Oral Answers to Questions

Debate between Paul Burstow and Norman Lamb

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

Actually, we are all agreed on this. We all want free care at the end of life, but whoever is in power after the election in May will have to ensure that we understand fully the costs. There is a lot of evidence, and the evidence is growing. We are having very good discussions with groups involved in care at the end of life and we all want to achieve a solution. Of course, the truth is that very many people are receiving free care at the end of life, but they are in hospital, where they often do not want to be. I am completely with the hon. Lady in trying to achieve this.

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

Eight out of 10 people say that they would prefer to die at home when their time comes. Since the Government published their White Paper and said that they saw merit in social care being free at the end of life, a succession of reports from Macmillan, Nuffield and others have shown that there are savings to be made and benefits in terms of more dignified deaths and compassion for families. Is it not time to act on the evidence and make social care free at the end of life?

Child and Adolescent Mental Health Services

Debate between Paul Burstow and Norman Lamb

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

Ultimately, it has to be down to clinical decisions. Indeed, the whole thrust of policy, which was very much started under the right hon. Gentleman’s Government and during the period that he was Secretary of State for Health, is to devolve decision making about the make-up of services to local areas. That approach has been maintained. Ultimately, he would probably agree that such issues cannot all be determined in a Whitehall office.

None the less, the right hon. Gentleman raises serious concerns. I have tried to engage with him on them and am happy to talk to him and meet him further. I share his concerns about the lack of sufficient response to the concerns he raises, but I will repeat one other point I have made: the emphasis of policy should be on building up crisis response services and better and stronger community support services to reduce the need for in-patient care as much as possible. It is not therapeutic to put children and young people on in-patient wards, and particularly not away from home.

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

I can recall many Labour Health Ministers telling us from the Dispatch Box that local decisions were made by primary care trusts and were not a matter for them. Will the Minister consider what he has told us about the CAMHS review? He has been frank about the fact that CAMHS are dysfunctional and broken. Surely the review is the opportunity to lay down a route map and set out how we can deliver the preventive early intervention services that prevent the crisis from occurring in the first place and the need for the admission. Do we not need that so that when there is a spending review after the general election, there is clarity about the investment needs for children’s mental health?

[Norman Lamb]

I think my right hon. Friend is referring to the children and young people’s taskforce that I established last summer. He is right that this provides us with an incredibly valuable opportunity to modernise the way in which we organise and commission children’s mental health services. There are many fantastic professionals working in children’s mental health services, but in my view they are let down by a dysfunctional system with horribly fragmented commissioning, which is a long-standing problem. Because we are involving experts and campaigners from outside and, critically, children and young people, we have a great opportunity to get services modernised and effective and focusing particularly on prevention.

Oral Answers to Questions

Debate between Paul Burstow and Norman Lamb

Tuesday 25th November 2014 Commons Chamber

[Norman Lamb]

Over the past decade and a half, there has been a very substantial reduction in bed numbers, and it is a trend that we should thoroughly support because we want to move away from institutional care towards supporting people at home in their communities. With children’s mental health, we have invested an extra £7 million this year to ensure that children get access to beds close to home when they need them.

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

Will the Minister ensure that the taskforce he mentioned considers the evidence that one in five mothers suffers from mental health problems during pregnancy or within a year of giving birth because the costs of that to society are massive and three quarters of those costs are borne by the child and subsequent generations? Is it not time to make sure that we focus on perinatal mental health because it can make such a big difference?

[Norman Lamb]

I very much agree with my right hon. Friend. Accompanied by my hon. Friend the Member for Torbay (Mr Sanders), I visited a brilliant perinatal mental health service in Torbay recently. My right hon. Friend is absolutely right. The London School of Economics has done a lot of work, showing evidence that if we invest in perinatal mental health, we get a return on the investment, but most importantly, we change people’s lives. I am determined to pursue that.

Care Home Top-up Fees

Debate between Paul Burstow and Norman Lamb

Tuesday 22nd July 2014 Westminster Hall

[Norman Lamb]

I agree with the hon. Gentleman. He will find that the Care Act has a much greater focus on transparency, and it strengthens the legal obligation by providing that personal budgets must reflect the cost to the local authority of meeting the adult’s needs. That is a legal requirement in the Care Act, whereas previously it had been guidance.

[Paul Burstow]

Will my right hon. Friend give way?

[Norman Lamb]

Yes, but I will not be able to respond to all the issues.

[Paul Burstow]

I understand, and I am grateful to my right hon. Friend. The guidance allows local authorities to consider whether to make an adjustment to a personal budget, but guidance should not give such discretion. If it is about care costs to meet eligible needs, an adjustment should be made.

[Norman Lamb]

I take that point. I do not want to pre-empt the outcome of the consultation, but I am happy to ensure that the Hansard report of this debate is counted as part of the consultation exercise. The comments of all right hon. and hon. Members will be included in that report.

Although we all agree that, in an ideal world, local authorities would be able to fund a person’s chosen accommodation, that is simply not possible in every circumstance. We are in a tough financial situation, and local authorities need to take great care in how they spend their resources to ensure that they can meet the care and support needs of the whole population that they serve. There are clear rules in place on the operation of top-up fees, which we are strengthening to achieve greater clarity and force under the Care Act. It is important that everyone is aware of those rules, as my right hon. Friend said.

