Care Bill [Lords]

Robert Buckland Excerpts

Monday 10th March 2014 Commons Chamber

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

My amendments 27 and 28 are on safeguarding. Clause 42 contains a raft of measures that will go some way to enhancing the powers and role of the authorities in dealing with disturbing and worrying cases of abuse or neglect, which we hear about all too often when it comes to the care of vulnerable adults.

Amendment 27 relates to the definition of abuse in clause 42(3), which rightly makes reference to financial abuse. We are all aware of the rising phenomenon of financial abuse, where older people and those with learning difficulties have been preyed on, sometimes by their own family, for financial gain. My worry is that, while a distinct reference to financial abuse is welcome, there is a danger of creating an imbalance that will make other forms of abuse less relevant or important.

Statistics from the Health and Social Care Information Centre on the number of safeguarding referrals in the last year for which records are available show that the most common causes or types of abuse are physical abuse and neglect. My concern is that they do not appear in the Bill. It would perhaps be better to have an amendment, along the lines of the one I have tabled, that acknowledges different types of abuse and refers the matter to guidance that could be carefully and comprehensively drafted, so that practitioners can be safe in the knowledge that one type of abuse does not take precedence over another. This is an issue that has been raised in the other place and in Committee here. The Government have said they are concerned that defining abuse further might restrict the scope of a local authority’s duty to inquire, but my concern, and the concern of organisations such as Mencap, is that not having a reference to other forms of abuse might lead to an undue focus on financial abuse only, to the detriment of others.

Amendment 28 would place a duty on relevant partners, such as those providing care and support, to notify the local authority if they believe an adult is at risk of abuse. It is clear that local authorities cannot be expected to identify all types of abuse themselves, or to rely on the good will of other people or agencies. If relevant partners, including providers of care, had a duty to report that adults were at risk of abuse, that would make their responsibilities clear, and would help to secure greater transparency. I, and others, fear that leaving the matter to guidance would pose a risk that the duty would not be taken seriously enough. A legal duty for relevant partners has already been introduced in Wales, and the amendment seeks to mirror that.

We are familiar with the existing framework relating to adult safeguarding boards and the joint agency working that takes place, but concerns that arise day in, day out are not always reported, and, sadly, there is also under-reporting of concerns from hospitals. While there are many examples of local excellence in the development of safeguarding procedures, I fear, as do others, that there will be too much of a patchwork and not enough of a national framework. It is essential for us to know, wherever we live, that the standards of reporting and obligations placed on agencies and other partners to make that all-important report about abuse are consistent. Because adults are often much more isolated than children and young people who are surrounded by a framework, a duty to report when an adult is at risk could be considered to be more crucial.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I shall speak briefly about new clauses 17 and 18 and amendments 31 to 33, which stand in my name.

New clauses 17 and 18 go to the heart of the social care profession. They say a great deal about how much we value the care of vulnerable and older people. New clause 17 would reveal the full extent of poor employment practices in the care sector, including zero-hours contracts and failure to pay the national minimum wage. Good social care thrives on the provision of well-trained, motivated staff who can develop proper relationships with the people whom they visit, but we know that that does not happen. According to the Social Care Workforce Research Unit, more than 150,000 people in the care work force earn less than the national minimum wage. Poor pay not only affects employee morale, but makes it difficult to attract skilled staff and encourages high staff turnover. None of that is good for service users, who need to have confidence and trust in the people who visit them.

The Government promised to get tough on employers who do not pay the national minimum wage, but so far only five employers have been “named and shamed”. Not one of them was in the care sector, which is worrying given how widespread we know the problem to be. New clause 17 would give a clear picture of the state of the sector, and would create a foundation for possible action.

New clause 18 would create a requirement for local authorities to consider how the employment practices of providers they commission might affect the quality of care. The aim is to build checks into the system so that standards are not allowed to slip. Training is a particular concern: more than 40% of respondents to a Unison survey reported that they had not been given specialised training to deal with the specific needs of clients with conditions such as dementia. Nearly a quarter reported that they were required to carry out medical procedures or give medicine to clients when they had not been trained to do so. More worryingly, a care worker who spoke to me recently told me that it was standard practice in the agency to leave tablets for clients by their bedsides to save the cost of another visit later in the evening to ensure that the client had taken his or her medication. That means, essentially, that hundreds of vulnerable, confused people who are not in control of their own care are left to control their own medicine.

The issue of 15-minute care visits has rightly attracted considerable attention, not just because they often make the practicalities of care impossible, but because they eliminate almost any chance for a relationship to develop between carer and client. An under-reported crisis among older people is growing isolation, and the carer may be the only person to whom many of them speak on most days. That has real, measurable impacts on people’s well-being, and is made worse by those flying visits. New clause 18 would force authorities to take such factors into account when commissioning services.

