of post-natal depression, so I know what it is like. I am sure that many other Members and people who are following today’s debate will know exactly what it is like genuinely to feel that your family would be better off without you, and to experience the paralysis that can accompany severe depression.

It has been rightly said today that there is concern about the way in which some GPs handle depression, but I want to make it clear that in my own case, accepting that I had a problem and seeing my GP was very much part of the road to recovery. I think that we should be careful when we talk about how GPs manage depression, because I can tell the House—not only on the basis of my personal experience, but on the basis of what I have heard from others—that there are many GPs out there who provide an excellent service, which I think can only be assisted by a move towards longer appointment times and better training.

We have heard today about the various terms that people use for mental illness. Earlier, we heard it described as a mental health “experience”. I would say to anyone who is listening to the debate that an experience of depression makes many people stronger and more understanding. I am absolutely sure that my own experiences of depression and recovery—recovery is very important—caused me to become a much more sympathetic doctor, and I hope that it made me a more sympathetic and understanding MP, able to recognise the issues in others and respond to them appropriately.

I want to sound a note of caution about employment and depression. Many Members have rightly mentioned the issues surrounding Atos assessments, and I was glad to hear the Minister say that he would address himself to some of the concerns that had been expressed, but I think that we should be careful about making assumptions. We should not assume that people with depression are unable to work; we should individualise the position.

When I returned to work after having a baby, I was still suffering from severe panic attacks—especially when travelling on the underground—and in retrospect, I realise that I was still significantly depressed, but going back to work was part of my recovery. I know that it can be difficult to challenge the ideas of people who are depressed, but I think it important to present them with challenges and encouragement at some level, because depression is sometimes followed by a crisis of confidence, and getting back to work is part of the road to recovery from depression, however difficult it may feel. We should not make generalisations and assume that no one can return to work when they are depressed.

I pay tribute to all those who help people with mental illness, including the many volunteers in all our constituencies, and I pay particular tribute to a voluntary group in my constituency called Cool Recovery. It is an independent mental health charity which cares for a number of people—not only those who have experience of depression, or are currently living with depression or other forms of mental illness, but those who have recovered from mental illness, and those who care for people who suffer from it.

I feel that such voluntary sector groups are essential if we are to realise some of the benefits that can come from the Health and Social Care Act 2012. I was concerned to hear from the volunteers at Cool Recovery that they do not feel they have been sufficiently involved in the commissioning process, and that there are real anxieties about the extent to which the user voice and the voluntary sector voice are being heard in the new arrangements. Perhaps the Minister will give us an update on what is being done to ensure that there is adequate representation for the user voice and the voluntary sector at every stage on HealthWatch, on health and wellbeing boards, and right up to national level at the NHS Commissioning Board.

[Paul Burstow]

I give an undertaking to answer those points in the letter that I will write to Members.

[Dr Wollaston]

I thank the Minister for that, and I look forward to reading his response.

I was pleased to hear that my hon. Friend the Member for Croydon Central (Gavin Barwell) will introduce a Bill to remove stigma. From talking to service users and those who have recovered from mental illness, it is clear to me that they are entirely capable of taking a full part in every aspect of life in their community and workplace, and in our national life. I was glad that the Minister and shadow Minister gave their full and unconditional backing to that Bill, as it will mark a very important step in removing the stigma of mental illness. I also join the Minister in paying tribute to the work of Time to Change, and I hope he will commit to continuing to give support to that organisation.

Some 22% of the disease burden in England comes from mental health issues, and it is time that we recognised that in our local and national commissioning. The mental health strategy is excellent, but we now need to ensure it is implemented. I know the Minister has set up a cross-ministerial group centrally, but who in this new system will be accountable for the successful implementation of the strategy locally and regionally—and what levers for change can they exert, and what sanctions will there be if it is not carried out?

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 12th June 2012 Commons Chamber

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

5. What recent progress he has made on the evaluation of the thalidomide grant pilot scheme.

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

The thalidomide grant is a three-year pilot, running from April 2010 until March 2013, to explore how the health needs of thalidomide survivors can best be met in the longer term and how such a scheme might be applied to other small groups of geographically dispersed patients with specialised needs. Officials have discussed the evaluation of the first year of the pilot with members of the Thalidomide Trust and its national advisory council and we await the evaluation of the second year.