We are aware of concerns about top-ups, particularly the concerns raised in the research by the charity Independent Age. That is why in March 2014 the Department wrote to all local authorities in England to remind them of their responsibilities under existing regulations and guidance, let alone the rules coming in through the Care Act. We reminded them that the existing guidance is clear that a top-up fee should be sought from a local authority-supported person only where they have chosen to go into more expensive accommodations and a third party or, in limited circumstances, the person themselves, is willing and able to pay the additional cost.

The person should not be asked to pay a top-up fee where it is necessary to arrange care in a more expensive home to meet their assessed eligible needs, nor should a top-up fee be sought where accommodation is not available at the local authority’s expected rate due to a failure of commissioning. In such cases, the local authority must meet the full cost of care and should not seek to make a top-up arrangement.

Where a local authority arranges care it is responsible for the full cost of that care, including any top-up fee to the provider. That ensures that, if a top-up fee is not paid for any reason, the person can continue to receive care and support in their accommodation while a decision is made about their future care. A care home, therefore, should never ask a local authority-supported resident for a top-up fee without the involvement of the local authority, but it appears that that sometimes happens.

The local authority is responsible for the full cost of care, including the top-up, so it should not arrange more expensive care unless it is satisfied that the person paying the top-up has the resources to keep paying the fee. Local authorities should regularly review the position to ensure that a person will continue to be able to make those payments—that is another point raised by my right hon. Friend. It is in a local authority’s interest to do that, as it will be liable to pay the full costs if the person is unable to pay the top-up.

We are maintaining people’s right to choice in the accommodation where they receive care under the Care Act. As part of that we will give people more rights to top up their own fees from 2016. We would have liked to have been able do that from next year, but we need to ensure that extending the right to self top-up is sustainable and that those receiving care are not adversely affected. We are working with stakeholders to resolve those issues.

Currently, as I am sure my right hon. Friend knows, the circumstances in which people can top up their own fees are restricted. People can top up during the 12-week period only when their main or only home is disregarded, or when they have a deferred payment agreement—in effect, where they have a property to sell that can meet the cost of the top-up fee. People should be able to decide how to spend their own money, and they should be able to pay more for care if they wish. Under the Care Act we will enable people to self top-up using other assets, not just property, from April 2016 at the same time as we implement the cap on care costs that, for the first time ever, will protect people from the risk of catastrophic care costs—protection that my right hon. Friend fought for before I took over this role.

We are also strengthening the regulations and guidance on top-up fees, which will apply from April 2015. That will make the position on top-up fees even clearer and provide additional protection to cared-for people and their families. We will make further changes in April 2016 to give people greater scope to self top-up. The draft regulations and guidance currently out for consultation set out that the local authority must ensure that the person paying the top-up is willing and able to meet the cost for the likely duration of the arrangement. The local authority must also ensure that the person enters into a written agreement, thereby ensuring that all involved are fully aware of their responsibilities and any consequences should the arrangement break down. Again, my right hon. Friend referred to the written agreement in his speech. The local authority must review top-up arrangements from time to time.

[Paul Burstow]

Will my right hon. Friend give way?

[Norman Lamb]

Very quickly.

[Paul Burstow]

“From time to time” are classic words that can be wriggled out of—they mean nothing. It is important that the guidance is clear that “from time to time” means at least annually.

[Norman Lamb]

I note my right hon. Friend’s point, but I will complete my comment.

The local authority must set out in writing details of how the arrangements will be reviewed, what may trigger a review and when any party can request a review. Although the regulations and guidance do not set a specific review period—my right hon. Friend’s point is now in the consultation responses, as I indicated—we expect top-up arrangements to be reviewed at the same time as the local authority reviews the financial assessment of what the person can afford to pay for their care. That normally happens at least annually, around the time when changes are made to the charging regulations.

Additionally, the local authority must make clear in writing the consequences should the top-up arrangement break down. That may result in the resident’s having to move to alternative, less expensive accommodation, where such accommodation is suitable to meet their needs. As with any change of circumstance, the local authority must undertake a new needs assessment before considering that course of action, including an assessment of health needs and having regard to the person’s well-being, which is the central principle of the Care Act. Local authorities should already be monitoring all top-up arrangements for the people they support because they are ultimately responsible for the full cost of accommodation. Local authorities should also discourage arrangements for top-up payments to be paid directly to a provider.

The new regulations and guidance under the Care Act are being consulted on at the moment, and I encourage all right hon. and hon. Members to contribute to that consultation alongside their contributions today. The consultation closes on 15 August, and we will consider all the responses that we receive. We are aware that, although our approach has been welcomed as a big improvement, there is always a desire to do more. We are continuing to engage with stakeholders and will await the close of the consultation before making any decisions on further changes.

The intention of the Care Act is to enable self top-ups in other circumstances, which is entirely right, but also to ensure that top-ups are not inappropriately used and to strengthen the rules on top-ups.

[Paul Burstow]

In the past 12 months I have been leading work with Demos on the future of residential care, and we will publish our report in September. Will the Minister meet me and colleagues from that commission in the autumn to discuss our recommendations?

[Norman Lamb]

That sounds like an interesting session in principle. I would like to attend that meeting if possible, but I cannot guarantee it at the moment because of the nightmare that is my diary.

