Social Care Funding

Dan Poulter Excerpts

Tuesday 1st October 2019 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Sir Charles.

It is also a pleasure to participate in this debate, albeit briefly, and I pay tribute to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for her very well-founded comments and to the right hon. Member for Twickenham (Sir Vince Cable) for securing this debate. It is indeed good to be talking about something other than Brexit.

This issue is the biggest piece of unfinished business not just of this Government or the coalition Government, but of the Governments of Gordon Brown and Tony Blair, because the concept of social care reform has been discussed in this place and more broadly in the country for many years. The right hon. Gentleman was right to recognise that many care providers face serious structural and numerical challenges in providing adequate numbers of people who want to work in the care sector. He was right to highlight the funding challenges that the care sector faces, which began about 15 years ago but have increased over the last few years. He was also right to highlight the fact that there is often a vocalised mantra of political consensus in this area but that when it comes to legislation or any sensible, proposal being made there is a failure in practice to deliver that political consensus, so as to deliver reform to the people on the ground who actually need care.

The care sector faces short-term funding pressures. I know that the Government will want to address some of those challenges by putting extra money into the system and supporting local authorities in providing better care, because we know that we have put local authorities into a position whereby they, and indeed the care sector, have faced very straitened financial circumstances for many years.

At the same time as talking about extra funding, however, we should talk about what sort of care system we want to see, because far too often the debate boils down to the funding discussion, when the reality is that we should also talk about how we want to deliver care. We should understand and put right the commissioning of care services. It seems extraordinary to me, given that we often talk about the benefits for people with long-term medical conditions of better integrated health and social care, that we have two different commissioning systems: local authorities commission local care; and the NHS commissions the health service. In their interventions today, many contributors have made the point that we are dealing with the same people with the same problems, but they are being dealt with in a fractured manner by two systems.

We must fundamentally deal with that issue of how we commission services, and the only way we will deliver improved care—care that is centred on the whole person—and dispense with fractured care is by having one point of commissioning. Unless we have that, we will end up putting more money into a system that, yes, needs to continue doing what it is doing at the moment, but it will still be a system that fundamentally is not the right one to deliver the right care for the people whom we care about.

At the moment, social care often duplicates the functions of the NHS, even when we are dealing with the same person. It is very difficult for families to understand why, on the one side, someone has undergone a life-changing medical event such as a stroke or severe dementia, yet some of their care is delivered not by the NHS but by social care. So, yes, let us put more money into the system, but let us also consider how we can have a better commissioning system and unified commissioning for the benefit of patients.

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[Caroline Dinenage]

I will make some progress, if the hon. Gentleman does not mind.

As a result of our investment in social care, 65% of local authorities were able to increase home care provision in 2017-18. Local authorities have increased the average fee paid for older people’s home care by 4.7% in 2018-19, bringing some much-needed stability to the provider market. I am very pleased that the Care Quality Commission has rated 84.1% of social care settings as good or outstanding.

I am delighted to say that in our most recent spending round we announced further investment in adult social care. We will provide councils with access to an additional £1.5 billion for adult and children’s social care next year, including £1 billion in new grant funding over and above the £2.5 billion of existing social care grants. In the spending round, we confirmed that all the existing funding streams would be maintained next year—hard-wired into the Budget, if you like. The Government will also consult on a 2% adult social care precept that will enable councils to access a further £500 million. This increase in funding is part of the biggest increase since 2015 in overall core spending power for local government: it will increase by 4.3% in real terms next year.

The new funding from the spending round will support local authorities in meeting the rising demands that they face, while helping them to continue to stabilise the wider social care market. This additional funding is the first step towards putting adult social care on a fairer and more sustainable footing. We have already started preparing for the multi-year spending round due next year.

The challenges facing social care are not purely financial, as hon. Members across the parties, including my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter) and for Newton Abbot (Anne Marie Morris), have said. It is important to point that out, because stakeholders across the sector tell MPs: “Even if money were no object, we would not necessarily continue to provide this service in the current system.” The current system is not working in so many respects, and it is not working properly for some of our most vulnerable citizens, which is why we are continuing to support the system through a programme of sector-led improvements to help councils to make better use of funding to deliver high-quality personalised service, with more than £9.2 million committed by the Department in 2019-20.

We are also breaking down barriers to encourage much better integration of health and care, and we are looking at what more we can do to support the workforce and carers, as I have mentioned. In terms of integration, the better care fund has helped to enable much better co-operation between health and social care partners at a local level. It has also been instrumental in reducing delayed transfers of care, which has been mentioned: they have decreased by 2,147 since February 2017. We are looking at how we can use the fund to drive better integration.

My hon. Friend the Member for St Ives (Derek Thomas) spoke about bed vacancies and people stuck in hospitals. There is a lot more integration going on between care providers and health settings that are using those beds to provide the step-down care and discharge to assess that we want to see.

[Dr Poulter]

The better care fund and how it is applied on the ground locally varies across the country. Overall, the impact has been disappointing in terms of the ambition for that fund. I urge my hon. Friend to look at why there are two different commissioning systems for the NHS and social care. Unless we get that right, we are not going to drive improved integration or more personalised care.

[Caroline Dinenage]

My hon. Friend is right to say there were teething problems, but in the most recent reporting cycle, 93% of local areas agreed that joint working had improved as a result of the better care fund. We want to use it to drive much better integration and to look at how we undertake more joint commissioning in future.