A care worker on a zero-hours contract told me that it was common for 15 or 30- minute visits to be scheduled back to back, which gave him time to do only the bare minimum. He had no time to speak to his clients, or to go the extra mile to keep them comfortable. He often drops in on them in his spare time just to ensure that they are okay. On one occasion, he arrived at a client’s home to find that the man had fallen and needed to go to hospital. The man asked whether the care worker—a constituent of mine—could go with him, and my constituent rang his employers to see whether that was possible. He was told that it was not. It is extremely worrying to see cases in which social care has lost that basic element of compassion. Employers must be required to build some kind of flexibility into their practices.

My own experience in adult social care has convinced me that a general duty of well-being is simply not enough.

Adult Autism Strategy

Robert Buckland Excerpts

Wednesday 5th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Clark. Indeed, it is a pleasure to follow the hon. Member for Strangford (Jim Shannon), who made some powerful points on cross-departmental working. I am glad to see the Minister is here with the lead civil servant on autism from the Department of Health, with whom I have had many conversations about cross-departmental working.

I have a quick example of cross-departmental working in relation to the transition period. We have all had casework in recent years involving 17 or 18-year-olds who are moving away from secondary education into further education and who find that their transition period is, frankly, stymied by lack of clarity on the funding of their FE places. I have had a number of such cases. Last year was particularly problematic in certain instances. That was through no-one’s ill will, but it was a result of the lack of genuine communication and cross-working between those responsible for the funding of further education and the other services that work with young people with autism. They are young adults coming into the adult world, and their first experience is negative. That is not a good sign of what is to come, not only for those young people but for their families and carers. There is a fear that I call the 4 o’clock in the morning syndrome, which is when a parent wakes up and thinks, “My child is young now, but what will happen when they grow up?” We keep having to ask ourselves that question. It is the exam question that I set for the Minister in today’s debate and at every opportunity we have to discuss the strategy for adults with autism.

I pay tribute to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) for her sterling work to help to bring the Autism Act to the statute book, which was before I came to this place. The Act means that the autism strategy, which is now being revised, is the core document for local authorities and all providers and commissioners of services across England in working with and providing a proper strategy and service for adults with autism.

I have the pleasure and honour of chairing the all-party group on autism, and I enjoy working with Members from both sides of the House. The all-party group has had significant success in the years since it was founded in 2000 not only in campaigning but in achieving real change for children and adults with autism and their families. As my right hon. Friend said, the Act has, in certain areas of the country, delivered that real change. I am delighted that in my constituency in Swindon we now have not only an autism partnership board, the meetings of which I have attended, but an efficient adult diagnostic service. Our social enterprise, SEQOL, was commissioned to provide that diagnostic service, which is one of the best in the country. We are now able to identify adults in their 50s, who are getting a diagnosis for the first time. That is important for them and is an acknowledgement not only of the questions and issues that they have been raising over the years but that, for far too long, far too many people have lived without any support or diagnosis. Diagnosis, of course, is only the first stage. What comes next is as much a challenge, and it is a question that we need to answer.

[Tim Loughton]

My hon. Friend is a much greater expert than I am on autism. I was one of the founding officers of the all-party group on autism back in 2000, and it has done important work in this area, among the most important of which was our work with schools and local authorities to encourage early diagnosis, joined-up work and greater consistency in how we detect autism in the first place. If we can do that and tailor the school experience to the special needs of people with autism, we will not end up with people not being detected until as late as their 40s or 50s, which means that they miss out on a whole lifetime of support.

[Mr Buckland]

I entirely agree with my hon. Friend. I am grateful to him not only for his work on the all-party group but for his work as shadow children’s Minister and as children’s Minister in this Government. He played his part in ensuring that early diagnosis is a step closer to reality. The Children and Families Bill, which is shortly to be enacted, now incorporates education, health and care into one plan for young people who previously received statements of special educational needs. I am talking about children, but what my hon. Friend says is relevant. If we fail to take those early steps, the problems that manifest in later life become not only more difficult for the adults and their families but more expensive for the state. One example is that adults with Asperger’s are seven times more likely to come into contact with the criminal justice system than those without the condition. Why? Because Asperger’s is still a relatively unknown condition. It is not understood by many agencies that deal with it, and misunderstanding leads to sad results.

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

I thank my hon. Friend for his extraordinary leadership and for having a positive impact in a relatively short time on the understanding of autism. On Asperger’s, he will share my concern for those who unfortunately fall into the criminal justice system, but how far do we need to go to ensure that all agencies properly understand Asperger’s? Just last week, a constituent told me that Atos did not have a clue on how to deal with it. His older child was completely let down by the work capability assessment.