I hope my comments have been helpful. The points that have been raised today are an incredibly important part of the consultation process.

Oral Answers to Questions

Debate between Paul Burstow and Norman Lamb

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

The hon. Lady is absolutely right. The cardiovascular disease outcomes strategy, which was published last year, acknowledges the importance of access to psychological therapies. Indeed, there is some really innovative work going on. A psychiatrist called Andre Tylee in London is doing work with heart patients, bringing in psychological therapies and improving their physical as well as their mental health outcomes, and the hon. Lady is absolutely right to make the case for that.

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

14. What the timetable is for publication of a successor to the current national dementia strategy.

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

T9. Given that last year, more than 7,500 people with a mental health crisis found themselves in police cells rather than anywhere appropriate such as a hospital, given that 263 of those people were children and young people, and given that they stayed for 10 and a half hours in a police cell, is it not time that we took the evidence of street triage, which we know works, and rolled it out across the country?

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

The fascinating thing is that street triage is spreading across the country because forces and mental health trusts see the enormous value of it. The really exciting news is the significant reduction in the number of people who end up in police cells. That is in part due to the standards that we set through the crisis care concordat for the first time for mental health crisis care.

Oral Answers to Questions

Debate between Paul Burstow and Norman Lamb

Monday 12th May 2014 Commons Chamber

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

My hon. Friend is setting out the important changes that have been made in the Lords on the trust special administration process. He might consider giving further emphasis to the point that Earl Howe made in relation to all the steps that would be taken prior to the consideration of a trust special administration process being put in place, not least the intervention powers of Monitor and others.

[Norman Lamb]

Given that time is tight, I simply confirm that I strongly support what Earl Howe said in the other place, and reinforce the points that my right hon. Friend has made.

For NHS trusts, clause 118 already requires the Secretary of State to produce guidance on seeking commissioner support and involving NHS England, and we will ensure that the key principles of parity between affected commissioners and the essential services they commission are captured in the guidance. I urge the House to support the Lords’ amendments.

Care Homes

Debate between Paul Burstow and Norman Lamb

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

First, I share the right hon. Gentleman’s recognition of the work that “Panorama” has done. It is interesting that two examples of appalling abuse—namely this case and that at Winterbourne View—have been exposed as a result of hidden cameras. We must acknowledge that and recognise that there might be a role for the use of hidden cameras in the CQC’s work where there is potential evidence of abuse and where we need to establish that evidence in order to take effective action.



On the right hon. Gentleman’s question about registration, my concern is that the registration of nurses did not stop awful things happening at Mid Staffordshire. It is not in itself a panacea that ensures good-quality care. For me, the most important element is proper training to ensure that everyone is trained to an acceptable standard before undertaking unsupervised care work. If we can establish that standard across the country, we can drive up standards.

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

Care homes should be places of light and laughter, rather than places of fear and neglect. They should be seen as part of their communities, rather than apart from their communities. Will the Minister therefore look again at the proposals in this Government’s White Paper on care and support for commissioning a piece of work delivered by the programme called My Home Life, which is all about delivering relationship-based care? Rather than care that is just about transactions, the programme is about changing the nature of the relationship between those who provide care and those who receive it.

[Norman Lamb]

I am certainly happy to have another look at the White Paper and to discuss it with my right hon. Friend, but let me just address his key point. It is absolutely right to say that when we have closed doors, awful things can happen beyond the sight of the public. Professor Martin Green, who is a very good leader of providers of care, has argued the case for care homes to become a sort of hub in their local community, opening their doors to ensure that they become a centre of excellence for that community and providing services and support for people who may live independently at home, but who would benefit from the skills in such an organisation. Openness, transparency and ensuring that the public gaze is cast upon what goes in such places is the right way forward.

Oral Answers to Questions

Debate between Paul Burstow and Norman Lamb

Tuesday 1st April 2014 Commons Chamber

[Norman Lamb]

I will absolutely discuss parity of esteem with Simon Stevens when I meet him very soon and I will ensure that the case for third sector organisations is taken into account, as they play an incredibly important role. I was delighted, incidentally, to be down in the south-west at the signing of the crisis care concordat to ensure that people who are suffering a mental health crisis are treated in the same way as people who are suffering a physical health crisis.

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

The Minister is absolutely right to talk about the institutional bias and that is why it is absolutely right to introduce choice today and to set access standards for mental health for the first time. Will he go one step further and do something else that the previous Labour Government did not do by introducing the standards that the National Institute for Health and Care Excellence sets for mental health and ensuring that they are must-dos as well?

[Norman Lamb]

I very much share my right hon. Friend’s frustration that when a medicine is determined by the National Institute for Care Excellence as an evidence-based intervention, the system has to allow it, but when NICE determines that a procedure should be followed, it is discretionary. We must address that to ensure that we use the money in the most effective, evidence-based way.

Care Bill [Lords]

Debate between Paul Burstow and Norman Lamb

Monday 10th March 2014 Commons Chamber

[Paul Burstow]

That is a helpful way forward, but I ask the Minister to say a little bit more about new clause 11 and the Human Rights Act issue.

[Norman Lamb]

I have already confirmed that we will return to the matter later in the process, and I hope that we will then end up in a satisfactory place.