We are committed to working alongside all partners in adult social care to attract and support a growing workforce with the right skills and the right values to deliver quality and compassionate care. Earlier this year, we launched the “Every Day Is Different” national adult social care recruitment campaign to raise the profile of the sector. We have secured a further £3.8 million for the next wave of that campaign, which will start later this month. We fund Skills for Care to support the sector in recruitment and retention.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Matt Hancock]

I am always very happy to visit hospitals around the country, including St George’s. Of course, the individual management of staff is a matter for the hospital itself. I look forward to discussing with the hon. Lady what more we can do.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The Secretary of State has quite rightly outlined the global progress that has been made on the medical and nursing workforces, but he will be aware that the picture is very different in mental health services, with the loss of 4,000 mental health nurses over the last decade. Indeed, the fill-rate for doctors entering higher training in child and adolescent mental health services this August is only 63% and only half the higher trainee posts in general adult mental health have been filled. What is the Secretary of State going to do to turn the very good rhetoric on mental health into a reality on the ground for patients?

[Matt Hancock]

The increase in funding for mental health services, which is the largest increase as part of the overall £33.9 billion increase, goes to mental health services. Of course, the vast majority of that will go towards employing more people. As my hon. Friend says, we need to encourage more people into training in mental health services and psychiatry, as well as mental health nursing, which is also under pressure. The expansion of these services ultimately means that we need to have more people doing the work: supporting people to improve their mental health and supporting people with mental ill health. My hon. Friend is absolutely right to raise this issue, which is right at the top of the priorities for the NHS people plan.

Children and Mental Health Services

Dan Poulter Excerpts

Tuesday 16th July 2019 Westminster Hall

[Andrew Griffiths]

I point my hon. Friend to some of the work done in my area by Matthew Ellis, the Staffordshire police and crime commissioner, and the work done by the Prime Minister when she was Home Secretary on how we treat mental health in our police stations. That is very important, but it is even more important for vulnerable young children. She makes a valid point. I will canter through some more points before taking more interventions.

The Government’s own survey shows that one in four children with a mental health disorder are seen by a mental health specialist and over 400,000 children are receiving no assistance at all. The NHS is managing to see only a fraction of the young people who have problems. My hon. Friend talks about cross-departmental working. I am delighted that the Minister is here, because she has done a huge deal to bang heads together and make this a priority. It involves the NHS, local government, the police and so many different areas, which we need to bring together.

The Children’s Commissioner’s analysis of NHS figures from 2017-18 shows that 325,000 children were treated by community services, while another 5,000 are in hospital—less than 3% of the population. Around £700 million is spent on child and adolescent mental health services and eating disorder support. By comparison, services for adults received 15 times more, despite the fact that children represent 20% of the population. While it is important that we are putting money into mental health services, we are turning it on its head. We need to put more money into children’s services, not only because there is such a great demand, but because if we can nip problems in the bud by making that early intervention, we can avoid those services being needed later in life.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing the debate; he is making some very good points. As he recognises, CAMHS are the Cinderella services of the Cinderella service—mental health is still woefully underfunded in comparison with many other parts of the NHS. Does he also recognise that CAMHS recruitment is a real challenge? The August 2019 fill rates for higher trainees in the UK stand at only 63% for those entering CAMHS specialist training and at only 23% for learning disabilities, which means that almost 80% of new posts in learning disabilities for new trainees will be unfilled. Does he agree that that is a key issue for the Government to address if they want to improve CAMHS provision?

[Andrew Griffiths]

I absolutely agree with my hon. Friend, whom I congratulate on his work in our NHS; I am grateful that he does such a great job on mental health work in the community. He raises the very important point that it is all very well wanting to deliver these services and putting the money in place, but if we do not have the staff to deliver on the ground, we will always be running to catch up.

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[Andrew Griffiths]

My hon. Friend, who is always a champion for rural communities, makes an important point about rural isolation. We have known for a long time about the mental health challenges of farmers and rural communities, but it is all the more difficult for young people who are isolated from their friends. We talk about the social media pressure on young people with Facebook, Twitter and so on, but it is even more difficult for kids in isolated rural communities, because they are even more separated. That social media connection is often their only chance to talk to their friends.

[Dr Poulter]

My hon. Friend is making one of the best speeches that I have heard in this Chamber for some time, and is going into granular detail to make his case. In the medical workforce, the numbers of mental health nurses have fallen nationally over the past decade, and we know that there are challenges with CAMHS and LD recruitment. We cannot deliver mental health care without bodies on the ground. Unless we get the workforce challenge right, it will just be rhetoric. We need to start turning rhetoric into reality by recruiting the right number of staff on the ground to deliver high-quality mental health care.

[Andrew Griffiths]

My hon. Friend is absolutely right. It is about not just the psychiatrists and the doctors, but the mental health nurses out in the community. I have witnessed their great work at first hand, so I know just how important they are.

The extensive roll-out—as the Government rightly claim it to be—over the five-year pilot is great, but it will address just 20% to 25% of the country’s need. So many young people will miss out on support until at least 2023 or perhaps even later. The mental health training for schools and colleges announced in the past week is fantastic, but under the NHS long-term plan, an extra £2.3 billion is due to be put into mental health services by 2023-24. That is a lot of money, and I want us to make sure that as much of it goes into children’s mental health services as is humanly possible. If we spend it wisely, it can have a double-whammy effect.

Drug Treatment Services

Dan Poulter Excerpts

Tuesday 16th July 2019 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing the debate. I agree with everything he said. I draw the attention of Members to my declaration of interest as a practising NHS psychiatrist and as someone who has worked in drug addiction, or drug treatment, services.