[Mr Buckland]

My hon. Friend, of course, has constituency experience with the Gary McKinnon case of how we can reach a dreadful situation where, because of a complete misunderstanding of the condition, serious consequences can flow. He makes an important point about Atos, and we have seen the difficulties that it has got itself into. It is unacceptable that we have a system that does not properly recognise these conditions. Frankly, it is a scandal. We can do far better than that, not only for adults with Asperger’s but for the range of invisible conditions—I do not call them hidden conditions, because the word “hidden” has connotations of its own—right through the gamut of mental health. We do not have a grip of that, either in the benefits system or with some other agencies.

[Mrs Gillan]

I pay tribute to my hon. Friend for his chairmanship of the all-party group. He has been driving forward progress in this area in a superb fashion. In my experience, the issue he is discussing also manifests itself in all sorts of strange areas. If a local authority or housing association dealing with an adult with Asperger’s has no idea of that individual’s sensitivities, it can positively harm that individual and others surrounding them, leading to immeasurable costs to the taxpayer and in the damage done to the individual.

[Mr Buckland]

I entirely agree. It is time that we recognise that conditions such as autism are particular disabilities that open a gateway to specialised housing. Unless we deal with that, we will carry on down the failed route of institutionalisation. We can see the logical conclusion of that in Winterbourne View and other serious examples. The Minister has a passion to deal with these issues, and I know he agrees that independent, supported living in properly tailored, properly built housing—it does not yet exist in any great measure—is what is needed for adults with autism if we are to avoid the tragedy that I and other hon. Members see week in, week out, whether we are canvassing or in surgery. We see young people sitting upstairs in the family home, without a job and they do not know what to do. They have no support, and their families are at their wit’s end in knowing what to do. We have to do better than that, and they deserve better.

On interface with agencies—I was talking about criminal justice—in many police areas, we now have autism alert cards. That system works well in Wiltshire, which is the police force area in which I live. We relaunched our autism alert card only last week. It is a simple thing: a bit of plastic with next of kin details on it. Importantly, the card tells the reader that the person carrying it has autism. That should trigger a series of events happening and make the police aware that autism is a factor. If various support services and care services are needed, they can be brought into the package and the family and the support network can also be informed about the incident or problem that the adult is having. Those simple measures can make a great difference.

[Mr Henry Bellingham (North West Norfolk) (Con)]

My hon. Friend is being incredibly generous. Where do GPs sit in all this? He has mentioned awareness and the need for different agencies to work more closely together. Does he agree that GPs should be given more training on autism at medical schools?

[Mr Buckland]

In a word, yes. GPs would welcome it and it would, at a stroke, deal with a whole range of unidentified problems. With greater awareness among general practitioners, referrals can take place. Where there are existing diagnostic services, as there are in Swindon, they can be used and, as I have mentioned, SEQOL and other organisations in other areas can get to work, using the pathways and identifying the condition.

What is next? What else is needed? I am a great believer in advocacy services, and I can see their power in some excellent local examples. The Swindon Advocacy Movement has recently had more funding to extend its remit to help people with autism and Asperger’s. It is a wonderful organisation, with a one-stop shop in the centre of Swindon that gives support to adults with learning disabilities. Its motto is that it is not there permanently to do things for people, but to empower people to help themselves. With that little bit of help, support and advocacy, lives can be changed for the better, and I see that happening through its wonderful work.

We also have Discovering Autism Spectrum Happiness, a voluntary organisation set up by a group of like-minded individuals some years ago in Swindon. It is now working from the Pinetrees community centre, offering the Swindon autism information and advice service, which is an invaluable resource. It only started last year, and it has already reached out to more than 150 individuals with autism and their families. By its estimate, there might be a couple of thousand of people in the community who have not yet been identified. Through its support work and its network, it is giving advice and empowering people with autism. I had the pleasure of visiting it only two weeks ago to talk about some of the cases that it is finding and some of the cases that are coming across my desk. There is a lot going on in local communities, but there is much more that we can do on an overall strategy to identify best practice, to knit that together in a co-ordinated and coherent way and to give other commissioning bodies and other authorities a gold standard from which they can work.

The Minister knows that I am not into lowest common denominators or prescriptive measures when it comes to this sort of thing, because I believe in localism. There has to be, however, some standard to which all commissioning bodies should work. Like adults who are neurotypical, adults with autism should not be frightened or worried to move about. If they can move to another part of the country to secure employment, they should reasonably expect that autism services in their new town or city will be of a similar standard to where they have come from. When they have a family support network, the tendency is for people with autism to stay close to home, and in many cases that is not a bad thing at all. Bearing in mind the Winterbourne View example, bringing people with a disability closer to home and to their network is a good thing, but there will be many high-functioning people with autism who want to travel, want to move about and want to take that job at the other end of the country. Why can they not do that? At the moment, there is a fear that the support network that they might enjoy in Swindon would not exist in another part of the country. That is the function that the strategy could fulfil; it is an empowerment strategy, not some prescriptive “We know what is best for you, so we will tell you what to do” strategy.