[Mr Cunningham]

The thalidomide grant was introduced by my right hon. Friend the shadow Secretary of State under the previous Labour Government and has been going on for many years. Can the Minister assure me that it will continue until a decision is taken on whether to carry on with the scheme beyond the pilot stage or to do something else?

[Paul Burstow]

I can certainly assure the hon. Gentleman that we are in earnest in making sure that we learn the lessons from this evaluation and work actively with the Thalidomide Trust to ensure that we implement the lessons in future schemes.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

My constituent Mr Joseph Bannon of Cleveleys, who is a thalidomide patient, has made clear to me the great importance of continuing the scheme. They are a declining group of people with increasing needs and any failure by the state to meet those needs would be absolutely unconscionable. Will the Minister reassure me that there is no prospect of that occurring under this Government?

[Paul Burstow]

What I can reassure the hon. Gentleman about is that the Government are carrying on with the evaluation. We are waiting for the evaluation of the second year to see how the scheme is working. The grant is not intended to meet all the additional costs that thalidomiders face. Aside from the grant, there are other sources of public funding and, of course, the funds that the Thalidomide Trust administers on behalf of those survivors of this catastrophe.

[Mr Mark Spencer (Sherwood) (Con)]

6. What improvements in health outcomes relating to cancer he anticipates by the end of the decade.

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

Our cancer outcomes strategy sets out the ambition to save an additional 5,000 lives every year by 2014-15, which would halve the gap in survival rates between England and the best in Europe. Looking further ahead, our aim is to have survival rates among the best. To realise our goal, we are acting across a broad front: raising public awareness of the symptoms of cancers and supporting GPs; extending screening and the introduction of flexible sigmoidoscopy; improving access to diagnostic tests; expanding radiotherapy; reducing variation in treatment; and improving quality of life for cancer survivors.

[Mr Spencer]

Given the importance of early detection, does my hon. Friend share my concern that young women under the age of 25 in Sherwood are currently being refused smear tests?

[Paul Burstow]

The important point about the extension of any screening programme is that it is based on evidence. The most recent review of cervical smear and screening campaigns took place in 2009, and on the basis of all the available evidence at the time the Government’s advisory committee on cervical screening concluded that it would do more harm than good to extend screening below that age, but it is a standing item on the committee’s agenda. It looks at any new evidence and will continue to do so.

[Dr William McCrea (South Antrim) (DUP)]

Pancreatic cancer is greatly feared by many of our constituents. What funds are going to be made available to assist in its research, and how will the Minister measure improvements in that field?

[Paul Burstow]

I am afraid that I did not entirely hear the hon. Gentleman’s question, but it was about research, and the Government are certainly committed to substantial investment, working with partners to ensure that we have among the best research in the world so that we have access to treatments at the earliest opportunity.

[Mr John Baron (Basildon and Billericay) (Con)]

Does the Minister agree with the recent report by the all-party group on cancer, which found that, if we are to drive improvements and outcomes consistently throughout the NHS, both the one-year and five-year cancer survival rates should be included in the NHS outcomes framework and in the commissioning outcomes framework?

[Paul Burstow]

My hon. Friend, who chairs that all-party group, met me recently to make those points, and as a consequence of that meeting and his excellent note of it I undertook to write to him in greater detail. He will understand that some of those issues go to the heart of data collection and to the quality of the data currently available throughout all cancer sites, and that is the reason why we may not be able to do quite what he wants at the pace that he wants.

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

Why do the tests for bowel cancer and breast cancer have an age cut-off? Just when people are more likely to have either condition, they are not regularly tested. Why is that the case in many parts of our country?

[Paul Burstow]

On the day that the Government have confirmed that from October there will be a complete ban on age discrimination within the national health service, except when it can be objectively justified, the answer to the hon. Gentleman’s question is that the evidence used to determine who is eligible for a screening programme is the basis on which recommendations are made to the Government, and they will be extended in future.

[Robert Flello (Stoke-on-Trent South) (Lab)]

7. What assessment he has made of the potential effect of regional pay on recruitment in the NHS.

--- Later in debate ---

[Steve Brine (Winchester) (Con)]

15. What progress his Department has made in introducing fully digital breast screening; and if he will make a statement.