I do not intend to rehearse the discussion on the lack of, or reduction in, funding for the treatment of addiction services since the commissioning moved to local authorities, because that argument has been well established. The challenge we face is how to encourage more people to engage with addiction services and how to improve the quality of care available to those who are drug and alcohol-dependent. In my view—this is increasingly the consensus—commissioning by local authorities has probably been the single biggest failure of health legislation under our Government, and we need to revisit that if we want to improve the quality of care available to the patients we are looking after.

Between 2009-10 and 2016-17, the number of people with opiate addiction who access services has reduced by about 16%. Heroin deaths are on the rise; the number of people presenting with alcohol-related illness, pathology and morbidity is rising; and alcohol-related deaths are rising. Our current approach to additions is not working, which appears to be that the NHS will patch you up as best it can. We are not doing a good job of preventing people from appearing in A&E or in the acute hospital because the commissioning of addiction service is not right. While I do not believe that local authorities are in the right place to commission services, the lack of funding they receive has been a contributing factor.

There are five key challenges and problems with commissioning by local authorities. The first is the quality of patient care delivered. There is poor integration of services between the NHS and the providers that often are commissioned by the local authority, be they in the private sector or the charitable sector. Historically, NHS services have had a good integrated approach between physical healthcare and addictions care. NHS providers have a joined-up approach to treating people with hepatitis, HIV and other physical health problems, or older addicts who may need support for physical health needs, such as cardiac or respiratory problems they may develop as a result of their addictions, particularly if they smoke heroin. That does not happen when there is fragmented commissioning by private-sector providers and local authorities. That needs to change for the benefit of many patients.

Secondly, all private sector providers operate under their own IT systems that have no integration with the NHS whatsoever, so an NHS doctor does not know necessarily what care those private providers are giving. That is dangerous because there is no continuity of healthcare and it is fragmented, to the extent that one part of a supposed health system cannot see what is happening elsewhere.

[Mr Philip Hollobone (in the Chair)]

Order.

Vaccination and Public Health

Dan Poulter Excerpts

Wednesday 12th June 2019 Westminster Hall

[Chris Green (Bolton West) (Con)]

I beg to move,

That this House has considered vaccination and public health.

It is a pleasure to serve under your chairmanship, Mr Davies, and a particular pleasure to participate in a debate on health with my near neighbour and hon. Friend the Member for South Ribble (Seema Kennedy) for the first time in her new position as Minister.

Vaccination and public health is an immensely important area not only for the UK, but across the world, and vaccination has contributed so much to our public health. It is a pleasure to open this debate, following on from a Westminster Hall debate that I recently secured on clinical trials. It highlights the UK’s strength in the life sciences sector, not only in the companies and corporations involved, but in the importance of our medical research charities and the academics who work in the sector. In this area, we truly are a world leader.

Some of the concerns that I highlighted about clinical trials also feed into this debate. Fundamentally, it is about saving millions of lives every year, and with immunisation we can also eradicate diseases. The World Health Organisation declared in 1980 that it had eliminated smallpox, a terrible disease that killed a great many people and left survivors with terrible afflictions throughout their lives. I suppose the most famous example of a smallpox sufferer was Queen Elizabeth I.

In 1796—we were a little bit behind the Chinese; I think the first example of Chinese inoculation was about 1,000 years ago—Edward Jenner in Gloucestershire and others noticed that milkmaids caught cowpox, but milkmaids who caught cowpox did not catch smallpox. When that was identified, Edward Jenner inoculated James Phipps, the eight-year-old son of his gardener, and that inoculation protected James Phipps from smallpox. Since then, the World Health Organisation and health organisations around the world have targeted smallpox with such amazing success that the terrible disease has been defeated and eradicated.

Immunisation speaks to something that is increasingly important and increasingly recognised in the national health service: maintaining one’s health rather than having something go wrong and then repairing the damage. It is about asking, “What can we do to keep fit, keep active, avoid excesses in one regard or another and maintain our health?” It is so much cheaper, more effective and better for our standard of living to maintain our health than it is to lose our health and try to regain it. It is also immensely cost-effective; like all organisations, the national health service is under resource pressure, and, in terms of both direct and indirect costs, immunisation is reckoned to provide a saving of £13 for every £1 spent.

In the United Kingdom, we do well on immunisation. The population of the UK is well informed and well educated on immunisation, which leads to a high take-up of those vaccinations; but we cannot rest on our laurels. In 2017-18, there was a 91% take-up of the measles, mumps and rubella vaccination in England, the lowest since 2011-12.

It is reckoned that, in order to have herd immunity, an immunisation take-up rate of 95% is needed. A 95% uptake protects the remaining 5% of people who, for whatever reason, fall through the gaps, do not take the immunisation or perhaps move to the UK after missing the opportunity. England is falling behind the rest of the United Kingdom; in the rest of the UK, the take-up rate is 3% higher than it is in England, and it is important that we close that gap.

Media, and particularly social media, present a problem. When we look at the information that is available, we can see that it is easy for scare stories to develop in the media or to be perpetuated on social media. When stories or misleading ideas not backed by any evidence get out of hand and people buy into them, it is very important that they are challenged.