Turning to new clauses 7 and 9 to which a number of hon. Members have spoken, the spending review considers spending pressures across adult care and support, the NHS and public health. In the current spending review period, we allocated significant additional funding to local authorities for adult care and support, including a transfer from the NHS of £1.l billion a year by 2014-15 to be spent on social care with a health benefit. That is not to say that I do not recognise how challenging the financial environment is for local authorities, but we know from figures provided by the local authorities themselves that the vast majority of cost savings have been achieved as a result of efficiencies and not of cutting services for people.

However, as the hon. Member for Leicester West (Liz Kendall) said in Committee, the answer is not just to throw more money at the system, but to look at how public funding is spent and to deliver a more radical reform of health and social care. That is why, in the spending review for 2015-16, we announced the better care fund, which is a £3.8 billion pooled budget for health and social care. That not only provides the resources needed to protect access to social care, but breaks absolutely new ground in establishing structures that will drive further and faster integration between health and social care.

As hon. Members have noted, the better care fund includes £135 million of additional funding for implementing the Bill in 2015-16. Some have argued that including that in the better care fund means that local authorities will face a choice between implementing the Bill and investing in integrated services. In my view, that is a false choice. On the contrary, our reforms are part of the same agenda, and we cannot afford to see those as separate issues. Both systems need to work more effectively together to help people live independently for longer.

[Norman Lamb]

I am conscious that I owe it to hon. Members to respond to all the issues that have been raised.

The reforms in the Bill to extend assessments and support for carers can play a big part in keeping people out of hospital. The spending review provided £335 million in 2015-16 to help local authorities’ transition to the capped cost system and to offer universal deferred payments. Locally, health and wellbeing boards have a statutory responsibility to analyse current and future health and care needs and to develop a strategy to address them. Given such an approach, there is no need for the proposed amendments.

[Paul Burstow]

rose—

[Norman Lamb]

I am sorry; I must ensure that I get through all the amendments.

On new clause 13, I am clear that the current lack of good information on deferred payment agreements is not acceptable, given the importance of the scheme. That is why we are working with national partners in local government and the National Association of Financial Assessment Officers to develop a range of questions that will improve and expand the data we already have. The new clause is therefore unnecessary as we already have plans under way to achieve a similar goal.

On new clause 4 on local authorities making “reasonable charges”, the Government’s proposal to set a clear amount beyond which a person’s income cannot be reduced is much clearer and provides stronger protection. I have written to my right hon. Friend the Member for Sutton and Cheam and other Committee members on this subject, and I would be happy to share the letter with other Members. I have nothing to add to that analysis and do not agree that the new clause is required.

On amendment 21 and new clause 15, the Bill makes it clear that local authorities must work to maintain a sustainable market that delivers a wide variety of high quality services for people who need care and support in the local area. Local authorities’ own commissioning is an important part of this process. Additionally, local authorities will have to have regard to the well-being of individuals when commissioning services. Therefore, any local authority that commissions inappropriately short care visits or does not consider the actual cost of care when setting fee levels is highly unlikely to be fulfilling their duties. These matters will be set out fully in statutory guidance. It would not be appropriate to have a nationally set formula that would lead to standard rates or “tariff prices” for care and support, as this is best left to local negotiations in the open market.

On new clause 24, local authorities are already under a duty to work with their local clinical commissioning groups and others through the health and wellbeing boards to undertake joint strategic needs assessments and to develop joint health and well-being strategies. Statutory guidance published in March 2013 makes it clear that these must be published and have specific regard to

“what health and social care information the community needs, including how they access it and what support they may need to understand it”.

Awareness-raising will be an important part of the Bill’s implementation. The Department will co-ordinate involvement of wider interests, including local authorities and the private and voluntary sectors, to raise the public’s awareness of the new arrangements, specifically on the need for people to plan for care costs. We will add to what is already available to monitor the effectiveness of information and advice, public accessibility and public awareness.

On new clauses 22 and 23 about financial advice, the Financial Conduct Authority already has a responsibility to keep under review the financial advice market as regards how it is serving customers, and qualifications for advisers, and this includes those looking to fund long-term care costs. These requirements are published in FCA rules. Such an addition to the Bill would therefore be unnecessary.

I understand the intention behind new clauses 17, 18 and 32—it is to ensure fair payment for care sector workers. In response to the Cavendish review, statutory guidance for the Bill will include guidance to local authorities on commissioning services and arranging contracts that will explicitly require them to have regard to ensuring that provider organisations adhere to minimum wage legislation, including, crucially, the payment of travel time between social care visits. We are also working closely with Her Majesty’s Revenue and Customs to ensure that the national minimum wage guidance is appropriate to the care sector. We have amended the Bill to enable specified bodies to provide training standards for groups of workers, initially focusing on health care assistants and social care support workers. This will form the core of the new care certificate.

New clause 31 is outside the remit of Health Education England, which has a delegated duty under the National Health Service Act 2006. The duty relates to education and training in relation to persons working, or considering working, in connection with the provision of services as part of the health service in England. The duty does not extend to regulated social care, which is taken to mean social care delivered by providers registered with the Care Quality Commission.