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

As at 1 May 2012, 74 out of 80 local breast screening services had at least one digital X-ray set, and 53 were fully digital. All services must have at least one digital X-ray set in order to enter the breast screening randomisation project and extend screening to women aged 47 to 73.

[Steve Brine]

I thank the Minister for his reply, but may I press him on making digital happen in my constituency? Where is funding responsibility in the new NHS for investment in new digital equipment and for making the switch? Does it fall 100% with the foundation trust wishing to be commissioned to provide the service, or with the body wanting to commission it, or—dare I say?—is there a third way?

[Paul Burstow]

There are three aspects to that question. The first is that we need to ensure that providers can purchase equipment at the lowest possible price. That is why NHS Supply Chain is making arrangements to ensure that digital mammography is available at the lowest possible price to providers through the various initiatives it is taking. The primary responsibility sits with the provider to provide the equipment against which they have been commissioned to provide services. Of course, in the specification it makes for the service, the commissioner will make it clear that digital is required.

[Mark Lancaster (Milton Keynes North) (Con)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

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

Last evening, I attended the launch of UKCK—a group of charities coming together to raise funds to purchase advanced radiotherapy equipment. Will the Minister explain why, despite his previous assurances, regions like the north-east are having to turn to charities to raise funds to buy this potentially life-saving equipment?

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

If the hon. Gentleman would like to supply me with the details of regions that are having to do that, I will certainly write to him on the matter. What we are doing is making an extra £750 million available to the NHS during this spending period to support the investment in radiotherapy services. I will certainly come back to the hon. Gentleman on his particular point.

[Greg Mulholland (Leeds North West) (LD)]

In an Adjournment debate last year on the safe and sustainable review, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) confirmed the minimum number of operations at 400 a year, saying that it was based on the level of activity needed to provide good quality care around the clock. Does he share my astonishment that the chairman of the joint committee of PCTs has said that he can give no assurance that that will be included in the final review? Does that not undermine this unhappy process?

Dementia Services (South-West)

Paul Burstow Excerpts

Monday 11th June 2012 Commons Chamber

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

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing this debate. He is absolutely right to highlight the importance of the issue of dementia. It is, without doubt, one of the biggest health and personal issues affecting our society today, and it will touch the lives of many families in this country. He rightly rehearses the statistics, and dementia is a priority for this Government. We know that in England there are 670,000 people living with dementia, that the figure is set to double over the next 30 years and that in England the cost of dementia to society as a whole is about £19 billion. However, the true costs of dementia are incalculable. I am talking about the cost in terms of the impact on people’s lives, the lost opportunities and the consequences of taking on a caring responsibility within the family, and the costs and consequences for the individual. As has been said in this debate, we know that cancer has been replaced by dementia as the disease that people in their 50s now fear the most, and the right hon. Gentleman has highlighted a number of reasons for that.

That is why, on 26 March, the Prime Minister, on behalf of this coalition Government, set out this Government’s dementia challenge: to go further and faster in implementing the previous Government’s dementia strategy; to focus, in particular, on the issue of diagnosis rates; to raise awareness and ensure that we prepare our society to be adapted and adaptable to the needs of people with dementia; and to double the research funding available in the area of neurosciences and dementia by 2015.

The dementia challenge builds on the previous Government’s work on the national dementia strategy. We kept and built on that strategy, rather than losing any of the momentum that it put in place. I pay tribute to the Alzheimer’s Society for the work it does, and we are working closely with it. We have brought together three champion groups that are taking forward the work on raising the need to improve diagnosis and the treatment and care of people so diagnosed. We are also focusing on issues associated with how we raise awareness, both within the social care and health care work forces and in wider public services. Finally, we are working with the research community to improve capacity significantly and make sure that we have more good quality bids for funding for dementia research in this country.

On the recognition of dementia, we need to ensure that the challenge is not just for the national health service or social services departments, but for our whole society. Work is being led by the Alzheimer’s Society and one of its key champions and ambassadors, Angela Rippon, on how we create dementia-friendly cities, towns and villages. The county of Devon is taking a lead working with schools so that young people better understand dementia and get involved in services supporting people with dementia in the community.

The Government have laid the foundations for dementia research, investing heavily in biomedical research centres and seeding the necessary interest among the research community through themed calls. Something in the region of £17 million of new money is now going into research.