On community autism awareness, I have talked somewhat about advocacy services and information, but I want to talk about the sense of isolation that many with autism and their families feel. In a survey conducted by the National Autistic Society, 82% of adults with autism said that they have days and 42% said that they have weeks when they do not talk to anybody outside their household. Just think about that for a moment. Some 72% said that they have been bullied or discriminated against. A survey by Ambitious about Autism found that 87% of parents and carers of people with autism felt unsupported by the community. Those are stark statistics, but some of the solutions are simple. Small adjustments are all that is needed to change things. In the supermarket, staff are often not trained to know how best to deal with individuals who have autism. In the hairdressers, a few sensory adjustments would allow someone with hypersensitivity to access those facilities. The cinema at Greenbridge in Swindon regularly hosts autism-friendly screenings for children and young people, which make all the difference in the world. Parents at those screenings do not need have to have eyes in the back of their heads or worry about whether their child will be seen as naughty or misbehaving. They can relax, secure in the knowledge that everybody around them is accompanying someone with autism. Such adjustments make a huge difference in the lives of not only the individuals who have autism but their carers and families.

[Tim Loughton]

My hon. Friend is making an important point. The large DIY chain B&Q made a virtue of employing older people and disabled people, who are sensitive to the needs of their older and physically disabled customers. As a result, more disabled or older people tend to shop there than at other DIY chains, because the staff understand them. There is a commercial advantage in training and employing staff who have greater sensitivity to, and experience of, autism and other learning disabilities.

[Mr Buckland]

That is a powerful point. Employing older people and disabled people is good not only for business but for employment. Doing so is not simply about being a kind employer; it is about being savvy. We have already heard about the huge potential that those with autism, Asperger’s and related conditions offer. They have qualities and gifts that we do not have, and they have incredible resources. If we only empower them, they can show us what they are capable of.

[Robert Halfon]

My hon. Friend is making an incredible speech. I have mentioned PACT for Autism, and the pilot apprenticeship schemes for people with autism. Given that the Government are investing so much in apprenticeships, does he agree that they should incentivise companies to hire apprentices with autism?

[Mr Buckland]

That is an excellent idea. As my hon. Friend knows, our hon. Friend the Member for Ilford North (Mr Scott) has pioneered a wonderful scheme in his area whereby employers are matched up to young people with autism in order to offer them apprenticeships and job opportunities. I commend that local initiative to my hon. Friend the Minister as a great example of what can be done to empower young people and adults with autism.

I have talked about local cinemas and hairdressers, but what about training bus drivers to be aware of the needs of passengers with autism? I am sure that bus drivers would be receptive, because such training would make their life much easier. A lot of useful measures, such as the provision of quiet spaces in shops, can be done very easily. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, they will open up business to new opportunities.

I draw a parallel with some of the excellent work that has been done on dementia awareness. The co-ordinated dementia-friendly communities programme has been supported by the Government since 2012, and the Prime Minister has commended it. In dementia-friendly communities, local people come together to decide how to include people with dementia. Transport providers, charities, schools and local authorities all open up their facilities to ensure that people with dementia and their carers—let us not forget them—are not discriminated against. Only two weeks ago, I opened a memory café in the Wyvern theatre in Swindon, where people with dementia and their carers can come on Thursdays to have some space, enjoy mainstream activities and feel part of life.

There is an important parallel to be drawn with autism. How are we going to achieve similar improvements for those with autism? Not only must environments be made easy to navigate, but businesses and services must be respectful and responsible; public and private service providers must receive better training; there should be volunteer-led public education in workplaces and schools; and we must work with venues to help them adapt their buildings. Things such as better signage, more information and befriending schemes are also important. All that has been done with dementia, and we must do the same with autism.

The National Autistic Society gave me an example from a blog of a mother who loves musicals but has not been able to go to see a show for some years because her four-year-old son has autism with hypersensitive hearing. Believe me, I know what that is all about. Last year, she bought tickets for an autism-friendly performance of “The Lion King” in London’s west end. The organisers provided accessible information about the venue to ensure that children with autism would not be overwhelmed on the day. When mother and son went to the theatre, they found that there was a relaxation area where parents could go. At the beginning of the performance, one of the actors came on stage to help children understand the difference between actors and characters in the play. That performance brought families together and beat isolation.