A sense of solidarity is also important. It is very difficult if a number of people think, “I am concerned about the risk of this immunisation, so I will rely on the 95% of other people to have their children immunised and I will be part of the 5% who are otherwise protected.” We cannot rely on everyone else to do the right thing, because the proportion of people who do not take up the immunisation may increase to more than 5%.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate and calling out the frankly irresponsible behaviour of some in the anti-vaccination movement. Does he agree that it is particularly important that mothers get their children inoculated with the MMR vaccine, because otherwise they are potentially putting at risk not just their own children, but other mothers whom those children may come into contact with, who may develop measles, mumps or rubella—all of which can be very harmful to a developing foetus and to mothers in pregnancy?

[Chris Green]

I wholeheartedly agree with my hon. Friend. When I was young, I had both chickenpox and measles. At that time, it was part of growing up, and many people who have had those diseases think, “It’s not a big thing; it’s not a big problem.” However, serious health outcomes or problems can develop from diseases that people may dismiss as not being terribly important. In that sense, solidarity is vital; we must all take responsibility not only for ourselves and our own families, but for the wider community.

Media and social media concerns are just one factor. There are a number of other barriers to achieving comprehensive vaccination. The World Health Organisation highlights vaccine hesitancy, and identifies three Cs: confidence, complacency and convenience. Is it convenient to have the vaccination? Are people confident or complacent about take-up, with a sense of, “I’ll be one of the 5%,” or, “It’s not really a problem in our society; the treatment isn’t actually dealing with a significant problem”? Or do people think that the disease has gone the way of smallpox and been effectively eradicated? That is not the case, especially given the ease with which people can travel across the world.

The UK is a leader in what we do here, but our support for countries around the world is also incredibly important. Support for funding the Department for International Development is often challenging, but I think there will be pretty much universal support for the announcement earlier this year of the £10 million to develop vaccines against global infectious diseases. That came on the back of the Ebola crisis in west Africa, where 11,000 people were killed, and it goes into a wider fund of £120 million committed to infectious diseases. The UK is the single largest contributor to Gavi, contributing a quarter of its funding and saving hundreds of thousands of lives around the world.

The UK also has an important role to play in co-ordinating and helping other countries. If another country does not have the health infrastructure that we have, they will need that support—that was the case in the Ebola example in west Africa—and we can lend our expertise. I reiterate that with flights from west Africa to the UK, Europe and the rest of the world, the transition of easily communicable diseases is a significant risk.

Medical Aesthetics Industry: Regulation

Dan Poulter Excerpts

Tuesday 14th May 2019 Westminster Hall

[Alberto Costa]

My hon. Friend is correct. I am sorry to learn of the incidents he heard about from his constituent at his surgery. I had a similar matter. Indeed, that is what prompted me to champion this issue, along with other hon. Members.

I pay tribute to the Minister at this early stage of the debate. The welcome moves that she has introduced today, by coincidence, are exactly the sort of moves we want; they are on the right path. Today, we are arguing for more, and I am confident she is in listening mode.

Save Face, a Government-approved register for accredited practitioners, highlighted in its audit report last year that it had received just under 1,000 complaints about unregistered practitioners. This register is not compulsory and there are thousands of practitioners who have chosen not to sign up. The mark of a professional is someone who is regulated, qualified and licensed. They do not need to be a medic or a nurse to be able to be regulated, qualified or licensed to practise in this field. In the private sector, professionals such as solicitors—I declare an interest, as I am a solicitor—are regulated, have to be qualified and have to have an annual licence. Most importantly, they are obligated to carry professional indemnity insurance. That marks out those who are professionals and those who are not. That is why we urgently need a professional regulatory body for this industry.

Let me give a simple example. As a nation of animal lovers, we would not consider taking a cat, a dog or even a hamster to an unregulated vet to have an injection. Therefore, why are we allowing our constituents to have the option of going to someone who is unregulated to have potential poison injected into them, as my hon. Friend the Member for Ribble Valley (Mr Evans) mentioned?

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

My hon. Friend makes some good points about the need for better regulation. The challenge is about who we would be regulating, how we would set up a new body and how indemnity insurance would work for people working in the cosmetics industry. We know that healthcare professionals who do cosmetics have indemnity insurance; they have a regulated body they can be held accountable to. Would it not be better, as the Keogh review looked at, to have other practitioners responsible to healthcare professionals, so they had the oversight of healthcare professionals, who would make sure they were engaging in their practices correctly? Is that not an easier way to put into place quickly and effectively something that could actually deal with the issue of regulation?

[Alberto Costa]

My hon. Friend, in his time as the relevant Minister in this area, contributed enormously to this field, and I pay tribute to the work he has done in pushing for regulation of the industry.

I am not sure how to answer my hon. Friend’s point, because regulation takes many different forms. I think we would all argue that we want a healthy, thriving, competitive beauty industry. We do not want to strangle it or place an unnecessary obstacle before the business. We seek to achieve a safe beauty industry, where our constituents can approach any beautician of their choice, safe in the knowledge that these individuals have been properly trained and are qualified and regulated. I am certainly up for having the debate on whether they should be regulated by the General Medical Council, the overarching regulator of healthcare professionals or some other regulatory body, but regulation is the key.

I would also like to highlight the distinct difference between Botox and dermal fillers. Botox is a prescription-only medicine that can be prescribed only by a regulated healthcare professional, such as somebody regulated by the GMC. However, there is a loophole. At present, the prescriber is able to delegate the administration of the injections to another person, which unfortunately creates a way for people who are perhaps not regulated at all to administer the product. On the point my hon. Friend made a moment ago, if we were to have a regulatory body that somehow was able to delegate to others, we would have to ensure that those to whom the administration of the procedure was delegated were suitably trained to administer the procedures.