The right hon. Gentleman is right on diagnosis: there is still inexplicable and unacceptable variation within his own region, let alone across the whole of England. In 2011, 30,000 people had been diagnosed and were living with dementia in the south-west, which is among the lowest rates in England. However, we know from the figures that the movement is in the right direction. It is not as fast as he would like, nor as fast as I want it to be in future, but in 2010, the diagnosis rate was 35.4%; by 2011, it had risen to 37.3%.

The Government are ensuring through our dementia challenge that general practitioners and other health professionals are referring more people for assessment. We are making people aware of the availability of memory services and targeting hospitals to ensure that they receive extra resources to undertake dementia risk assessments of people over the age of 75. There will be additional resources to support that activity. We are confident that it will lead to a significant increase in the numbers of people being both diagnosed and referred for diagnosis.

The right hon. Gentleman referred to the Royal College of Psychiatrists accreditation programme. I endorse what he said. It is important that more memory services seek that accreditation, and many in his region are doing just that.

I can tell the right hon. Gentleman that there has been a further acceleration in progress on diagnosis. Devon commissioners tell me that, in the past year, Exeter has been among the strongest performers in Devon in improving its rate of diagnosis. Indeed, there was an 11.6% increase in the number of people receiving a diagnosis in the county. The local NHS is building into its commissioning plans for the coming year an improving diagnosis trajectory. I hope that he and other hon. Members continue to hold local commissioners to account for their commissioning decisions on dementia.

The right hon. Gentleman referred to Northern Ireland and the reasons for its success. One reason Northern Ireland has been successful is that it has invested heavily in its community and voluntary sector services, which has played a part in raising community awareness. More people have in turn asked whether they need to be referred to a memory service. That is one reason why the Government have sponsored an advertising campaign. We want to raise awareness and get families to talk about dementia, and not to put it off or believe that it is just a consequence of ageing.

[Alison Seabeck]

What the Minister says about Northern Ireland and the figures for Devon is interesting. Does he believe there is a connection between dementia diagnosis and support and the relative stability of a population, such as that of Belfast? Devon has a more transient population, and people move there to see out their old age, perhaps away from their families. How important is proximity to family and close friends in terms of diagnosis and support?

[Paul Burstow]

That is part of the Government’s approach to raising awareness. We recognise that getting families to have conversations when they see the first signs of memory loss, or other behaviours that might indicate dementia, is an essential part of getting people to have a conversation with their GP about referral to a memory service. Whether that is to do with more stable communities is an interesting question to consider further. We are working with the research community because we want to encourage more applications for social research as well as research into the underlying causes of the disease.

The right hon. Member for Exeter asked about waiting times. Although there have not historically been routine central collections of waiting times, we will have to consider the matter closely. The Government are keen to drive improvements, and it is no good somebody getting a referral if they and their family are then left hanging for too long. He made an important challenge on that matter.

The right hon. Gentleman rightly talked about support for families. In the operating framework for the NHS, which we published last December and which covers this year, we were absolutely explicit that NHS organisations must work with local authorities and carers’ organisations to get their sign-off for their plans for carers. We stated that they must be explicit about the number of carers’ breaks they will provide and the budget that they allocate for carers in their area. We need to ensure that carers get vital breaks, rather than having to have a breakdown before the NHS picks up the pieces.

From next year, we will also expect NHS organisations to demonstrate that they are supporting carers of people with dementia in line with the guidance that the National Institute for Health and Clinical Excellence issues. Early diagnosis is important because families and the individual themselves need to be able to plan, but also because NICE’s guidance on medication states that people need access to drugs at an early stage. I will write to the right hon. Gentleman about the variations that exist.

[Julie Hilling]

What are the Minister’s views on the funding of dementia groups and carers’ groups? I visited my local group a fortnight ago, and it is struggling for money because of cuts in its local authority grants and health grants. Will there be money behind the new strategy for carers, and more money to support dementia groups in the community?

[Paul Burstow]

I say two things in response to that question. First, the picture is actually quite varied, and I will come on to the investment that is being made in the support network of voluntary and community organisations in Devon. Secondly, the Government have provided £400 million, through the NHS, to support carers through carers’ breaks and other arrangements. We have specifically said that local plans will have to be signed off by carers’ organisations to ensure that the voice of carers is heard when decisions are made.