That example relates to children, but there is no reason on earth why we cannot do the same for adults. For a few hours, children and family members were able simply to be themselves. That is the point I made about the Greenbridge cinema experience, which has been invaluable for so many families. Parents are not judged and they do not need to have eyes in the back of their heads. They are accepted and they do not need to apologise for their children or the person for whom they are caring. That is priceless, and I cannot describe how important it is for families of people with autism.

I have to contrast that with my experience some years ago at the Riverside theatre, where we went to see the musical “Salad Days”. As those of us who know and love it will be aware, it is all about a piano that makes people dance. Well, my daughter decided to dance. I thought that that was wonderful, but some in the audience, who did not really understand, did not, so that was the end of that. We really need to move away from such experiences. That has lived with me as a very bad experience for the family, and I hope that I never have to go through that again. I hope that one day we will no longer have to put up with the sort of phrases that I have encountered, or the lack of thought that people often show for those for whom we care.

I hope that the revised and re-published autism strategy will acknowledge what ordinary people and ordinary businesses can do better to make our communities autism friendly. My experience of talking to and e-mailing with many families across the country who are affected by autism indicates that there is a will for change. The right framework and the right resources from central Government could help us make the step change in society’s attitudes towards autism that we have championed, and on which we want to see real action.

--- Later in debate ---

[Mrs Gillan]

rose—

[Mr Buckland]

rose—

[Norman Lamb]

I will give way to both colleagues, but first to my right hon. Friend the Member for Chesham and Amersham.

--- Later in debate ---

[Norman Lamb]

I thank my right hon. Friend for accepting my offer, and now give way to my hon. Friend the Member for South Swindon.

[Mr Buckland]

I am grateful to the Minister. I will not take up his valuable time, but I want to thank him for the meeting he had on the strategy the other day with me and my hon. Friends the Members for Salisbury (John Glen), and for Cambridge (Dr Huppert). We have already started the work here in Westminster, and I am very grateful to the Minister for agreeing to a further meeting with my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) to push the agenda forward.

[Norman Lamb]

I acknowledge my hon. Friend’s comments. I share the shadow Minister’s view that this issue is entirely bipartisan. There is a massive need to change and increase society’s understanding of autism. Awful things so often happen through ignorance of autism and the entire spectrum. It is crucial to raise awareness, as several Members have said.

My right hon. Friend the Member for Chesham and Amersham raised a number of queries about whether the revised strategy would reinforce the points from the original strategy, and I can confirm that it will do so on all the points she mentioned. It must also go further and look into other areas.

My hon. Friend the Member for South Swindon talked a lot about the criminal justice system, and we must look at how we can improve things there. He made the point that someone with Asperger’s is seven times more likely to end up having some contact with the criminal justice system. We have started to roll out the Government’s liaison and diversion service, which I announced back in January. By 2017, we aim to have a nationwide service for people with mental health problems, autism and learning disabilities who end up in the criminal justice system, often inappropriately and unnecessarily. Getting people diverted to diagnosis, which Members have talked about, and to the right treatment can often prevent further offending and potentially thereby transform someone’s life while protecting others.

[Mr Buckland]

I pay tribute to the Minister for the mental health pilot schemes that are being introduced in Wiltshire and other places; they were recommended by the Bradley review some time ago. Does he agree that community psychiatric nurses need training, particularly in cases of comorbid autism and mental health conditions, which are sadly quite common? We must ensure that the pilot covers autism when it comes to the diversion at the police station.

[Norman Lamb]

I absolutely agree with my hon. Friend. I wanted also to touch on the point made by my hon. Friend the Member for South West Bedfordshire (Andrew Selous) about the parents of adults with autism who, far too often, are told by clinicians that they cannot talk to them about their adult child’s circumstances. Clinicians often hide behind the absolute importance of confidentiality about a condition in order to refuse to talk at all to the parents—the people who know the individual better than anyone. That is an attitude of mind among too many clinicians. It has to change.

I also wanted to refer to the points made by my hon. Friend the Member for Strangford (Jim Shannon). I think I can call him my hon. Friend. [Hon. Members: “Hear, hear!”] Thank you for that. He talked about the pressure on families, and he is absolutely right. Whether one is talking about learning disability, autism or dementia—there are parallels with dementia—the need to raise awareness in society is real. I am also happy to look at the Northern Ireland legislation and at what lessons can be learned throughout the jurisdictions.

Another point in response to the debate was to do with transition. Whether with mental health, learning disability or autism, we so often find that disasters happen at the age of 18. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) alluded to that important point. Too often, people are lost to the system. The age of 18 is the worst possible age to withdraw support, whether we are talking about mental health in general or autism in particular.