It is evident that these procedures are becoming more popular, and social media has an influence: so many young people are having procedures such as dermal fillers and Botox that that is almost normalising them. Given that the procedures are so widely seen on social media, they are being viewed by young people as equivalent to, for example, having one’s hair cut, as they are just as accessible. I have heard that people will say, “I’m just going out to have my lips done,” just as we might say, “I’m just popping out to have my hair done.” The normalisation of a procedure that can result in trauma should be looked at carefully.

Mental Health Services: Leeds

Dan Poulter Excerpts

Tuesday 23rd April 2019 Westminster Hall

[Fabian Hamilton]

I thank the hon. Gentleman for that important intervention. He is absolutely right. It is clear from what I, and all of us, have seen that all GPs need far better training in how to deal with mental health issues.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It seems extraordinary that it is not compulsory for GPs to be trained in mental health. That is something that the Royal College of General Practitioners would like to change and something I hope the Minister will be able to pick up and work on. On the capacity in Yorkshire and the Humber, general and adult psychiatry at ST4 in 2017 had 20 places for trainee psychiatrists, only six of which were filled, and for dual general adult and older adult there were two places, none of which were filled. How much does the hon. Gentleman believe that a lack of staff resources contributes towards the poor care available to his constituent?

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[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I thank the hon. Member for Leeds North East (Fabian Hamilton) for the passionate and articulate speech he has made on behalf of his constituents.

I often get frustrated by debates about the NHS, which are all about inputs—how much money is being spent, or what the size of the workforce is—and not enough about the direct patient experience and whether what we have is delivering the right outcomes. The story that the hon. Gentleman has shared illustrates that, for a lot of people experiencing mental ill health, their journey towards getting care is not always optimal. That is for a whole host of reasons, including historical issues regarding process and how people interact with their services. I will go away and take a deeper look at what he has highlighted, because it is a very good example of how things can go wrong.

As I say, the issue is not just about money, because we have made money available to all clinical commissioning groups. The hon. Gentleman has asked why, when we are making money available at an increased rate across the board, mental health services are so much worse in Leeds than elsewhere. As is so often the case with these things, a lot of it is about leadership. One issue that has been specifically raised with me is that often, the person responsible for commissioning mental health services within a CCG is not as senior as others. They are not as experienced, and that can cause weaknesses in commissioning.

It is important that we take action centrally to make sure that we deliver services more consistently, and I expect that to be achieved through the Care Quality Commission. The hon. Member for York Central (Rachael Maskell) raised specific concerns about her local trust. The CQC’s inspection report last year said that the trust requires improvement, so I fully expect it to work collaboratively with the CQC to take the steps that it is advised to take, in order to improve its performance when providing care. That CQC scrutiny will continue until the relevant improvement in performance is delivered.

NHS England also demands that CCGs achieve the mental health investment standard. Under that criterion, CCGs are bound to spend more of the additional money they receive on mental health services than their overall increase in budget. We expect NHS England to take direct action to secure that. However, that is not the whole story, because it depends on what CCGs are commissioning.

One of the messages that I have been keen to give CCGs is that delivering good outcomes for people suffering from mental ill health is not just about clinical services; the voluntary sector can play a big role. I have challenged CCGs to use some of their budgets to commission services directly from the voluntary sector. When someone is suffering a mental health crisis, they need help to navigate the system. In the example that the hon. Member for Leeds North East shared, that help was clearly not forthcoming from the GP.

Having someone with an understanding of mental health who can help a person suffering a crisis navigate through the system is clearly beneficial and, frankly, is good value for money. We should not spend all our NHS budgets on clinical staff when that additional support can deliver so much. In the case that the hon. Gentleman outlined, the GP did not do as much as he could have done, so we perhaps need to consider what else we can do to make sure that GPs understand that system. Again, the voluntary sector has a role to play.

My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) mentioned having more mental health education in schools, which is an issue that we are taking forward. She specifically mentioned Place2Be, which is a good example of how a third-sector organisation can work with the NHS to deliver the right outcomes. We are in the process of rolling out a whole new workforce in our schools to do exactly as my hon. Friend has challenged us to do.

On people who have attempted suicide, I readily concede that patients in such circumstances have not had a joined-up service between their GPs and their primary care providers. However, through the liaison psychiatry teams that we are rolling out in A&E, we intend to make sure that that wrap-around care is provided more readily.

[Dr Poulter]

Will the Minister give way?

[Jackie Doyle-Price]

I will, although I was just about to come to my hon. Friend’s point.

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[Dr Poulter]

Suicides are very unpredictable, and a lot of people who attempt to take their own life were not previously known to services—whether their GP or psychiatric services. The problem with mental health services in Leeds and elsewhere is that community services have been completely hollowed out by funding cuts over many years. Unless we invest in community services to stop people ending up in crisis in the first place, we are not going to solve the problem of suicide or deliberate self-harm, or provide help to those who really need it. I hope that the Government are going to get a grip on that problem and push it through NHS England and CCGs.

[Jackie Doyle-Price]

My hon. Friend is absolutely right. When we try to deliver a transformational step change in the level of service, one of the problems is that we end up raising expectations quicker than we can deliver on them, because we need a whole workforce that is able to deliver. I note my hon. Friend’s points about the number of people applying for psychiatric posts; we need to do much more to encourage people. We have spent a lot of time raising awareness of mental health and put a huge amount of investment into psychological therapies. However, at the heart of the forward plan for the next 10 years is a recognition that we need much more service available in the community, and much more help for people with severe mental ill health. I hope that my hon. Friend is reassured by that.