The right hon. Gentleman asked me about the costs facing families. I understand that concern, which the House has been debating for at least the past 15 years, and it is important that we reach conclusions. We will shortly publish a White Paper and a progress report on our deliberations on funding reform. Dilnot produced a clear set of recommendations, which the Government welcomed when they were published last year.

It is also important to stress that funding reform, important though it is, is only one of a number of issues to consider in improving social care in England. Others include variability of quality, a lack of focus on prevention and early intervention, services that do not join up well for families and do not always integrate well with the NHS, and a lack of personalisation. We expect to address all those issues in the White Paper that we will publish shortly.

When it comes to legislation, we will publish a draft Bill before the summer recess, which will set out the details of a comprehensive reform of social care. We will address the fact that for 60 years, social care legislation in this country has evolved in a piecemeal fashion and as a consequence, in my view, constitutes something of a dog’s breakfast. It is hard for people to navigate their way around the system and identify when they are entitled to support from their local authority and when they are not.

Innovation is important in driving improvements in quality for people with dementia. That is one reason why, as part of the dementia challenge, we identified an innovation prize of £1 million for NHS organisations developing ideas for the transformation of dementia care services. In the south-west and south of England, the NHS has specifically identified and made available a further £10 million for such innovations.

I said that I wanted to mention briefly some of the other actions in the south-west. The Royal Devon and Exeter NHS Foundation Trust has piloted patient passports in a very good piloting exercise. It has alighted on a scheme proposed by the Alzheimer’s Society called “This is me” passports, which are very useful for people with out-patient appointments and those who are being discharged from hospital. The trust is also running an “An hour to remember” training programme to raise the awareness of staff about both the people who have dementia and the people who are with them—that is, their family members and carers—and that is ever so critical. Every fortnight, there is a day’s training in dementia care for clinical and ancillary staff. The trust has also recently strengthened its mental health liaison services and is reaching out into its communities to pilot a virtual ward scheme, which is a very important way of avoiding unnecessary admissions into hospital. Beyond the hospital, there are networks of support and there are 37 memory cafés around the county—I believe that there is one in Exeter itself—and more than 200 volunteers have been trained in dementia awareness to help support those areas.

The right hon. Gentleman also mentioned the role of GPs. I am not certain that we have the same figures, but my understanding is that 67 of the 107 GP practices across Devon have already undergone GP-led dementia training, which has already led to a significant increase in the number of referrals going through.

There is much to be done and much that the Government are doing already. There are significant signs of progress up and down the country. The dementia challenge set out by the Prime Minister in March is real and it is about ensuring that we mobilise not just the national health service and our local authorities but our whole community to engage with one of the biggest challenges faced by our society. I would certainly say that the evidence points towards a lot of hard work being done by NHS and social care professionals across Devon and the south-west that is beginning to lead to a significant increase in the diagnosis rates. As a consequence, many more people are getting the treatment and care that they need and that their loved ones deserve. I thank the right hon. Gentleman for securing this debate.

Question put and agreed to.

Winterbourne View (Hospital)

Paul Burstow Excerpts

Tuesday 15th May 2012 Written Statements

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

I promised to update the House about ongoing activity in relation to Winterbourne View private hospital and other services for people with learning disabilities.

The House will wish to note that nine people employed at Winterbourne View hospital have pleaded guilty and have been referred for sentencing reports. A further two people have pleaded not guilty and are due back in Bristol Crown court on 6 August. Once the criminal proceedings are completed, we expect the serious case review, chaired by Dr Margaret Flynn, to be published.

The Care Quality Commission (CQC) has now completed its programme of focused inspections of 150 hospitals and care homes for people with learning disabilities. The reports from these inspections are being published in batches, and the final 10 reports were published on 9 May 2012. They can be found at: www. cqc.org.uk/LDReports?1atest. These reports have found poor practice in some of the units, and common areas of concern include limited person-centred care, limited appropriate activities and a lack of monitoring and learning from incidents of restraint. CQC will publish a summary national report of these inspections in the summer.

The final departmental review of Winterbourne View will draw its conclusions on the basis of the findings from the serious case review and evidence from the other investigations and reports that have been undertaken, and so will be published soon after the serious case review.

In recognition of the seriousness of this issue, the Department intends to publish an interim report before summer recess, based on the findings of the CQC summary report and other evidence from the engagement with key partners, which will set out proposed actions and solutions.

I will continue to update the House.