Children and Families Bill

Robert Buckland Excerpts

Monday 10th February 2014 Commons Chamber

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

I was interested to hear the hon. Gentleman’s point about rule 148 of The Highway Code. It is, in fact, only advisory with regard to avoiding distractions such as smoking and playing loud music in vehicles. It is not mandatory in the sense the hon. Gentleman might have been suggesting.

[Ian Paisley]

I was not suggesting that it was mandatory, but it does say that people should not do it. Rule 148 is very clear that people should not do a crossword, read a map, eat a sandwich or smoke while driving.

That takes us back to the crux of the matter. A person who lights up and smokes in front of a child—I hope the hon. Gentleman will accept this—is a prat, in my view, and we as a House should not be legislating on that, but educating. What we should really be engaging in is educating people. We do not require legislation to educate people not to be prats and to be sensible.

The number of people involved is minuscule, so is it right that this House is taking time, money and effort to legislate on such a minor problem? I do not believe it is.

Oral Answers to Questions

Robert Buckland Excerpts

Tuesday 14th January 2014 Commons Chamber

[Norman Lamb]

I thank the hon. Lady for her question. The National Autistic Society is doing fantastic work, working closely with the Government. It has put this idea forward and we are considering it seriously; it has real merit. We shall announce our decisions when we announce the results of the consultation in March.

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

What plans does my hon. Friend have to use the review as an opportunity to bring forward programmes that will increase autism awareness among the general public?

[Mr Buckland]

My hon. Friend raises an incredibly important point. Awareness is still far too low. We are now in a position where the legislation is in a good place and we have a good strategy, now being reviewed. There remains, however, an awful lot of work to do on implementation on the ground and on making a real difference to the lives of people with autism.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

7. What representations he has received on IT and data security issues relating to the GP extraction service; and if he will make a statement.

--- Later in debate ---

[Dr Poulter]

I am not aware of any direct conversations with Ministers here, but as the hon. Lady will be aware, the Minister responsible for A and E services is my right hon. and noble Friend Earl Howe. I will write to her about the discussions that have been had with the noble Lord and Health Education England.

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

T10. I warmly welcome initiatives such as the introduction of personalised GP care for the over-75s, but what more can be done to ensure that personalised care treats the individual’s well-being as opposed to merely a collection of symptoms?

[Mr Jeremy Hunt]

We want people to be treated as individuals, not a bundle of illnesses. That personalised care must happen not only out of hospitals but in hospitals, too. We want doctors to take responsibility for the whole stay and to avoid that sense of people being passed from pillar to post. That is an area in which we hope to announce some important changes shortly.

Care Bill [Lords]

Robert Buckland Excerpts

Monday 16th December 2013 Commons Chamber

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

When I say that it is a pleasure to follow the hon. Member for Lewisham East (Heidi Alexander), that is not a mere formality; it really is a pleasure, and it was fascinating to hear the family experience of her late grandmother in Swindon. As the Member of Parliament for some other members of her family, I was particularly interested in, and concerned to hear, that story. Clearly there is a measure of consensus about the progress that the Bill allows us to make. Although I understand and appreciate her concerns about the process that was successfully challenged in the courts in relation to her local hospital, and the detail in respect of clause 118, I do not think, with respect to her and to the Opposition, that that is sufficient for the reasoned amendment to pass tonight. I say that because I think of the thousands of families like hers who, over the years, have had to wait for change and for politicians to come up with a decision. We have procrastinated and prevaricated, and had review after review, so surely time is now up and decisions have to be made. That is why this Bill comes not a moment too soon.

I want to address an aspect of the Bill that has been dealt with by other Members: the care of adults with learning difficulties, and especially with autism. I speak in my capacity as chair of the all-party group on autism. I also declare an interest as the parent of a child who one day might fit some of the criteria of the Bill and as the parent of a young carer. I say with enthusiasm that I welcome those provisions in the Bill that relate to the assessment of young carers. They were very much part of a cross-party campaign with which my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Worsley and Eccles South (Barbara Keeley) were involved. A necessary change was made to allow young carers’ rights and needs to be assessed as well. Let us not forget that while this Bill makes its way through this House, the Children and Families Bill is making its way through the other place. We must ensure that both Bills dovetail in a way that is truly effective. In particular, I am thinking of the provisions of the Children and Families Bill that extend the education, health and social care plans to those young people between the ages of 18 and 25. We must ensure that the social care aspects of this Bill dovetail properly with the needs of those young people, because this Bill affects adults from the age of 18 and onwards.