On new clause 5, given the inherent complexity presented by the different legislative frameworks operating in the different territories of the United Kingdom, we will look to develop principles on cross-border continuity of care that achieve the same practical effect as further legislation. I absolutely agree with the hon. Member for Edinburgh East (Sheila Gilmore) about the importance of this issue. We have started discussions with colleagues in the devolved Administrations and we will aim to publish the principles by November. I hope that that helps her.

On new clauses 3 and 19 about NHS work to identify and promote the health of carers, I can confirm that the guidance will absolutely reinforce the importance of co-operation between the NHS and local authorities on local authorities’ duty to identify carers. NHS England is developing its own action plan for identifying and supporting carers. In addition, our vision for out-of-hours hospital care, which will be published in April, will build on changes to the GP contract for 2014-15. All patients aged 75 and over will have a named accountable GP with responsibility for their care, and we will consider how we can extend this approach to all people with long-term conditions. The plan will emphasise the importance of GPs identifying carers and supporting them in their caring role by directing them to information, advice and support.

On new clauses 20 and 21, a legislative approach that compels schools, universities and colleges to identify young carers and student carers would not be in keeping with the Government’s drive to reduce burdens. The Department for Education has already been doing a lot in this regard, and it is now working with the National Governors Association in raising awareness in schools. The Department of Health has invested in many initiatives to help to identify and support young carers. We have trained over 150 school nurses as young carers’ champions. Along with other Departments, we will also explore the factors that are challenging in young adult carers’ transition from school to college or university. Along with ministerial colleagues, I will shortly write to Universities UK and the Association of Colleges to seek their engagement in this work.

Amendment 20, tabled by the hon. Member for Islington North (Jeremy Corbyn), is not required because the scope of the new powers in clause 12 already allows for the collection of such information if we choose to require it.

On amendments 31 to 33, we have carefully considered the issue of time frames in the care planning process, including reviews. On balance, we feel that a flexible approach is best. It is important for local authorities to retain the ability to be proportionate to the needs to be met. For some people—[Interruption.]

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[Norman Lamb]

I do not have time, I am afraid.

We will set out in guidance best practice on conducting care plans. I hope that that reassures the hon. Member for South Shields (Mrs Lewell-Buck).

Amendment 26 is unnecessary because the concepts of independent living and inclusion in the community are already core parts of the duty to promote individual well-being. We have merely captured them in more concrete ways rather than using those terms, which are too unclear, as the Law Commission agreed.

Schedule 2 to the Children Act 1989 requires local authorities to keep registers of sight-impaired children, and amendments 22 to 25 would only duplicate that. We have committed to explicitly reinforcing this duty in the forthcoming code of practice for children and young people with special educational needs or disabilities.

I turn briefly to the Government amendments. Amendments 1 and 2 simply clarify the scope of the regulation-making powers as set out in the other place by Lord Howe, the Under-Secretary with responsibility for quality. They ensure that regulations can specify where local authorities do have the power to be more generous and contribute to the costs of an adult with resources above the financial limit, as well as where they do not.

Amendment 3 allows regulations to specify where certain costs do not have to form part of the personal budget and thus do not count towards the cap on care costs. It has always been the intention that some provision, such as reablement, should be a universal, free service and therefore should not be incorporated in the personal budget. Such exemptions will not apply to general care and support that a local authority can charge for.

Amendments 4 and 5 correct small drafting omissions in clause 34. Amendment 6 will enable us to make provision in the regulations for the appeals system for the investigation of the appeals body itself—for example, regarding allegations of maladministration. Amendment 14 sets out that, as per usual practice, we will use affirmative regulations if we need to amend primary legislation as part of the appeals regulations.

Finally, on amendment 7, the feedback from local authorities is that it would make sense for them to have flexibility to be able to delegate functions relating to direct payments if they so wish. We agree and have accordingly tabled an amendment to remove the prohibition related to that.

[Paul Burstow]

I give notice that I would like to press new clause 9 to a vote and beg leave to withdraw new clause 1.

Clause, by leave, withdrawn.

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[Norman Lamb]

Let me begin by thanking all Members for their contributions to the debate.

Part 2 of the Bill contains a range of measures to implement the Francis recommendations following the awful events at the Mid Staffordshire NHS Foundation Trust. The changes that we are introducing are intended to make a reality of Robert Francis’s recommendation that the NHS, and indeed all care services and those who work in them, should adopt and demonstrate a shared culture in which the patient is always the priority.

I accept the principle that lies behind new clause 8 and amendment 19, but the oversight of commissioning is not the core purpose of the CQC. I want the CQC’s main focus to be on providers and the quality of care provided for patients and service users. Any review or investigation of commissioning of services by the CQC will have an impact on its capacity to oversee service provision, and should be selected with care. It is therefore right for any CQC special review or investigation of commissioning to continue to be either at the request of, or subject to the approval of, Ministers—in the case of reviews of local authority commissioning, the Secretaries of State for both Health and Communities and Local Government.

I want to make my position absolutely clear. If there is strong evidence of a link between commissioning and poor care, the CQC will be able to examine it.

[Paul Burstow]

rose—

[Mrs Lewell-Buck]

rose—

[Norman Lamb]

I will give way to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) first.

[Paul Burstow]

I apologise for getting in just before the hon. Lady.

May I return to a point that I raised in my opening remarks? At present, inspectors disavow the opportunity of providers to give them the evidence to which the Minister has referred. They say that they are not interested in it. Will the Minister ensure that the CQC and its inspectors are open and receptive to such evidence when providers offer it to them?