As I have limited time, I will follow up in writing on the other points made by the hon. Member for Leeds North East. As I said, we have made money available in Leeds, but when we look through the prism of someone who needs help and whose journey in getting that care is less than optimal, we clearly need to consider what is going wrong with that care pathway. If someone is vulnerable and needs help, and perhaps does not have a good understanding of mental health or has no experience of it, the whole process is very confusing and distressing.

How we navigate people through the NHS can often feel very inhuman—it is very reliant on process. The hon. Gentleman gave an example of how people are sent online to register, which feels a bit uncomfortable. We need to make sure that we take every opportunity to ensure that the patient is at the heart of this process and that their experience is pleasant, at a time when they are going through great distress. To say, “Here you are: go to this website—you’re on your own, so see you later,” is not a good start for anyone looking for help.

I am grateful to the hon. Member for Leeds North East for having brought this case to my attention, and I pay tribute to Mr and Mrs Downey for sharing their story, because doing so is incredibly difficult. I will look at the specific points that the hon. Gentleman has raised and come back to him.

Health Inequalities

Dan Poulter Excerpts

Wednesday 20th March 2019 Westminster Hall

[Lucy Allan]

I thank my hon. Friend for his intervention, and I am aware of the position he sets out. He is absolutely right; these problems are happening elsewhere with the combination of CCGs coming together and not being able to meet the needs of the individual areas that are receiving the funding.

In Telford, the local hospital trust serving both Telford and Shropshire announced in January, after five years of bizarrely convoluted and contorted deliberation, that it was pleased to announce its investment of a total pot of £312 million in a state-of-the-art critical care unit in the leafy, affluent shire town of Shrewsbury in Shropshire, 19 miles from Telford. In addition, the trust announced that it was pleased to say it would transfer Telford’s women and children’s unit and emergency care from Telford to Shropshire.

I have repeatedly asked the revolving door of hospital management over the past five years to explain how that proposal narrows health inequalities, how that decision improves the health outcomes of the most disadvantaged groups in the area they serve and how it improves health access for the most disadvantaged group if it is moving their provision 19 miles from its current location.

The response to my questions over a significant period has been to take no notice whatever. As an MP I have found, and I know from talking to them that many colleagues have also found, that local hospital trusts and CCGs feel no obligation whatever to respond to or even take notice of elected representatives. Indeed, my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) noted in this place just last week, in an excellent debate on his local trust, that he had “absolutely no influence” on any decisions made by the CCG in his area.

As the Shrewsbury and Telford trust felt no obligation to respond to questions on this incredibly important issue, I asked the then Secretary of State if he could seek a response on my behalf. However, even that did not bring so much as an acknowledgement that reducing health inequalities is an important issue for the hospital trust or the CCG when making spending decisions.

The trust seems to feel entirely unaccountable to anyone. The Department of Health and Social Care says that it is accountable to NHS England, and NHS England says that the trust board is accountable to the trust chairman. In reality, there is no accountability. This subject has been raised with me over and over again by local residents who strongly oppose this reallocation of funding from a disadvantaged area to a more advantaged area.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

My hon. Friend will be aware that there are health and wellbeing boards at play in local authorities. How effective has her local health and wellbeing board been at holding the CCG and other parts of the NHS to account, not only for their spending decisions but for how those decisions impact on frontline patient care?

[Lucy Allan]

I thank my hon. Friend for sharing his expertise in this area. My local council and health and wellbeing board have equally not been listened to on this issue. It is a Labour council, but it has tried extremely hard; if there was an opportunity to suggest otherwise, I would perhaps take it, but that is not the case. Both tried hard and have not been listened to. Most frustrating has been that the voice of local people has not been heard. Who do we expect to enforce this statutory duty? We cannot expect constituents to crowdfund a legal process because we want to hold CCGs to account.

NHS 10-Year Plan

Dan Poulter Excerpts

Tuesday 19th February 2019 Commons Chamber

[Stephen Hammond]

I am sure that there will be a number of excellent questions and interventions, but it was a good question. The plan sets out that all local health systems will be expected to outline this year how they will reduce health inequalities by 2023-24, and the intention is that that process will consider exactly the health inequalities that the hon. Member for Sheffield, Heeley (Louise Haigh) mentions.

Additional money for the primary sector will ensure that funding for primary medical and community health services, such as GPs, nurses and physiotherapists, increases by £4.5 billion in real terms in the next five years. That will mean up to 20,000 extra health professionals working in GP practices, with more trained social prescribing link workers within primary care networks. By 2021, all patients will be offered a digital-first option when accessing primary care. The plan also considers the future of the health system, and the new proposals for integration are the deepest and most sophisticated ever proposed by the NHS.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The plan recognises that some proposals in the Health and Social Care Act 2012 were made in error when it comes to the transference of powers to public health bodies and local authorities. However, based on my reading of the plan, the omission from that list relates to addiction services. If we are serious about mental health and about improving care and reducing health inequalities in areas such as Sheffield, which was just mentioned, we need to get the commissioning of addiction services right and transfer that back to the NHS. Such services deal with some of the most vulnerable patients, but they are underfunded and failing to treat people, and the taxpayer is paying the price. Patients badly need those services, so will my hon. Friend take the matter up and give it a push?

[Stephen Hammond]

My hon. Friend makes a good point and urges me to take up the issue, which I will. He is obviously an expert in this field and will know that the Government have asked the NHS to come forward with proposals for legislative reform to support the long-term plan’s ambitions, and I will reflect on his comments in my thinking.