This is a hugely important Bill, and I want to address it in the context of the Autism Act 2009. That groundbreaking legislation was passed in this House with all-party support and following the work of my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan). I pay tribute to all Members, and former Members, who played their part in that legislation. As a result of it, an adult autism strategy was passed in 2010, which committed both national and local government and the NHS to improve the lives of adults with autism.

However, here we are in 2013, and there is still some way to go to meet the aims of that legislation. The strategy is currently under review. Ahead of that review, the National Autistic Society launched its “push for action” campaign, which identified some of the most important barriers to implementation and outlined the key challenges that adults with autism continue to face. Some of those challenges can be met by this Bill.

I am particularly pleased with clause 2, which places new duties on local authorities to prevent the needs for care and support from developing in the first place. Change in that area for adults with autism has been slow and patchy. A third of adults with autism who responded to a survey by the National Autistic Society said that they developed serious mental health problems because of a lack of services. Support at a low level can allow people with autism to become more independent, work, socialise and take part in their communities. At the same time, it can prevent an escalation of care needs.

Back in 2009, the National Audit Office found that providing such low-level services is cost-effective and helps people to avoid the use of in-patient mental health care, which costs between £200 and £300 a day. The NAO said that if just 4% of adults with Asperger’s syndrome or high-functioning autism are identified and supported, that would become cost-neutral over time.

I am glad that the right hon. Member for Stirling (Mrs McGuire), who is no longer in her place, referred to the Deloitte economic model, which quite clearly shows that for every pound spent to support people with autism and other disabilities, there is an average return of £1.30 for central Government, local government and disabled people and their families. Clear duties that prevent mental ill health are essential if we are to make the aims of the adult autism strategy a reality and to save money. I would be grateful if my right hon. Friend the Secretary of State and the Government ensured that local authorities’ understanding of prevention is wide ranging and includes the very types of low-level support that can make this prevention aspiration a reality.

Let me turn now to the existing duties of local government and the NHS. I welcome the Bill’s intention to bring together in one place statutory guidance on care and support. However, the statutory guidance that was published as a result of the Autism Act is slightly different. As opposed to the Care Bill, the 2009 Act also places important duties on the NHS. I want to ensure that those duties on the NHS are not unintentionally omitted from this Bill.

There is still much progress to be made with regard to the duty to develop a diagnostic pathway for adults with autism. I am happy to say that in Swindon the local social enterprise SEQOL has already done that, and has developed an important diagnostic pathway, which is also followed up by meetings with and assessments by clinicians. That has resulted in adults as old as 50 and above being diagnosed with autism or Asperger’s for the first time. The issue of what happens next will be key if we are to make this Bill, and the good intentions behind it, work for people with autism.

A common problem reported by families of people with autism is that far too often the person carrying out the care assessment does not sufficiently understand the condition or how to communicate effectively with someone on the spectrum. I am therefore encouraged by the recent amendment to the Bill to enable regulations that will specify where community care assessments should be carried out by assessors with specific expertise. Assessments for adults with autism must be covered by those regulations, because that will reinforce the obligation already placed on local authorities by the Autism Act and the statutory guidance to train those who carry out community care assessments. The NAS found that, at the moment, only just over half of local authorities have specialised training available for their staff, so, quite clearly, more work needs to be done to deal with that.

The right to advocacy is essential to enable people who find it hard to communicate to exercise their rights. I pay tribute to the work of the Swindon advocacy movement, which, as a result of its efforts and funding from the local authority, is now extending advocacy to adults with autism and Asperger’s, who have never had that support before. What often makes us parents lie awake at night is the question of who will speak for our children when we are gone. Who will be there to carry out that advocacy? This service is essential to provide peace of mind to parents and carers of sons and daughters with autism who will outlive them. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) mentioned the definition in clause 68 of “substantial difficulty”. This debate on Second Reading is about the principle of the Bill. I am sure that we will be able to iron our further details when the Bill goes to Committee. None the less, I commend it to the House as an overdue attempt to address the concerns of real people in our communities, and to help people with disabilities, including autism, lead fulfilling lives.

Accident and Emergency Departments

Robert Buckland Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

It absolutely does. There are nearly 4,000 more front-line staff under this Government than there were under the previous Government at the time of the last election. More importantly, where there are problems in hospitals—my hon. Friend’s hospital has had a number of problems—this Government are not sitting on them or seeking to cover them up. We are addressing them and I hope that by the time of the next election we will be able to demonstrate that we have turned around my hon. Friend’s hospital and a number of others and that finally these serious problems are being addressed.

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

Will my right hon. Friend join me in thanking A and E staff at the Great Western hospital for their hard and successful work? Will he assure me that, if hospitals such as the GWH and the Royal Berkshire just down the M4 corridor incur any additional needs this winter, there is contingency in the budget?