[Norman Lamb]

Subject to the fact that the CQC is an independent body, I will certainly reinforce that point in my discussions with it. In the context of mental health, we were discussing with the CQC only last week the importance of the role of commissioning as well as that of provision. I entirely accept that good care can be provided only if we get both the commissioning side and the provider side right: the two must go together.

Is it appropriate to set out the specifics of a review of commissioning in the Bill? I do not believe that it is. Flexibility is vital. While the CQC has a power to conduct special reviews and investigations of commissioning, that must be set in the context of other measures in the Bill that will strengthen the duties that local authorities must fulfil in exercising their care and support functions.

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[Paul Burstow]

The Minister mentioned that a number of measures may be taken pre-failure in order to avoid the failure regime being triggered. Before tomorrow’s debate on clause 119, will he supply the measures by way of example, so that we can debate those very issues?

[Norman Lamb]

I am happy to ensure that a note goes to my right hon. Friend and other Members, as he requests.

New clauses 29 and 30 would introduce a power to create new requirements for registration with the CQC, one requiring providers to minimise the risk of harm to patients and service users, and the other requiring providers to inform patients and their representatives where treatment leads to harm, and to prepare a safety management plan. Section 20 of the Health and Social Care Act 2008 sets out the areas in which the Government may impose, through regulations, requirements on providers registered with the CQC. It is a broad power and expressly allows regulations for

“securing the health, safety and welfare of persons”

for whom services are provided. This is broad enough to include minimising harm to patients. In addition, it expressly includes a power for the registration requirements to cover

“the manner in which a regulated activity is carried on”,

which would cover a requirement to prepare a safety management plan.

Clause 80 also places a duty on the Government to introduce a new registration requirement of informing patients and service users where there have been failings in their care—the duty of candour. I hope that I have reassured my hon. Friend the Member for Bristol North West that the power already exists to include the proposed areas in the CQC registration requirements.

My Department is consulting on draft regulations to put in place new fundamental standards as requirements for registration with the CQC. These would require providers to take “appropriate steps” to mitigate the risks of service users receiving care that is “inappropriate or unsafe”. We plan to consult shortly on a new duty of candour requirement. We will, of course, develop the final regulations, which will be subject to the affirmative procedure, in the light of the comments received in the planned consultation.

Finally, I support the sentiment behind new clause 27, that providers of care services should be held to account where they allow abuse or neglect, and that there should be serious consequences where this occurs. Under the fundamental standards on which we are consulting at the moment, all providers registered with the CQC must take steps to avoid abuse and neglect, and take action where those occur. Where providers are responsible for abuse, the CQC will be able to prosecute them. In fact, in response to Winterbourne View, I took the view that there was a gap in the regulatory framework, which did not allow for proper corporate accountability. I felt that we had to change the arrangements to ensure that companies, trusts and other providers were held to account where they were responsible for abuse or neglect. We are achieving that objective.

In addition, we have brought forward proposals to respond to the most egregious failures of care. On 27 February, we published our consultation on the detailed proposals for a new criminal offence of ill-treatment or wilful neglect. The Berwick report was clear that this offence should apply to individuals and organisations, whether or not they are registered with the CQC. We agree with that approach, and are consulting on the proposal. The new criminal offence, together with the CQC’s responsibility to respond to poor quality care, is sufficient to ensure that action is taken against unacceptable standards of care, and that there are serious consequences where this occurs.

[Paul Burstow]

I am grateful for the Minister’s responses to my three new clauses. I look forward to hearing what other hon. Members have to say about their provisions, but on the basis of the assurances I have been given, I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.



New Clause 27

Corporate responsibility for neglect

‘(1) This section applies where a person registered under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (a “registered care provider”) in respect of the carrying on of a regulated activity (within the meaning of that Part) has reasonable cause to suspect that an adult in their care is experiencing, or at risk of, abuse and neglect.

(2) The registered care provider must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case and, if so, what and by whom.

(3) Where abuse or neglect is suspected, the registered care provider is responsible for informing the Safeguarding Adults Board in its area and commits an offence if (without reasonable cause) it fails to do so.

(4) A registered care provider is guilty of an offence if the way in which its activities are managed or organised by its board or senior management neglects, or is a substantial element in, the existence and or possibility of abuse or neglect occurring.

(5) A person guilty of an offence under this section is liable on conviction to imprisonment for a term not exceeding two years, or to a fine, the range of which will be specified by regulations, or to both.’.—(Nick Smith.)

Brought up, and read the First time.

Question put, That the clause be read a Second time.

Francis Report

Debate between Paul Burstow and Norman Lamb

Wednesday 5th March 2014 Commons Chamber

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

Police cell.

[Paul Burstow]

I am grateful to the Minister for correcting the record from a sedentary position.

There were 350 children on adult wards in 2013-14, including one as young as 12, and the use of restraint has been at a high level. I know that the Minister for care services is championing changes in that area. I very much welcome his leadership on the crisis care concordat. It is very important that the CQC leads on regulation to show that it is not just words, but will be backed by regulatory teeth.