By 2021, every part of the country will be covered by integrated care systems, which will bring together local organisations, including local authorities, to redesign care and improve population health. They will become the driving force for co-ordination and integration across primary and secondary care. Any claim that such reforms might lead to privatisation are misleading. In fact, the Chair of the Health and Social Care Committee said that the proposals

“will not extend the scope of NHS privatisation and may effectively do the opposite”.

The NHS will invest more in preventing ill health and stopping health problems getting worse. That includes offering tobacco treatment services to all in-patients and pregnant women who smoke, establishing new alcohol care teams, and offering preventive treatments to more people with high blood pressure and other risk factors for heart disease.

--- Later in debate ---

[Jonathan Ashworth]

The last Labour Government put record investment into the NHS, which was voted against every step of the way by the Conservatives. That Labour Government delivered some of the best waiting times on record and some of the highest satisfaction ratings, and they increased access to GPs in constituencies such as Ashfield.

The A&E standard is important not only for patients waiting in an overcrowded A&E but because it tells us much about flow through a hospital. Last week we had the worst A&E performance data since records began, with just 76.1% of those attending type 1 A&E seen, discharged or admitted to a ward in four hours. Behind the statistics are stories of patients left waiting in pain and distress and of the elderly languishing on trolleys. In fact, we have had 618,000 trolley waits in the past year. Patients have been waiting without dignity, at risk of cross-infection. There is no road map at all in the long-term plan to restoring access standards. Of course, the A&E standard is being revised in the long-term plan, even though the Royal College of Emergency Medicine has said:

“In our expert opinion scrapping the four-hour target will have a near catastrophic impact on patient safety in many Emergency Departments that are already struggling to deliver safe patient care in a wider system that is failing badly.”

I hope that when the review reports we can have a full debate in the House.

[Dr Poulter]

The hon. Gentleman is right to highlight the Blair Government’s injection of cash into the NHS and the meaningful difference that that made to many patients’ lives. On the waiting-time targets, if we are serious about parity for mental health and physical health, we should reflect on the fact that historically there have not been access targets for mental health of anywhere near the same standards that there are for physical health. Will the hon. Gentleman join me in urging a rethink of that and a much greater push for access targets for mental health services as a way to raise standards and improve the time within which patients get care?

[Jonathan Ashworth]

The hon. Gentleman makes an important point. There are elements of the long-term plan that we welcome, including the access targets for mental health. We also welcome the commitment to save 400,000 lives, although there is no detail in the plan about how those lives are going to be saved. We welcome the rolling out of early cancer diagnostic and testing centres—after all, it is a policy that I announced in the 2017 general election campaign. We welcome the roll-out of alcohol care teams in hospitals—a policy that I announced at the Labour party conference last year. We welcome the commitments on perinatal mental health—again, a policy that we announced previously. We welcome the commitment for preferential funding allocated to mental health services—another policy that the Labour Opposition previously announced—but we will need to study the details carefully, as the hon. Member for Oxford West and Abingdon (Layla Moran) said.

The points about mental health from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) were well made, because currently three in four children with a diagnosable mental health condition do not get access to the support they need. Child and adolescent mental health services are turning away more than a quarter of the children referred to them for treatment by parents, GPs, teachers and others. That is quite disgraceful, so I hope the extra investment in mental health services reaches the frontline quickly, and I hope that in summing up the debate the Minister will give us more details about when we can expect to see progress on that front.

Mental Capacity (Amendment) Bill [Lords]

Dan Poulter Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Chris Bryant]

Absolutely. One key thing that we saw repeatedly—this is an issue for the Bill, I think—was the fluctuating nature of some brain injuries. For instance, fatigue is a very common feature of many brain injuries. I do not mean just feeling tired because you are sitting at the back of a debate in the House of Commons and somebody is wittering on for far too long and you fall asleep, but real, genuine fatigue. I mean the kind of lassitude that leaves you unable to move from one side of the bed to the other. It is often misunderstood, because it might look like laziness to somebody with a judgmental eye. That lassitude can pass or go through phases and can sometimes be a bit difficult to explain or predict. I am therefore really keen that we ensure, in all the processes in the Bill, that anyone with an acquired brain injury is regularly and repeatedly reassessed so that they have an opportunity to escape. That is important.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The hon. Gentleman is making some good points. The only point I would make to him is that without a deprivation of liberty order—I agree that they should be open to review, and I am sure the Minister will go on to talk about how that can happen—some of the people he talks about may have to be put under the Mental Health Act 2007 due to the fluctuating nature of their capacity. That would be much more restrictive and could lead to them being sent to entirely the wrong places to be cared for. I would just give that caveat and that warning to him about the potential consequences of what he is saying.

[Chris Bryant]

I think the hon. Gentleman has just read, in some weird way, what I was about to say—he has a very special mental capacity of his own if he is able to read my notes from that distance. He is absolutely right, however, and I do not want to drive a coach and horses through the Bill at all. I fully accept that there is a requirement for some elements of it.

I have an anxiety about the pace at which the Bill is going. It is a shame that the code is not yet available, because it would significantly affect how we viewed some of the issues that we are talking about today. All the things in my amendments should probably be in the code, rather than on the face of the Bill—that is what the Minister said to me yesterday, and I should have given her a much harder time, by the way—but why do we not have the code now? We are not going to have it before the Bill receives its Third Reading, and I think that is a mistake. It is not as though we have lots of wonderful business to be getting through.