[Mr Hunt]

We do have a contingency built into these plans, but it is also important for trusts to plan in advance. One of the reasons why we announced this funding in August and why we have today announced where it will go is in order to enable people to make long-term plans. The lesson we have learned from previous years is that if we come up with these packages in the middle of winter it is too late for anything to happen. I totally join my hon. Friend in commending the hard work at Great Western hospital.

Mental Health

Robert Buckland Excerpts

Thursday 16th May 2013 Commons Chamber

[Paul Burstow]

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

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

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

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

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

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

[Paul Burstow]

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

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

Regional Pay (NHS)

Robert Buckland Excerpts

Wednesday 7th November 2012 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

It is a pleasure to follow my constituency neighbour, the hon. Member for Bristol East (Kerry McCarthy). I apologise for not attending the earlier Westminster Hall debate secured by the right hon. Member for Exeter (Mr Bradshaw); I will read the Hansard report to see what was said. I want to talk about the background to the debate and the south-west pay, terms and conditions consortium, which affects my constituency. We heard the right hon. Member for Leigh (Andy Burnham) and a few other Opposition Members talk of cartels. It is rather unfortunate that such language has been used, because we want trusts to work together to come up with productive solutions to the problems we face in the NHS.

I have heard from constituents, many of them nurses, who are concerned about what is happening. To be honest, I think that they are concerned because there is a lot of scaremongering and a lot of knowledge has not been put out in the open, partly because the unions that are driving the campaign are refusing to speak to the consortium and engage. We need that engagement from the unions, so I urge them to get around the table.

I wrote to the chief executive of the south-west pay, terms and conditions consortium, Chris Brown, to ask for his reasoning as to why the consortium was formed and why it has put the measures on the table—they are not definite and are there to be discussed by individual trusts. This is about flexibility for individual trusts. As has been discussed, the previous Labour Government provided that flexibility. It will be up to the trusts to decide. We should have faith in local foundation trusts to make the decisions that need to be made.

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

I am grateful to my hon. Friend for breaking down the language that has been used, because one of the worries my constituents have is that Swindon is right on the edge of the south-west region. The prospect of a wholesale regional pay structure causes them real concern. Is not the issue local pay bargaining and how local trusts run their services to the best of their ability?

Regional Pay (NHS)

Robert Buckland Excerpts

Wednesday 7th November 2012 Westminster Hall

[Anna Soubry]

I absolutely support anyone who takes a mature and sensible approach to the matters. I also understand why the south-west consortium—like many others, no doubt—is frustrated, because a two-year set of negotiations continues when it should have reached an agreement. The trade unions must take a responsible approach to ensuring that we have a national health service that is sustainable. It is in the interests of their members, and they are meant to represent their members, whose interests they should put first.

The consortium has published two discussion documents. What is our attitude and what are we to do as a Government? To be clear, we support national terms and conditions of service, but not at any cost. Individual employers must have the right to exercise the freedom, which the Labour Government gave foundation trusts in 2003, to be free of ministerial control. That is what the previous Government did.

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

Having been contacted by many concerned constituents about the matter, I took the trouble to meet my local NHS trust chief executive to discuss those concerns and put them directly to her. Will the Minister assure me that the worrying spectre of a monolithic regional pay structure that would ill-suit employees in Cornwall as much as in Wiltshire will not be welcomed by the Government?

[Anna Soubry]

I agree with my hon. Friend. Monolithic structures would not be welcome. What is welcome is when trusts take a responsible view to ensure that they act in the best interests of their employees and that they have a financially sustainable system. That is in the interests of everyone—staff and patients.

Winterbourne View

Robert Buckland Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

Inspections are essential to ensure that we identify where problems exist. The role of the Care Quality Commission is critical in that respect. We need to do more to open up those establishments to public view. One role that the new local HealthWatch can take is to go into care homes, nursing homes and so on to see for itself. The more there is a culture of openness, the less likely it is that abuse will take place.

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

I commend to my hon. Friend the work of organisations such as the Swindon Advocacy Movement, which does so much work not only to advocate for service users, but to train volunteers, so that more adults with learning difficulties can stay in the communities in which they live, work and thrive. In that way, the nightmare scenario of Winterbourne View can be avoided in future.

[Norman Lamb]

I absolutely commend the work of the organisation to which the hon. Gentleman refers and would be interested to hear more about it. The scandal is that so many people over so many years have been put into institutions and ended up there for years when their care would be much more appropriate for their needs if it took place in their communities through supported living or in a care home. As my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) mentioned, the extraordinary thing is that we were spending public money—on average, £3,500 per patient in Winterbourne View—to put people at risk of abuse. Often, an appropriate care package costs less than that, and gives the individual the care they need in their own community.