The culture change also needs to be about listening to patients. The evidence again suggests that there is still a long way to go. The Care Quality Commission has found that a quarter of care plans showed no evidence of patient involvement. That cannot be right, whether for a long-term physical health condition or a mental health problem.

We have only just had a tariff for mental health. When I arrived as a Minister with responsibility for it, I found that the task of producing tariffs had already taken five years, having dragged on and on. Yet because of the difference in how we funded mental health services, it was easier to cut them in the past. The picture of spending on mental health is rather more nuanced than it is sometimes portrayed in debates in this place.

Given all that, we might have expected NHS England to ensure that its response to the Francis inquiry and to the Government response recognised that poor care can occur in mental health as well. The chair of NHS England, Malcolm Grant, has put his name to the statement of common purpose that prefaces the Government response to Francis. Yet NHS England has ignored this Government’s mandate to it to deliver parity of esteem. NHS England’s financial experts do not get it: they are delivering Francis’s agenda simply for the acute sector, and taking money away from mental health services through adjustments to how payments are made for them. That cannot be right. I know that the Minister agrees with me, but doing so is not sufficient: there must be a challenge to NHS England’s decision to take away money from mental health, given that both sectors need to make progress and to take steps to deal with the Francis agenda.

[Norman Lamb]

I just want to alert my right hon. Friend to the fact that David Nicholson, the chief executive of NHS England, has made it clear to area teams and therefore to clinical commissioning groups that they must take parity of esteem fully into account in financial settlements with mental health trusts. That clarification of the importance of parity of esteem on finances is critical, and I hope that he welcomes it.

[Paul Burstow]

I very much welcome that and what the Minister says.

The reason I have raised issues about mental health in this debate is that it would be a mistake for Members to see Francis simply through the lens of acute hospital care. As the Government said in their response to Francis, we need to be concerned right across the piece. That is why I make no apology for focusing my speech on mental health, and why I hope that the Government will continue to drive an agenda of parity of esteem and make it a reality.

Care Bill [Lords]

Debate between Paul Burstow and Norman Lamb

Monday 16th December 2013 Commons Chamber

[Paul Burstow]

I entirely understand that, and I see it in my constituency, where my local authority is grappling with those budget choices, but there is still scope for innovation. There are good, bad and ugly local authorities when it comes to grappling with the resource constraints that the deficit has led to, and I will come back to that in a moment.

I believe that the Bill deserves to be described as landmark legislation, because it will provide a new governing purpose for our social system—the idea of well-being, to which I will return—new rights for carers and, for the first time, parity of esteem between those who are cared for and family members who provide care and support. The new national eligibility threshold will end the postcode lottery for access. We can debate where the line is drawn, but for the first time that will become a national debate rather than simply a local one.

There will also be new obligations on local authorities on behalf of the whole population that they serve. There will be obligations to prevent and postpone the need for care, to ensure quality and choice of services and to ensure that there is good information and advice about the whole range of choices that people might need to make as they approach the point at which they need care. Importantly, the Bill is foundation legislation upon which a more co-ordinated and integrated system of health and social care can be built.

I could stop there, but the Bill will do more than that. It will simplify and clarify entitlements to state-funded support and put personal budgets into law for the first time. That is all before I have even mentioned the Dilnot reforms, about which it is important to give some context. Social care in this country today is not free. That is the nasty little secret that families discover when they are tipped into crisis and have to negotiate with their local authority over whether they will have access to any means-tested support. Most people do not know that, and it comes as a shock and creates anger and dismay in many families. While I was a Minister, Members from both sides of the House showed me letters of anguish from people who felt that the system was letting them down. To understand the value of Dilnot is to make a true comparison not with what people hope the system will be but with what it actually is today—a nasty, mean system that is means-tested. That is why the Government deserve to be commended for having the courage to start to put in place the principles that Dilnot proposed.

The right hon. Member for Leigh gave no direct quotation from Andrew Dilnot in opposition to what the Government are doing. I know why—it is because there is no direct quotation of that sort. Andrew Dilnot supports the changes and sees them as a much-needed step towards implementing all the principles that he recommended in his report.

Of course, it is important that we recognise that not everyone will ever need formal care. A minority of our population will need formal support, no matter where the threshold is drawn. Perhaps some will need it right at the end of their life. Those who do will want the Bill to give them peace of mind, and that is what Dilnot provides to everyone. Some people are confused by the idea of catastrophic costs based on all people needing care, but the reality is that most people will never reach the cap wherever it is drawn, because they will never need to draw down that much resource to pay for care costs. Moving the means test threshold from £23,250—the meanest of means tests in our welfare state—to £118,000 is a huge step forward.

For all those reasons, the Bill can be marked out as a comprehensive reform of our social care system, and it deserves the House’s wholehearted support today. There are other reasons why it deserves support, too. The draft Bill was consulted on extensively and has been subject to pre-legislative scrutiny, of which I am a great fan. As the Minister at the time, I actively sought permission for it to be subject to that approach. By a curious twist of fate, I then found myself chairing the very scrutiny Committee that I had advocated. I was lucky to have cross-party support from both Houses in doing that job, and it was a strong Committee. We made 107 recommendations, the vast majority of which the Government accepted before introducing the Bill. Many of the others have been persuaded upon them through their lordships’ scrutiny, and I am grateful to colleagues in the Lords for what they have done.