--- Later in debate ---

[Barbara Keeley]

It is not helpful if the Minister and I argue about this. We have had this argument enough times in Committee. She just needs to see that there is a level of concern. I am quoting a case where significant harm was done to a young person in a care home because the parents were not listened to and the care staff were.

[Dr Poulter]

I can understand where the hon. Lady’s concerns come from, but having had detailed discussions with my hon. Friend the Minister, I am reassured, perhaps more than the hon. Lady, by the systems and some of the amendments that have been put in place to take into consideration concerns about conflicting provider interest. She makes a good point on the lack of funds and resources and cash-strapped local authorities. Without the money to support local authorities, there is a real risk that scrutiny of care homes and the processes in place under the legislation will be sadly lacking, to the detriment of people under deprivation of liberty orders. What reassurance has she had, if any, during the passage of the Bill that the funding crisis affecting social care and local authorities is being addressed by the Government, both in respect of this legislation and otherwise?

[Barbara Keeley]

I thank the hon. Gentleman for that question. We have had no reassurances whatever. In fact, since the Committee finished, £1.3 billion has been taken out of central Government funding to local councils. Whatever our position was when we were in Committee, things are now much, much worse.

The Minister does not agree, but it is disturbing that we are still in the position on Report of trading the arguments back and forth. We gave lots of examples. There is provision in the Bill for an approved mental capacity professional. With our amendment we want to be sure that we do not have cash-strapped local councils delegating responsibility. There is talk under some amendments to bring in reviews, but reviewers have to be able and willing to stand up to care home managers, and that is a difficult thing.

As my hon. Friend the Member for Bridgend (Mrs Moon) said earlier, care home managers have a lot of power. They have the power to evict and the power to stop visits. Amendment 49 would work with amendment 50 to address the role that the care home manager could play. It is one of the most concerning provisions in the Bill, and it must be addressed if the new liberty protection safeguards are to be fit for purpose.

I do not in any way want to stigmatise care home managers, but I ask Government Members to accept that we are talking about a situation where at least 20% of care homes require improvement or are rated inadequate. Care home manager vacancies are at 11%. We are not talking about a situation where all care homes have a proper care home manager in place, or where they are all doing as well as they could. If the Minister reads many CQC reports, she will see that care homes often fall down on care planning. CQC inspectors often find that there is not a proper or adequate care plan for the situation.

--- Later in debate ---

[Caroline Dinenage]

I beg to move, That the Bill be now read the Third time.

Our liberty is the most fundamental of our human rights. By passing this Bill, we can be proud that we have helped to promote the human rights of our country’s most vulnerable people and increased access to protections for the 125,000 individuals who are being deprived of their liberty and are not receiving the safeguards they deserve. That means 125,000 people whose families do not have the peace of mind that their loved ones are being protected, and 125,000 care providers who do not have the requisite legal protection.

Members of both Houses have contributed to the discussions and debates on this Bill, for which I am extremely grateful. We have made changes in both Houses to ensure that the liberty protection safeguards system introduced by the Bill does everything possible to protect human rights—to give a voice to the person and those close to them—while also ensuring that the system is targeted and not cumbersome to people, their families and our health and care sector. I committed from the outset that we would collaborate on this Bill, listen and take on board all the ideas and feelings of stakeholders and Members from both Houses, and many of the amendments we have put forward today are exactly in that collaborative spirit.

[Dr Poulter]

I thank my hon. Friend for the conciliatory way in which she has gone about dealing with this Bill, engaging with colleagues on both sides of the Houses, and putting forward some good and sound amendments to get the Bill to a better place. However, on the issue of funding, which was raised during the debate earlier, if we are going to make social care legislation or legislation of this sort appropriate and have the right safeguards in place, we need local authorities to have a better funding settlement. Is that something she can take away and raise with the Secretary of State for Housing, Communities and Local Government?

[Caroline Dinenage]

My hon. Friend raises a very important point. I am grateful to him for all his feedback on this Bill, because it is very helpful to be able to speak to somebody from a medical background to understand how such a Bill will work in practice at the sharp end. We have given councils access to £10 billion over this three-year period, which just shows the scale of the issues we are facing in adult social care. The Green Paper that will be published shortly will go further in setting out the long-term sustainability of the sector.

As we have heard today, there is no question but that the current DoLS system is failing. In 2014, a House of Lords Committee identified the system as being complex and bureaucratic, and since then the situation has only got worse. An increased number of cases means that local authorities are unable to process all the applications. With more than 48,000 people now waiting over a year, we cannot risk people being subject to overly restrictive health and care practices. This new system will enable quicker access to safeguards, meaning that we can ensure less restrictive practices are being used.

The Government tasked the Law Commission with reviewing the DoLS system and recommending improvements. After more than three years of careful work and consultation, it published its report, which stated the urgent need for reform. That was followed by a report from the Joint Committee on Human Rights, which also recommended having a more targeted system by focusing resources on those who are the most vulnerable or those who have the most complex circumstances, and on cases where objections have been raised. Coupled with this, we have ensured robust safeguards in the system, including independent review and oversight, alongside access to representation and support.

I am grateful to all our partners who have worked with us on this Bill. The input of third sector groups, those who work in the health and care sector and of course those who receive safeguards themselves has all helped to shape our Bill for the better. The Law Commission was absolutely right when it said that DoLS needed to be replaced as a matter of urgency, and that is why we have brought this legislation forward now. We cannot continue with the current system. We are proud to bring forward the Law Commission’s recommendations in this Bill, and we are proud to reform the system and introduce a less bureaucratic, more personalised approach that will work better for people, their families and professionals. I commend this Bill to the House.