All of that will be worth nothing if the Bill is not well implemented. As the debate has demonstrated powerfully, there is a huge knowledge gap that leaves people struggling in a crisis. It means that people do not plan or prepare for care, financially or in other ways. We need not just local information and advice services but a multi-channel, multi-media campaign to inform and educate the public, hon. Members and the people who work in the system. We need to ensure that we manage changes well, such as deferred payments, about which I hope the Minister will say more later, not least because it is not a sufficient defence to say, “Because Labour did this when it was in government, we will do it as well”. I hope the Minister will have a better answer on that point.

I want to give one example of why the implementation challenge is big. There are 300,000 to 400,000 people in this country who already pay for their care. It would make no sense for them all to be told to line up on 1 April 2016 to get their care accounts sorted out. The change needs to be phased and planned so that we do not overwhelm local authorities in April 2016. I hope that the Minister will be able to reassure us about that.

The hon. Member for Sheffield, Heeley, said that the Bill was a look back to 20th-century models of care. I disagree, because at front and centre, in the Bill’s first clause, is the disruptive idea that we should promote individual well-being. It states that well-being is about quality of life, work, leisure, study, the right to be an active member of the community, being in control and maintaining and recovering physical and social function—all things that were anathema to many of the paternalistic models of 20th-century care.

We need only compare current care plans for older people with those for active and working-age people to see the stark difference. The plans for working-age people are about their being engaged with their communities, but for far too many years the plans for older people have too often been about “task and finish”, with tasks being burned down to just 15 minutes or less. That cannot be right, and it has to change. That is why I welcome the fact that the Secretary of State will also be subject to the well-being principle in discharging his obligations under the Act to regulate the system.

I would welcome some clarification of the term “beliefs” with regard to well-being. It would be helpful if the Minister said whether it applies to religious and spiritual beliefs, and whether that point will be covered in guidance.

On prevention, which has an important link to the well-being principle, can the Minister confirm that the duty set out at the beginning of the Bill will be outside the consideration of national eligibility, and that it will be a universal obligation that will not just apply to those who qualify for care? Will the local authority actively have to secure it?

[Norman Lamb]

I pay tribute to my right hon. Friend for his amazing work in launching the Bill and in its pre-legislative scrutiny. I can confirm that the prevention duty will be universal and have no relation to the criteria for eligibility.

[Paul Burstow]

That is very helpful, and I am grateful. The fact that the prevention duty will be outside the eligibility criteria gives the lie to the idea that it will be curtailed. That is important to understand. There has been some dispute about that, and the Association of Directors of Adult Social Services now suggests that the change in eligibility will be more generous than many people have thought.

Several Members have touched on the issue of carers. Progress has been made in the Children and Families Bill, and I hope that there will be progress on the identification of carers as well. One of my deep frustrations as a Minister was that, even when I had pulled all the levers available to me to try to get the NHS to do more on carers, it still did not get it. It did not do enough, and although there are beacons in the NHS, the whole thing has not been set afire so that the NHS really changes how it engages with carers. We need seriously to consider legislation on that, and I look forward to the Minister setting out how that might be achieved.

I want to touch on the role of the Care Quality Commission. It might be right to remove its duty to do periodic reviews, but it is important that it can exercise its power to conduct special reviews of commissioners without reference to Ministers. Where it finds that there a provider’s failure is attributable to commissioning failures, it should be able to inspect the local authority in question without having to seek Ministers’ permission. In that way, the special inspection powers could be used much more creatively.

A lot has been said about integration in this debate. I hope that we can make more progress on the matter to include it in all parts of the Bill during its passage through the House. I believe that the Bill deserves a Second Reading tonight, because it offers a transformative vision of how care is delivered in this country. By making well-being the central organising principle, we can deliver a much better quality of life for those who need care.

Carers

Debate between Paul Burstow and Norman Lamb

Thursday 20th June 2013 Commons Chamber

[Paul Burstow]

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

[Norman Lamb]

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

Mental Health

Debate between Paul Burstow and Norman Lamb

Thursday 16th May 2013 Commons Chamber

[Paul Burstow]

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

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

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

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

[Paul Burstow]

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

--- Later in debate ---

[Paul Burstow]

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

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

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

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

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

[Norman Lamb]

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

[Paul Burstow]

rose—

--- Later in debate ---

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Paul Burstow]

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

[Norman Lamb]

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

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

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

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

Health and Social Care

Debate between Paul Burstow and Norman Lamb

Monday 13th May 2013 Commons Chamber

[Paul Burstow]

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

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

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

[Paul Burstow]

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

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

NHS Commissioning Board

Debate between Paul Burstow and Norman Lamb

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

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

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

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

[Norman Lamb]

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

Dementia

Debate between Paul Burstow and Norman Lamb

Thursday 10th January 2013 Commons Chamber

[Paul Burstow]

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

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

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

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

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

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

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

Winterbourne View

Debate between Paul Burstow and Norman Lamb

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

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

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

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

[Norman Lamb]

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

Oral Answers to Questions

Debate between Paul Burstow and Norman Lamb

Tuesday 27th November 2012 Commons Chamber

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

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

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

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

[Paul Burstow]

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

[Norman Lamb]

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

Winterbourne View

Debate between Paul Burstow and Norman Lamb

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

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

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

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

[Norman Lamb]

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